Multiples Pregnancy Flashcards
Predisposing factors
Previous twins
Increased maternal age
Race - Nigerians (Yorubas)
Induced ovulation and IVF
Features
Uterus large for dates
Hyperemesis
Types:
Difference between dichorionic (DC) and monochorionic (MC)?
What does monozygotic (MZ) and dizygotic (DZ) mean?
What one DC/MC can be both MZ and DZ?
Diamniotic: two separate amniotic sacs
Monochorionic: share a single placenta
Dichorionic: two separate placentas
Sign on USS?
Separate placentas and one placenta
Arising from a single zygote vs 2 separate eggs
Dichorionic can be both MZ/DZ
Lambda sign/Twin peak sign
The twin peak sign is a triangular appearance of the chorion insinuating between the layers of the intertwin membrane and strongly suggests a dichorionic twin pregnancy. It is best seen in the first trimester (between 10-14 weeks) 5.
Fetal risks:
There is impaired growth. How much of a difference between the twins is a sign of IUGR?
Other risks?
Twin-twin transfusion syndrome:
- What type of twin pregnancy does this occur in?
- Why does this happen?
- Risks to recipient?
- Risks to donor?
- How it treated?
25% difference
Prematurity
Malpresentation
Polyhydramnios
Perinatal mortality
If monochorionic and monoamniotic
Placental vascular anastomoses which leads to disparate twin sizes
R - heart failure, polyhydramnios
D - Growth restriction, anaemia, oligohydraminios
Laser ablation of placental vessels via entry through the maternal abdominal wall
Maternal risks - LIST SOME
Anaemia - Extra tests for anaemia throughout pregnancy
PET
HG
APH and PPH
Delivery:
Plan for delivery made according to scenario!
Monoamniotic - CS
Diamniotic - Can be NVAD if cephalic presentation!
What should be given to all mothers before birth to help the baby?
35 wks
STEROIDS
