how has multifetal pregnancies increased
- advanced maternal age and assisted human reproduction
maternal risks for multifetal pregnancies
- preeclampsia
- preterm labour
- HELLP
- gestational diabetes
- PPH
Neonatal risks with multifetal pregnancy
- preterm birth
- low birth weight
- cerebral palsy
- perinatal death
dizygotic twins
- fertilization of 2 ovum
- 2 amnions
- 2 chorions
- and 2 placentas
- may be opposite or same sex
monozygotic twins
- identical twins
- one fertilized ovum
- saem sex and same genotype
- can have 2 placentas/fused/or one large shared one
diamniotic/dichorionic
- in monozygotic twins when cell division happens soon after fertilization
- 2 placentas develop
- 2 amnion and chorions
mono amniotic/monochorionic
- in monozygotic twins when cell division is late
- one placenta forms with shared amnion and chorion
diamniotic/monochorionic
- most common for monozygotic twins
- one placenta
- 2 amnions and one chorion
monochorionic/mono-amniotic is at greater risk for
- cord entanglement and twin-twin transfusion
at age 30 what is the monthly conception rate for women
- 15-20%
at age 40 the monthly conception rate for women is:
6%
IVF success for women age 35 is
41
IVF success rates for women 35-37 is?
- 34%
IVF success rate for ages 38-40 is
- 24%
IVF success rate from 40-43 is
11%
IVF success rate after age 43 is
6%
what is the difference between induction of labour and augmentation
- induction is initiation of contractions before the spontaneous onset
- augmentation is interventions to stimulate/increase contractions once they have started
what are 4 risks associated with induction of labour
- tachysytole
- abnormal fetal HR
- c-section
- PPH
tachysytole is defined as
- 5 or more contractions in 10 minutes over 30 minutes
- resting tone between contractions less than 30 seconds
- a contraction lasting longer than 90 seconds
twin to twin transfusions is when
- shared vessels between twins where one twin receives more nutrients from the other (fluid overload, polyhydramnios, polycythemia)
- other twin results in growth restriction, oligohydramnios, and anemia
treatment options for TTTS includes
- amnioreduction
- fetoscope selective laser ablation surgery
- intervening membrane septostomy,
- selective reduction
late preterm infants have difficulties feeding due to:
- immaturity suck, swallow, breath coordination
- longer sleeps
- less feeding cues
- easily tired when feeding
large for gestational age
- weight above the 90th percentile
small for gestational age
- weight below the 10th percentile
