Multiples

Question 1

Risk factors

Mat risks

Fetal risks

Answer 1

IVF, genetics, age, parity

Mat risks: anaemia, GDM, misc, PET, PTB, CS, epidural, gest HTN, OC, AFLP, HG, PUPP

Fetal: prematurity, cerebral palsy, IUGR, LBW, SB

Question 2

Specific MCDA twins

Answer 2

TTTS
Stage 1: poly and oilgo
Stage 2: Absent bladder
Stage 3: Abn UAPI
Stage 4: death

TAPS
Twin anaemia, polycaethemia sequence

Selective IUGR
Type 1, 2, 3

Mg
- Normal AN care
- HD folic acid
- Scanning from 16 weeks two weekly
- Early OGTT
- Delivery by 36-37 weeks
- Consider CS vs vaginal delivery
- Do not delay cord clamp

Question 3

Twin birth counselling

Answer 3

Options: CS vs VD
Indications for VD: leading twin cephalic, no indication for CS eg previous classical, previa
Risks: PPH, CS for 2nd twin
Mg:
In hospital, IVL, G+S
Continuous monitoring
Early epidural recommended
Senior obstetric support, anaesthetics and OT availability plus paeds
At delivery need oxytocin for intrapartum and PP in the room
Scanner for second twin
Paeds to receive twins
Active third stage