1.8 Multiple Gestation Pregnancy

Question 1

List potential complications a/w multiple gestation birth

Answer 1

1. Maternal Complications

2. Fetal Complications

Question 2

1. Maternal

Answer 2

1. Prem labour
2. Prem Rupture membranes
3. PET and Eclampsia
4. APH
5. Abruption
6. Prolonged Labour
7. Uterine Atony
8. Trauma obsteric organs
9. Chance Instrument or Caesarean delivery
10. PPH
11. Increase weight gain -
    airway
12. TLC and FRC less
    Quicker desat during apnoea
13. Gravid uterus bigger
    further compromise of oesophageal sphincter
    risk regurg and aspiration
14. Fetal weight and volume amniotic fluid bigger

Question 3

Fetal Complications

Answer 3

1. Congen abnorm
2. IUGR and death
3. Malpres
   - twin 2 following
4. Twin-Twin transfusion
5. Prem delivery
6. Polyhydramnios
7. Umbilical cord prolapse
8. Umbilical cord entanglement

Question 4

Anaesthetic Mx Multiple gestation preg

Answer 4

1. Early assessment
   risks as above
2. Standard hx and exam
3. Risks increased instruments and section
   analgesia discussed
4. Early epidural in labour
   labour pains and delivery if section required
5. Ensure wide bore cannula
   - x2 if high risk
   test - fbc u+e coag x match
6. ?prokinetic

Question 5

Anaesthetic Mx Multiple gestation preg

Answer 5

7. Vigilance in manage epidural
   low threshold for re-site if not adequate
8. Regular comm w/ obs
   progress and delivery plan
9. Delivery in theatre
   quick progress to instrument or section prn
10. Left lateral or full lateral - risk compression
11. Early top up of analgesia
    facilitate instruments
    espec if mispresenting
    of second twin requires section