Twin and Triplet pregnancy NICE Flashcards
When determining GA, which baby size to use?
Use the largest baby
What does lamda sign and T sign tell you
Lamda - Dichorio
T sign Mono
When to performed FBC in multiple pregnancy?
20-24 and 28 weeks
How many appointments for DCDA, MCDA twins, TA triplets
DCDA
8 AN app, 2 with specialist
MCDA
11 AN app, 2 with specilist
Triplets
uncomplicated TCTA: 9 AN appointments, 2 with specilist
DCTA or MCTA: 11 AN, 5 with specialist
Shared amnion - tertiary level
How many scans for DCDA
11-14 weeks
Every 4 weeks from 20 weeks
How many scans MCDA twins
11+2-14+2 weeks
Every 2 weeks from 16 weeks
TCTA twins scans
11-14
20, 24 then evert 2 weeks
DCTA or MCTA scans
Every 2 weeks from 16 weeks
How to offer screening for chromosomal abnormalities in triplet pregnancy
High risk of false positive and being offered invasive testing
Use NT and maternal age when CRL 45-84,, (11+2-14+1)
Can you use FFN in twin triplet pregnancy?
No
From when can offer screening for FGR in DC twins or TC triplets?
How often
From 24 weeks
Every 4 weeks DC twins
Every 2 weeks in TC triplets
How to calculate discordance for DCDA twins
(EFW largest / EFW smallest) x 100
How to calculate discordance in triplets
([EFW largest fetus − EFW smallest fetus] ÷ EFW largest fetus) × 100
and
([EFW largest fetus − EFW middle fetus] ÷ EFW largest fetus) × 100
When to increase the scanning to weekly assessing for discordance?
If EFW >20%
Any baby <10th
When to refer to tertiary unit for discordance of DCDA twins or TCTA triplets
If discordance >25% and EFW of a baby is <10th centile
Mains risks with shared placenta
Risk TTS, FGR, TAPs
How often to scan assessing for TTS, when to increase scanning to weekly
Scan every 2 weeks from 16 weeks
Scan weekly if difference >4cm
When to refer to tertiary unit for TTS when
Amniontic sac DVP <2cm
and
Amniotic sac of another baby
>8cm <20 week sor >10cm from >20 weeks
In TTS, when to refer to specilist obstetrician for multiple pregnancy
Amniotic sac of 1 baby has DVP in normal ranger
and
Other baby DVP <2vm or >8cm
What part of USS assess for twin anaemia polycythamia sequence?
MCA-PSV
Who should be offered weekly USS assessing for TAPs?
TTS that has been treated by fetoscopic laser therapy
sGR (discordance >25% and EFW <10th)
Which other cases should TAPs be assessed with MCA-PSV
Monochorionic and evidence
- Cardiovascular compromise
- Unexplained isolated polyhydramnios
- abnormal umbilical artery
Do multiple pregnancies need aspirin?
Moderate RF, so only if other RF present
When should you discuss timing of birth/plans for birth
By 28 weeks
