Multiple Pregnancy

Question 1

What proportion of twin births result from natural conception?

Answer 1

50 - 60%

Question 2

What factors predispose to multiple gestation?

Answer 2

• Fertility treatments
• Maternal age
• Race
• Parity
• FHx
• Maternal BMI and height

Question 3

What maternal age bracket confers greatest risk of twins?

Answer 3

15 - 35y = 4x increased risk of twins

Question 4

Describe chorionicity

Answer 4

• A: DCDA (Dizygotic twins or Monozygotic twins with cleavage day 3)
• B: MCDA (Monozygotic twins with cleavage days 4- 8)
• C: MCMA (Monozygotic twins with cleavage days 8-12)

Question 5

US features of twinning?

Answer 5

Twin peak or lambda sign

Question 6

What complications are increased due to twin pregnancy?

Answer 6

ALL complications except post term gestation and macrosomia

Question 7

What are the maternal complications of multiple gestation?

Answer 7

• Nutrition
• PIH and PET
• APH / PPH
• GDM
• Hyper emesis
• DVT/ PE
• Cholestasis
• MSK issues
• Social stressors

Question 8

Foetal complications of multiple gestation?

Answer 8

• Perinatal mortality
• CP
• Congenital anomalies
• IUGR
• Prematurity

Question 9

What is average gestation of twins?

Answer 9

35- 36 / 40

Question 10

What are the principles of managing a multiple pregnancy?

Answer 10

Routine antenatal plus:

• Early USS (dates and chorionicity)
• FTCS
• Tertiary morph scan
• Surveillance of twins
• Surveillance for complications
• Multi disciplinary approach (diet, SW, paeds)
• Timing

Question 11

Timing of twin delivery?

Answer 11

• DCDA 37 - 37+6
• MCDA 36 - 36+7
• MCMA 32 - 33+6 (act on abnormal CTG after 26w)

Question 12

What is the risk of PET in primigravida twin pregnancy?

Answer 12

30% in primigravida twin pregnancies

Question 13

Which women carrying twins should take aspirin for PET minimisation?

Answer 13

From 12 weeks if RFx of:
- first pregnancy
- 40y+
- FHx
- pregnancy interval 10y+
- BMI 35 +
(almost all multiples)

Question 14

Complications of donor twin in TTTS?

Answer 14

• Anaemia
• Oliguria
• Hypovolemia
• Oligohydramnios
• IUGR
• FDIU

Question 15

Complications of recipient twin in TTTS?

Answer 15

• Polycythaemia
• Polyuria
• Hypervolemia
• Polyhydramnios
• Cardiomyopathy
• FDIU

Question 16

What is TTTS?

Answer 16

MC twins share a single placenta with intertwin anastomoses. Unbalanced twin transfusion results in TTTS

Question 17

Treatment options in TTTS?

Answer 17

• Amniodrainage +/- septosotomy

- Selective laser photocoagulation of placental vessels