Twin and Triplet pregnancy NICE

Question 1

When determining GA, which baby size to use?

Answer 1

Use the largest baby

Question 2

What does lamda sign and T sign tell you

Answer 2

Lamda - Dichorio
T sign Mono

Question 3

When to performed FBC in multiple pregnancy?

Answer 3

20-24 and 28 weeks

Question 4

How many appointments for DCDA, MCDA twins, TA triplets

Answer 4

DCDA
8 AN app, 2 with specialist

MCDA
11 AN app, 2 with specilist

Triplets
uncomplicated TCTA: 9 AN appointments, 2 with specilist
DCTA or MCTA: 11 AN, 5 with specialist

Shared amnion - tertiary level

Question 5

How many scans for DCDA

Answer 5

11-14 weeks
Every 4 weeks from 20 weeks

Question 6

How many scans MCDA twins

Answer 6

11+2-14+2 weeks
Every 2 weeks from 16 weeks

Question 7

TCTA twins scans

Answer 7

11-14
20, 24 then evert 2 weeks

Question 8

DCTA or MCTA scans

Answer 8

Every 2 weeks from 16 weeks

Question 9

How to offer screening for chromosomal abnormalities in triplet pregnancy

Answer 9

High risk of false positive and being offered invasive testing
Use NT and maternal age when CRL 45-84,, (11+2-14+1)

Question 10

Can you use FFN in twin triplet pregnancy?

Answer 10

No

Question 11

From when can offer screening for FGR in DC twins or TC triplets?
How often

Answer 11

From 24 weeks
Every 4 weeks DC twins
Every 2 weeks in TC triplets

Question 12

How to calculate discordance for DCDA twins

Answer 12

(EFW largest / EFW smallest) x 100

Question 13

How to calculate discordance in triplets

Answer 13

([EFW largest fetus − EFW smallest fetus] ÷ EFW largest fetus) × 100
and
([EFW largest fetus − EFW middle fetus] ÷ EFW largest fetus) × 100

Question 14

When to increase the scanning to weekly assessing for discordance?

Answer 14

If EFW >20%
Any baby <10th

Question 15

When to refer to tertiary unit for discordance of DCDA twins or TCTA triplets

Answer 15

If discordance >25% and EFW of a baby is <10th centile

Question 16

Mains risks with shared placenta

Answer 16

Risk TTS, FGR, TAPs

Question 17

How often to scan assessing for TTS, when to increase scanning to weekly

Answer 17

Scan every 2 weeks from 16 weeks
Scan weekly if difference >4cm

Question 18

When to refer to tertiary unit for TTS when

Answer 18

Amniontic sac DVP <2cm

and

Amniotic sac of another baby
>8cm <20 week sor >10cm from >20 weeks

Question 19

In TTS, when to refer to specilist obstetrician for multiple pregnancy

Answer 19

Amniotic sac of 1 baby has DVP in normal ranger

and

Other baby DVP <2vm or >8cm

Question 20

What part of USS assess for twin anaemia polycythamia sequence?

Answer 20

MCA-PSV

Question 21

Who should be offered weekly USS assessing for TAPs?

Answer 21

TTS that has been treated by fetoscopic laser therapy

sGR (discordance >25% and EFW <10th)

Question 22

Which other cases should TAPs be assessed with MCA-PSV

Answer 22

Monochorionic and evidence
- Cardiovascular compromise
- Unexplained isolated polyhydramnios
- abnormal umbilical artery

Question 23

Do multiple pregnancies need aspirin?

Answer 23

Moderate RF, so only if other RF present

Question 24

When should you discuss timing of birth/plans for birth

Answer 24

By 28 weeks

Question 25

What % twin pregnancies delivery < 37 weeks

Answer 25

60%

Question 26

What % triplet pregnancies delivery < 35 weeks?

Answer 26

75%

Question 27

When to delivery
DCDA twins

Answer 27

37 weeks

Question 28

When to delivery
MCDA

Answer 28

36 weeks

Question 29

When to delivery
MCMA

Answer 29

32-34 weeks, offer CS

Question 30

When to delivery TCTA twins by

Answer 30

35 weeks, offer CS

Question 31

If patient declines delivery at the preposed time how often to offer ANC and USS

Answer 31

Weekly

Question 32

Which uncomplicated DC or MC twins can have VD

Answer 32

If 1st twin cephalic
No significant size difference between the twin
No obstetric contraindications
>32 weeks

Question 33

> 32 weeks DC or MC twins having vaginal delivery, how many will require EMCS?

Answer 33

1/3
Small number will need CS for delivery oft he 2nd twin after vaginal delivery of 1st

Question 34

Who to offer CS DC or MC twins

Answer 34

Planned CS 1st baby not cephalic
EMCS Preterm labour 26-32 weeks

Question 35

From what gestation to offer CTG in labour for multiple pregnancy?

Answer 35

26 weeks
Located on USS 1st

Question 36

Can scalp stimulation be performed for pathological CTG

Answer 36

No

Question 37

What to do if difficult monitoring twins

Answer 37

Bedside USS
Fetal scalp electrodes from twin 1 >34 weeks
If remains unclear - consider CS

Question 38

1st baby CTG suspicious

Answer 38

correct reversible causes
Fetal scalp electrode if >34 weeks

Question 39

If CTG pathological 1st baby

Answer 39

Consider fetal blood sampling >34 weeks
CS
If secondary stage - consider vaginal birth if can be achieved within 20 mins

Question 40

2nd baby suspicious/pathological before the first baby is born

Answer 40

If VD cannot be achieved within 20 mins, consider CS

Question 41

Why to offer epdiural

Answer 41

Improve chance of success and otimal timing of assisted vaginal delivery
Quicker birth by CS

Question 42

Risk reduction PPH

Answer 42

Offer active blood stage consider additional uterotonics

Question 43

How many AN appointments for primps and multip?

Answer 43

P0 10 An appointments
Multip 7 AN appointment