Twins Flashcards
% of monochorionic preg
30% of twins
Complications for mum
- PTB
- FGR
- PET
- PPH
- PN complications- Adverse mood changes, feeding diff
Complications for fetus
- TTTS
- sGR
- TAPS (T anaemia-polycythaemia seq)
- TRAP (reverse arterial perfusion)
- Single IUD
Twins risk bases on type
MCMA - highest risk of loss <24w
MCDA
DCDA - least risk but still higher than singleton
Higher neuro disability in MC also
TTTS- mainly in MCDA
- Affect 15% of MC preg
- Usually BEFORE 26w
- Unidirectional blood flow
- Affects fetal cardiac, placenta, renal function
TTTS staging
I - sig discordance in LV
DVP <2cm in donor and >8cm in recipient
Normal doppler and bladder.
II - Bladder of donor not visible, severe oligo.
Doppler not critically abnormal.
III - Dopplers are critically abnormal
IV - Ascites, pericardial/pleural effusion, scalp oedema or hydrops in recipient
V- one or both babies have died
TTTS mx
Stage I - might only need monitoring
- If <26w- Laser ablation - Soloman technique
In tertiary centre (at least 15procedures/year) - Weekly scan for 2 weeks then back to every 2 week scans
- > 26w- consider amnio- reduction
TTTS recurrence
14% of preg treated w laser w or wo TAPS
TAPS
- 13% of twin after laser ablation for TTTS
or 2% of twins - Slow tx of blood from donor to recipient
- Anaemia in donor (MCA PSV >1.5x normal)
Recipient ( MCA PSV <1.0) - No oligo/poly
TAPS mx
- Difficult to mx due to very small anastomosis
- Mx with laser, IU tx
- Outcomes can vary
Selective GR %
- 15% of MC twin wo TTTS
- 50% w TTTS
- Wt difference >20%
Diff to TTTS as one will be oligo and other normal LV
sGR staging
I - growth discordance but + diastolic flow in both umbilical arteries.
90% survival
II - Growth discordance w absent or reversed EDV.
29% risk of demise
III - GD w cyclical UA diastolic waveforms, intermittent AREDV.
10-20% risk of demise
sGR mx
- Selective reduction- inc risk of neuro disability in surviving T
- sGR delivery-
T I- 34-36w
T II/ III- 32 weeks
or cCTG STV <4.0
Impact on surviving T after fetal death of co-twin
- 15% risk of death
- 26% risk of neuro disability
Monitoring of surviving twin
- Fetal MRI 4 weeks after twin death
- Monitor MCA PSV for anaemia
- Delivery only if close to term