Multiple pregnancies

Question 1

What are the causes of multiple pregnancies?

Answer 1

Ethnicity
Increasing maternal age
Increasing parity
Family history
Fertility treatment

Question 2

What are the features of dizygotic twins?

Answer 2

separate amnions, chorions and placentae (DCDA)

Question 3

How is a twin pregnancy diagnosed?

Answer 3

Uterine size
Up to 50% at delivery worldwide
Ultrasound - lambda sign indicates dichorionic twins, T sign indicates monochorionic twins.

Question 4

How is the first trimester managed in twin pregnancies?

Answer 4

Discuss screening for chromosomal anomalies
Determine chorionicity
Discuss fetal reduction if triplets or more

Question 5

How is the second trimester managed in twin pregnancies?

Answer 5

Detection of fetal abnormality
Serial scans for growth for all - DC monthly from 24 weeks
Serial scans for TTTS if MC twins
Maternal complications

Question 6

What are the risks of monochorionic twin pregnancies?

Answer 6

More fetal malformation
More fetal growth restriction
Twin to twin transfusion

Question 7

What are the features of twin-to-twin transfusion?

Answer 7

Unbalanced placental vascular anastamoses
Donor smaller, decreased liquor
High mortality (esp recipient)
Treatment: laser or amnio-reduction, early delivery by caesarean

Question 8

How is the third trimester managed in twin pregnancies?

Answer 8

Scanning as in 2nd trimester
Monitor blood pressure
Pre-term labour
Delivery planning