Multiple_Pregnancy_Considerations_Flashcards

Question 1

When should gestational age, chorionicity, and amnionicity be determined in a multiple pregnancy?

Answer 1

During the 1st trimester dating scan (10 – 13+6 weeks gestation).

Question 2

How is gestational age estimated in multiple pregnancies?

Answer 2

Use the largest baby to estimate gestation age to avoid the risk of estimating it from a baby with early growth pathology.

Question 3

What are the methods to determine chorionicity and amnionicity?

Answer 3

Determine by using number of placental masses, lambda (dichorionic) or T-sign (monochorionic) and membrane thickness, and discordant foetal sex.

Question 4

Why is it important to assign nomenclature to each baby in a multiple pregnancy?

Answer 4

To ensure consistency throughout pregnancy by documenting clearly in the woman’s notes.

Question 5

What type of antenatal care is required for multiple pregnancies?

Answer 5

Obstetric-led antenatal care with increased screening for anaemia and serial growth and Doppler US scans.

Question 6

How often should FBC be performed in multiple pregnancies?

Answer 6

At 20 weeks, as well as at booking and 28 weeks as in routine antenatal care.

Question 7

Why is increased screening for anaemia important in multiple pregnancies?

Answer 7

To identify women who need extra supplementation of iron or folic acid due to increased risk of anaemia.

Question 8

What is the schedule for serial growth and Doppler US scans in dichorionic-diamniotic twin pregnancies?

Answer 8

Every 4 weeks from 20 weeks gestation.

Question 9

What is the schedule for serial growth and Doppler US scans in monochorionic-diamniotic twin pregnancies?

Answer 9

Every 2 weeks from 16 weeks gestation.

Question 10

What are some indications for referral to a tertiary level foetal medicine centre?

Answer 10

Pregnancy with shared amnion, discordant foetal growth (>25% difference), foetal anomaly, discordant foetal death, TTTS, TAPS, TRAP, conjoined twins or triplets.

Question 11

What support group is recommended for multiple pregnancies?

Answer 11

Twins and Multiple Birth Association (TAMBA).

Question 12

What is the mode of delivery for dichorionic-diamniotic and monochorionic-diamniotic twin pregnancies?

Answer 12

Vaginal delivery is possible if the first twin is in a cephalic presentation.

Question 13

What is the recommended timing of delivery for dichorionic-diamniotic twin pregnancies?

Answer 13

37 weeks.

Question 14

What is the recommended timing of delivery for monochorionic-diamniotic twin pregnancies?

Answer 14

36 weeks (after a course of steroids).

Question 15

What is the recommended timing of delivery for monochorionic-monoamniotic twin pregnancies?

Answer 15

32 weeks (after a course of steroids).

Question 16

What is the recommended timing of delivery for trichorionic-triamniotic or dichorionic-triamniotic triplet pregnancies?

Answer 16

35 weeks (after a course of steroids).

Question 17

What should be done if elective birth is declined in a multiple pregnancy?

Answer 17

Offer weekly appointments with specialist obstetrician including weekly Doppler US and fortnightly growth scans.

Question 18

What is the risk of preterm birth in twin pregnancies?

Answer 18

60% of twin pregnancies result in spontaneous birth before 37 weeks.

Question 19

What is the risk of preterm birth in triplet pregnancies?

Answer 19

75% of triplet pregnancies result in spontaneous birth before 35 weeks.

Question 20

What complications should be discussed regarding multiple pregnancies?

Answer 20

MONOAMNIOTIC MONOZYGOTIC: twin-to-twin transfusion syndrome. All twin pregnancies: IUGR, antepartum haemorrhage, PPH (x2), prematurity, spontaneous miscarriage.

Question 21

What additional precautions should be taken during labor in multiple pregnancies?

Answer 21

Two obstetricians present.