25.    A 25-year-old woman was diagnosed to have a twin pregnancy during her booking visit at 12 weeks. Her ultrasound scan is shown below.

a)        What is shown by the arrow?

           Lambda sign. (due to extension of placental tissue into base of inter-twin membrane)

b)         What does it show?

            Dichorionicity.

c)         Why is the result significant?

            It diagnoses the chorionicity of the twin pregnancy. If it is monochorionic, the patient has to be monitored closely for possible development of twin-twin transfusion syndrome. The delivery is usually at 36 weeks by LSCS. 

d)         Name three complications that can arise in the 2nd trimester.

             1.    Pre-eclampsia.

             2.    Gestational diabetes.        

             3.    Placenta praevia major. 

e)         What must you look out for during the 3rd trimester visit?

             Monitor for signs of IUGR via ultrasound, CTG, Doppler and BPP. 

f)          What is one important complication that can happen after the delivery?

             Postpartum hemorrhage.