Multifetal Pregnancy Flashcards
Ovulation during the course of an established pregnancy. Possible due to obliteration of fusion of decidua capsularis to the deciduas vera
Superfetation
Most common: Monzygotic or Dizygotic?
Dizygotic
Best time to do ultrasound for multifetal pregnancies
First trimester
Different genders are often di-di except when?
XX and XO (Turner’s Syndrome of the other twin)
If unable to establish chorionicity?
Should be managed as monichorionic until proven otherwise
On sonography, a thick groove between membranes at the insertion of the placenta is noted. Which is true?
a. Twins have same gender
b. One may has polyhy the other has oligo
c. Delivery at 38 weeks
d. Discordance is common
C. Dichorionic-Diamnionic pregnancy
Pathophysiology: Unidirectional flow through deep A-V anastomosis
TTTS
2 Criteria for Diagnosis of TTTS
- Mono-Di Pregnancy
2. Oligo of 1 twin (SVP <2), Polyhy of the other (SVP >8)
Twins have Poly-Oli syndrome, the recipient twin has “stuck syndrome” and donor twin has absent urine in bladder. Quintero stage?
3
Although inclusion is still controversial, cardiac function by 2D Echo is sometimes included in quintero staging through what index?
MPI (Myocardial Perfusion Index) or Tei index
In what trimester in which severity of TTTS is usually present?
2nd Trimester
Complications of Single fetal death in a twin pregnancy?
Maternal: Coagulopathy
Other twin: Neurologic compromise due to Acute Hypotension (rarely: Embolic events)
Most common management used in TTTS
Amnioreduction
Pathophysiology: 3 weeks after laser photocoagulation of placental anastomoses, twins had significant differences in Hgb concentration
Iatrogenic TAPS (within 5 weeks of Laser photocoag)
Spontaneous TAPS usually occurs when?
26 weeks or later
