2021 MCDA

Question 1

What gestation chorionicity determined

Answer 1

Determined and documented in all twins prior to 14 weeks

Question 2

Monitoring frequency for MCDA

Answer 2

2/52 for TTTS and IUGR from 16/40

Centre sufficient experience to recognised complications and refer if occur

Question 3

What should USS include for MCDA

Answer 3

Growth
Amntioic fluid in each sac and bladder
UAPI and MCA from 20./40 but may be appropriate earlier if issues

Question 4

Recommended treatment for TTTS ?

Answer 4

Laser ablation of vascular connections even if requiring transfer interstate or international

Question 5

What gestation delivered and why ?

Answer 5

By 37 weeks

Higher SB rate despite intensive surveillance

Question 6

4 specific monochorionic complications

Answer 6

TTTS 15%
sIUGR due to unequal placental sharing and velamentous cord
Death of one twin
TRAP - twin reversed arterial perfusion sequence

Question 7

What do women need to monitor with MCDA ?

Answer 7

Acute increase abdo girth, breathlessness –> signs of poly due to TTTS

Question 8

Screening in twin pregnancies ?

Answer 8

Some centres just use nuchal

Tri 21 99% and Tri 18% recent meta (mainly DCDA)

Question 9

TRAP

Answer 9

Twin reversed arterial perfusion sequence
One dies early, surviving twin perfuses dead body via anastomoses, rare complication, consider cord occlusion, tertiary centre !