Multiple Pregnancy

Question 1

Definition

Answer 1

Presence of more than 1 foetus

Question 2

Incidence increases with assisted conception. True or false?

Answer 2

True

Question 3

Identical twins are MONOZYGOTIC / DIZYGOTIC ?

Answer 3

Monozygotic

Question 4

What does monozygotic mean?

Answer 4

2 embryos develop from the one zygote

Question 5

Definition of mono-chorionic?

Answer 5

One placenta

Question 6

Definition of di-chorionic?

Answer 6

Two placentas

Question 7

If the fertilised egg splits at day 3 after fertilisation, this results in di-chorionic or mono-chorionic twins?

Answer 7

Di-chorionic

Question 8

If the fertilised egg splits at day 4-7 after fertilisation, this results in mono-chorionic or di-chorionic twins?

Answer 8

Mono-chorionic

Question 9

If the fertilised egg splits at day 8-13 after fertilisation, this results in mono-chorionic or di-chorionic twins?

Answer 9

Mono-chorionic

Question 10

If the fertilised egg splits at day 13-15 after fertilisation, this results in?

Answer 10

Conjoined twins

Question 11

Monozygotic / Dizygotic twins are at higher risk of pregnancy complications?

Answer 11

Monozygotic

Question 12

Non identical twins are MONOZYGOTIC / DIZYGOTIC ?

Answer 12

Dizygotic

Question 13

What does dizygotic mean?

Answer 13

Fertilisation of 2 eggs by 2 sperm

Question 14

Dizygotic twins are ALWAYS di-chorionic. True or false?

Answer 14

True

Question 15

How can you determine chorionicity?

Answer 15

US

- look at shape and thickness of membrane

Question 16

Determining chorionicity - Y sign

Answer 16

Di-chorionic, Di-amniotic

Question 17

Determining chorionicity - T sign

Answer 17

Mono-chorionic, d-iamniotic

Question 18

Complications of mono-chorionic twins

Answer 18

Single foetal death
Selective growth restriction
Twin anaemic polycythaemia sequence (TAPS)
Twin to Twin transfusion syndrome (TTTS)

Question 19

Twin to Twin transfusion syndrome is more common in early/late pregnancy?

Answer 19

Early

Question 20

Risk factors for multiple pregnancy

Answer 20

Assisted conception
Race - African 
FH
Increased maternal age 
Increased parity

Question 21

Clinical features

Answer 21

Exaggerated pregnancy symptoms

Hyperemesis gravidarum

Question 22

Clinical signs

Answer 22

High AFP
Large for dates uterus
Multiple foetal pole

Question 23

All multiple pregnancies are under consultant led care. True or false?

Answer 23

True

Question 24

How often do mono-chorionic twins get screened?

Answer 24

Appointments and US every 2 weeks from 16 weeks gestation

Question 25

How often do di-chorionic twins get screened?

Answer 25

Appointments and US every 4 weeks

Question 26

Medications

Answer 26

Iron supplementation Low dose aspirin Folic acid

Question 27

When do you aim to deliver di-chorionic twins?

Answer 27

37-38 weeks

Question 28

When do you aim to deliver mono-chorionic twins?

Answer 28

Deliver after 36 weeks

Question 29

If you are delivering triplets (or more) then which mode of delivery?

Answer 29

Casarean section

Question 30

If you are delivering mono-chorionic twins then which mode of delivery?

Answer 30

Caesarean section

Question 31

If the leading twin is cephalic then aim for which mode of delivery?

Answer 31

Vaginal

Question 32

Inter-twin delivery time should be less than _____

Answer 32

30 mins

Question 33

There is a higher risk of perinatal mortality with multiple pregnancy? True or false

Answer 33

True | - 6X higher

Question 34

Foetal complications

Answer 34

``` Congenital anomalies Pre-term birth Growth restriction Cerebal palsy Twin to Twin transfusion ```

Question 35

Maternal complications

Answer 35

``` Hyperemesis gravidarum Anaemia Pre-eclampsia Antepartum haemorrhage Pre-term labour Caesarean section ```

Question 36

Twin to twin transfusion syndrome can occur in both monochorionic and dichorionic pregnancies. True or false?

Answer 36

False | - TTTS only in monochorionic

Question 37

What is Twin to twin transfusion syndrome

Answer 37

Where there is disproportionate blood supply to fetuses in monochorionic pregnancies

Question 38

How are monochorionic monoamniotic twins to be delivered

Answer 38

C-section | - due to risk of cord entanglement