Multiple Pregnancy

Question 1

What is multiple pregnancy?

Answer 1

Pregnancy involving more than one fetus.

Question 2

What is the aetiology of multiple pregnancy?

Answer 2

Monoxygous: division of fertilised egg

· DCDA: splitting 3 days, 2 chorions, 2 amnions.

· MCDA: Splitting 4-7d, one chorion, 2 amnions.

· MCMA: solitting 8-12d, single placenta, one amnion, one chorion.

Dizygous: fertilisaiton of >1 ovum be different spirm. DCDA.

Question 3

What are the risk factors for multiple pregnancy?

Answer 3

Previous hx, FHx, ovulation, africal race, high maternal age.

Question 4

What is the epidemiology of multiple pregnancy?

Answer 4

11% incidence twins, 1/8100 triplets.

Question 5

What would you find in the history and examination of multiple pregnancy?

Answer 5

First trimester: incindental finding on USS, hyperemesis (increased BHCG)

Later in pregnanct: large for date, multiple fetal parts on abdominal examination.

Abdomen: high fundal height, multiple fetal parts, >1FH.

Question 6

What investigations do you do for multiple pregnancies?

Answer 6

Confirm by USS: establish choronicity (almost 100% accurate in first trimsster only) nuchal translucency (serum screening unreliable for Downs

Question 7

What is the management of multiple pregnancies?

Answer 7

Antenatal: serual USS for growth (dichoronic 4-weekly from wk24, monochoronic 2weekly from wk18). Monitor FBC (anaemia in mom) monitor BP )higher eclampsia), GTT (higher chance of diabetes)

Vaginal delivery: may be attempted if first twin cephalic (need continuou smonitoring and management in third stage)

C section: recommended for delayed delviery of second twin, fetal distress in early twim, malpresentation of secodn twin (can attempt ECV first). Monoamniotic wtins. Higher order births.

Question 8

What are the complications and prognosis of multiple pregnancies?

Answer 8

Maternal: miscarriage, HEG, PREC, anaemia, PPH, APH, DM, operative delivery, PNDepres

Fetal: prematurity, PHDRMN, congenital malform, IUGR, fetal death, discordant growth.

Monochorionic twins: trim-twin transfusion syndrome (placental anastomoses -> haemodynamic imbalance -> PHMN+hydrops in one twin, OHMN+IUGR in other.

Other: cord prolapse, interlocking, high perinatal morbidity. Mortality 4xhigher if twins.