Multiple Births ✅

Question 1

What is the incidence of twins?

Answer 1

1 in 89

Question 2

What is the incidence of triplets?

Answer 2

1 in 4000

Question 3

What has caused the increase in incidence of multiple births?

Answer 3

• Increased maternal age of childbearing

- Increased use of fertility enhancing techniques

Question 4

What are the type of twins?

Answer 4

• Dizygotic

- Monozygotic

Question 5

How many amnions do dizygotic twins have?

Answer 5

2

Question 6

How many chorions do dizygotic twins have?

Answer 6

2

Question 7

What is it called when twins have 2 chorions and 2 amnions?

Answer 7

Dichorionic-diamniotic

Question 8

How many amnions to monozygotic twins have?

Answer 8

2

Question 9

How many chorions do monozygotic twin have?

Answer 9

1 or 2

Question 10

What is it called when twins have 1 chorion and 2 amnions?

Answer 10

Monochorionic-diamniotic

Question 11

What are the main complications of multiple pregnancy?

Answer 11

• Preterm delivery
• Intra-uterine growth restriction
• Congenital abnormalities
• Twin twin transfusion syndrome
• Death of fetus

Question 12

What is the median gestation of twin pregnancies?

Answer 12

37 weeks

Question 13

What kind of twins are likely to need to be delivered preterm?

Answer 13

Monochorionic

Question 14

In what kind of twins is intrauterine growth restriction particularly common?

Answer 14

Monochorionic

Question 15

How much is the risk of congenital abnormality increased in twins?

Answer 15

2x in dichorionic (as there are 2 fetuses)

4x in monochorionic

Question 16

What causes twin-twin transfusion syndrome?

Answer 16

Transfusion of blood across placental arteriovenous anastomoses in monochorionic twins

Question 17

What are the features of the donor twin in twin twin transfusion syndrome?

Answer 17

• Hypovolaemic
• Growth restriction
• Oliguria
• Oligohydraminos

Question 18

What are the features of the recipient twin in twin-twin transfusion syndrome?

Answer 18

• Hypervolaemic
• High output heart failure
• Polyuria
• Polyhydraminos

Question 19

How is twin-twin transfusion syndrome managed?

Answer 19

Fetoscopic laser therapy to divide placental blood vessels

Question 20

What might fetal death in one twin result in?

Answer 20

Preterm labour

Question 21

What can fetal death of one twin lead to in monochorionic twins?

Answer 21

Blood loss from live to dead fetus, resulting in hyporolaemia, severe anaemia, neurological impairment, or death of the surviving twin