Multiple Pregnancy

Question 1

Biggest risk of multiple preg?

Answer 1

Preterm delivery.

Question 2

What twins are lower risk?

Answer 2

Dichorionic: two placentas

Question 3

Kinds of monozygotic implantation?

Answer 3

Di chorionic, monozygotic
Monochorionic diamniotic

Monoamniotic twins (high risk)

Question 4

Monochorionic twins, why dangerous?

Answer 4

Twin-twin transfusion Syndrome
TAPS-slower twin twin transfusion
TRAP
-Conjoined
Severe IUGR

Question 5

If Monochorionic twin dies, what happens to other twin?

Answer 5

They will also die. Very dangerous

Question 6

Nasal bones at 12 weeks?

Answer 6

If missing, likely trisomy 21.

Question 7

Concordance between twins?

Answer 7

ADHD

Schizo

Question 8

What maternal factor strongly associated with premature birth?

Answer 8

Poor weight gain by 24 weeks

Question 9

Preeclampsia, how to reduce in multiple preg?

Answer 9

Aspirin 100mg/day from 12 to 36weeks

Question 10

Maternal complications, Gestational DM, how manage?

Answer 10

More risk

Early GTT 14 weeks, 26 weeks.

Question 11

Maternal complications

Answer 11

Anaemia
APH
PPH

Question 12

Big psych for multiple preg?

Answer 12

Depression
Postnatal: 5x more likely
Marital disharmony: 50% of relationship end within 2 years of triplets arriving.

Question 13

Fetal anomalies?

Answer 13

More likely in multiples, monochionic more than dichroic nic

Question 14

Growth of multiples? After born?

Answer 14

Slows earlier
Twins: 32w
Triplets: 28w
Catch up growth happens in absence of pathology

Question 15

What other growth do you look at in multiples?

Answer 15

Discordance in size between twins

Question 16

Preterm Delivery prevention?

Answer 16

Stop smoking
Avoid multiples
Treat bacteriuria

Cervical sutures: ineffective
?Progesterone.

Question 17

When is safest time to delivery complicated twins?

Answer 17

37 weeks.

Question 18

When to deliver Monochorionic and Monoamniotic twins?

Answer 18

32 weeks

Question 19

When to deliver Monochorionic and diamniotic?

Answer 19

36-37weeks

Beware of TTTS

Question 20

Difference between C-section or vaginal for twin delivery?

Answer 20

Not much difference. As long as same conditions in study which is access to theatre, obstetrician, paeds, anaesthetist.

Question 21

Best way to deliver Monoamniotic twins?

Answer 21

C-section

Question 22

Monochorionic twins vaginally?

Answer 22

Careful, twin B may exanguinate, twin twin transfusion in labour….
Best in C-section

Question 23

How to deliver twin B?

Answer 23

Ensure longitudinal lie
Restart Syntocinon
ARM
Assist vertex/breech
Internal podalic`` version and breech extraction of twinB
Routine third stage

Question 24

Discordant Monochorionic twins

Answer 24

Liquor volume - TOPS Twin Oligohydramnios POlyhydramniis sequence

MCA - TAPS - twin Anaemia-polycythaemia sequence

Growth: Selective IUGR

Question 25

TTTS natural history?

Answer 25

Always fatal

Question 26

Rx for TTTS?

Answer 26

Laser photocoagulation

Fetoscoptic surgery