multifetal gestation- moulton

Question 1

what is the general pattern as you add kids into multifetal births?

Answer 1

as you get more and more, they get smaller, and born earlier, with a higher chance for having a major handicap

Question 2

what is a monozygotic twin?

Answer 2

arises from the cleavage of a single fertilized ovum that splits during embryogenesis

Question 3

what is a dizygotic twin?

Answer 3

arises from the separate fertilization of two eggs with two sperms in the same uterus`

Question 4

how are dizygotic twins organized in the the uterus?

Answer 4

they have separate amnions, chorions and placentas

Question 5

what is the result of monozygotic twins that separate from day 0-3?

Answer 5

dichorionic, diamniotic

Question 6

what is the result of monozygotic twins that separate from day 4-8?

Answer 6

monochorionic, and diamniotic

this is the MOST COMMON PRESENTATION

Question 7

what is the result of monozygotic twins if they divide from day 9-12?

Answer 7

monochorionic, monoamniotic

most dangerous becasue they are in the same amnion and can get cord tangled ( 50% net mortality)

Question 8

what is the result of cleavage of monozygotic twins from day 13-15?

Answer 8

conjoined twins

thoracopaus ( joined by thorax) is the most common presentation

Question 9

what is the frequency of monozygotci twins?

Answer 9

1 in 250

Question 10

what is more common, monozygotic or dizygotic?

Answer 10

dizygotic

increased frequency with increasing maternal age

Question 11

what should you suspect if the hCGis higher than normal ?

Answer 11

multiple fetuses in the uterus

Question 12

what is the most important step in dealing with twins after you determine there are twins?

Answer 12

determine the zygosity

Question 13

what do yiou see on ultrasound for dizygotic?

Answer 13

peak, or inverted V sign

Question 14

how must you deliver conjoined twins?

Answer 14

C-section

Question 15

what is the msot common interplacental vascular anastamosis? 2nd most common?

Answer 15

arterial to arterial

second most common is arterial- venous

Question 16

what does an uncompensated arterial- venous anastamosis lead to?

Answer 16

twin twin transfusion syndrome

Question 17

what are the characteristics of TTTS/

Answer 17

donor twin- smaller of the twins, hypotension, hypovolemia

recipient twin- larger, thrombosis, cardiomyopathy

Question 18

what is the appearance of the smaller twin on ultrasound?

Answer 18

“stuck on” appearance

Question 19

hwo do you treat TTTS?

Answer 19

serial amniocentesis, or laser photocoagulation

Question 20

what do arterial-arterial anastamosis lead to?

Answer 20

thrombosis in one of the twins, which leads to ACARDIAC twin, this happens becasue the twin that is getting the deoxygenated blood doesnt get an upper body( this is the recipient twin in arterial-arterial anastamosis)

Question 21

what are the differnet things that can come from retained fetal parts?

Answer 21

if before 12 weeks= absorbed
if greater than 12 weeks- shrinks and drys up, becomes a fetus papyraceus
after 20 weeks= dead fetus syndrome

Question 22

what are some complications of multiple gestations in the mother?

Answer 22

hydramnios, anemia, uterine atony ( most common cause of post birth hemorrhage)

Question 23

when doing serial ultrasounds on twins, what is the diparity you start to get worried about when it comes to difference in twins size?

Answer 23

20% deifference in the size of the twins= worisome

Question 24

when should monoamniotic twins be delivered?

Answer 24

34-36 weeks, due to increased chance of lethal cord entaglement

Question 25

if not monoamniotic, when is it recomended to deliver twins?

Answer 25

at 38 weeks

Question 26

what is twin A? B?

Answer 26

twin A is the presenting baby ( first one that is going to exit the vagina) B is the second twin

Question 27

whcih twin is at an increased risk for complications?

Answer 27

Twin B

Question 28

what is the most common presentation of twins?

Answer 28

vertex-vertex

Question 29

how do you deliver breech- breech, or breech-vertex twins?

Answer 29

C-section, ALWAYS

Question 30

how must you deliver multiple fetuses above twins?

Answer 30

C section- no matter what, above two babies

Question 31

what axis is the breech presentation in?

Answer 31

longitudinal

Question 32

what is most common breech position?

Answer 32

Frank- legs up over head- 65%
complete- cannon ball 25%
incomplete- jackknife -10%- risk of umbilical prolapse more common with this

Question 33

what is external cephalic version?

Answer 33

moving the fetus from outside to get them in a better position to birth vaginlly, DONT DO THIS if you can’t/ arent going to deliver vaginally, only do this after 36 weeks NOT in labor

Question 34

when doing external cephalic version, what can you give mom to relax the uterus to make it easier to flip the baby?

Answer 34

terbutalline

Question 35

if delivering a breech baby vaginally, when can you/should you apply traction to the baby?

Answer 35

after you can visualize the inferior part o the scapula- thei reduces the risk of head entrapment

Question 36

what forceps are used for an assisted breech delivery?

Answer 36

PIPER

Question 37

how do most physicians deliver breech babies?

Answer 37

C section

Question 38

what is the brow presentation?

Answer 38

presenting part of the fetus is between the facial orbits and anterior fontanelle, if a baby has a persistent brow presentation , CAN NOT DELIVER VAGINALLY

Question 39

what is the face presentation?

Answer 39

full extension of the fetal head and neck with occiput against upper back

Question 40

which type of face presentations can you deliver vaginally?

Answer 40

mentum anterior, this is how 80 percent of these babies present, if the baby is mentum posterior- CAN NOT DELIVER VAGINALY

Question 41

what is compound presentation?

Answer 41

when fetal extremity (hand) is found prolapsed alongside the presenting fetal part