Multiple Pregnancy

Question 1

What are the risk factors for multiple pregnancy?

Answer 1

Maternal heredity
Ethnicity (Nigeria 1:20)
Maternal age and parity
Nutrition
Assisted reproduction

Question 2

How do you tell the difference between mono and dichorionic twins?

Answer 2

On USS at 14/40
With monochorionic, see the T sign
With dichorionic, see the lambda sign

Question 3

How does the maternal physiology adapt for multiple pregnancy?

Answer 3

Blood volume increases
Cardiac output increases
BP drops even more than in singleton, and increases more toward term
Physiological anaemia increase

Question 4

What are the maternal complications of multiple pregnancy?

Answer 4

Hyperemesis
Anaemia
Preeclampsia x2
Weight gain, striae, varices
Poor glucose tolerance
PPH x2
Increased maternal mortality x2

Question 5

What are the fetal complications in multiple pregnancy?

Answer 5

Prematurity (median age 35/40). Poor growth from 28-30/40. Twin-to-twin transfusion syndrome. TRAP. Mono amniotic twins. Congenital anomalies. Conjoined twins. Placenta praevia/ abruptio. Second twin delivery. Vanishing twin.

Question 6

How is the mother cared for antenatally in multiple pregnancy?

Answer 6

Protein, iron folic acid nutrition and supplementation
Thorough scan at 22/40
Monitor fetal growth- 3weekly scan from 28/40
Manage preeclampsia
Predict preterm labour
Be aware of and able to manage fetal complications

Question 7

How are mono amniotic twins managed in utero and why?

Answer 7

Monitor twice weekly. Once lungs mature, delivery or at 36/40
Increased mortality mainly due to cord entanglement

Question 8

What are the risks for labour in multiple pregnancy?

Answer 8

Indications for C/S
Delivery of second twin
PPH

Question 9

What are the four different types of twins?

Answer 9

Monoamniotic monochorionic
Diamniotic monochorionic
Diamniotic dichorionic fused
Diamniotic dichorionic separated