Multiple Pregnancies

Question 1

Describe what the following abbreviations mean:
MCMA
MCDA
DCDA

Answer 1

M = mono
D = di 

C = chorion (placenta)
A = amniotic sac

Question 2

Lambda and T sign can be seen on USS with multiple pregnancies. Explain what both mean

Answer 2

Lambda - triangular sign - DCDA

T sign - MCDA

Question 3

What are the symptoms/signs of multiple pregnancies

Answer 3

• Hyperemesis gravidarum caused by high levels of hCG
• Large for dates
• High levels of b-hCG

Question 4

When would delivery be induced in DCDA and MCDA?

When can elective C-section be undertaken in MA twins?

Answer 4

DCDA - 37-38wks
MCDA - 36wks w/steroids

32-33+6wks

Question 5

How are foetus monitored during labour?

Answer 5

1 w/ USS
1 w/ FSE - fetal scalp electrode

Helps to differentiate

Question 6

How does appointment times change for MC as compared to DC?

Answer 6

MC - 2 weeks

DC - 4 weeks

Question 7

Explain Twin-To-Transfusion syndrome

How is it managed?

What is either twin at risk of?

Answer 7

When twins share a placenta there can be anastomosis between the two fetal capillary networks

One twin becomes the donor and other recepitant

Donor - FGR, olgiohydramnios and anaemia

laser ablation of anastomosis if before 26 wks
>26wks aminoreduction

Deliver at 34-36 wks

Receiptant - heart failure and polyhydramnios