Multiple Twin Pregnancies

Question 1

Incidence of multiple births in europe?

Answer 1

9-20 per 1000 deliveries

Question 2

In 1978?

Answer 2

First test tube baby, IVF

Question 3

In 2002 the law said?

Answer 3

Forbidding putting back more than one embryo in IVF

Question 4

Causes of multiple pregnancy?

Answer 4

Fertility treatment
Maternal age
Increase parity
Family history 
Ethnicity 

All due to super ovulation

Question 5

Zygosity?

Answer 5

How many zygotes did pregnancy come from?

Question 6

Chorionicity?

Answer 6

How many placentas you’ve got?

Question 7

Monozygotic accounts for how much of twins?

Answer 7

1/3

Question 8

Dizygous accounts for what of twin pregnancy?

Answer 8

2/3

Question 9

What fraction of monozygous twins are dichorionic?

Answer 9

1:3

Question 10

Loss rate in monochorionic monozygous twins?

Answer 10

X3

Question 11

Diagnosis of twin pregnancy?

Answer 11

Uterine size

Ultrasound

Question 12

What percentage of deliveries of twins are found at birth?

Answer 12

50%

Question 13

To identify two chorions look for?

Answer 13

Lambda sign

Question 14

Monochorionic split at what stage?

Answer 14

Blastocyst

Question 15

Which pregnancy is high risk?

Answer 15

Monoamniotic

Question 16

How to tell if diagnostic or mono?

Answer 16

Small thin membrane in between if diamniotic

Question 17

Multiple pregnancy complications?

Answer 17

Symptoms of pregnancy
Anaemia
Hypertension
Intrauterine growth restriction 
Pre term labour 
Delivery problems
Perinatal mortality

Question 18

Stillbirth happens at?

Answer 18

After 24 weeks

Question 19

Early neonatal death happens?

Answer 19

First 7 days

Question 20

Neonatal death?

Answer 20

First 28 days

Question 21

Perinatal death?

Answer 21

Stillbirth and early neonatal

Question 22

First trimester management?

Answer 22

By 14 week determine chorionicity

Screening for chromosomal anomalies

Discuss fetal reduction

Question 23

Second trimester management?

Answer 23

Fetal abnormality detection

Serial growth scans, DC
monthly from 24 weeks

MC- twin to twin transfusion, abnormal anastomoses, scan every 2 weeks from 16-24 then monthly

Maternal complications

Question 24

Monochorionic twins problems?

Answer 24

More fetal malformation, fetal growth restriction and twin twin transfusion

Question 25

How to deal with twin twin transfusion?

Answer 25

Laser, in utero, destroying blood vessels

Amnio reduction

Early delivery by caesarean

Question 26

Third semester management?

Answer 26

Monitor bp
Delivery planning
Pre term labour
Scanning

Question 27

Delivery planning?

Answer 27

DC- 37 weeks and 6 days
If twin 1 is not head down, then c section recommended

MC- 37 weeks
All by c section historically, patient preference