Multiple pregnancy

Question 1

define mx preg

Answer 1

pregnancy with two or more fetuses

• 1/90 preg // 1%
• high-risk pregnancies -preterm labour -preeclampsia
• twin pregnancies can be
  
  • monozygotic: division of fertilized oocyte on day 4-day 12
  • dizygotic: fertilization of two oocytes with two spermatozoa pregnancies.

Question 2

how is mx preg classified

Answer 2

based on how the amniotic sac and placenta are divided among the fetuses determined by US fraternal/dizygotic -dichorionic & diamniotic - identical/monozygoti variable types

Question 3

class of placental division in monozygotic twins

Answer 3

1)Dichorionic-diamniotic (Each twin has an individual amniotic sac and placenta. 20–30% 2)Monochorionic-diamniotic The twins share a placenta and have individual amniotic sacs.70% 3)Monochorionic-monoamniotic The twins share both the placenta and amniotic sac. 1–5% 4)Monochorionic-monoamniotic (conjoined twins) The twins share the placenta and amniotic sac, and are conjoined. < 0.1%

Question 4

predisposing factors for mx pregnancy

Answer 4

maternal age (> 35 years) d/2 increased gonadotropin Previous multiple pregnancy Use of fertility enhancing treatments Maternal family history of dizygotic twins

Question 5

dg of mx preg

Answer 5

1) phys exam
- Fundal height and abdominal girth are unusually large(2-4cm larger) for the gestational age
- Two or more fetal heart rates can be heard on auscultation.
2) US in 1st trimester(10-14wk most accurat) Evidence of more than one fetus LAMBDA sign for dichorironic twins T-SIGN for monochorionic twins

Question 6

what is fundal height

Answer 6

height of the fundus of the uterus (palpated as the highest point of resistance in the abdomen) above the symphisis pubis. between 24 and 36 wks gestation, SFH in centimeters roughly equals the gestational age in weeks.

Question 7

what is the lambda sign

Answer 7

both chorionic cavities are separated from each other. Separation of the chorionic and amniotic sacs resembles the Greek symbol “λ = lambda” on ultrasound

Question 8

what is the T-sign

Answer 8

One chorionic cavity is present and each twin has an individual amniotic sac. Separation of the amniotic sacs resembles a “T” on ultrasound.

Question 9

complications of mx preg

Answer 9

maternal illness

-hyperemesis gravidum -gestational db -preeclampsia

• Uterine atony
• placental insufficiency (disorder of the fetomaternal circulation that results in inadequate blood flow to the placenta and impairment in substance exchange )

fetal illness -Spontaneous reduction, or vanishing twin syndrome, can occur during the first trimester -Twin-to-twin transfusion syndrome -

Question 10

what is twin to twin transfusion

Answer 10

monochorionic twin pregnancies, the twins share a placenta.

Blood can flow in a fixed direction from one twin to the other results in the transfer of blood from the donor twin to the recipient twin.

recipient twin: polycythemia; polyhydramnios

Donor twin: anemia, dehydration, growth retardation; oligohydramnios in diamniotic pregnancies