Multiple Gestation Flashcards
Multiple gestation?
Pregnancy of more than one foetus
Why may multiple gestation occur?
- If more than one egg is released during one menstrual cycle
- If the zygote divides after fertilisation
- IVF treatment- often transfer more than 1 embryo to the uterus
->number 2 gives rise to identical twins
Amnionicity?
Number of amnions ( inner membranes) that surround babies in multiple pregnancies
What are pregnancies with one amnion described as?
Monoamniotic- babies share an amniotic sac
What are pregnancies with two amnions described as?
Diamniotic- babies have two amniotic sacs
Chorionicity?
Number of chorionic (outer membranes) that surround the babies in a multiple pregnancy
What are pregnancies with one chorionic membrane described as being?
Monochorionic
->and two is dichorionic, you get the idea
Okay so what is meant by dichorionic diamniotic twins?
Each baby has separate placenta and amniotic sac
Okay so what is meant by monochorionic diamniotic twins?
Both babies share a placenta but have separate amniotic sacs
Okay so what is meant by monochorionic monoamniotic twins?
Both babies share a placenta and amniotic sac
What is done to determine the amniocity and chorioncity?
Foetal ultrasound scan
What does the Lambda sign on ultrasound show?
Two placenta so dichorionic diamniotic twins
What does the T sign show on ultrasound?
Single placenta so monochorionic diamniotic twins
What are some of the potential maternal complications of multiple births?
Preterm labour
Hyperemesis
Anaemia in pregnancy
Gestational diabetes
Postpartum haemorrhage
What are some of the potential foetal complications of multiple births?
Growth restriction
Prematurity
Increased birth complications
Increased perinatal mortality and morbidity
What is one potential complication which is more common with monochorionic twins?
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
What is done in antenatal care in multiple gestation?
-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
How many antenatal visits do dichorionic diamniotic twins require?
At least 8
How many antenatal visits do monochorionic twins require?
At least 11
Delivery of dichorionic diamniotic is aimed at how many weeks?
37wks
Delivery of monochorionic diamniotic is aimed at how many weeks?
36wks
Delivery of triplets is aimed at how many weeks?
35wks
What is the mode of delivery for multiple gestation?
Depends for twins, either vaginal or CS
CS for triplets
->if first twin is not in cephalic presentation, offer CS
