Multifetal Gestation

Question 1

What should AFP level be in twin gestation?

Answer 1

alpha fetoprotein levels in twin gestations are elevated and should be roughly twice that seen in singleton pregnancies; additional clue to twin gestation is fundal height exceeding gestational age in weeks

Question 2

What are some causes of AFP elevation?

Answer 2

twin gestation, neural tube defects, pilonidal cysts, cystic hygroma, sacrococcygeal teratoma, fetal abdominal wall defects and fetal death

Question 3

What are ultrasound markers suggestive of dizygotic(non-identical) twins?

Answer 3

dividing membrane thickness greater than 2mm, twin peak(lambda) sign, different fetal genders and two separate placentas (anterior and posterior)

Question 4

What division timeline results in different placentation in monozygotic conceptions?

Answer 4

diamniotic dichorionic placentation occurs with division prior to morula state(within 3 days post-fertilization), diamniotic monochorionic occurs with division between days 4-8 post fertilization, monoamniotic monochorionic occurs between days 8-12, division after day 13 results in conjoined twins

Question 5

What is the average length of twin gestations?

Answer 5

35 to 37 weeks

Question 6

What can help reduce risk of preterm and low birth weight babies?

Answer 6

adequate weight gain in first 20 to 24 weeks of pregnancy

Question 7

What is twin twin transfusion?

Answer 7

result of an intrauterine blood transfusion from one twin to the other and most commonly occurs in monochorionic, diamniotic twins

Question 8

What are clues to twin twin transfusion?

Answer 8

large weight discordance, polyhydramnios around larger twin and oligohydramnios around smaller twin

Question 9

What is superfecundation?

Answer 9

fertilization of two different ova at two separate acts of intercourse in the same cycle

Question 10

What is optimal mode of delivery for twins in which first twin is breech presentation?

Answer 10

cesarean delivery