Multiple pregnancy

Question 1

What is the chorionicity?

Answer 1

Determines whether the babies share a placenta

Question 2

What is the amnionicity

Answer 2

Determines whether the babies share an amniotic sac

Question 3

What is the risk of monochorionic twins?

Answer 3

Risk of feto-foetal (twin-twin) transfusion - one twin can be IUGR and oligohydramnios, the other macrocosmic and polyhydramnios

Question 4

What are the antepartum abnormalities with multiple pregnancy?

Answer 4

Miscarriage
Congenital abnormalities
IUGR - very common, due to placental insufficiency
Feto-foetal transfusion - unequal blood distribution through anastomoses in the placenta, causing a ‘donor’ twin and ‘recipient’ twin
Maternal medical problems - GD, pre-eclampsia, anaemia
Preterm birth
Malpresentation/breech
Delivery by C-section/forceps

Question 5

What additional appointments do mothers with multiple pregnancy occur?

Answer 5

Chorionicity scan
Serial scans at 16 and 18 weeks
Anomaly scan
Serial scans at 20, 22, 24, 28, 32 weeks

Question 6

When should monochorionic twins be induced?

Answer 6

36 weeks

Question 7

When should dichorionic twins be induced?

Answer 7

37 weeks

Question 8

What are the indications for vaginal birth in twins?

Answer 8

Both twins cephalic

Twin one cephalic, twin two breech

Question 9

How should the second twin be delivered?

Answer 9

May require syntocinon, should take about 20 mins

Question 10

When is feto-foetal transfusion checked for?

Answer 10

16 and 18 week scans

Question 11

In multiple pregnancy, in which cases should aspirin be prescribed?

Answer 11

• Primigravida
• Pregnancy interval > 10 years
• Age over 40
• BMI over 35
• Family history of pre-eclampsia