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R2F > Multifetal gestation and malpresentation > Flashcards

Multifetal gestation and malpresentation Flashcards

1
Q

Monozygotic twins- placenttion

A

depends on time of cleavage

  • Dichorionic, diamniotic- 0-3 days
  • Monochorionic, diamniotic- 4-8 days
  • Monochorionic, monoamniotic- 9-12 days
  • conjoined twins- > 13 days
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2
Q

Dichorionic diamniotic

A
  • 0-3 days cleavage
  • 2 chorions, 2 anions
  • 30% of monozygotic twins
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3
Q

Monochorionic diamniotic

A
  • 4-8 days cleavage
  • 1 chorion, 2 amnions
  • 69% of monozygotic twins
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4
Q

Monochorionic monoamniotic

A
  • 9-12 days of cleavage
  • 1% of monozygotic twins
  • most dangerous- cord entanglement
  • net mortality 50-80%
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5
Q

Monochorionic monoamniotic- conjoined twins

A
  • 13-15 days of cleavage
  • craniopagus- joined at cranium
  • thoracopagus- joined at chest wall
  • ischopagus- joined by coccyx and sacrum
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6
Q

confirmation of multiples by?

A

US

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7
Q

most important step after dxing twins

A
  • determination of zygosity
  • monozygotic
  • dizygotic
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8
Q

US to determine zygosity

A
  • dizygotic- diff fetal gender, thick amnion-chorion septum, peak or inverted V sign at base of septum
  • monozygotic- dividing membrane is thin
  • if US is not definitive- inspect placenta after delivery, DNA analysis
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9
Q

abnormalities in monozygotic twins- Interplacental vascular anastomoses

A
  • 90% occur in monochorionic twins

- abortion, polyhydramnios, TTTS, fetal malformations

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10
Q

abnormalities in monozygotic twins- TTTS (twin twin transfusion syndrome)

A
  • anastomses in monochorionic placenta- blood flow from 1 twin to the other
  • donor twin- hypovolemia, hypotension, anemia, oligohydramnios, growth restriction
  • recipient twin- hypervolemia, polyhydramnios, thrombosis, HTN, polycythemia, edema, CHF
  • both at risk for HF
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11
Q

TTTS- dx

A

US

  • donor twin- smaller, “stuck”, oligohydramnios
  • recipient twin- larger, polydyramnios, ascites
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12
Q

TTTS- tx

A
  • amniocentesis with amniotic fluid reduction

- laser photocoagulation of anastomosis vessels on placenta

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13
Q

abnormalities in monozygotic twins- Arterial to Arterial anastomoses

A
  • can cause thrombosis
  • recipient twin (perfused with poorly deoxygenated blood) fails to develop normally- ACARDIAC twin- no anatomic structures cephalad of abdomen
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14
Q

abnormalities in monozygotic twins- Umbilical cord abnormalities

A
  • absence of umbilical a

- velamentous umbilical cord insertions occur more freq- may cause growth abnormalities

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15
Q

abnormalities in monozygotic twins- retained dead fetus syndrome

A
  • if gestation is > 20 wks
  • DIC in mother
  • check plts and fibrinogen levels weekly
  • if gestation is < 12 wks- dead fetus is reabsorbed- vanishing twin syndrome
  • if > 12 wks- fetus shrinks, dehydrates- fetus papyraceus
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16
Q

Monoamniotic twins- should be delivered when

A
  • 32 wks

- due to inc risk of lethal cord entanglement

17
Q

majority of twin gestations deliver when

A

35-36 wks

18
Q

Vertex-Vertex presentations

A
  • presenting twin is twin A
  • 40-50% of time
  • 2nd twin at risk of cord prolapse, placental abruption, malpresentation
  • risk of postpartum hemorrhage (uterine atony)
19
Q

breech-breech and breech-vertex- delivered via?

A

c-section

20
Q

perinatal mortality due to

A
  • RDS and intracranial hemorrhage

- birth asphyxia- second twins have 2x mortality

21
Q

fetal malpresentation

A
  • breech- most common!
  • face
  • brow
  • shoulder
  • compound
22
Q

breech presentation

A
  • fetal buttocks or LEs presents into maternal pelvic
  • 4% of all deliveries
  • factors assoc- prematurity (most common), fetal malformations, mult pregnancies, uterine malformations
  • dx- leopolds maneuver, US, pelvic exam
23
Q

breech presentations- classifications

A
  • Frank (65%)- most common- thighs flexed, LEs extended at knees
  • Complete (25%)- thighs flexed, LEs flexed
  • Incomplete (10%)- 1 or both thighs extended, 1 or both feet below buttocks
24
Q

External Cephalic Version (ECV)

A
  • apply pressure to mother’s abdomen to turn fetus in a fwd or backward somersault to achieve a vertex presentation
  • 36 wk gestation not in labor
  • contraindications- placental previa, non reassuring fetal monitoring, oligohydramnios, prev uterine surgery
  • performed when ready to perform an immediate c-section!!
25
Q

deliver breech how?

A

most places do c-section

26
Q

assisted breech vaginal delivery

A
  • allow fetus to deliver to scapulae (premature traction can cause head entrapment, nuchal arm entrapment)
  • external rotation of each thigh and opp rotation of fetal pelvis- delivery of leg
  • wrap towel around fetus for traction
  • piper forceps
27
Q

brow presentation

A
  • presenting part is b/w facial orbits and anterior fontanelle
  • diameter- supraoccipitomental diameter
  • most convert to a face presentation or vertex presentation and then deliver
  • delivery by c-section
28
Q

face presentation

A
  • full extension of fetal head and neck with occiput against upper back
  • 60% present mentum anterior- can deliver vaginally
  • can NOT deliver vaginally if mentum posterior presentation
29
Q

compound presentation

A
  • fetal extremity (usually hand) is found prolapsed alongside the presentation fetal part (heaD)
  • may resolve on its own
  • c-delivery if failure to progress, cord prolapse, or non reassuring fetal status

R2F (18 decks)

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