Exxcellence pearls: twin pregnancy Flashcards
How is chorionicity diagnosed?
First trimester ultrasound reveals a thickened septum between chorionic sacs or the presence of the lambda or “twin-peak” sign which represents the same thickening of the chorion at the base of the intertwined membrane. This reveals dichorionic gestation.
What is the rate of twin pregnancy?
3%
What is the major risk of mono-di twin gestation?
Twin-twin transfusion syndrome which leads to growth discordance and potential fetal loss.
What is the zygosity of dichorionic twins?
Monochorionic twins?
What is the incidence of each?
Mono or dizygotic.
Monozygotic
1 in 30 and 1 and 250 respectively.
What complications of pregnancy are increased with twin gestation?
Premature labor, preeclampsia and gestational diabetes.
When should serial ultrasounds for mono-di twins begin?
How frequently should these be followed?
16 weeks, when the earliest signs of TTTS may appear.
Every 3-4 weeks. And more frequently if there are findings of concern.
What is the rate of mono-mono twins amongst monochorionic twin gestations?
What is the rate of perinatal mortality?
What is leading cause?
3%
At least 20%.
Cord entanglement.
How should the imminent demise of one twin be managed if a viable gestational age has been reached in mono-di twins? Why?
Immediate delivery. If one fetus dies in utero the potential for damage of the second twin including hypertension and cerebral ischemia occurs immediately.
How should mono-mono twins be managed?
Optimal management is unclear. Many advocate for hospitalization during third trimester for intensive fetal surveillance.
