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OBGYN 1 > 9.1: Normal Multiple Gestations > Flashcards

9.1: Normal Multiple Gestations Flashcards

1
Q

twins should be b/w what growth percentile of each other?

A

~20%

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2
Q

are twin pregnancies automatically high risk

A

yes

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3
Q

mortality rate of twins compared to single babies

A

5-10 X higher

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4
Q

why are the number of twins initially higher in early preg

A

often one twin will die in early preg leaving 1 baby… many pregnancies start as twins

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5
Q

what are the 2 main types of twins? and how many eggs do they include

A
  • dizygotic (fraternal): 2 eggs, so genetically different

- monozygotic (identical): 1 egg that splits, so genetically identical

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6
Q

are dizygotic twins hereditary?

A

yes, on the maternal side

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7
Q

what maternal age is associated w/ increased chances of having dizygotic twins

A
  • young (15)

- advanced maternal age >37

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8
Q

what are the factors thats increase the chances of having dizygotic twins

A
  • young
  • advanced maternal age >37
  • hereditary
  • racial background
  • pharmaceutical agents (clomide and pergonal… fertility drugs that increase ovulation)
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9
Q

which racial background has the lowest incidences of dizygotic twins? highest incidence?

A

lowest: Japanese
Highest: Nigerian

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10
Q

are monozygotic twins hereditary?

what determines the number of membrane in a monozygotic preg

A

no, random occurrence

when the egg splits

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11
Q

what type of twins have a higher mortality rate (dizygotic or monozygotic)?

A

monozygotic because they can share more structures

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12
Q

anytime twins share a placenta theres a risk of what event occurring?

A

twin to twin transfusion which occurs when the vessels in the placenta anastomse

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13
Q

what are the 4 types of monozygotic twins

A
  • dichorionic/diamniotic
  • monochorionic/diamniotic
  • monochorionic/monoamniotic
  • conjoined
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14
Q

are all dizygotic twins DI/DI

A

yes

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15
Q

when will monozygotic twins be DI/DI

how many membranes and placentas in this type of twin preg

A
  • if the morula splits before it implants (~ 2 days post fertilization)
  • each egg implants separately
  • 4 membranes (we dont see these membranes after 16 wks becasue the chorion and amnion fuse at 16 wks)
  • 2 placentas
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16
Q

whats the only way we can tell monozygotic DI/DI twins from dizygotic DI/DI twins?

A

only if theres a dizygotic DI/DI preg w/ one girl and one boy

17
Q

when will monozygotic twins be Mono/DI

how many membranes and placentas in this type of twin preg

A

-if division of the egg occurs at the blastocyst stage after the inner cell mass of the embryo forms and implantation has occurred (~ 4-8 days post fertilization)

  • 2 membranes
  • 1 placenta
18
Q

when will monozygotic twins be Mono/Mono

how many membranes and placentas in this type of twin preg

A
  • when the division of the egg occurs after the embryonic disc stage, after the amniotic sac has formed (~ 8-12 days post fertilization)
  • 1 membrane (No membranes b/w the fetus)
  • 1 placenta
19
Q

why do monozygotic Mono/Mono twins have a higher mortality rate

A

due to cord entanglement

20
Q

when will monozygotic twins be conjoined

how many membranes in this type of twin preg

A
  • when there incomplete division at the embryonic disc stage (division is after 13 days post fertilization)
  • no separating membranes
21
Q

what is a fused placenta

what sign will this create and why?

A
  • when the 2 placentas of the DI/DI preg implant so close together that they appear fused
  • creates the Lambda sign or ‘twin peak sign’ because some of the placenta grows up b/w the membranes
22
Q

what sign will a Mono/DI preg show on US

A

T- sign

23
Q

what are the clinical indications for a scan for twin preg

A
  • strong family history
  • LGA
  • high maternal hCG levels (b/c of 2 placentas)
  • 2 or more heart beats heard by doctor
  • severe morning sickness due to increased hCG
24
Q

which twin would we label twin A?

what else would we include in our labeling of the twins?

A
  • the baby thats closet to the cervix or the ‘presenting twin’
  • would also include which side of mom each twin is on
25
Q

do you complete all documentation of 1 twin before moving on to the next

A

yes

26
Q

what type of image is often taken to prove that there are 2 babies

A

-an images that shows similar fetal parts close together

27
Q

its important to rule out what condition rated to amniotic fluid levels when assessing the twins

A

polyhydramnioses

28
Q

when does a fetal demise of one twin often occur

A

during 1st trimester preg… but can occur at any time

29
Q

what is a papyraceus fetus

how do we document it

A
  • the boney reminds of a demised fetus

- 1 SAG and 1 TRANS image

30
Q

what is the term that refers to a fetal reduction and why would it be performed

A
  • fetoscide

- in high number multiple preg to reduce the risk of preterm labour and improve the outcome of the preg

31
Q

can we do an AFI on a twin preg?

what amount of amniotic fluid do we look for

A

no…. try to see a pocket of fluid of at least 2X2 near the membrane or around the fetuses

OBGYN 1 (24 decks)

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