12 - Obs - Multiple Pregnancy - Complications

Question 1

Virtually all obstetric risks exaggerated in multiple pregnancy

-Maternal
Gestational ? and ? more freq. ? common, due to incr ? volume and more ? and ? acid needed

Fetal
Twins have greater ? (6x) and long term ? risk (5x). ? fare even worse, 18x incr risk of handicap. Major RFs are ?
deliv, ???? and ?

Answer 1

DM
preeclampsia
anaemia
blood
iron
folic

mortality
handicap
triplets
preterm
IUGR
monochorionicity

Question 2

All multiple pregnancies have these 4 possible complications

Answer 2

miscarriage, preterm labour, congen abnorms, co-twin death

Question 3

Miscarriage: One of a twin or more of a higher order can ?, ? trimester death. Late miscarriage also more common, esp in ?? twins as a compx of ????.

Preterm labour: ? cause of perinatal mort – 40% of twin and 80% triplet pregs deliver before ?wks. 10% twins deliver before ?wks. ????
much more common

Answer 3

vanish
first
MC
TTTS
main
36
32
IUGR

Question 4

Congenital Abnormalities: Not more common per baby in ? but are in ?.
Co-twin death: If one of ??
twins dies, other usually ?, though risk of preterm ? is incr.

Answer 4

dichorionic
monochorionic

DC
survives
delivery

Question 5

Intrapartum Complx
? of first twin in 20% -> ? ?. Fetal ? in labour more common, 2nd twin also has incr risk of death (?x) after 1st delivered due to ?, cord ? , tetanic uterine ? or ?, and may present ?. ??? more common – 10%.

Answer 5

malpresentation
c/s
distress
5x
hypoxia
prolapse
contraction
abruption
breech
PPH

Question 6

Complications of Monochorionicity

Largely due to ? blood supply in ? placenta.

IUGR: more common In MC twins. Particular problem is where the ? artery waveform of the ? twin is v ?. May result in sf aa-aa ?. Sudden in utero ? in up to 20%.

Answer 6

shared
single
umbilical
smaller
erratic
anastomoses
death

Question 7

Twin-twin transfusion syndrome TTTS: Only in ????twins, most common form, and in 15%. Due to ? blood distribution through vascular ? of ? placenta. One twin, ‘donor’, ? is depleted and has ?, ???? and ?. Other ‘recipient’ twins gets volume ? and may dev ?, ?? and massive ?. Can cause massive distension of ? if extreme. Both twins at high risk of in utero ? or severely ? delivery. Even w optimal trt, ?% survival of both, 80% of one. 10% survivors have ?
disability.

Answer 7

MCDA
unequal
anastomoses
shared
volume
oligohydramnios
anaemia
IUGR
overload
polycythaemia
HF
polyhydramnios
uterus
death
preterm
50
neuro