Multiple Pregnancies Flashcards
What is the risk with MPs?
Preterm deliveries
What type of MP are higher risk?
Monochorionic, monoamniotic
Why do you worry about in monochorionic vs dichorionic twins?
Twin twin transfusion syndrome Twin anaemia polycythemia sequence (TAPS) Twin reversed arterial sequence (TRAP) Conjoined Consequences of death to cotwin
What is the perinatal mortality of monochorionic vs dichorionic?
12% vs 5%
What is routine care of MPs?
• Determine gestational age and chorionicity • Provision of information • Nutritional advice • Monitor for complications – Maternal – Fetal • Prevent preterm delivery
How does weight gain monitor differ in MP? Why?
It is actively monitored and encouraged as failure to gain is associated with preterm
What is the difference with pre-eclampsia in MPs?
30% (cf to 10% in singleton)
All on 100mg aspirin
What are some maternal complications of MPs?
Gestational diabetes Antepartum haemorrhage Postpartum haemorrhage Anaemia Depression Marital disharmony
When do you stop work at MPs?
28-30 weeks in twins
24 weeks in triplets
How do you prevent preterm delivery?
Primary
- Stop smoking
- Avoid multiples
- Treat asymptomatic bacteriuria
Secondary
- Progesterone is debatable
When is the safest time to delivery twins?
37 weeks if uncomplicated DC
36-37+6 - MC, DA
32 to 33+6 - MC, MAmniotics
What is the best mode of delivery for twins?
No difference between vaginal and CS as long as sufficient staff and technology is available
How does labour work for twins?
Delivery the first twin normally
Ensure transverse lie for second, restart syntocinon
Routine third stage
What is twin twin transfusion syndrome? What are the implications
Shunt of blood from donor to recipient twin
Death of donor if untreated
How do you prevent TTTS?
Laser the anastomotic vessels
