Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

MRCOG - Part 2 > Twin pregnancy > Flashcards

Twin pregnancy Flashcards

(70 cards)

Start Studying
1
Q

Incidence of multiple pregnancy?

A

3% of lofe birth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

how many od successful IFV results in twins

A

1/4
24%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

maternal mortality im multiple compared to singleton

A

2.5 times more

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

incidence of PTL in twins

A

up to 50%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

TTTs accounts for what percent of stillbirth

A

20%

66% of stillbirth in twin has IUGR - 39% in singleton

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Of twins, how many are dichorionic and monochorionic ?

A

DC: 70%
MC: 30%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

For a twin pregnancy, what do you see on the 1st trimester ultrasound?

A

11-14+1 w
Gestational age - determine GA from largest twin to avoid estimating it from a baby with early growth pathology

Chorionicity and amnionicity

Before 14 wks
Number of placental masses
Membrane thickness
Lambda & T sign

After 14 weeks
Additional - fetal sex

+ screening for trisomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Determin chorioniciy in twins by us using:

A
  1. Number of placental masses
  2. Membrane thickness
  3. Lambda & T sign
  4. gender >14w
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Lambda sign seen in ?

A

DCDA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

T sign is seen in

A

MCDA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What if difficult to detect chorionicity or amnionicity ?

A
  • 2nd opinion from senior or
  • Referral to a competent health-care professional

If still difficult after referral - manage as monochorionic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

when determining chorionicity, if TAS is difficult d.t. high BMI or RVF

A

use TVS

not 3d

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Due to high risk of anemia in multiple pregnancy, when do you perform an additional CBC apart from at booking and 28 wks ?

A

20-24 W then 28w

early supplement w/ iron or folic acid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How many antenatal appointments for
DCDA twins ?
TC TA triplets ?
Twins or triplets with a shared chorion ?
Twins or triplets with a shared amnion ?

A

8
9
11
Shared amnion - Individualise from tertiary level fetal medicine unit

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How do you screen for chromosomal anomalies in twins ?

A

Same as singleton
TWINS:
1st 11-14+1w : Age + Combined (NT+PAPPA+BHCG)
2nd: Age+ Quadrable (HIAE HCG+Inhibin+AFP+E3)

Triplets:
1st: age+NT
2nd: no test

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How do you screen for chromosomal anomalies in triplets?

A

Maternal age + NT
No 2nd trimester serum markers

For screening of dichorionic and monochorionic triplets- refer to fetal medicine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

interpretation of the result of down syn screening in twins

A

if >1:150: refer to FMU

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

How many twin & triplet pregnancies have a spontaneous Preterm birth ?

A

60% before 37 wks for twins
75% before 35 wks for triplets

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

How is monitoring for FGR done ?

Can it be done in the 1st trimester ?

A
  • SFH and abdominal palpation not used
  • Ultrasound done
  • 24 wks onwards - in TriTri and DiDi
    Rest - from 16 wks onwards

Not in 1st trimester

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

calculating EFW discordance dor DC twins using the formula

A

the largest-the smallest/the largest

if >25%:FGR -> FMU
if 20%: suspect SGR -> u/s weekly +umb A doppler

25% or 1 <10th centile
20% or 1 < 10th centile

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

When to deliver twin preg

A

MA: 32-34 (to avoid cord entanglement)
Tri: 35
MC: from 36
DC: 37

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

When to perform CX LENGTH SCAN IN TWIN

A

16-20w

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What to do if Cx length less than 25 mm

A

200 mg progesterone vaginal once daily to 34 w

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Remedies that has no role in CL <25 mm in twin preg.

A
  • IM progesterone
  • arabian pessary
  • bed rest
  • cx cerclage
  • oral tocolytics
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
do we offer cx cerclage if cx length < 25 mm
NO
26
Role of corticosteroids in twin pregnancy
Give in any twin preg delivery bef 34+6, if pt is going to deliver in a week
27
Role of mgso4 in twin pregnancy
Should be given to all twins before 34w In singleton bef 30w If the pt is going to deliver in 24 hr
28
Monochorionic twin fetal complications
- twin to twin transfusion TTTs: 15% - selective growth restriction SGR: 10-15% - twin reversed arterial perfusion TRAP: 1% - twin anemia polycythemia sequence: 2% - after laser 13%
29
Which fetal biometry we take for GA
The largest
30
cleavage days that lead to chorionicity
Morula D 1-3: DCDA Blastocyst D 4-8: MCDA Implanted Blastocyst D8-13: MCMA Embryonic disc D 13-15: conjoined
31
Monitoring of TTTS in twins
MC or tri: u/s every 2 w from 16 w (biometry+ DVP +bladder) if DVP difference > 4cm (concerning): weekly + Umb a doppler
32
If TTTs is diagnosed refer to FMU if:
* 1 baby had DVP <2cm + the other has a DVP: 1. >8cm <20w 2. >10 cm >20 w
33
what is Quantiro staging of TTTs
1. Water: 1 oligo+1 poly 2. bladder: not seen in 1 baby 3. doppler: abnormal 4. hydrops: acites+- percardial or pleural effusion 5. DEATH
34
refer woman to her named obs. for multiple preg. in her 2nd or 3rd trim. if
1 baby has normal DVP and the other has DVP: 1. <2 cm or 2. > 8cm
35
Most accurate test in women with symptom of PTL
fetal fibronectin
36
indication for referal to 3ry level in twins
1. twins: MCMA 2. triplets: MCMA, MCDA, DCDA 3. Discordant fetal growth 4. discordant fetal death 5. TTTs 6. fetal anomaly
37
rate of spontaneous birth of twins and triplets
twins: 60% bef 37w triplets: 75% bef 35w
38
how many woman w/ twins who plan a VD go on to have a CS
1/3
39
for women who decline elective birth of twins
1. weekly appointements 2. weekly us: afv, umb a doppler 3. fetal growth scan every 2w
40
why do we deliver MCMA twins as early as 32-34w
high risk of fetal demise high risk of cord entagelement planned CS
41
Do we need CEFM intrapatum of twins
yes in labour >26 w check hourly
42
# twins in labor vaginal delivery >26w and there is no CTG
no CTG = no VD go for CS
43
# twins in labor 1st baby has suspicious or pathological ctg in 1sst stage
suspicious: apply fetal scalp electrode if >34 w pathological: fetal bloos sampling if >34w
44
# 1st baby has suspicious or pathological ctg in 1st stage what if FBS is not available in > 20 mins or CI
immediate CS
45
# twin in labor if 1st baby has pathological ctg in 2nd stage
- senior review - if VD isn't within 20 mins: CS
46
# twins in labor 1st baby not delivered, 2nd baby has suspicous or pathological CTG
- senior review - if VD isn't within 20 mins: CS
47
# twins in labor 1st baby delivered, 2nd baby has suspicous or pathological CTG
Discuss CS
48
when to start oxytocin infusion in VD of 1st twin
once head is at the pelvis to ensure adequate uterine contractions
49
what to do to 2nd non cephalic twin
1. ECV: 60-80% success then start ocytocin 2. 1ry breech extraction: membrane will rupture during foot traction 3. 1ry CS 3-5%: if prolonged more than 30 m
50
indication of CS in 2nd non cephalic twin
1. fetal distress 2. cord prolapse 3. abruption 4. no progress after ECV 5. prolonged more than 30 min 6. failed ECV or IPV
51
birth interval between 1st and 2nd twin
max 30 min (less fetal distress and acidosis in 2nd twin) can be > 30 mins if reasssuring fetal and maternal status
52
anc monitoring of MC twins
u/s every 2 weeks (DVP+UAPI+ bladders)+ screen for trisomy 21 after 16w: EFW+ DVP+ MCA PSV + +ve or AREDV in UA
53
sudden inc in abd. size or breathlessness in twin preg what to do
refer to healthcare professional suspecting TTTs
54
difention of TTTs
deep unidirectional arterio venous anastamosis
55
staging of ttts called
Quintero staging
56
doppler meadurements that should be done in TTTs
1. umb a doppler velocities 2. MCA PSV 3. DV doppler
57
TTT of TTTs
fetoscopic laser ablation <26w Solomon technique | >26w: amnioreduction
58
amnioreduction indications in TTTs
1. if expertise for ablation isn't available 2. pending transfer for ablation 3. diagnosed >26w
59
Moratility rate if TTTs is left untreated
80%
60
in TTTs after ablation, when to deliver
by 36+6w
61
selective reduction in twins and triplets are abortion clause?
triplets: Clause E twins: Clause C
62
Indications for monitoring TAPS and how
- weekly us from 16 w using MCA-PSV if multiple preg. complicated with: 1. TTTS treated by ablation 2. SGR: discordance>25% or 1 <10th centile 3. MC w/ cvs compromise, isolated poly or abnormal umb a doppler | in all MC: MCA PSV fortnightly from 20 w
63
in SGR monitoring, +VE EDV in AUD for both babies, when to deliver
34-35+6
64
in SGR monitoring, absent or REDV in AUD for 1 or both babies, when to deliver or cyclic UA pattern (present- AEDV- REDV) over mins
32w
65
STV criteria for consideration of delivery time in SGR
- 26-28+6: <2.6 ms - 29-31+6: <3 ms - 32- 33+6: <3.5 ms - >34: <4.5 ms
66
risk to the surviving twin after single twin demise
death 15% neuro abnormality: 26%
67
what to do after single twin demise
1. Reg. US 2. MRI after 4 weeks: to detect neuro morbidity 3. deliver by 36+6 | mode of birth individualized
68
in case of TRAP what is the pathology
one normal fetus shift blood to the other acardia twin who will die, and the donor at risk of death d.t. CHF
69
indication of CS in TWins
1. 1st baby not cephalic 2. MA 3. triplets
70
do we inject selective feticide in MC
no d.t. presence of placental anastomosis

MRCOG - Part 2 (69 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions