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Twin and Multiple Pregnancy - Part II

St George’s Hospital, University of London

Faculty of St George’s Hospital, University of London

Main Areas of Interest

ONLY THOSE WHO COMPLETED PART I WILL BE ALLOWED TO DO PART 11 (PLEASE APPLY FOR BOTH THE PARTS SIMULTANEOUSLY IF YOU'RE INTERESTED)

Lecturing and Teaching:

This fellowship is designed for physicians and sonographers who look after women with twin and multiple pregnancies. Twin pregnancy, which is becoming more common, is associated with increased maternal and perinatal mortality and morbidity. Offering a practical guide and a wealth of videos, images and illustrations, the fellowship will help clinicians to feel more confident when caring for women with twin pregnancy.

Its main objectives are:

To increase the level of knowledge of healthcare professionals involved in the care of these women;
To update their knowledge in keeping with the recommendations of the latest national and international guidelines; and
To promote a multidisciplinary approach to the management of women with multiple pregnancy.

Techniques You Will Learn

Learning Outcomes:

Obtain fundamental knowledge in keeping with the recommendations of the latest national and international guidelines
Critically apply their understanding to different scenarios including complicated monochorionic twin pregnancy, such twin to twin transfusion syndrome, selective fetal growth restriction, twin anaemia polycythaemia sequence and twin reversed arterial perfusion
Promote a multidisciplinary approach to the management of women with multiple pregnancy

Learning and Teaching Resources: (any articles or textbooks that you recommend)

RCOG Monochorionic twin guideline

https://obgyn.onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.14188

NICE twin and triplet guideline

https://www.nice.org.uk/guidance/ng137/chapter/Recommendations

ISUOG twin guideline

https://www.isuog.org/uploads/assets/uploaded/b4ce0129-a7e8-40a9-8543c4243fb7638f.pdf

FIGO twin guideline

https://obgyn.onlinelibrary.wiley.com/doi/10.1002/ijgo.12742

AJOG (SMFM) TTTS guideline

https://www.ajog.org/article/S0002-9378(12)01980-1/pdf

Twin growth chart

https://www.ncbi.nlm.nih.gov/pubmed/29660172, https://www.ncbi.nlm.nih.gov/pubmed/27622538, https://www.ncbi.nlm.nih.gov/pubmed/25052857

Twin PSP

https://obgyn.onlinelibrary.wiley.com/doi/abs/10.1002/uog.20858

A core outcome set for studies investigating the management of selective fetal growth restriction in twins

https://www.ncbi.nlm.nih.gov/pubmed/31273879

Modules

Tasks and Timeline:

Module 7 (Week 7) Twin-to-twin transfusion syndrome

Twin-to-twin transfusion syndrome affects 10-15% of twin pregnancies. In this course, we will learn the diagnostic criteria, how to monitor and whether we can screen for it. We will also learn the manage options, their complications and how to follow up these pregnancies.

Module 8 (Week 8) Assessment of growth in twins and fetal growth restriction

There are many controversies in the assessment of fetal growth in twin pregnancy, including which chart to use, the diagnostic criteria of selective fetal growth restriction and its management. In this course, we will learn the new diagnostic criteria, how to monitor and manage twin pregnancies complicated by selective fetal growth restriction.

Module 9 (Week 9) Twin anaemia polycythaemia sequence

Twin anaemia polycythaemia sequence is a complication of monochorionic twin pregnancy which is associated with increased risk of perinatal mortality and morbidity. Most cases occur following Laser treatment of twin-to-twin transfusion syndrome. However, spontaneous twin anaemia polycythaemia sequence can occur in up to 5% of monochorionic twin pregnancy. In this course, we will learn the new diagnostic criteria, how to monitor and manage twin pregnancies complicated by twin anaemia polycythaemia sequence.

Module 10 (Week 10) Twin reversed arterial perfusion sequence

Twin reversed arterial perfusion sequence is increasingly diagnosed in the first trimester. In this course, we will learn the pathology, how to diagnose it, how to monitor and the manage options. We will also discuss recent research and ongoing trials.

Module 11 (Week 11) Screening and prevention for preterm birth in multiple pregnancies

Preterm birth is the biggest contributor to perinatal mortality and morbidity in twin and multiple pregnancy. In this course, we will learn the pathology, risk factors, screening options (including cervical length and biochemical markers) , options for prevention (including bed rest, progesterone, cervical pessary and cervical cerclage). We will also discuss controversial issues, such as mode of delivery in preterm twin and multiple pregnancies, monitoring in labour and measures to reduce the risk of cerebral palsy.

Module 12 (Week 12) Stillbirth in twins: how to avoid it and how to manage single intrauterine demise

Stillbirth is more common in twin and multiple pregnancy, with increased risk of monochorionic twin pregnancies. In the UK there has been unprecedented fall in stillbirth in twin pregnancies reported in 2018, which was not seen in singletons. In this course, we will learn the causes, risk factors, monitoring algorithms, and timing of birth in uncomplicated as well as complicated twin pregnancies. We will also learn how to counsel, monitor and manage twin pregnancies complicated by single intrauterine fetal demise.

Program Fee


Total Number of Modules
Time duration of Each module	minutes
Total Program Cost	$0

This program allows Merit Applications. This program allows merit-based applications for virtual and onsite clinical and research programs. If you are successfully awarded under this category, Trialect or the host mentor will cover the tuition fee only. All applications will be evaluated based on merit. Due to the high level of competition, the chances of being selected under the merit category are quite limited.

Who Can Apply

Physicians and those professionals who critically apply their understanding to different scenarios including complicated monochorionic twin pregnancy, such twin to twin transfusion syndrome, selective fetal growth restriction, twin anaemia polycythaemia s

Host Details

Host Name: Professor Asma Khalil

Affiliation: St George’s Hospital, University of London

Address: 78 Harley Street, London W1G 7HJ

Website URL: http://www.asmakhalil.co.uk/

Disclaimer:It is mandatory that all applicants carry workplace liability insurance, e.g., https://www.protrip-world-liability.com (Erasmus students use this package and typically costs around 5 € per month - please check) in addition to health insurance when you join any of the onsite Trialect partnered fellowships.

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