Multiple pregnancy Flashcards
What are dizygotic twins?
non-identical
develop from two separate ova fertilised at the same time
What are monozygotic twins>?
identical, develop from single ovum which has divided to form two embryos
What is the most common twin type
dizygotic
What is monoamniotic?
share same amniotic sac
what is monochorionic
share same placenta
what are predisposing factors to multiple pregnancy?
- Prev. twins
- FHx (dizygotic only)
- maternal age
- Induced ovulation + IVF
- Race (Nigerian Yoruba and Japanese)
What are features of multiple pregnancy (early + late)
early - uterus large for date, hyperemesis
later - polyhydramnios
What are signs of multiple pregnancy
⎫ >2 fetal poles felt
⎫ Multiple fetal parts felt
⎫ 2 fetal heart rates
How and when is the type of multiple pregnancy usually diagnosed?
US at 11-13+6 weeks
what sign indicates dichorionic twins
lambda sign
What are complications of multiple pregnancy
→ Polyhydramnios → Pre-eclampsia → Anaemia → APH (both abruption and praevia) → Gestational DM → Operative delivery
What are complications of multiple pregnancy to the fetus
- prematurity
- IUGR
- malformation
- twin-twin Transfusion syndrome
- fetus papyraceous
What is the mean gestation of twins
37w
what is the mean gestation of triplets
33w
What is twin to twin transfusion syndrome
monochorionic, disparate twin size w one twin acting as ‘donor’ and other as ‘recipient’ due to placental vascular anastomoses, these can be ablated by laser coagulation in utero
What is fetus papyraceous
fetus dying in utero shrinks and mummifies, delivers prematurely
What are the complications of labour due to multiple pregnancy
PPH Malpresentation Vasa praevia rupture cord prolapse placental abruption cord entanglement
What is the management of multiple pregnancy
US 11-13+6 for viability, chorionicity nuchal translucency, malformation
US monthly from 20w
How often should monochorionic twins be monitored>?
every 2 weeks
When is elective birth for
uncomplicated triplets
uncomplicated monochorionic twins
uncomplicated dichorionic twins
37+0 if uncomplicated dichorionic twins
36+0 if uncomplicated monochorionic twins
35+0 if uncomplicated triplets
What are features suggesting twin to twin transfusion syndrome
− Membrane folding
− Discordant growth >25%
what are the two most common malpresentation in twins
cephalic: cephalic
cephalic: breach
