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Olivia MD3 2nd semester > multiple pregnancy > Flashcards

Flashcards in multiple pregnancy Deck (21):
1

define monochorionic multiple pregnancy?

single placenta is shared by two or more fetuses

2

risk factors for multiple pregnancy?

assisted reproduction, increasing maternal age, increasing parity

3

what do we mean by dizygotic twins?

non-identical twins; two different eggs were fertilised and implanted into uterine wall--> 2 x placenta

4

what do we mean by monozygotic twins?

identical twins- one fertilised egg splits into two and implants into uterine wall

5

what are some maternal complications that we have to consider in multiple pregnancy

pre-eclampsia
gestational diabetes
APH
PPH
anaemia

6

what does TTTS stand for in multiple pregnancy?

twin to twin tranfusion syndrome

7

what does TAPS stand for in multiple pregnancy?

twin anaemia polycythaemia sequence

8

which u/s is best to confirm twinning and their chorionicity and amnionicity?

first trimester u/s

9

in a mother carry dizygotic twins, what is risk of having one child affected by down's syndrome?

doubled risk bc each twin carries their own risk

10

how might we reduce the risk of pre-eclampsia in a woman carrying multiple pregnancies?

aspirin 100mg/day from 12-36 weeks

11

when might we trial vaginal delivery for a pregnant woman with twins?

if the first twin is in a vertex position may try to do a vaginal delivery, however low threshold for c-section in the case complications arise

12

after ___ weeks gestation, chorionicity in a multiple pregnancy becomes difficult to determine.. fill in the gap

14 weeks' gestation

13

what is the management of twin to twin transfusion sequence?

Laser ablation of vascular connections is the recommended treatment for the majority of pregnancies with TTTS that require intervention, and referral to a laser surgery facility should be considered - even where this would mean interstate transfer

Early referral is recommended to allow optimal treatment before the onset of severe disease and cervical shortening.

14

what is the risk of delivering term monochorionic monoamionic twins vaginally?

cord entanglement

15

what defines chorionicity and amnionicity in multiple pregnancy?

Chorionicity and amnionicity is determined by timing of zygote cleavage

16

how do we determine the zygosity of a dichorionic multiple pregnancy seen on u/s?

Zygosity can only be reliably determined however if two different genders are seen on u/s

17

what is the sensitivity of combined screening for down's syndrome for multiple pregnancy?

Down's syndrome combined screening 75-85% sensitive in twins (U/s is better than maternal serum analytes in this case)

NIPS-> mixed pattern on cell free fetal DNA (but still quite sensitive)

18

what are some antenatal/intrapartum considerations for multiple pregnancy?

• Generally will go into spontaneous preterm labour
• Cervical cerclage +/- progesterone plessaries have NOT been shown to reduce preterm labour

• Advise women to stop smoking, treat asymptomatic bacteriuria
• Administer 100-150mg aspirin daily from < 16 weeks to prevent preeclampsia
• IM celestone +/- magnesium sulfate for neuroprotection in anticipation of preterm labour

Caesarean deliveries are more common than vaginal delivery however vaginal delivery may be possible if presentation appropriate

19

a lady with twins has her 20 week u/s and it shows:
Duodenal atresia- double bubble on u/s
Polyhydramnios
VSD

What are you thinking and what are your management options?

--> Highly likely that this is T21
--> amniocentesis for each sac to diagnose T21
--> option of selective termination--> dependent on chorionicity

If dichorionic--> KCL into the heart --> fetal death in 60% but this leads to increased mortality of the surviving fetus in the early gestation period

Late termination for T21 is preferred at 36 weeks in this case but runs the risk of going into labour before termination can be performed

20

monochorionic twins are always....?

what about dichorionic twins?

monochorionic twins are always monozygotic identical twins

dichorionic twins can either be monozygotic or dizygotic but the chances are higher for dizygotic

21

what are the different chorionicity/amnionicity arrangements for monozygotic twins?

dichorionic diamnionic

monochorionic diamniontic

monochorionic monoamniotic

conjoined twins