15. Multiple Pregnancies Flashcards
aetiology
ethnicity increasing maternal age increasing parity family history fertility treatment
zygosity
monozygous = 1 egg (1/3) dizygous = 2 eggs (2/3)
dichorionic twins
all dizygotic twins
must be diamniotic
separate circulations
1:3 monozygous twins are dichorionic
monochorionic twins
monozygous twins (2/3)
vascularly joined placentae
3x increased loss rate
usually diamniotic
diagnosis of multiple pregnancy
uterine size
up to 50% on delivery worldwide
ultrasound
USS findings
dichorionic twins: lambda sign
monochorionic twins: T sign
monochorionic, monoamniotic twins: no sign
complications of multiple pregnancy
symptoms of pregnancy anaemia hypertension intrauterine growth restriction pre-term labour delivery problems perinatal mortality
mortality in multiple pregnancy
still birth - after 24 weeks early neonatal - first 7 days neonatal - first 28 days perinatal: stillbirth + early neonatal infant: first year
first trimester management
discuss screening for chromosomal abnormalities
determine chronicity
discussen foetal reduction if triplets or more
second trimester management
detection of foetal abnormality
serial scans for growth for all
serial scans for TTTS if monochorionic twins
maternal complications
risks of monochorionic twins
more foetal malformation
more foetal growth restriction
twin to twin transfusion
twin-to-twin transfusion
unbalanced placental vascular anastomoses donor smaller, decreased liquor high mortality (esp in recipient) treatment: laser of amnio-reduction early delivery by caesarian
third trimester management
scanning as in 2nd trimester monitor blood pressure pre-term labour delivery planning 37-38 weeks for DC twins 36-37 weeks for MC twins
labour management
monitor both twins
problems delivering twin 2
risk of postpartum bleed
puerperium
period of 6 weeks after labour
feeding difficulties
emotional and social support
