Twin Gestation Flashcards
What percentage of twins are monozygotic?
30%
Is the frequency of monozygotic twins constant across all age and ethnic groups?
Yes
What increases the frequency of dizygotic twins?
African Americans
older women
+ FHx
Use of ovulation induction
What is the frequency of spontaneous twins?
1%
What is the frequency of ovulation induction?
5-8%
What is the explanation of increases in frequency of twins and triplets?
older age of mothers and increased use of ART
What are some findings that are suggestive of twins?
Uterus is large for dates
maternal perception of excess emotion
auscultation of two distinct heart beats
How do you diagnose that the mother has twins
US
If the placenta is monchorionic and monoamniotic what is the zygosity?
monozygotic
If the placenta is monochorionic and diamniotic, what is the zygosity?
monozygotic
If the placenta is dichorionic and diamniotic what is the zygotisity?
Either
What determines the type of twins?
the timing of the egg cleavage
What are possible antenatal complications?
spontaneous abortions anomalies preterm labor- 30% impaired growth of one or both twins polyhydramnios twin to twin transfusion syndrome pre-eclampsia placental abnormalities
What are possible peripartum complications?
dysfunctional labor malpresentation abruption abnormal FHR tracing Cesarian delivery
What are complications with cesarian delivery during peripartum?
abnormal labor
abnormal presentation
abnormal FHR
What are possible postpartum complications for twin gestation?
severe parenting stress
postpartum hemorrhage- due to uterine anomaly
maternal depression
child abuse
How do we look out for and manage twin gestation
early prenatal care early US to determine zygosity second trimester scan (anomalies and cervical length) Cerclage? Third trimester scan for fetal growth frequent prenatal apts limited activity antepartum monitoring
What is the usual timing of delivery of monozygotic twins?
37 weeks
What is the usual timing of delivery of dizygotic twins?
38 weeks
What is the method of deliver when both babies present cephalic?
vaginal
what is the method of delivery if both babies present abnormal?
Cesarian
what is the method of delivery if the babies present cephalic-breech?
cesarian, vag, or vag-breech
What causes higher order multiples?
ovulation induction with gonadotropins
ivf- 2 embryos transferred
What is a dominant complication of higher order multiples?
preterm delivery
worse prognosis with more fetuses
beneficience
greatest good for the greatest number
