Multiple Pregnancies (04/10/2021)

Question 1

What are fraternal twins?

Answer 1

-Non-identical twins

Question 2

What are Dizygotic twins?

Answer 2

-Two eggs, two sperms, Two placentas (dichorionic).

Question 3

What is the Lambda?

Answer 3

The tissue space between the two membranes to see if they are dichorionic.

Question 4

What are monozygotic twins?

Answer 4

-Identical twins. Same gender. Share the same genetic material. May be monochorionic or dichorionic. Chorionicity depends on when the zygote splits.

Question 5

What risks are associated with monochorionic?

Answer 5

-Increases the risks of poorer outcomes and complications. Increases gestational age specific mortality. Conjoined fetal circulation.

Question 6

How are Dichorionic, Diamniotic twins classified?

Answer 6

DCDA twins have their own placenta, and their own amniotic sac.

Question 7

How are monochorionic, diamniotic twins classified?

Answer 7

Monochorionic, diamniotic (MCDA) twins are the product of a single fertilized ovum (egg), resulting in genetically identical offspring. MCDA twins share a single placenta (blood supply) but have separate amniotic sacs.

Question 8

How are monochorionic, monoamniotic twins classified?

Answer 8

MCMA twins share the same amniotic sac, as well as the same placenta. This involves the highest risk of complications.

Question 9

As a midwife what do you do with a woman with monoamniotic twins?

Answer 9

Refer to fetal medicine centre.

Question 10

Why should there be emphasis on folate supplementation?

Answer 10

There is an increased risk of structural abnormalities for multiple pregnancy.

Question 11

What can be determined for twins in the first trimester USS?

Answer 11

• Chorionicity/ Amniocity.
• Gestational age
• Major congenital malformation

Question 12

What are the implications of multiple pregnancies for the woman?

Answer 12

-Exaggerated physiological response increases ‘minor’ disorders. Increased hormone produced causes nausea and vomiting. Anaemia is more common and pre-term birth.

Question 13

How are hypertensive disorders treated in pregnancy?

Answer 13

-Aspirin 75mg if risk factors

Question 14

What is the average length of pregnancy for twins, triplets and quads?

Answer 14

37,34 and 32.

Question 15

When is elective delivery for twins? Monozygotic and Dizygotic

Answer 15

• Offer elective delivery of uncomplicated DC twins at 37 weeks gestation
• Offer birth at 36 weeks following steroids for MC/DA twins.

Question 16

How is the outcome for a twin determined if one twin dies inutero?

Answer 16

-Outcome after death of one twin determined by chronicity. DC twins 5-10% risk death or disability. MC twins 25% risk of death or disability.

Question 17

What is twin to twin transfusion syndrome?

Answer 17

-Feto-placental anastomoses present in all MC placentas. Imbalance in flow of blood results in twin to twin transfusion. Normally diagnosed 15-22 weeks ultrasound.

Question 18

Which types of twins are at a higher risk of twin to twin transfusion syndrome?

Answer 18

-Monochorionic twins should have two weekly ultrasound from 16 weeks gestation to detect TTTS. Advise women with MC twin pregnancy to report sudden increase in abdominal size or shortness of breath.

Question 19

What is treatment for twin to twin transfusion syndrome?

Answer 19

-Refer to fetal medicine centre for fetoscopic laser ablation.

Question 20

What cardiac issues are associated with multiple pregnancy?

Answer 20

• HR and stroke volume increase= higher cardiac output
• Greater drop in diastolic pressure in 2nd trimester, greater rise in third trimester.
• Plasma volume in 10-20% more than singleton pregnancy.

Question 21

What gastrointestinal issues are associated with multiple pregnancy?

Answer 21

-increase obstetric cholestasis/ acute fatty liver of pregnancy.