Mutlifetal Malpresentation - Moulton

Question 1

If cleavage occurs > 13 days what do the membranes look like?

Answer 1

Conjoined twins

Question 2

Which presentations of twins may deliver vaginally?

Answer 2

Vertex-transverse

Vertex-breech

Question 3

Which presentations of twins CANNOT be delivered vaginally?

Answer 3

Breech-breech

Breech-vertex

Question 6

A recipient twin being perfused in a reverse direction w/poorly oxygenated blood fails to develop normally known as what?

Clinical features?

Answer 6

Acardiac twin

Fully formed LEs w/no structures cephalad of abdomen

Question 7

What kind of breech is 1 or both thighs extended and 1 or both feet below the buttocks?

Answer 7

Incomplete

ONLY C-section delivery

Question 9

What is the most dangerous twin presentation?

Why?

Answer 9

Monochorionic monoamniotic

Cord entanglement

Question 10

How are dizygotic twins diagnosed on US?

Answer 10

Diff fetal gender
Thick amnion-chorion septum
Peak or inverted V sign

Question 11

What is defined when a fetal extremity is found prolapsed alongside the presenting fetal part (head)?

How to remedy?

Answer 11

Compound presentation

Pinch hand or upward pressure, if fails C-section

Question 12

When can retained dead fetus syndrome develop?

Answer 12

Gestation 20 weeks or greater

Question 13

When should monoamniotic twins be delivered?

Hospitalized?

Answer 13

32 weeks

26 weeks

Question 15

What occurs when the presenting part of the fetus is bw the facial orbits and anterior fontanelle?

Presenting diameter is what?

Deliver how?

Answer 15

Brow presentation

Supraoccipitomental diameter

C section ONLY

Question 17

If gestation is < 12 weeks what happens to a dead fetus?

After 12 weeks?

Answer 17

Reabsorbed, “vanishing twin”

Fetus papyraceus (it shrinks, dehydrates, flattens)

Question 18

During assisted breech vaginal delivery where is cephalic flexion maintained?

Answer 18

Pressure on maxiall, NOT mandible

Question 19

Antepartum management of twins requires what in the 1st and 2nd trimesters?

3rd?

Answer 19

2 wk office visits and cervical length US (< 2.5 = inc risk)

Cervical length < 25 mm at 24-28 weeks 2x risk for premature birth

Question 20

What is characterized by full extension of the fetal head and neck w/occiput against upper back?

What is chosen as point of designation?

Answer 20

Face presentation

Chin

Question 21

What forceps are used in Breech delivery?

Answer 21

Piper

Peanut Butter

Question 25

ECV is what?

For whom?

Answer 25

Apply pressure to mother’s abdomen to turn fetus

36 weeks gestation not in labor

Question 27

Can mentum anterior be delivered vaginally?

Mentum posterior?

Answer 27

Yes

No

MA ok

Question 28

How are monozygotic twins diagnosed on US?

Answer 28

Dividing membrane is fairly thin

Question 29

What type of breech are the thighs flexed and LE flexed?

Answer 29

Complete

Question 33

What is the most common factor assoc. w/breech presentation?

Dx how?

Answer 33

Prematurity

Leopold’s maneuver, US, pelvic exam

Question 34

What type of breech is the most common, thighs are flexed and LE are extended at the knees?

Answer 34

Frank

Question 37

If cleavage occurs 9-12 days what do the membranes look like?

Answer 37

Monochorionic, monoamniotic

Question 40

If cleavage occurs 0-3 days what do the membranes look like?

Answer 40

Dichorionic, diamniotic

Question 41

TTTS tx?

Answer 41

Serial amniocentesis w/amniotic fluid reduction

Laser photocoagulation

Question 46

When do interplacental vascular anastomoses occur?

Answer 46

90% in monochorionic twins

Question 48

Monozygotic twins arise from what?

Answer 48

Cleavage of a single fertilized ovum during embryogenesis

Question 53

If cleavage occurs 4-8 days what do the membranes look like?

Answer 53

Monochorionic, diamniotic