Multiple Gestation

Question 1

Multiple gestation?

Answer 1

Pregnancy of more than one foetus

Question 2

Why may multiple gestation occur?

Answer 2

1. If more than one egg is released during one menstrual cycle
2. If the zygote divides after fertilisation
3. IVF treatment- often transfer more than 1 embryo to the uterus

->number 2 gives rise to identical twins

Question 3

Amnionicity?

Answer 3

Number of amnions ( inner membranes) that surround babies in multiple pregnancies

Question 4

What are pregnancies with one amnion described as?

Answer 4

Monoamniotic- babies share an amniotic sac

Question 5

What are pregnancies with two amnions described as?

Answer 5

Diamniotic- babies have two amniotic sacs

Question 6

Chorionicity?

Answer 6

Number of chorionic (outer membranes) that surround the babies in a multiple pregnancy

Question 7

What are pregnancies with one chorionic membrane described as being?

Answer 7

Monochorionic

->and two is dichorionic, you get the idea

Question 8

Okay so what is meant by dichorionic diamniotic twins?

Answer 8

Each baby has separate placenta and amniotic sac

Question 9

Okay so what is meant by monochorionic diamniotic twins?

Answer 9

Both babies share a placenta but have separate amniotic sacs

Question 10

Okay so what is meant by monochorionic monoamniotic twins?

Answer 10

Both babies share a placenta and amniotic sac

Question 11

What is done to determine the amniocity and chorioncity?

Answer 11

Foetal ultrasound scan

Question 12

What does the Lambda sign on ultrasound show?

Answer 12

Two placenta so dichorionic diamniotic twins

Question 13

What does the T sign show on ultrasound?

Answer 13

Single placenta so monochorionic diamniotic twins

Question 14

What are some of the potential maternal complications of multiple births?

Answer 14

Preterm labour
Hyperemesis
Anaemia in pregnancy
Gestational diabetes
Postpartum haemorrhage

Question 15

What are some of the potential foetal complications of multiple births?

Answer 15

Growth restriction
Prematurity
Increased birth complications
Increased perinatal mortality and morbidity

Question 16

What is one potential complication which is more common with monochorionic twins?

Answer 16

Twin to twin transfusion syndrome

-> when blood moves from one baby to another due to a shared placenta, that baby then loses blood and is called the donor twin.

Just looked it up and apparently in 85-90% that receive treatment, one twin survives and in about 50%, both survive

Question 17

What is done in antenatal care in multiple gestation?

Answer 17

-Routine care including trisomy 21 screening/ structural scans
-Specialist clinic with regular scans to monitor growth and identify complications
-Monitor BP/commence iron if required

Question 18

How many antenatal visits do dichorionic diamniotic twins require?

Answer 18

At least 8

Question 19

How many antenatal visits do monochorionic twins require?

Answer 19

At least 11

Question 21

Delivery of dichorionic diamniotic is aimed at how many weeks?

Answer 21

37wks

Question 22

Delivery of monochorionic diamniotic is aimed at how many weeks?

Answer 22

36wks

Question 23

Delivery of triplets is aimed at how many weeks?

Answer 23

35wks

Question 24

What is the mode of delivery for multiple gestation?

Answer 24

Depends for twins, either vaginal or CS
CS for triplets

->if first twin is not in cephalic presentation, offer CS