13: Multifetal Gestation and Malpresentation

Question 1

four reasons to suspect multiple gestation

Answer 1

1. hCG higher than normal
2. uterus palpates higher than date
3. auscultation of more than one fetal heart
4. pregnancy after ovulation induction / IVF

Question 2

dizygotic twins on US

Answer 2

thick amnion-chorion septum that looks like a peak or inverted V sign

Question 3

monozygotic twins on US

Answer 3

dividing membrane is fairly thin

Question 4

maternal complications of multiple gestation

Answer 4

polyhydramnios, anemia, HTN, preeclampsia, DM, preterm labor, PPH, uterine atony

Question 5

fetal complications of multiple gestation

Answer 5

prematurity, malpresentation, placenta previa, placental abruption, PROM, umbilical cord prolapse, IUGR, congenital anomalies

Question 6

when to deliver monoamiotic twins + when to admit to hospital

Answer 6

admit at 26 weeks, deliver at 32 weeks

Question 7

average age of gestation for most twins to deliver

Answer 7

35-36 weeks

Question 8

if twin pregnancy has no complications, when is delivery recommended

Answer 8

38 weeks

Question 9

best position for both twins for vaginal delivery

Answer 9

vertex-vertex

Question 10

risks that are increased with twins vs in singletons

Answer 10

stillbirths, RDS, intracranial hemorrhage, birth asphyxia, cerebral palsy

Question 11

average gestation weeks for triplets and quadruplets

Answer 11

triplets: 33 weeks
quadruplets: 29 weeks

Question 12

malpresentation

Answer 12

any fetal presentation besides vertex

Question 13

ECV: external cephalic vesion

Answer 13

applying pressure to mothers abdomen to turn fetus to acheive vertex presentation

Question 14

what week to do ECV

Answer 14

36 weeks

Question 15

contraindications of ECV

Answer 15

placenta previa, non-reassuring fetal monitoring, oligohydramnios

Question 16

Piper forceps

Answer 16

used in breech deliveries