Course BASIC_Graduate level learning material about the challenges of human reproductive medicine in a changing Europe

2021-1-HU01-KA220-HED-000027613 - COHRICE

TEACHER’S GUIDE

Special Challenges of Twin Pregnancies 

(Basic level)

Slide 3: Present the two types of twins, defining the dizygotic and the monozygotic twins. 

Slide 4: Talk about the mechanism of twinning and the formation of dizygotic, monozygotic twins as presented at the picture. 

Slide 5: Define the special type of fetation (superfetation) and fecundation (superfecundation). Talk about the ‘’vanishing twin’’ syndrome. 

Slide 6: Some factors can influence the incidence of twin formation, enumerate the factors that can have a positive effect on the incidence. 

Slide 7: Using the figure in the presentation present how can be determined if the twins are mono-, or dizygotic? 

Slide 8: Show the different signs on the pictures that can be found and have to be determined during ultrasound examination in twin pregnancies to determine the amniocity and chorionicity.

Slide 9:  Present the signs in detail that can be found and have to be determined during ultrasound examination in twin pregnancies to determine the amniocity and chorionicity.

Slide 10: Talk about the possible outcomes of multifetal gestations (spontaneous abortion, congenital malformations, birthweight, preterm delivery).

Slide 11: Present the conjoined twins as a unique complication of multifetal gestation. 

Slide 12: Present the conjoined twins as a unique complication of multifetal gestation. 

Slide 13 and 14: There are four types of complications that can be found in monochorionic pregnancies. Enumerate the complications and explain the pathophysiology of them, discussing the vascular malformations in detail. 

Slide 15: Present the TRAP sequence, show the vascular malformation on the picture in the presentation. 

Slide 16: Explain the pathophysiology of TRAP sequence (acardiac twin) presenting the acardius acephalus and the acardius myelacephalus. 

Slide 17: Talk about the treatment and the survival of the pregnancy in TRAP sequence. 

Slide 18: Define the twin-to-twin transfusion syndrome (TTTS) and present the diagnostic criteria of it. Talk about the prognosis (mortality rate and the possible manifestations among survivals), 

Slide 19: Explain in detail the pathophysiology of TTTS

Slide 20: Present the fetal finding occurred in TTTS: donor twins: anaemia, growth restriction, pale skin, oligohydramnion. Recipient twin: polycythemia,hydrops foetalis, polyhydramnion, hearth failure, hypervolemia, hyperviscosity, hyperbilirubinaemia. 

Slide 21: The severity of TTTS can be defined during ultrasound examinations, Present the different staging of TTTS based on the Quintero staging system. 

Slide 22: Talk about the treatment options in TTTS in different stages. Present the basics of fetoscopy and intrauterine laser therapy. 

Slide 23: Define and present the pathophysiology of twin anaemia-polycythaemia sequence (TAPS). Talk about the possible treatment options (intrauterine laser therapy and in utero transfusion), Highlight that there is no real consensus on the optimal treatment in TAPS. 

Slide 24: Present the definition of selective intrauterine growth restriction (sIUGR). Highlight that there is no oligohydramnion-polyhydramnion sequence is observed. 

Slide 25: Some factors can have a protective and positive influence on the outcome of twin pregnancies. Present the dietary factors and the importance of ultrasoung during the whole pregnancy. Present the factors that can prevent the preterm delivery. 

Slide 26: Present the general approaches during labor and delivery.

Slide 27: Show the students the potentioan fetal lie variations during labour which can be determined using ultrasoung. 

Slide 28: The chorionicity and amnionicity determine the optimal time for delivery of uncomplicated twin pregnancies. Present the optimal time for each type of twin pregnancy. 

Slide 29: Using the diagram in the presentation, present the route of delivery in diamniotic twins. 

Slide 30: Talk about the practical approaches during the vaginal delivery, presenting the possible indication of emergecy cesarian section during delivery and the possible complications (eg. Colissio gemellorum).

Slide 31 and 32: Present the prenatal care in case of monochorionic and dichorionic multifetal pregnancies, presenting in detail the timing of ultrasounds using the picture in ithe presentation. 

Views and opinions expressed are however those of the author(s) only and do not necessarily reflect those of the European Union or the Foundation for the Development of the Education System. Neither the European Union nor entity providing the grant can be held responsible for them.