Multiple Pregnancy Flashcards
What proportion of twin births result from natural conception?
50 - 60%
What factors predispose to multiple gestation?
- Fertility treatments
- Maternal age
- Race
- Parity
- FHx
- Maternal BMI and height
What maternal age bracket confers greatest risk of twins?
15 - 35y = 4x increased risk of twins
Describe chorionicity
- A: DCDA (Dizygotic twins or Monozygotic twins with cleavage day 3)
- B: MCDA (Monozygotic twins with cleavage days 4- 8)
- C: MCMA (Monozygotic twins with cleavage days 8-12)
US features of twinning?
Twin peak or lambda sign
What complications are increased due to twin pregnancy?
ALL complications except post term gestation and macrosomia
What are the maternal complications of multiple gestation?
- Nutrition
- PIH and PET
- APH / PPH
- GDM
- Hyper emesis
- DVT/ PE
- Cholestasis
- MSK issues
- Social stressors
Foetal complications of multiple gestation?
- Perinatal mortality
- CP
- Congenital anomalies
- IUGR
- Prematurity
What is average gestation of twins?
35- 36 / 40
What are the principles of managing a multiple pregnancy?
Routine antenatal plus:
- Early USS (dates and chorionicity)
- FTCS
- Tertiary morph scan
- Surveillance of twins
- Surveillance for complications
- Multi disciplinary approach (diet, SW, paeds)
- Timing
Timing of twin delivery?
- DCDA 37 - 37+6
- MCDA 36 - 36+7
- MCMA 32 - 33+6 (act on abnormal CTG after 26w)
What is the risk of PET in primigravida twin pregnancy?
30% in primigravida twin pregnancies
Which women carrying twins should take aspirin for PET minimisation?
From 12 weeks if RFx of: - first pregnancy - 40y+ - FHx - pregnancy interval 10y+ - BMI 35 + (almost all multiples)
Complications of donor twin in TTTS?
- Anaemia
- Oliguria
- Hypovolemia
- Oligohydramnios
- IUGR
- FDIU
Complications of recipient twin in TTTS?
- Polycythaemia
- Polyuria
- Hypervolemia
- Polyhydramnios
- Cardiomyopathy
- FDIU
