Multiple Pregnancy Flashcards
What are the factors increasing the likelihood of multiple pregnancy?
- Assisted conception
- Increasing maternal age
- Parity
What are the four types of multiple pregnancies?
- Dizygotic twins (DZ)
- Dichorionic, diamniotic, but monozygotic (DCDA)
- Monochorionic, diamniotic (MCDA)
- Monochorionic, monoamniotic (MCMA)
What is this describing and how common is it?
Fertilisation of different oocytes by different sperm.
Dizygotic twins (DZ) - 2/3 of all multiple pregnancies
What is this describing and how common is it?
Separate placentas, separate amnions.
Dichorionic, diamniotic but monozygotic (DCDA) - 30% of monozygotic twins
What is this describing and how common is it?
Shared placenta, separate amnions.
Monochorionic, diamniotic (MCDA) - 70% of monozygotic twins
What is this describing?
Shared placenta, shared amnion.
Monochorionic, monoamniotic (MCMA)
What is this a presentation of?
Vomiting more marked in early pregnancy, uterus larger than expected, lambda sign on USS.
Dichorionic multiple pregnancy
What is this a presentation of?
Vomiting more marked in early pregnancy, uterus larger than expected for dates, T-sign on USS.
Monochorionic multiple pregnancy
What are the maternal complications of multiple pregnancy?
GDM, PET, anaemia
What are the foetal complications of multiple pregnancy?
- Mortality, morbidity
- Preterm delivery, IUGR, miscarriage
- Twin-twin transfusion syndrome if MCDA
- Malpresentation of the 1st twin
- Foetal distress
- PPH
How is twin-twin transfusion syndrome diagnosed and treated?
Growth discordance, laser ablation.
When are the recommended delivery dates for dichorionic twins, monochorionic twins, and triplets?
- Dichorionic - 37/40, induction of labour or C-section
- Monochorionic - 36/40, induction of labour or C-section
- Triplets - 35/40, C-section
