T2 L15:Multiple pregnancies

Question 1

aetiology of twin pregnancy

Answer 1

2-7 Far East
9-20 Europe
20-45 Nigeria

incidence increased since 1980’s due to IVF treatment

Ethnicity

Increasing maternal age

Increasing parity-indicates the number of pregnancies reaching viable gestational age (including live births and stillbirths)

Family history

Fertility treatment

All factors for ‘super ovulation’

Question 2

what are the 3 factors that are looked at in multiple pregnancies

Answer 2

Zygosity

Chorionicity

Amnionicity

Question 3

explain the difference between monozygous dizygous

Answer 3

Monozygous = 1 egg = identical (1/3)​
​
Dizygous = 2 eggs = nonidentical (2/3)​
​

Question 4

describe dizygotc twins

Answer 4

separate amnions, chorions & placentae​

DCDA

Question 5

describe the possible combinations of monozygotic twins

Answer 5

common chorion, separate amnions & “joined” placentae​
MCDA

common chorion amnion, & “joined” placentae​
MCMA​​

Question 6

what gives rise to the difference between mcma and mcda twins and dizygotic twins

Answer 6

Mcda:
-splitting in early
blastocyst yields 2 inner
cell masses
-Blastocyst – 4 days after fertilisation, inner cell mass forms (forms part of embryo)

MCMA:
-Later splitting yields ​
2 embryos from one ​
inner cell mass

DCDA: -Splitting occurs very early (24 hours after fertilisation)-at 2 cell stage

Question 7

what is the different combinations with dichorionic twins

Answer 7

All dizygous twins are dichorionic​
Dichorionic twins must be diamniotic​
Dichorionic = separate circulations​
1:3 monozygous twins are dichorionic​
​

Question 8

what is the different combinations with monochorionic twins

Answer 8

Monozygous twins may be monochorionic (2/3) or dichorionic​
MC have vascularly joined placentae​
MC twins 3x increased loss rate​
MC twins usually diamniotic​
​

Question 9

how do you diagnose twin pregnancies

Answer 9

Uterine size​
Up to 50% at delivery worldwide​
Ultrasound​

Question 10

what does the Lambda sign denote

Answer 10

Dichorionic

Question 11

what does an ultrasound tell

Answer 11

Whether its MA or DA

Question 12

what does the T-sign denote

Answer 12

T sign –MONOCHRONIONIC BC NO LAMDA SIGN- ( LAMDA IS A SIGN OF DIFF PLACENTAS​

Question 13

what are the complications with twin pregnancies

Answer 13

“Everything except post-dates”​
Symptoms of pregnancy​
Anaemia ​
Hypertension ​
Intrauterine growth restriction​
Pre-term labour​
Delivery problems ​
Perinatal mortality​

Question 14

twin pregnancy mortality

Answer 14

Stillbirth – after 24 weeks​
Early neonatal – first 7 days​
Neonatal – in first 28 days​
Perinatal – SB + early neonatal​
Infant – first year​
Rates are per 1000 births

Question 15

how do you manage the first trimester

Answer 15

• Discuss screening for chromosomal anomalies​
• Determine chorionicity​
• Discuss fetal reduction if triplets or more​

Question 16

what is second trimester management

Answer 16

-Detection of fetal abnormality​
-Serial scans for growth for all​
DC monthly from 24 weeks​
-Serial scans for TTTS if MC twins​
2 weekly 16-28 weeks then monthly​
-Maternal complications​

Question 17

what risks are specific to monochorionic twins

Answer 17

• More fetal malformation​
• More fetal growth restriction​
• Twin to twin transfusion​

Question 18

look at slides for quizzes 29-38

Answer 18

How was it?

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Question 19

what does Unidirectionality A-V shunt in twin-twin transfusion, cause ?

Answer 19

Can cause heart failure in fetus receiving too much blood ​

• Unbalanced placental vascular anastamoses ​
• Donor smaller, decreased liquor​
• High mortality (esp recipient)​

​

Question 20

how do you treat twin-twin transfusion

Answer 20

Laser treatment:
Rx - laser or amnio-reduction​

Early delivery by caesarean​

​

Question 21

slide 50

Answer 21

how was it

Question 22

what is the 3rd trimester management

Answer 22

• Scanning as in 2nd trimester​
• Monitor blood pressure​
• Pre-term labour​
• Delivery planning​

Question 23

what are the delivery plans for twins

Answer 23

• 37-38 weeks for DC twins​
• -vaginal birth or caesarean​

-Presentation of twin 1

• 36-37 weeks for MC twins​
• -?all MC twins by caesarean?​​

Question 24

what is the labour management of twin pregnancy & monitoring method

Answer 24

• Monitoring both twins​
• Problems delivering twin 2
• Risk of postpartum bleed
• Monitoring- via fetal calp electrode for first baby and the other monitored externally ​

Question 25

what are the puerperium management

Answer 25

-Feeding difficulties​

Emotional & social support