Multiple pregnancy

Question 1

What is the classification of multiple pregnancy

Answer 1

1. How is the amniotic sac divided
2. How is the placenta divided

Question 2

What are predisposing factors to multiple gestation?

Answer 2

1. advanced age >=35
2. ethnicity
3. history of previous multiple pregnancy
4. medication

Question 3

for dichorionic diamniotic what is the time of zygote division

Answer 3

first 3 days of conception

Question 4

for monochorionic diamniotic what is the time of zygote division

Answer 4

day 4-7 after conception

Question 5

for monochorionic monoamniotic what is the time of zygote division

Answer 5

day 8-11 after conception

Question 6

for monochorionic monoamniotic what is the time of zygote division

Answer 6

from day 12 after conception onwards

Question 7

what are the maternal complications of multiple gestation

Answer 7

hyperemesis gravidarum
gestational diabetes
gestational hypertension
pre-eclampsia
postpartum hemorrhage
antepartum hemorrhage

Question 8

what are fetal complication in multople gestation

Answer 8

grotwth restriction
twin to twin transfusion
twin reversal arterial perfusion

Question 9

what is the ultrasound sign for dichorionic twins

Answer 9

lamda sign

Question 10

in twin to twin transfusion syndrome what is the presentation

Answer 10

recipient :
polycythemia
hypervolemia
polyhydramnions
donor
anemia
growth restriction
hypovolemia
oligohydramnios

Question 11

describe the management

Answer 11

1. ultrasound for dating and chronicity as early as possible
2. ultrasound for anormalies (18-20wks)
   3.U/S every 2-3 weeks if discordant-doppler
3. for growth discordance > 20 NST with AFI or BPP
4. antenatal care every month till 28 weeks then every 2 weeks till 36 weeks then every week till 38 weeks for delivery (monochorionic diamniotic ; dichorionic diamniotic)
5. for Mono - mono treat sterioods at 28 weeks admit for daily ward monitoring CTG & delivery C/S btwn 32-34 weeks

Question 12

For triplet gestation and beyond

Answer 12

28 weeks steroids
C/S delivery at 34 weeks

Question 13

if there is IUFD of twin

Answer 13

treat for DIC OR INFECTION
monitor for surviving twin
expectant management

Question 14

what is the management of delayed twin delivery

Answer 14

is the twin is in transverse lie, internal podalic version then breech delivery in the OT
and start oxytocin augmentation if there is delay >30 mins
monitor with continuous fetal heart monitoring if not available monitor every 15 minutes.
third stage
oxytocin 20IU in NS or ringers lactate

Question 14

What is Quintero Stage I of twin-twin transfusion syndrome (TTTS)?

Answer 14

Stage I: The amniotic fluid discrepancy is present with a maximum vertical pocket (MVP) of ≥8 cm in the recipient and ≤2 cm in the donor, but the bladder of the donor twin is still visible.

Question 15

What is Quintero Stage II of TTTS?

Answer 15

Stage II: The donor twin’s bladder is no longer visible on ultrasound, but there are no signs of abnormal Doppler studies yet.

Question 16

What is Quintero Stage III of TTTS?

Answer 16

Stage III: Abnormal Doppler studies are present in either twin, such as absent or reversed end-diastolic flow in the umbilical artery, or abnormal ductus venosus flow, regardless of visible bladder or fluid status.

Question 17

What is Quintero Stage IV of TTTS?

Answer 17

Stage IV: Hydrops fetalis is present in one or both twins, which indicates severe fetal compromise due to fluid imbalance.

Question 18

What is Quintero Stage V of TTTS?

Answer 18

Stage V: This stage is marked by the intrauterine demise (death) of one or both twins.