Multiple pregnancy Flashcards
What is chorionicity, amnionicity, zygocity?
Chorionicity - no of placenta
Zygocity - no of fertilised eggs
Amnionitis - no of amniotic cavities
Why is death of 1 MCMA twin dangerous for the other?
Can result in hypotension in other twin due to twin-to-twin anastamoses
Which pregnancy does TTTT occur?
Monchorionic
Name of staging for TTTT
Quintero
What are the diagnostic criteria for TTS?
Single placental mass Oligohydramnios w/polyhdramnios Concordant gender Discordant bladder appearance Haemodynamic and cardiac compromise
Treatment for TAPS
Expectant amnioreduction septostomy fetoscopic ablation of vascular anastomoses (considered definitive tx for TTS between 16-24wks) Consider delivery after 26 weeks
Risk with MCMA during pregnancy
Cord entanglement (as they’re both in the same sac)
Mx of MCMA twins
Admit at 28wks for daily monitoring
Deliver around 32-34 weeks
What are important antenatal considerations in multiple pregnancy
Increase screening for anaemia (FBC at 20 weeks as well as 28)
arrange serial doppler ti assess growth (2-4 weekly) depending on chorionicity
When would you refer to tertiary centre
pregnancy w/ shared amnion discordant foetal growth (>25%) discordant foetal death foetal anomaly TTTS TAPS
Mx of DCDA
8 appts
serial growth scan every 4 weeks from 20 wks
MCDA
11 appts
serial growth scan every 2 weeks from 16 wks
TCTA
9 appts
serial growth scan every 4 weeks from 16
MCMA
individual assessment by specialist centre
Delivery of twins? Which can you deliver cephalic?
if DCDA or MCDA can deliver vaginally as long as first is cephalic
