Flashcards in Multiple Pregnancy Deck (17)
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1
What proportion of twin births result from natural conception?
50 - 60%
2
What factors predispose to multiple gestation?
- Fertility treatments
- Maternal age
- Race
- Parity
- FHx
- Maternal BMI and height
3
What maternal age bracket confers greatest risk of twins?
15 - 35y = 4x increased risk of twins
4
Describe chorionicity
-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)
5
US features of twinning?
Twin peak or lambda sign
6
What complications are increased due to twin pregnancy?
ALL complications except post term gestation and macrosomia
7
What are the maternal complications of multiple gestation?
- Nutrition
- PIH and PET
- APH / PPH
- GDM
- Hyper emesis
- DVT/ PE
- Cholestasis
- MSK issues
- Social stressors
8
Foetal complications of multiple gestation?
- Perinatal mortality
- CP
- Congenital anomalies
- IUGR
- Prematurity
9
What is average gestation of twins?
35- 36 / 40
10
What are the principles of managing a multiple pregnancy?
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
11
Timing of twin delivery?
- DCDA 37 - 37+6
- MCDA 36 - 36+7
- MCMA 32 - 33+6 (act on abnormal CTG after 26w)
12
What is the risk of PET in primigravida twin pregnancy?
30% in primigravida twin pregnancies
13
Which women carrying twins should take aspirin for PET minimisation?
From 12 weeks if RFx of:
- first pregnancy
- 40y+
- FHx
- pregnancy interval 10y+
- BMI 35 +
(almost all multiples)
14
Complications of donor twin in TTTS?
- Anaemia
- Oliguria
- Hypovolemia
- Oligohydramnios
- IUGR
- FDIU
15
Complications of recipient twin in TTTS?
- Polycythaemia
- Polyuria
- Hypervolemia
- Polyhydramnios
- Cardiomyopathy
- FDIU
16
What is TTTS?
MC twins share a single placenta with intertwin anastomoses. Unbalanced twin transfusion results in TTTS
17
