Multiple Pregnancy

Question 1

define

Answer 1

this is the presence of more than one foetus

Question 2

risk factors

Answer 2

assisted conception
African
FH
increased maternal age
increased parity
tall women

Question 3

classification

Answer 3

• zygosity

- chorionicity

Question 4

zygosity classification

Answer 4

1. monozygotic

2. dizygotic

Question 5

define monozygotic

Answer 5

splitting of a single fertilised egg

Question 6

define dizygotic

Answer 6

fertilisation of 2 ova by 2 spermatozoa

Question 7

what is chorionicity affected by?

Answer 7

cleavage

Question 8

chorionicity classification

Answer 8

1. dizygous

2. monozygous

Question 9

define dizygous

Answer 9

DCDA

each has own placenta with own inner and outer membranes

Question 10

define monozygous

Answer 10

MCMA, MCDA, DCDA nd conjoined

Question 11

presentation

Answer 11

exaggerated pregnancy symptoms e.g. HG
high AFP
large for dates
multiple foetal poles

Question 12

complications

Answer 12

higher perinatal mortality
congenital abnormalities
preterm
FGR
cerebral palsy
TTTS
PET
haemorrhage
C/S

Question 13

diagnosis

Answer 13

USS 11-13 +6 weeks

DCDA is lambda sign and MCDA is T sign on USS

Question 14

management

Answer 14

consultant led care, extra appointments
maternal education
iron
lose dose aspirin
folic acid
deliver early?

Question 15

what is TTTS?

Answer 15

twin-to-twin transfusion syndrome is an artery-vein anastomoses where the donor twin perfuses the recipient twin

Question 16

presentation of TTTS

Answer 16

oligohydramnios

polyhydramnios

Question 17

management of TTTS

Answer 17

• <26 weeks= fetoscopic laser ablation
• > 26 weeks= amnioreduction/ septostomy
• Deliver 34-36 weeks

Question 18

risk in use of fetoscopic laser ablation in TTTS

Answer 18

risks twin anaemia- polycythaemia