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OBSTETRICS > CHAPTER 48: MULTIFETAL PREGNANCY > Flashcards

CHAPTER 48: MULTIFETAL PREGNANCY Flashcards

1
Q

Multifetal pregnancy results from?

A
  1. 2 or more fertilization events
  2. Single fertilization followed by splitting of the zygote
  3. Noth
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2
Q

Problems encountered by the mother when having multiple gestation

A

High rate of mortality and morbidity
Risk for pre-eclampsia
Postpartum hemorrhage
Maternal death

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3
Q

Problems encountered by the fetus in multifetal gestation

A

High mortality rate
Increased rate of very low birthweight
Congenital malformation
Preterm birth

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4
Q

What do you call when during a multifetal pregnancy, one or more fetuses may die simultaneously or sequentially

A

Fetal demise

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5
Q

What do you call a twin that dies early

A

Vanishing twin

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6
Q

Does the survivor twin has increases risk of death after the first trimester and requires additional surveillance?

A

No

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7
Q

What do you call when the dead fetus compressed appreciably

A

Fetus compressus

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8
Q

What do you call a dead fetus that is flattened remarkably through desiccation

A

Fetus papyraceus

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9
Q

The neurological prognosis for the surviving co twin is greatly influenced by:

A

Chorionicity

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10
Q

What is recommended weight gain for women with twins according to Institute of Medicine

A

37 to 54 lb weight gain

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11
Q

What is the daily recommended augmented caloric intake for women with twins?

A

40 to 45 kcal/kg/d

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12
Q

What is given to women at high risk for preeclampsia

A

Low dose aspirin prophylaxis 81 mg oral daily dose initiated between 12 and 28 weeks of gestation

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13
Q

What to use in screening structural anomalies and when it is usually done

A

Mid pregnancy using a anatomic sonography survey

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14
Q

How to assess the amniotic fluid volume

A

Using a quantified deepest vertical pocket

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15
Q

Oligohydramnios is considered when?

A

A measurement of <2 cm

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16
Q

Hydramnios is considered when

A

A measurement of >8 cm

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17
Q

Factors that could influenced preterm birth

A

Prior preterm birth
Adolescence
Obesity
Diabetes
Nulliparity

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18
Q

Cervical length that is accurate in predicting birth before 34 weeks gestation

A

<20 mm

19
Q

Other name for dizygotic twins

A

Fraternal twins

20
Q

Other name for monozygotic twin

A

Identical twin

21
Q

Twins of the opposite sex is always dizygotic

A

Yes

22
Q

Monozygotic twins does not have the equal sharing of protoplasmic material

A

Yes

23
Q

Outcome of monozygotic twinning when zygotes divide within 72 hours after fertilization

A

Two embryos
Two amnions
Two chorions
Monozygotic dichrionic diamnionic

24
Q

Outcome of monozygotic twinning when division occurs between 4 to 8 days

A

Monozygotic monochrionic diamnionic twin pregnancy

25
Q

Outcome of monozygotic twinning when division occurs at day 8

A

Monozygotic monochorionic monoamnionic

26
Q

Outcome of monozygotic twinning when division occurs at later than 8 days

A

Conjoined twins

27
Q

Factors that affect twinninh

A

Infertility treatment
Maternal age
Race
Heredity
Size

28
Q

What infertility treatment is most commonly associated with twinning

A

Ovulation induction with clomiphene citrate or with follicle stimulating hormone plus human chorionic gonadotrophin

29
Q

Why is advancing maternal age and delayed childbearing increases the risk for twinning

A

FSH levels rise with age and lead to greater ovarian stimulation

30
Q

Heredity, which side has most affect

A

Maternal

31
Q

Maternal size is another risk factor which includes the

A

Taller and heavier woman

32
Q

What is superfecundation

A

Fertilization of two ova within the same menstrual cycle but not in the same coitus nor necessarily by the sperm from the samke make

33
Q

Superfecundation leads to

A

Heteropaternity

34
Q

What is superfetation

A

When a second pregnancy occurs during an initial pregnancy

35
Q

What is used to diagnose a multifetal gestation

A

Accurate fundal height
Palpation of two fetal heads
Doppler may detect two fetal heartbeats distinct from each other and from the mother

36
Q

Twin gestation is not diagnosed until

A

26 weeks gestation

37
Q

Dizygotic is also known as

A

Double ovum- fraternal twins

38
Q

What weeks we will able to detect the chrorionicity of the pregnancy

A

24 weeks

39
Q

What are the sonographic features to assess the chorionicity

A

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

40
Q

What do you call the twin peak sign that appears as triangular projection of placental tissue

A

Lambda or delta

41
Q

What do you call the sign between membrane and placenta without apparent extension of placenta between the dividing membrane

A

T sign

42
Q

Why are radiographs limited in diagnosing twins

A

Limited especially when the twins move

43
Q

Are there biochemical test that identifies multifetal gestations

A

No

OBSTETRICS (3 decks)

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