Multiple Gestation Flashcards
What is a multiple pregnancy?
It refers to a pregnancy with more than one fetus
What are monozygotic twins?
Identical twins
When does a monozygotic pregnancy occur?
When a zygote divides after fertilisation
What are dizygotic twins?
Non-identical
When does a dizygotic pregnancy occur?
When more than one egg is released during one menstrual cycle
What are dichorionic diamniotic twins (DCDA)?
Babies that have a separate placenta and amniotic sac
What is a dichorionic pregnancy?
When babies have two separate placentas
What is a diamniotic pregnancy?
When babies have two separate amniotic sacs
What is the cause of a dichorionic diamniotic pregnancy?
It results from two separate eggs being fertilised by two separate sperms
It results from an early division of one zygote before implantation
What type of multiple pregnancy has the best outcome? Why?
Dichorionic diamnitoic
Each fetus has their own nutrient supply
What are monochorionic diamniotic twins (MCDA)?
Babies that share the same placenta but have separate amniotic sacs
What is the cause of monochorionic diamniotic pregnancy?
The zygote divides after implantation between day 6- 8
What is a monochorionic pregnancy?
When babies share a single placenta
What are monochorionic monoamniotic twins (MCMA)?
Babies that share the same placenta and amniotic sac
What is the cause of a monochrorionic monoamniotic pregnancy?
The zygote divides after day 8
What is a monoamniotic pregnancy?
When babies share a single amniotic sac
What investigation is used to diagnose and determine the type of multiple pregnancy?
US scan
What is the sign of dichorionic diamniotic twins on an US scan? Describe this sign
Lambda sign, also known as the twin peak sign
This refers to a triangular appearance where the membrane between the twins meets the chorion
This indicates a dichorionic pregnancy (two placentas)
What is the sign of monochorionic diamniotic twins on an US scan? Describe this sign
T sign
This refers to the appearance to where the membrane between the twins abruptly meets the chorion, giving a T appearance
This indicates a monochorionic pregnancy (one placentas)
What is the sign of monochorionic monoamniotic twins on an US scan?
The presence of no membrane separating the twins
What are the six maternal complications of a multiple pregnancy?
Anaemia
Hypertension
Gestational Diabetes
Postpartum Haemorrhage
Preterm Labour
Malpresentation
What are the six fetal complications of a multiple pregnancy?
Prematurity
Growth Restriction
Miscarriage
Stillbirth
Twin-Twin Transfusion Syndrome
Twin Anaemia Polycythaemia
What is twin-twin transfusion syndrome?
It occurs when the fetuses share a placenta
When there is a connection between the blood supplies of the two fetuses, one fetus (the recipient) may receive the majority of blood from the placenta, while the other fetus (the donor) is starved of blood
Which type of twins are commonly affected by twin-twin transfusion syndrome?
Monochorionic twins
What are the two complications that can occur in the recipient of twin-twin transfusion syndrome?
Heart failure
Polyhydramnios
What are the three complications that can occur in the donor of twin-twin transfusion syndrome?
Growth restriction
Anaemia
Oligohydramnios
What is twin anaemia polycythaemia sequence?
It results in one twin becoming anaemic whilst the other develops polycythaemia
When should we aim to deliver dichorionic diamnitoic twins?
37 weeks of gestation
When do we deliver dichorionic diamniotic twins vaginally?
When the first baby has a cephalic presentation
When do we deliver dichorionic diamniotic twins via an emergency c-section?
For the second baby after successful birth of the first baby
When do we deliver dichorionic diamniotic twins via an elective c-section?
When the presenting twin is not cephalic presentation
When should we aim to deliver monochorionic diamnitoic twins?
36 weeks gestation
How do we deliver monochorionic diamniotic twins?
Elective c-section
When should we aim to deliver triplets?
35 weeks of gestation
How do we deliver triplets?
Elective c-section
