Multiple Gestation Flashcards
During what time periods would splitting result in different chorionicty and amnionicity?
Monozygotic twins 0-3 days - dichorionic diamniotic 3-8 days - monochorionic diamniotic 8-13 - monochorionic monoamniotic >13 - conjoined twins
What is the incidence of multiple gestations?
1 : 80 pregnancies 1 : 66 Jamaica 1 : 72 Trinidad Monozygotic twins 20% 33%** Dizygotic 80% 66%**
What are 5 risk factors for multiple gestations?
Increasing maternal age Family history of twins High parity African ancestry Assisted techniques eg IVF, newly discontinued OCP
What is the presentation of multiple gestations?
Hx Hyperemesis gravidarum Abdominal discomfort and backache Increased fetal movement Respiratory embarrassment (dyspnoea)
Examination:
Symphysio-fundal height large for date
Several palpable fetal parts
May be fluid thrill due to polyhydramnios
What are 7 maternal complications of multiple gestations?
Anemia
PIH
GDM
Antepartum hemorrhage (placenta previa and placental abruption)
Post partum hemorrhage (atony due to overdistension)
Polyhydramnios (more common in monochorionic)
Supine hypotension (due to weight)
What are fetal complications of multiple gestations?
Congenital abnormalities - dizyogotic twice at risk for trisomy 21 and monozygotic twins for conjoined twins
Preterm labour - 39 singleton, 37 twins, 33 triplets, 31 quad
IUGR -
Abnormal lie and presentation - 50% V/V, 33% V/B, 13% B/V, 3% B/B, 3% V/S
Twin interlocking - B/V
TTTS
What are placental complications of multiple gestations?
Placenta previa Placental abruption Polyhydramnios Cord prolapse Cord anomalies (velamentous insertsion, 2 cord vessel)
What are your differential diagnosis for multiple gestations?
Wrong dates Fetal macrosomia Fibroids/ovarian cysts Polyhydramnios Hydatidiform mole
What investigations would you do for multiple gestations?
U/S to determine chorionicity and zygosity
Look for lambda or T sign
Concordance of EFW
Doppler flow for placental supply
