multiple pregnancy

Question 1

what is a dizygotic twin

Answer 1

2 or more ova released and fertilised

Question 2

what is a monozygotic twin

Answer 2

single fertilised ovum divides early

Question 3

predisposing factors

Answer 3

prev twins, FHx twins, incr maternal age, induced ovulation/IVF, race

Question 4

what happens in DZ twins (placenta, chorion, amnion)

Answer 4

have their own individual placenta, chorion, amnion

Question 5

what happens in MZ twins (placenta, chorion, amnion)

Answer 5

share placenta and chorion. 98% MZ twins have their own amnionic sac

Question 6

what happens if MZ share an amniotic sac

Answer 6

risk cord entanglement

Question 7

features multiple pregnancy

Answer 7

early in pregnancy uterus is large for dates, two poles felt, multiplicity of fetal parts felt, hyperemesis, 2 FHR. ultrasound

Question 8

maternal complications

Answer 8

polyhydramnios, anaemia, pre eclampsia, APH

Question 9

fetal complications

Answer 9

perinatal mortality, growth restriction, prematurity, malformation rates incr, twin to twin transfusion syndrome, fetus papyraceous

Question 10

what is fetus papyrecous

Answer 10

fetus dying in utero, shrinks and mummifies

Question 11

what is twin to twin transfusion syndrome

Answer 11

net flow blood from one twin to the other resulting in poly/oligo hydramnios, placental vascular anastomoses.

Question 12

complications of labour

Answer 12

PPH, malpresentation, vasa praevia rupture, cord prolapse, premature placental separation and cord entanglement

Question 13

what should be taken throughout pregnancy

Answer 13

folic acid and iron supplementation

Question 14

when should ultrasounds be done for fetal growth

Answer 14

to monitor fetal growth so every 2-3 weeks from 30 weeks

Question 15

what should be looked at by ultrasound at 11-14 weeks

Answer 15

viability, chorionicity, nuchal translucency, malformation. monitor from 20 weeks

Question 16

how often to do scans in MZ twins

Answer 16

every 2 weeks

Question 17

when should elective birth take place in uncomplicated DZ twins

Answer 17

37 weeks

Question 18

when should elective birth take place in uncomplicated MZ twins

Answer 18

36 weeks and give steroids

Question 19

when should elective birth take place in uncomplicated triplets

Answer 19

35 and steroids

Question 20

which twin has a greater risk of asphyxia

Answer 20

2nd twin

Question 21

what are the risks of sharing a placenta

Answer 21

twin to twin transfusion

Question 22

what should be given if contractions don’t resume after first child

Answer 22

oxytocin

Question 23

what is the risk of cerebral palsy in twins

Answer 23

4-5x greater (17x greater in triplets and quadruplets compared to singletons)