Mx twin pregnancy

Question 1

RFs

Answer 1

FH, ++ maternal age, west African, assisted contraception

Question 2

presentation/detection

Answer 2

1st trimester USS
hyperemesis & exaggerated preg symptoms

Question 3

screening

Answer 3

nuchal translucency assessment 10-14w screen Down
selective termination risks harming other twin

Question 4

antenatal care

Answer 4

obstetrician led
hospital delivery in SCBU
PO iron, folic acid 5mg, aspirin 75mg
regular scans from 16 weeks - growth & mother monitoring: DCDA 4 weekly, MC 2 weekly
regular BP & urine checks

Question 5

potential complications & mx

Answer 5

TTT/IUGR - laser surgery of placental anastomoses <26; IU blood transfusion; elective delivery

Foetal: Smaller babies; Prematurity - twins average 37 weeks, triplets 31 weeks.

Congenital abnormalities, Cerebral palsy: twins and triplets

Perinatal mortality: twins, triplets.

Maternal: hyperemesis, polyhydramnios, pre-eclampsia, anaemia, antepartum haemorrhage.

Malpresentation, vasa praevia, cord prolapse, premature separation of placenta, cord entanglement, postpartum haemorrhage.

Developmental: developmental delay, behavioural problems and parent-child interaction probs

Non-medical financial, social and emotional consequences

Question 6

intrapartum care /delivery

Answer 6

vaginal okay if 1st cephalic - c-sec/instrumental more likely