22 - Multiple Pregnancy

Question 1

Diagnosis method and criteria:

Answer 1

— A) Sonographic exam [To identify 2 sacs [As early as 6 wks]]
B) Fetal heart activity for 2 fetuses

— Sacs without heart activity isn’t diagnostic

Question 2

Mono VS Dizygotic:

Answer 2

— Splitting of an embryo

— Fertilization of 2 or more eggs in a single cycle [Each in its own amnion, chorion and placenta]

Question 3

Relationship between timing of cleavage and nature of the membranes in twins:

Answer 3

— Within 1st 72 hrs —> Diamniotic+Dichorionic
— 4–8d —> Diamniotic+Monochorionic
— 8–12d —> Monoamniotic+Monochorionic
— >12d —> Conjoined twins

Question 4

Define Superfecundation and superfetation:

Answer 4

— 2 ova fertilized but not at the same coitus

— 2 cycles intervene between fertilization

Question 5

Factors increasing the multiple pregnancy:

Answer 5

1– Race
2– Genetics
3– Maternal age [High=Twins]
4– Nutritional factors
5– Pituitary gonadotropins 
6– IVF or IUI

Question 6

How to determine Zygosity [Are the twins mono or di?]

Answer 6

1– Chorionicity [2 separate placenta and a thick membrane between more than 2mm —> Di]
2– Opposite genders —> Di
3– Different blood type groups —> Di
4– Peak signs [V] —> Di

Question 7

Maternal physiological changes:

Answer 7

1– High BP —> Pre-eclampsia and HTN
2– Increased demand for Fe+ and folate
3– Distressed RS [Due to VC and aorta compression]

Question 8

CC on fetuses:

Answer 8

Abortion, malformation and low birth weight

Question 9

CC uniquely for mono twins:

Answer 9

1– Umbilical cord abnormality [Either one cord, or intertwined cord and entanglement]
2– Conjoint twins [Requires CS]
3– Interplacental vascular anastomoses

Question 10

Stopped at page 8

Answer 10

Okay bye :)