Multiple Pregnancy

Question 1

INCIDENCE:

1. Twins
2. Triplets

Answer 1

1. 1/105

2. 1/10 000

Question 2

COMPLICATIONS:

1. Antenatal
2. Fetal
3. Labour
4. Monoamniotic monozygotic twins

Answer 2

1. • Polyhydraminos
     - Pregnancy-induced hypertension
     - Anaemia
     - Antepartum haemorrhage
2. • Increased risk of perinatal mortality
     - Prematurity(mean twins=37w, triplets=33w)
     - Light-for date babies
     - Malformation
3. -Increased risk of PPH
   - Malpresentation
   - Cord prolapse, entanglement
4. • Increased spontaneous miscarriage
     - Increased perinatal mortality rate
     - Increased malfromations
     - IUGR
     - prematurity
     - Twin-to-twin transfusions where recipient is larger with polyhydraminos. Can treat with laser ablation of interconnecting vessels.

Question 3

RISK F:

Answer 3

1. Previous Hx
2. Family Hx
3. Increasing maternal age
4. Multigravida
5. Induced ovulation and IVF
6. Afro-Caribbean ethnicity

Question 4

MANAGEMENT

Answer 4

1. USS for Dx
   - Monthly checks
2. Additional iron and folate
3. Increased frequency of antenatal care
   - weekly when >30w
4. Precautions at labour
   - 2 obstetricians
5. 75% of twins deliver by 38w, if longer usually induced at 38-40w