Multiple Gestation Flashcards

1
Q

What is multiple gestation?

A

Multiple gestation = pregnancy of more than 1 foetus

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2
Q

What is amnioncity?

A

Amnionicity = number of amnions (inner membranes) that surrounds foetus in a multiple pregnancy:

  • Pregnancies with 1 amnion (all babies share amniotic sac) are monoamniotic
  • Pregnancies with 2 amnions are diamniotic
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3
Q

What is chorionicity?

A

Chorionicity = number of chorionic (outer) membranes that surrounds foetus in a multiple pregnancy:

  • If there is 1 membrane, monochorionic
  • If there are 2 membranes, dichorionic
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4
Q

What are the different types of twin pregnancies?

A
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5
Q

What does DCDA stand for?

A

Dichorionic diamniotic twins

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6
Q

What does MCDA stand for?

A

Monochorionic diamiotic twins

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7
Q

What does MCMA stand for?

A

Monochorionic monoamniotic twins

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8
Q

What is the aetiology of multiple gestation?

A
  • More than 1 egg released during 1 menstrual cycle
  • If zygote divides after fertilisation
    • Identical twins
  • IVF treatments
    • Often transfer more than 1 embryo to the uterus
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9
Q

How is determiniation of zygosity and chorionicity done?

A
  • Determination of zygosity and chorionicity is done by foetal USS
    • Lambda sign shows 2 placentas – diagnosing dichorionic diamniotic twins
    • T sign shows single placenta – diagnosing monochorionic diamniotic twins
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10
Q

Is a USS, what sign diagnosis dichorionic diamniotic twins and what sign diagnosis monochorionic diamniotic twins?

A

Lambda sign - dichorinic diamniotic twins (2 placentas)

T sign - monochorionic diamniotic twins (1 placenta)

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11
Q

What are possible complications of multiple gestation?

A
  • Maternal
    • Preterm labour
    • Hyperemesis
    • Anaemia in pregnancy
    • Hypertension
    • Gestational diabetes
    • Postpartum haemorrhage
  • Foetal
    • Growth restriction
    • Prematurity
    • Increased birth complications
    • Increased perinatal mortality/morbidity
    • In monochorionic twins, higher chance of
      • Twin-twin transfusion syndrome – blood moves from one foetus to other due to shared placenta, causing one baby to lose blood
      • Selective growth restriction
      • Twin anaemia polycythaemia sequence
      • Twin reversed arterial perfusion (TRAP)
      • Single twin death
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12
Q

Describe the management of multiple gestation?

A
  • Routine care including trisomy 21 screening and structural scans
  • Specialist clinic with regular scans to monitor growth and identify complications
    • Dichorionic diamniotic required at least 8 antenatal visits
    • Monochorionic required at least 11 antenatal visits
  • Monitor BP/commence oral iron if required
  • Aim for delivery at
    • Dichorionic diamniotic (DCDA) – 37 weeks
    • Monochorionic diamniotic (MDCA) – 36 weeks
    • Triplets – 35 weeks
    • Aim for earlier delivery if maternal or foetal complications
    • All delivery vaginal, unless first twin isn’t cephalic position and if triplets offer caesarean section
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13
Q

How many antenatal visits are required for dichorionic diamniotic twins, and how many for monochorionic diamniotic twins?

A
  • Dichorionic diamniotic required at least 8 antenatal visits
  • Monochorionic required at least 11 antenatal visits
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14
Q

At what weeks should deliver be aimed for: dichorionic diamniotic twins, monochorionic diamniotic twins and triplets?

A
  • Dichorionic diamniotic (DCDA) – 37 weeks
  • Monochorionic diamniotic (MDCA) – 36 weeks
  • Triplets – 35 weeks
  • Aim for earlier delivery if maternal or foetal complications
  • All delivery vaginal, unless first twin isn’t cephalic position and if triplets offer caesarean section
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