We’re back on scheduled wombmates! This week we’re talking about management of twin pregnancies as Dr. Moise takes us through the following topics:

• The role of ultrasound in twin pregnancies
  • CRL = Crown Rump Length for dating
  • Chorionicity determination
  • Transvaginal cervical length measurement
  • Importance of the 18-20 week anatomy scan and fetal echocardiogram
• Ultrasound monitoring based on chorionicity
  • Dichorionic pregnancies should be followed every 3 to 4 weeks with a growth scan ultrasound
  • Monochorionic pregnancies should begin regular ultrasound monitoring at 16 weeks gestation
    • Every 2 weeks – measurements of fluid levels and fetal bladders
    • Then at 20 weeks ISUOG says to start monitoring umbilical artery (UA) and middle cerebral artery (MCA) Dopplers during regular growth scans
• Discordant anomalies and their rate of occurrence in twin pregnancies
• Screening for chromosomal problems
  • Cell free DNA (cffDNA) – consider vanishing twin as source of abnormal result
  • Nuchal translucency with analytes
• Maternal complications in twin pregnancies & how they are managed prenatally
• Timings & method of delivery for twin pregnancies
  • Treatment options for short cervix in twin pregnancies
• Antenatal testing in twin pregnancies and when to start
• Management of monoamniotic twin pregnancies