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ENRP 1 > Multifetal Gestation and Malpresentation (Moulton) > Flashcards

Multifetal Gestation and Malpresentation (Moulton) Flashcards

1
Q

__1__ arise when two separate ova are fertilized by two separate sperm.

Each will have its own __2__, __2__, and __2__.

A

1) Dizygotic twins (Fraternal)

2) Amnion, chorion and placenta

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2
Q

__1__ arise from the cleavage of a single fertilized ovum at various stages during embryogenesis.

Thus the arrangement of __2__ and __2__ will depend on the time at which the embryo divides.

A

1) Monozygotic Twinning (Identical)

2) Fetal membranes and placentas

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3
Q

With Monozygotic twins, if cleavage takes place from 0-3 days, what happens with placentation? (30% of monozygotic twins have this placentation)

A

1) 2 chorions
2) 2 amnions
3) Placentas can be separate or fused

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4
Q

With Monozygotic twins, if cleavage takes place from 4-8 days, what happens with placentation? (69% of monozygotic twins have this placentation)

A

1) 1 chorion

2) 2 amnions

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5
Q

With Monozygotic twins, if cleavage takes place from 9-12 days, what happens with placentation? (1% of monozygotic twins have this placentation)

A

1) 1 chorion

2) 1 amnion

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6
Q

Monochorionic monoamniotic placentation (9-12 days) is the most dangerous because there are no separating amnions, this causes what risk to be high?

A

Risk of Cord entanglement

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7
Q

With Monozygotic twins, if cleavage takes place from 13-15 days, what happens with placentation?

This causes conjoined twins and if they are craniopagus (2% incidence) this means?

If they are thoracopagus (30-40% incidence)?

If they are ischiopagus (6% incidence)?

A

1) 1 chorion and 1 amnion
2) Joined at the cranium
3) Joined at the chest wall
4) Joined by the coccyx and sacrum

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8
Q

Dizygotic twins is strongly influenced by?

It is twice as common after?

A

1) Maternal age

2) 35 y/o

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9
Q

You should suspect multiple gestations if ___ is higher than normal.

A

hCG

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10
Q

Which type of twins have an increased incidence of

  • Congenital anomalies
  • Weight discordance
  • Premature delivery
  • Fetal demise?
A

Monozygotic

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11
Q

Dizygotic Ultrasound

When using US when determining zygosity for dizygotic twins you might see a different __1__ amongst the twins.

2) What septum can be visualized?
3) What sign at the base of septum may be seen?

A

1) Fetal gender
2) Thick amnion-chorion septum
3) Peak or inverted V

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12
Q

When using US when determining zygosity for monozygotic twins what may be seen?

A

Dividing membrane is thin

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13
Q

If ultrasound is not definitive in determining zygosity, what should you do?

A

1) Inspect placenta after delivery

2) DNA analysis

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14
Q

Conjoined twins

1) When does cleavage occurring at?

2) When should elective termination be an option?
3) What type of delivery occurs

A

1) 13-15 days
2) Cardiac or Cerebral fusion
3) C-Section

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15
Q

1) Who does Interplacental Vascular anastomoses occur in?

2) Which is the most common type is of IVA?

A

1) Monochorionic twins

2) Arterial-arterial

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16
Q

With interplacental vascular anastomoses, vascular communications between the 2 fetuses through the placenta can cause several problems such as?

A

1) Polyhydramnios
2) Abortion
3) Twin-twin transfusion syndrome (TTTS)

PAT

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17
Q

Twin-twin transfusion syndrome results secondary to uncompensated __1__ in a monochorionic placenta.

This leads to a net transfer of blood flow going from one twin to the other. Hypovolemia, hypotension, anemia, oligohydramnios, growth restriction occurs to the __2__.

Hypervolemia, polyhydramnios, thrombosis, hypertension, polycythemia, edema, cardiomegaly, and congestive heart failure occurs to the __3__.

A

1) Arteriovenous anastomoses
2) Donor twin
3) Recipient twin

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18
Q

With Twin-twin transfusion syndrome both twins are at risk of demise because of?

A

Heart failure

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19
Q

What findings on US for TTTS are seen with the donor twin?

For the recipient twin?

A

1) Smaller, stuck appearance, oligohydramnios
2) Larger, polyhydramnios, ascites

*Larger from more fluid

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20
Q

TTTS treatment consists of ____ of the anastomosis vessels on the placenta at specialized centers.

A

Laser photocoagulation

*Find Anastomoses
Ablation with laser zip zip

21
Q

ARTERIAL TO ARTERIAL ANASTOMOSES (monozygotic malformation)

Arterial to arterial anastomoses may lead to reversed blood flow causing __1__ within critical organs or
atresias due to trophoblastic embolization.

The recipient twin, being perfused in a reverse direction with poorly oxygenated blood fails to develop normally. It is known as an __2__ twin.

This twin presents with fully formed __3__ but no anatomic structures above the __4__.

A

1) Thrombosis
2) Acardiac twin
3) Lower extremities
4) Abdomen

*Uterine vein brings o2 rich blood into Donor bably
Blood leaves from donor through Uterine artery.

Recepient has o2 rich blood coming in through uterine artery AND waste blood out through Uterine Artery

THe two arteries attach and Recipient has blood from both directions then becoming reversed.

22
Q

What umbilical cord abnormalities can be seen primarily with monochorionic twins?

A

1) Absence of umbilical artery

2) Velamentous umbilical cord insertions (umbilical cord in wrong position)

23
Q

1) What is it called if one of monozygotic fetus dies at or past 20 weeks gestation

If gestation is < 12 weeks the dead fetus is __2__ and is known as what?

If > 12 weeks, the fetus shrinks, dehydrates and flattens called __3__.

A

1) Retained dead fetus syndrome
2) Reabsorbed (Vanishing twin syndrome)
3) Fetus papyraceus

24
Q

Retained dead fetus syndrome can lead to __1__ in the mother.

You want to check __2__ and __2__ levels weekly.

A

1) DIC (Disseminated intravascular coagulopathy)

2) Platelets and fibrinogen

25
Q

With the high risk of ____ and ____, close antepartum surveillance is required.

A

Preterm birth and preeclampsia

26
Q

In the third trimester, cervical length of less than ____ at 24-28 weeks doubled the risk for premature births in twins.

A

25mm

27
Q

ANTEPARTUM MANAGEMENT
Monoamniotic twins should be delivered at __1__ weeks.

This is secondary to an increase risk for __2__.

Delivering is recommended at __3__ weeks for twins if pregnancy has no complications.

A

1) 32
2) Lethal cord entanglement
3) 38

28
Q

What presentation occurs 40-50% of the time for twins?

A

Vertex-vertex

29
Q

Which twin in Vertex-Vertex presentation is at increased risk of

  • cord prolapse
  • placental abruption
  • malpresentation?
A

Second twin

30
Q

With delivery of twins be prepared for postpartum hemorrhage due to what?

A

Uterine atony

31
Q

__1__ and __1__ presentations can be delivered vaginally but often are delivered by cesarean section.

__2__ and __2__ twins are delivered via cesarean section.

A

1) Vertex-transverse and vertex-breech (VT, VB)

2) Breech-breech and breech-vertex (BB-BV)

32
Q

What can occur secondary to prematurity and congenital anomalies?

A

1) Respiratory distress syndrome (RDS)
2) Intracranial hemorrhage
3) Birth asphyxia

RIB

33
Q

Triplets: Prematurity increases as the number of fetus increase, the average gestation at delivery is ___ weeks.

Quadruplets: The average gestational age at delivery is ___ weeks.

A

1) 33

2) 29

34
Q

Malpresentation refers to any fetal presentation other then __1__.

__2__ is the most common malpresentation.

A

1) Vertex

2) Breech

35
Q

Breech presentation occurs when the fetal ____ or ____ presents into the maternal pelvis.

A

Buttocks or lower extremities

36
Q

What is the most common factor associated with breech?

A

Prematurity

37
Q

Which type of breech presentation is the most common where the thighs are flexed and the lower extremities are extended at the knees?

Which type of breech presentation is where the thighs and the lower extremities are flexed?

Which type of breech presentation is where one or both thighs are extended and one or both feet are below the buttocks?

A

1) Frank
2) Complete (criss cross apple sauce)
3) Incomplete

38
Q

____ involves applying pressure to the mother’s abdomen to turn the fetus in either a forward or backward somersault to achieve a vertex presentation.

A

External cephalic version

39
Q

In order for vaginal delivery of breech presentation, the fetus must be in a ____ or ____ breech presentation with gestational age >37 weeks.

A

Frank or complete

40
Q

The standard of care now in most practices is to deliver all breeches by?

A

Cesarean section

41
Q

When undergoing assisted breech baginal delivery, a __1__ wrapped around the baby can be used for better traction.

You want to maintain cephalic flexion by applying pressure on fetal __2__, NOT fetal __3__.

__4__ is a tool that can be used in breech deliveries.

A

1) Towel
2) Maxilla
3) Mandible
4) Piper Forceps

42
Q

__1__ presentation occurs when the presenting part of the fetus is between the facial orbits and anterior fontanelle.

The presenting diameter is the __2__ diameter.

__3__ bones are the point of designation.

A

1) Brow
2) Supraoccipitomental
3) Frontal

43
Q

50-75% of brow presentation will convert to a
face presentation through __1__
or
vertex presentation through __2__ and then deliver.

A

1) Extension

2) Flexion

44
Q

The vertex presentation allows the ____ diameter to be the presenting diameter.

A

Suboccipitobregmatic

45
Q

__1__ presentation is characterized by full extension of the fetal head and neck with occiput against upper back.

It can be seen frequently with fetal malformation such as __2__.

The fetal __3__ is chosen as point of designation.

A

1) Face
2) Anencephaly
3) Chin

46
Q

The mentum (chin) must be __1__ in order to deliver a face presentation vaginally.

You can NOT deliver face presentation vaginally if the mentum is __2__. Will need to proceed with cesarean section.

A

1) Anterior

2) Posterior

47
Q

The face presentation allows the ____ diameter to be the presenting diameter.

A

Trachelobregmatic

48
Q

____ presentation is defined when a fetal extremity (usually the hand) is found prolapsed alongside the presenting fetal part (head).

A

Compound

ENRP 1 (23 decks)

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