Multiple Gestations

Question 1

diagnosis of twins

Answer 1

• first and/or second trimester ultrasound
• size-date discrepancy
• elevated AFP

Question 2

what to look for on ultrasound of twins

Answer 2

number of genders, placentas, sacs

Question 3

what are all twins at risk for?

Answer 3

cesarean section
prematurity
placenta previa
post-partum hemorrhage

Question 4

ultrasound revealed different genders

Answer 4

di-zygote

• breech = c/section
• preterm

Question 5

ultrasound revealed one gender

Answer 5

check number of placentas

Question 6

ultrasound revealed one placenta

Answer 6

is there a septum?

Question 7

ultrasound revealed one placenta and no septum

Answer 7

mono-zygotic
mono-chorionic
mono-amniotic

Question 8

risk of monozygotic/monochorionic/monoamniotic

Answer 8

cord entanglement

conjoined

Question 9

ultrasound revealed one placenta and a septum

Answer 9

mono-zygotic
mono-chorionic
di-amniotic

Question 10

risk of mono-zygotic/mono-chorionic/di-amniotic

Answer 10

twin-twin transfusion

Question 11

ultrasound revealed multiple placentas

Answer 11

mono-zygotic
di-chorionic
di-amniotic

Question 12

what is ___zygotic?

Answer 12

number of eggs/fertilizations

Question 13

what is ___chorionic?

Answer 13

number of placentas

Question 14

what is ___amniotic?

Answer 14

number of sacs

Question 15

what is a dizygotic/dichorionic/diamniotic

Answer 15

two normal pregnancies at the same time

- two eggs, two fertilizations, two sacs, two placentas

Question 16

risks for having dizygotic/dichorionic/diamniotic

Answer 16

hormones to induce ovulation -> release of multiple eggs

Question 17

risks of dizygotic/dichorionic/diamniotic

Answer 17

vanishing twin

- one pregnancy dies and gets reabsorbed

Question 18

what is monozygotic/dichorionic/diamniotic

Answer 18

product of the same fertilization and have the same genetic material
- separate early = days 0-3
identical twins
- two sacs, two placentas, but one egg so same gender

Question 19

what is monozygotic/monochorionic/diamniotic

Answer 19

product of the same fertilization

- separate on days 4-8, so share placenta (blood supply)

Question 20

added risk of monozygotic/monochorionic/diamniotic

Answer 20

twin-twin transfusion

• one twin donates blood supply to other
• small twin does better because of reduced bilirubin load

Question 21

what is monozygotic/monochorionic/monoamniotic

Answer 21

same fertilization with same genetic material

• separate late (days 9-12) for nonconjoined
• splitting >12days for conjoined twins

Question 22

added risks of monozygotic/monochorionic/monoamniotic

Answer 22

cord entanglement

conjoined twins

Question 23

delivery decisions of twins

Answer 23

cephalic-cephalic = vaginal
cephalic-breech = 'clinical judgment'
breech-breech = c-section