Multifetal Pregnancy Flashcards
Ovulation during the course of an established pregnancy. Possible due to obliteration of fusion of decidua capsularis to the deciduas vera
Superfetation
Most common: Monzygotic or Dizygotic?
Dizygotic
Best time to do ultrasound for multifetal pregnancies
First trimester
Different genders are often di-di except when?
XX and XO (Turner’s Syndrome of the other twin)
If unable to establish chorionicity?
Should be managed as monichorionic until proven otherwise
On sonography, a thick groove between membranes at the insertion of the placenta is noted. Which is true?
a. Twins have same gender
b. One may has polyhy the other has oligo
c. Delivery at 38 weeks
d. Discordance is common
C. Dichorionic-Diamnionic pregnancy
Pathophysiology: Unidirectional flow through deep A-V anastomosis
TTTS
2 Criteria for Diagnosis of TTTS
- Mono-Di Pregnancy
2. Oligo of 1 twin (SVP <2), Polyhy of the other (SVP >8)
Twins have Poly-Oli syndrome, the recipient twin has “stuck syndrome” and donor twin has absent urine in bladder. Quintero stage?
3
Although inclusion is still controversial, cardiac function by 2D Echo is sometimes included in quintero staging through what index?
MPI (Myocardial Perfusion Index) or Tei index
In what trimester in which severity of TTTS is usually present?
2nd Trimester
Complications of Single fetal death in a twin pregnancy?
Maternal: Coagulopathy
Other twin: Neurologic compromise due to Acute Hypotension (rarely: Embolic events)
Most common management used in TTTS
Amnioreduction
Pathophysiology: 3 weeks after laser photocoagulation of placental anastomoses, twins had significant differences in Hgb concentration
Iatrogenic TAPS (within 5 weeks of Laser photocoag)
Spontaneous TAPS usually occurs when?
26 weeks or later
Diet modifications in multifetal pregnancy
Iron: 60-100 mg/day (from 27)
Folic Acid: 1mg/day (from 400mcg)
RCOG on serial sonographic assessment of Mono-Di pregnancies
Every 2-3 weeks after 16 weeks AOG
ACOG on uncomplicated twin gestations (ultrasound)
- Establish chorionicity on the 1st tri
- Repeat at 18-22 weeks
- Then every 4 weeks
Manner of Delivery: Vertex-Vertex
Trial of Labor regardless of gestational age
When to deliver: Uncomplicated Mono-Mono
32-34 weeks
When to deliver: uncomplicated Mono-Di
34-37 6/7 weeks
Manner of Delivery: Mono-Moni
Outright CS
Manner of Delivery: Non Vertex presenting twin
Outright CS
Manner of Delivery: Vertex/Non Vertex
If Twin B is > 1500g, > 32 wks, <3500 and no discordance: Breech extraction
If Twin B is < 1500, < 32 weeks, > 3500 or with significant discordance: Consider CS
