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Jason's MD3 Women's > Multiple Pregnancy > Flashcards

Flashcards in Multiple Pregnancy Deck (26):
1

Biggest risk of multiple preg?

Preterm delivery.

2

What twins are lower risk?

Dichorionic: two placentas

3

Kinds of monozygotic implantation?

Di chorionic, monozygotic
Monochorionic diamniotic


Monoamniotic twins (high risk)

4

Monochorionic twins, why dangerous?

Twin-twin transfusion Syndrome
TAPS-slower twin twin transfusion
TRAP
-Conjoined
Severe IUGR

5

If Monochorionic twin dies, what happens to other twin?

They will also die. Very dangerous

6

Nasal bones at 12 weeks?

If missing, likely trisomy 21.

7

Concordance between twins?

ADHD
Schizo

8

What maternal factor strongly associated with premature birth?

Poor weight gain by 24 weeks

9

Preeclampsia, how to reduce in multiple preg?

Aspirin 100mg/day from 12 to 36weeks

10

Maternal complications, Gestational DM, how manage?

More risk
Early GTT 14 weeks, 26 weeks.

11

Maternal complications

Anaemia
APH
PPH

12

Big psych for multiple preg?

Depression
Postnatal: 5x more likely
Marital disharmony: 50% of relationship end within 2 years of triplets arriving.

13

Fetal anomalies?

More likely in multiples, monochionic more than dichroic nic

14

Growth of multiples? After born?

Slows earlier
Twins: 32w
Triplets: 28w
Catch up growth happens in absence of pathology

15

What other growth do you look at in multiples?

Discordance in size between twins

16

Preterm Delivery prevention?

Stop smoking
Avoid multiples
Treat bacteriuria

Cervical sutures: ineffective
?Progesterone.

17

When is safest time to delivery complicated twins?

37 weeks.

18

When to deliver Monochorionic and Monoamniotic twins?

32 weeks

19

When to deliver Monochorionic and diamniotic?

36-37weeks
Beware of TTTS

20

Difference between C-section or vaginal for twin delivery?

Not much difference. As long as same conditions in study which is access to theatre, obstetrician, paeds, anaesthetist.

21

Best way to deliver Monoamniotic twins?

C-section

22

Monochorionic twins vaginally?

Careful, twin B may exanguinate, twin twin transfusion in labour....
Best in C-section

23

How to deliver twin B?

Ensure longitudinal lie
Restart Syntocinon
ARM
Assist vertex/breech
Internal podalic`` version and breech extraction of twinB
Routine third stage

24

Discordant Monochorionic twins

Liquor volume - TOPS Twin Oligohydramnios POlyhydramniis sequence

MCA - TAPS - twin Anaemia-polycythaemia sequence

Growth: Selective IUGR

25

TTTS natural history?

Always fatal

26

Rx for TTTS?

Laser photocoagulation
Fetoscoptic surgery