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RGU Exam 2 > Multiple Gestation > Flashcards

Multiple Gestation Flashcards

1
Q

Dizygotic twins are always…

A
  • Dichorionic-diamniotic
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2
Q

Amnionicity and chorionicity of monozygotic twins is determined by…

A
  • The timing of zygote cleavage
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3
Q

Cleavage days 1-4 results it…

A
  • Diamniotic-dichorionic
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4
Q

Cleabage days 4-8 results in…

A
  • Mnochorionic-diamniotic
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5
Q

Cleavage days 8-13 results in…

A
  • Monochorionic-monoamniotic
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6
Q

Cleavage days 13-15 results it…

A
  • Conjoined twins
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7
Q

All monochorionic twins are identical (T/F)

A
  • True
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8
Q

Dichorionic twins are always dizygotic (T/F)

A
  • False
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9
Q

Dizygotic twins are always dichorionic (T/F)

A
  • True
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10
Q

Monochorionic twins may be dizygotic (T/F)

A
  • False
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11
Q

Monoamniotic twins major issue is…

A
  • Cord entanglement (all have it)
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12
Q

Spontaneous conception of twins

A
  • 70% dizygotic/30% monozygotic

The monozygotic twin placentation is as follows:

  • 34% diamniotic-dichorionic
  • 65% monochorionic-diamniotic
  • 1% monoamniotic-monochorionic
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13
Q

Most common monozygotic twin placentation

A
  • Monochorionic-diamniotic
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14
Q

How are twin pregnancies diagnosed?

A
  • Ultrasound; count the # of placentas
  • Check gender
  • Check for lambda (or chorionic peak sign) sign
  • Check membrane thickness
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15
Q

Ultrasound method of diagnosing chorionicity/amnionicity

A
  • Count # of placentas
  • If 2 placentas = then DC
  • If 1 placenta = then either DC or MC
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16
Q

Gender check method in diagnosing chorionicity/amnionicity

A
  • If discordant genders, then DC
  • If same gender, either DC or MC
17
Q

Lambda sign method of diagnosing chorionicity/amnionicity

A

Lambda sign is the line where chorions meet

  • If there is a lambda sign, probably DC

(Note: Lambda sign may disappear after 16wks)

  • If no lambda sign, may be MC
18
Q

T-sign

A
  • Line produced when 2 amnions meet
19
Q

Membrane thickness check method in diagnosing chorionicity/amnionicity

A
  • DC membrane is thick (4 layers; 2 chorion, 2 amnion)

*usually easy to find

  • MC membrane is thin (2 layers; both amnion)

*can be very difficult to find

  • If its <2mm then it goes along with monochorionic-diamniotic twins
  • If its >2mm then it goes along with dichorionic-diamniotic twins
20
Q

Dichorionic-Diamniotic twins risks

A
  • Fetal aneuploidy (33 yrs is Advanced Maternal Age)
  • Delayed interval delivery
21
Q

Dichorionic-Diamniotic Management

A
  • Serial growth ultrasounds every 4-6wks
  • Serial (usually weekly) nonstress testing during 3rd trimester
  • Deliver by 38wks
22
Q

Monochorionic-Diamniotic twins risks

A
  • Twin-to-Twin Transfusion Syndrome (TTTS)
  • 20-30% risk of neurologic impairment (cerebral palsy) of surviving twin after death of one twin
  • Twin-Reversed-Arterial Perfusion (TRAP)
23
Q

Monochorionic-Diamniotic twins management

A
  • Serial ultrasound evals every 2wks to rule out twin-to-twin transfusion
  • Serial ultrasound evals every 4wks to evaluate interval fetal twin growth
  • Serial non-stress testing in third trimester
  • Deliver by 34-36wks
  • Invasive interventions to manage TTTS and TRAP
24
Q

Monoamniotic twins risks

A
  • Cord entanglement-leading to fetal death
  • 20-30% risk of neurologic impairment (cerebral palsy) of surviving twin after death of one twin
25
Q

Monoamniotic twins management

A
  • Serial growth ultrasounds every 2-3wks
  • A min. of 4hrs of daily fetal non-stress testing from 24-32wks
  • Delivery at 32wks via cesarean section
26
Q

Conjoined twins most frequent varieties

A
  • Thoracopagus: 40-70%
  • Omphalopagus: 10-33%
  • Pygopagus: 18%
  • Ischiopagus: 6%
  • Craniopagus: 1-6%
27
Q

Conjoined twins management

A
  • Termination
  • No surgery (unable to separate)
  • Estensive multidisciplinary surgery to separate both twins, or salvage one

RGU Exam 2 (21 decks)

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