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تحميل الدليل التدريبي

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MULTIPLE PREGNANCY

 

Following are true regarding multiple pregnancy except:

 

1.   Antenatal care as of high risk pregnancy.

2.   Assessment and management of the identified risk factor.

3.   Admit at  37 completed weeks or earlier in case of additional complication.

4.   Time of the delivery at term or  may be indicated in preterm period due to  additional complication.

5.   Mode of delivery is  cesarean section only. 

 

 

Following are correct definitions except:

 

6.   Vanishing twin is where  a viable pregnancy is accompanied by a non-viable one (blighted ovum/ missed abortion).

7.   Fetus papyraceous is a dead baby which is paper like and flattened by pressure from membranes of the survivor in twin pregnancy.

8.   Dizygotic twin is duplication of normal process of conception , implantation and further development of the embryo, arising from fertilization of 2 ova from the same/opposite ovary .

9.   Super fecundation is fertilization of 2 ova by single act of coitus , released during the same menstrual cycle

10.               Super fetation is a dizygotic twining which might arise from coitus during different cycles.

 

Incidence of the multiple pregnancy:

 

11.               Twin --------------------------- one in 7744.

12.               Tripplet----------------------- one in 7744.

13.               Quadriplet------------------ one in 7744.

14.               Pentaplex-------------------- one in 7744.

15.               Hexaplex --------------------- one in 7744.

 

Risks associated with multiple pregnancy includes all except

 

16.               Hyper tension.

17.               Anemia .

18.               Pressure effects due to gravid uterus on pelvic vessels and lymphatics .

19.               Infection (urinary tract infection ).

20.               Oligo hyderamnios.

 

Risks associated with multiple pregnancy includes all except:

 

21.               Placental insufficiency .

22.               Ante-partum hemorrhage .

23.               Post- partum hemorrhage .

24.               Cord accidents.

25.               Persistant occipito poterior position .

 

Risks associated with multiple pregnancy includes all except:

 

26.               Post term labour .

27.               Twin to twin transfusion syndrome .

28.               Inter-locked twin .

29.               Conjoint twin 10%.

30.               Congenital abnormalities .

 

Risks associated with multiple pregnancy includes all except:

 

31.               Growth disparity.

32.               Prematurity .

33.               Intrauterine growth restriction (20 –25%).

34.               Intrauterine demise .

35.               Perinatal mortality (50%).

 

Causes with multiple pregnancy includes all except :

 

 

36.               Parity.

37.               Incidence decreases with rising maternal age up-to 40 years .

38.               Induction of ovulation .

39.               Previous history of multiple pregnancy

40.               Familial tendency.

 

Clinical features with multiple pregnancy includes all except:

 

 

41.               Hyper emesis gravidarum .

42.               Larger than dates uterus.

43.               Mal-presentation .

44.               Poly-hyderamnios.

45.               Ease  in assessment of the fetal movements ,heart and parts .

 

Delivery of the first fetus includes all except :

 

46.               Increased risk of intrapartum hypoxia so anaesthetist and pediatrician should be available in such cases .

47.               Epidural analgesia preferred since can be extended as anaesthsia for the operative delivery if required .

48.               Intravenous syntocinon is contraindicated .

49.               Forceps and vacuum to shorten the second stage  ,used when required .

50.               Good neonatal  resuscitation  and pediatric care should be available.

 

 

Delivery of the second fetus includes all except:

51.               External cephalic version is the option in breech presentation with intact membranes , after successful version presenting part should be fixed in the pelvis then rest of the protocol is same as for the singleton pregnancy.

52.               Internal podalic version is an other option in selected cases

          (with intact membranes ).

53.               In second stage forceps , vacuum or  breech extractions are the modalities available.

54.               Active management of the third stage of the labour is done with syntocinon and  ergometrine to avoid post partum haemorrhage .

55.               The time interval between the delivery of the two fetuses should be less than 15 minutes .

 

Delivery of the second fetus includes all except :

 

56.               Epidural analgesia may be required for the delivery of the second twin so better to administer in first stage of the labour .

57.               If the second twin is large or disproportionate due to discordant growth leading to mechanical difficulty for vaginal delivery then cesarean section is option .

58.               Anti D injection if indicated .

59.               Avoid ergometrine .

60.               Syntocinon can be given .

 

 

If syntometrine given by mistake  after delivery of the first fetus then following are true except:

 

61.               Rapid delivery of the second fetus by forceps /vaccum or breech extraction .

62.               Where these methods are in-appropriate , do cesarean section immediately.

63.               An other option is avoid vigorous action of the uterine activity with ventoline and halothane to prevent hypoxia .

64.               Internal podalic version.

65.               This may lead to tetanic uterine contractions ,fetal distress ,fetal demise  or uterine rupture .

 

Complications of labour in multiple pregnancy includes all except:

 

66.               Mal-presentation .

67.               Post partum haemorrhage (large placental size ).

68.               Cord prolapse .

69.               Locked twins.

70.               IUGR .

 

Regarding dizygotic twin folowing are true except:

 

71.               Four times more common  than monozygotic .

72.               Four membranes present .

73.               2 amnions and 2 chorions.

74.               1 placenta.

75.               No outer placental anastomosis .

 

Regarding dizygotic twin following are true except:

 

76.               Different sex .

77.               Different blood groups .

78.               Not alike genetically .

79.               High risk of complications than monozygotic.

80.               Inheritance difference .

 

In vanishing twin following are true except:

 

81.               1st trimester             resorption .

82.               1st trimester             blighted ovum .

83.               2nd trimester            fetus papyracious.

84.               3rd trimester            missed abortion .

85.               3rd trimester            intrauterine death .

 

In locked twin following are true except

 

86.               Cesarean section.

87.               In vaginal delivery decapitation of the  leading dead fetus and pushing up the head to deliver  alive fetus .

88.               Vacuum or forceps delivery for the first twin .

89.               Rare incidence.

90.               The decapitated head of the fetus is delivered later with forceps .

 

Conjoint twin

 

91.               Incidence is 1:5000 of general population.

92.               Common in dizygotic twin .

93.               Seperation of zygote takes place before 4 days.

94.               Management is preterm vaginal delivery.

95.               Cesarean section is in appropriate mode of delivery.

 

Monozygotic

 

96.               Incidence  1%.                                              

97.               Perinatal mortality is high.

98.               Diagnosis by methylene blue  injected in the amniotic cavity or amniography .

99.               In mono-chorionics there  are vascular anastomosis.

100.            Mono chorionic monoamniotic incidence is around  1%.

 

Trap syndrome is :

 

101.            Twin twin transfusion syndrome .

102.            Resistant arterial perfusion syndrome.

103.            Common  condition.

104.            Diagnosed by colour flow doppler  for fetal acardia .

105.            Existence of the acardiac twin on blood supply of the co-twin.

 

 

Diagnosis of twin twin transfusion syndrome all except:

 

106.            Discordant growth of the twin.

107.            Anemia in donor.

108.            Polyhyderamnios in donor .

109.            Hemoglobin difference  of twins 5gram /dl .

110.            Weight difference of twins more than 20 %.

 

 

 

 

 

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