MULTIPLE PREGNANCIES. Flashcards
What is the incidence of multiple pregnancies?
1 in 62
What complications are associated with multiple pregnancies? How are these increased in comparison to a singleton pregnancy?
Maternal mortality (x2.5 increase) Pre-eclampsia (x3 increase for twins, x9 increase for triplets) Prematurity Neonatal death Congenital anomalies Stillbirth
Define the following terms:
Chorionicity
Zygosity
Chorionicity - number of placentas
Zygosity - identical or not
Cleavage at what stage in development leads to the formation of which kind of twins?
Cleavage of the morula at days 1-3: DCDA
Cleavage of the blastocyst at days 4-8: MCDA
Cleavage of the implanted blastocyst at 8-13 days: MCMA
Cleavage of the embryonic disc at 13-15 days: conjoined twins
What sign is indicative of a dichorionic pregnancy? What sign is indicative of a monochorionic pregnancy?
Dichorionic – Lambda sign
Monochorionic – T sign
Signs are easier to detect earlier in pregnancy
Monochorionic vs dichorionic twins:
Frequency of US
Timing of delivery
Down’s risk calculation
Risk of congenital abnormalities
US - fornightly for M, every 4 weeks for D
Timing of delivery - 36-37 weeks after a course of steroids (M), 37-38 weeks (D)
Risk of congenital abnormalities - increased with M
What is the ideal gestation that triplets should get to?
35 weeks (plus a course of steroids) if an uncomplicated pregnancy
Aspirin 75mg OD should be provided to women with a multiple pregnancy if they have what other risk factors?
First pregnancy 40 or older Pregnancy interval of more than 10 years BMI >35 at first visit Family history of PET
Referral to a tertiary unit is required for a multiple pregnancy if…?
Monoamniotic Discordant anomaly Increased Down’s risk Twin to twin transfusion Discordant growth restriction Discordant foetal death
What are the features of the donor twin in twin-to-twin transfusion syndrome? The recipient twin?
Donor – oliguria, oligohydramnios, IUGR
Recipient – polyuria, polyhydramnios, cardiac overload
