CHAPTER 48: MULTIFETAL PREGNANCY Flashcards
Multifetal pregnancy results from?
- 2 or more fertilization events
- Single fertilization followed by splitting of the zygote
- Noth
Problems encountered by the mother when having multiple gestation
High rate of mortality and morbidity
Risk for pre-eclampsia
Postpartum hemorrhage
Maternal death
Problems encountered by the fetus in multifetal gestation
High mortality rate
Increased rate of very low birthweight
Congenital malformation
Preterm birth
What do you call when during a multifetal pregnancy, one or more fetuses may die simultaneously or sequentially
Fetal demise
What do you call a twin that dies early
Vanishing twin
Does the survivor twin has increases risk of death after the first trimester and requires additional surveillance?
No
What do you call when the dead fetus compressed appreciably
Fetus compressus
What do you call a dead fetus that is flattened remarkably through desiccation
Fetus papyraceus
The neurological prognosis for the surviving co twin is greatly influenced by:
Chorionicity
What is recommended weight gain for women with twins according to Institute of Medicine
37 to 54 lb weight gain
What is the daily recommended augmented caloric intake for women with twins?
40 to 45 kcal/kg/d
What is given to women at high risk for preeclampsia
Low dose aspirin prophylaxis 81 mg oral daily dose initiated between 12 and 28 weeks of gestation
What to use in screening structural anomalies and when it is usually done
Mid pregnancy using a anatomic sonography survey
How to assess the amniotic fluid volume
Using a quantified deepest vertical pocket
Oligohydramnios is considered when?
A measurement of <2 cm
Hydramnios is considered when
A measurement of >8 cm
Factors that could influenced preterm birth
Prior preterm birth
Adolescence
Obesity
Diabetes
Nulliparity
Cervical length that is accurate in predicting birth before 34 weeks gestation
<20 mm
Other name for dizygotic twins
Fraternal twins
Other name for monozygotic twin
Identical twin
Twins of the opposite sex is always dizygotic
Yes
Monozygotic twins does not have the equal sharing of protoplasmic material
Yes
Outcome of monozygotic twinning when zygotes divide within 72 hours after fertilization
Two embryos
Two amnions
Two chorions
Monozygotic dichrionic diamnionic
Outcome of monozygotic twinning when division occurs between 4 to 8 days
Monozygotic monochrionic diamnionic twin pregnancy
Outcome of monozygotic twinning when division occurs at day 8
Monozygotic monochorionic monoamnionic
Outcome of monozygotic twinning when division occurs at later than 8 days
Conjoined twins
Factors that affect twinninh
Infertility treatment
Maternal age
Race
Heredity
Size
What infertility treatment is most commonly associated with twinning
Ovulation induction with clomiphene citrate or with follicle stimulating hormone plus human chorionic gonadotrophin
Why is advancing maternal age and delayed childbearing increases the risk for twinning
FSH levels rise with age and lead to greater ovarian stimulation
Heredity, which side has most affect
Maternal
Maternal size is another risk factor which includes the
Taller and heavier woman
What is superfecundation
Fertilization of two ova within the same menstrual cycle but not in the same coitus nor necessarily by the sperm from the samke make
Superfecundation leads to
Heteropaternity
What is superfetation
When a second pregnancy occurs during an initial pregnancy
What is used to diagnose a multifetal gestation
Accurate fundal height
Palpation of two fetal heads
Doppler may detect two fetal heartbeats distinct from each other and from the mother
Twin gestation is not diagnosed until
26 weeks gestation
Dizygotic is also known as
Double ovum- fraternal twins
What weeks we will able to detect the chrorionicity of the pregnancy
24 weeks
What are the sonographic features to assess the chorionicity
Number of placenta masses= 2 separate placenta suggests dichorionicity
Presence of intervening membrane=>2mm supports presumed diagnosis of dichorionicity while <2mm supports monochorionic
Thickness of the membrane= seen in second trimester
Fetal gender
What do you call the twin peak sign that appears as triangular projection of placental tissue
Lambda or delta
What do you call the sign between membrane and placenta without apparent extension of placenta between the dividing membrane
T sign
Why are radiographs limited in diagnosing twins
Limited especially when the twins move
Are there biochemical test that identifies multifetal gestations
No
