Antenatal - Multiple pregnancies

Question 1

multiple pregnancy:

define monozygotic

Answer 1

identical twins - from a single zygote

Question 2

multiple pregnancy:
define dizygotic

Answer 2

non-identical (from 2 different zygotes)

Question 3

risk factors for dizygotic twins

Answer 3

• super ovulater - FHx
• IVF
• PMHx
• nigerian
• clomifene
• age

Question 4

multiple pregnancy:

define monoamniotic

Answer 4

single amniotic sac

Question 5

multiple pregnancy:

define diamniotic

Answer 5

2 separate amniotic sacs

Question 6

multiple pregnancy:

define monochrionic

Answer 6

share a single placenta

Question 7

multiple pregnancy:

define dichorionic

Answer 7

2 separate placentas

Question 8

which twin pregnancies have the best outcome and why?

Answer 8

diamniotic dichorionic as each fetus has their own nutrient supply

Question 9

when are multiple pregnancies usually diagnosed?

Answer 9

booking ultrasound

10 - 13+6

Question 10

what is seen on ultrasound scan for dichorionic diamniotic twins?

Answer 10

have a membrane between the twins with a lambda sign or twin peak sign. this is the triangular appearance where the membrane between the twins meets the chorion as the chorion blends partially with the membrane

Question 11

what is seen on ultrasound scan of monochorionic diamniotic twins

Answer 11

have a membrane between the twins with a T sign. the T sign refers to where the membrane between the twins abruptly meets the chorion giving the T appearance

Question 12

what is seen on ultrasound of monochorionic monoamniotic twins?

Answer 12

no membrane separating the twins

Question 13

what are some risks to the mother of multiple pregnancies?

Answer 13

• Anaemia
• Polyhydramnios
• Hypertension
• Malpresentation
• Spontaneous preterm birth
• Instrumental delivery or caesarean
• Postpartum haemorrhage

Question 14

what are some risks to the fetus and neonates of multiple pregnancies

Answer 14

• Miscarriage
• Stillbirth
• Fetal growth restriction
• Prematurity
• Twin-twin transfusion syndrome
• Twin anaemia polycythaemia sequence
• Congenital abnormalities

Question 15

What is Twin-Twin Transfusion Syndrome?

Answer 15

occurs when the fetuses share a placenta. where there is a connection betwen the. blood supplies of the 2 fetuses, 1 may receive the majority of the blood (recipient) from the placenta while the other is starved of blood (donor).

the recipient gets the majority of the blood and can become fluid overloaded with heart failure and polyhydramnios

the donor has growth restriction, anaemia and oligohydramnios

Question 16

how is twin-twin transfusion syndrome managed?

Answer 16

referred to a tertiary specialist fetal medicine centre

laser treatment may be used to destroy the connection between the 2 blood supplies

Question 17

what is twin anaemia polycythaemia sequence?

Answer 17

like twin-twin transfusion syndrome but less acute

one twin becomes anaemic whilst the other develops polycythaemia

Question 18

what additional antenatal care is needed in multiple pregnancies?

Answer 18

FBC monitoring for anaemia at booking clinic, 20 wks and 28 wks

additional ultrasound scans to monitor fro FGR, unequal growth, TTTS - 2 weekly from 16 weeks in monochorionic twins and 4 weekly from 20 weeks for dichorionic twins

Question 19

when are births planned for uncomplicated monochorionic monoamniotic twins, monochorionic diamniotic twins, dichorionic diamniotic twins and triplets?

Answer 19

increased risk of fetal death beyond these dates

corticosteroids given before delivery to help mature lungs

Question 20

delivery options for twins

Answer 20

Question 21

delivery things for twins

Answer 21

continuous CTG of both babies

uss before - lie and fetal heart rate

epidural for vaginal

oxytocin use liberally

if 2nd not cephalic - ecv, icv or c section for 2nd baby

active management of 3rd stage