Multiple Pregnancy

Question 1

What are the factors increasing the likelihood of multiple pregnancy?

Answer 1

1. Assisted conception
2. Increasing maternal age
3. Parity

Question 2

What are the four types of multiple pregnancies?

Answer 2

1. Dizygotic twins (DZ)
2. Dichorionic, diamniotic, but monozygotic (DCDA)
3. Monochorionic, diamniotic (MCDA)
4. Monochorionic, monoamniotic (MCMA)

Question 3

What is this describing and how common is it?

Fertilisation of different oocytes by different sperm.

Answer 3

Dizygotic twins (DZ) - 2/3 of all multiple pregnancies

Question 4

What is this describing and how common is it?

Separate placentas, separate amnions.

Answer 4

Dichorionic, diamniotic but monozygotic (DCDA) - 30% of monozygotic twins

Question 5

What is this describing and how common is it?

Shared placenta, separate amnions.

Answer 5

Monochorionic, diamniotic (MCDA) - 70% of monozygotic twins

Question 6

What is this describing?

Shared placenta, shared amnion.

Answer 6

Monochorionic, monoamniotic (MCMA)

Question 7

What is this a presentation of?

Vomiting more marked in early pregnancy, uterus larger than expected, lambda sign on USS.

Answer 7

Dichorionic multiple pregnancy

Question 8

What is this a presentation of?

Vomiting more marked in early pregnancy, uterus larger than expected for dates, T-sign on USS.

Answer 8

Monochorionic multiple pregnancy

Question 9

What are the maternal complications of multiple pregnancy?

Answer 9

GDM, PET, anaemia

Question 10

What are the foetal complications of multiple pregnancy?

Answer 10

1. Mortality, morbidity
2. Preterm delivery, IUGR, miscarriage
3. Twin-twin transfusion syndrome if MCDA
4. Malpresentation of the 1st twin
5. Foetal distress
6. PPH

Question 11

How is twin-twin transfusion syndrome diagnosed and treated?

Answer 11

Growth discordance, laser ablation.

Question 12

When are the recommended delivery dates for dichorionic twins, monochorionic twins, and triplets?

Answer 12

1. Dichorionic - 37/40, induction of labour or C-section
2. Monochorionic - 36/40, induction of labour or C-section
3. Triplets - 35/40, C-section