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Obstetrics > Multiple Gestation > Flashcards

Multiple Gestation Flashcards

1
Q

What does zigosity refer to?

A

Number of fertilized eggs

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2
Q

What does chorionicity refer to?

A

number of placenta

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3
Q

What does amniocity refer to?

A

Amniotic sacs

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4
Q

What percent of Monochorionic Diamniotic result in TTTS?

A

10%

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5
Q

What is the mortality rate with Mono-Mono Twins?

A

20%

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6
Q

For Di-Di twins: What is the days of zygote division?

A

Day 2-3

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7
Q

What percent of twins are Di-Di?

A

25%

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8
Q

For Mono-Di twins: What is the days of zygote division?

A

Day 4-7

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9
Q

What percent of twins are mono-Di?

A

75%

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10
Q

For Mono-Mono twins: What is the days of zygote division?

A

8 - 12%

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11
Q

What percent of twins are mono-mono?

A

1-2%

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12
Q

What gestational age is it best to determine chorionicity and amnionicity?

A

6-8 weeks

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13
Q

In general the number of yolk sacs is equal to the number of ____

A

Amniotic sacs 6

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14
Q

What characteristic findings on US do you see with Di-Di Twins?

A

Lamda, Twin peak sign

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15
Q

What characteristic findings on US do you see with Mono-Di Twins?

A

T sign

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16
Q

How does the rate of preE change with twin gestation?

A

3 fold higher in twin pregnancy

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17
Q

GA matched twins have a ___ fold increase in CP than singletons

A

4 fold

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18
Q

When should you start serial growth evaluation for Dichorionic twins?

A

24 weeks

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19
Q

How often should you monitor growth in Dichorionic twins?

A

q 4-6 weeks

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20
Q

When should you start serial growth evaluation for Monochorionic twins?

A

16 weeks

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21
Q

How often should you monitor growth Monochorionic twins?

A

q 2 weeks

22
Q

True or false: Antenatal testing does not improve outcomes in uncomplicated dichorionic twins and thus is not indicated

A

True

23
Q

Is discordance an indication for fetal testing in Di-Di TIUP if both twins are AGA

A

No

24
Q

When is Antenatal testing indicated in twin gestations?

A

All monochorionic pregnancies

25
Q

When should Antenatal testing start for mono-Di Pregnancies

A

32 weeks

26
Q

When should you deliver Di-Di Twins?

A

38.0 - 38.6

27
Q

When should you deliver Mono-Di Twins?

A

34.0 - 37.6

28
Q

When should deliver Mono-Mono Twins?

A

32.0 - 34.0

29
Q

How should you deliver mono- mono twins?

A

Cesarean section

30
Q

What gestational age can you consider a vaginal delivery?

A

> 32wga

31
Q

What is the baseline risk for fetal malformations in SIUP pregnancies?

A

2-5%

32
Q

What is the risk of fetal malformations in twin pregnancies

A

4-10%

33
Q

What is the rate of vanishing twin in di-di twins in the first trimester?

A

20%

34
Q

What is the rate of vanishing twin in the second trimester for Di-Di twins?

A

2-5%

35
Q

True or False: A vanishing twin decreases the risk of PTB and mortality for remaining twin

A

True

36
Q

In the setting of IUFD of one twin in Monochorionic what are the major risk factors for the surviving twin?

A

Neurologic injury, Multi-organ damage

37
Q

True or false: With IUFD of one twin in a monochorionic pregnancy immediate delivery of the other twin is indicated

A

False

38
Q

What is the definition of discordance in the setting of TIUP?

A

EFW difference of > 20%

39
Q

in what percentage of Mono di pregnancies does TTTS occur?

A

10%

40
Q

What are the two criteria for diagnosing TTTS?

A
  1. Monochorionic, Diamniotic pregnancy

2. MVP > 8 in one fetus and MVP < 2 in other fetus

41
Q

What is the definition of Stage 1 TTTS based on Quintero staging?

A

Amniotic Fluid, MVP > 8 and < 2

42
Q

What is the definition of Stage 2 TTTS based on Quintero staging?

A

Absent bladder of donor twin

43
Q

What is the definition of Stage 3 TTTS based on Quintero staging?

A

Abnormal dopplers, AEDF or REDF

44
Q

What is the definition of Stage 4 TTTS based on Quintero staging?

A

Hydrops in one or both twins

45
Q

What is the definition of Stage 5 TTTS based on Quintero staging?

A

Fetal Death

46
Q

How do you manage stage 1 TTTS?

A

Expectant

47
Q

What percentage of stage 1 TTTS will progress to a higher stage?

A

15%

48
Q

How do you manage stage II - IV TTTS if less than 26 wga?

A

fetoscopic laser photocoagulation of placental anastomoses

49
Q

How do you manage stage II - IV TTTS if greater than 26 wga?

A

Delivery

50
Q

What is the rate of fetal mortality in monoamniotic twins?

A

10 - 20%

51
Q

When do you start fetal surveillance for Mono-Mono TIUP?

A

24 - 28 wga

52
Q

When do you delivery mono- mono TIUP

A

32 - 34wga

Obstetrics (28 decks)

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