Multiple pregnancies

Question 1

What are risks for the mother when having multiple pregnancies?

Answer 1

Larger hemodynamic changes – anemia.
Hyperemesis gravidarum. 
Pre-eclampsia.
Hypertension.
Gestational diabetes.
Cesarean section.
Post-partum hemorrhage.
Peripartum cardiomyopathy, especially if pre-eclamptic.

Question 2

What are causes of selective fetal growth restriction?

Answer 2

TTTS if MCDA
Anomalies.
Viral infections (Toxoplasmose, CMV, rubella).
Placenta insufficiency.

Question 3

What is the typical time of twin-to-twin transfusion syndrome?

Answer 3

16-26 weeks.

Question 4

What is the cause of twin-to-twin transfusion syndrome?

Answer 4

Unbalance in placental vessel anastomoses (in monochorionic, monoamniontic twins).

Question 5

What is the cause of twin anemia polycytemia sequence?

Answer 5

Caused by small AV-anastomoses, so that blood is transfused slowly from one twin:
One gets high hemoglobin (recipient), the other low/ anemia (donor).

Question 6

What is the treatment against twin anemia polycytemia sequence?

Answer 6

<28 weeks: Fetoscopic laser ablation.
28-32 weeks: Intrauterine transfusion.
>32 weeks: Delivery.

Question 7

What is TRAP (twin reversed arterial perfusion) sequence? What is the consequence of TRAP?

Answer 7

Acardial mass receiving de-oxygenated blood from healty twin («pump twin»).
Referred to as «True parasite», «acardiac twin», «parasite twin».
Leads to «high-output» heart failure in pump twin.