Twins And Malpresentation Flashcards
Difference between dizygotic twins and monozygotic twins?
Dizygotic is two separate eggs are fertilized by two separate sperm
Monozygotic is the cleavage of a single fertilized egg that splits
What is going on with amnion and chorion with different times when the egg can split for monozygotic twins?
0-3 days, 4-8 days, 9-12 days and greater than 13 days?
Di di
Monochroion and diamnion
Mono mono
Conjoined twins
Which placentation is most common and which one is most dangerous?
Monochor diamnion
Mono mono
Of spontaneous twins, which one is more common?
Dizygotic at 2/3.
How do we determine zygosity? 2 steps.
First, do an US. If dizygotic, different fetal gender, thick septum.
If mono, septum super thin.
If cant definitively say via US, then DNA analysis once born.
In order of decreasing frequency, most common interplacental vascular anastomoses?
Arterial arterial, arterial venous, and venous venous
What is the syndrome resulting from arterial to venous anastomoses and what is the big time complication for each?
Twin twin transfusion syndrome
Heart failure
2 treatments for twin twin transfusion syndrome?
Amniotic fluid reduction via amniocentesis
Laser photocoagulation of vessels that are anastomoses
What is Arcadiac twin?
When there is an arterial to arterial connection and the recipient is getting poorly oxygenated blood so nothing above the abdomen forms.
2 risks of twins?
Preterm birth and preeclampsia
2 things to do for first and second trimester management of twins?
Office visits every 2 weeks
Check cervical length via US
2 things to do for management of twins during third trimester?
Serial US for fetal growth
Antepartum testing
Recommended delivery for monoamniotic twins with complications like cord tangled and all other twins if everything is going good?
32
38
What presentation of twins occurs about half the time?
Vertex vertex
Two ways to deliver vertex transverse and vertex breech and which one is most common?
Most common is c section but can be vaginal
How is breech breech delivered?
C section
5 malpresentations of fetus in twins?
Breech, face, brow, shoulder, compound
What is breech presentation and what is the most common factor associated with it?
Butt or lower extremity presents first
Prematurity
3 types of breech presentations in order of decreasing frequency?
Frank - hips flexed, knees extended
complete, hips and knees flexed
incomplete not those
How do we treat a breeched baby? What gestational age must they be?
Push on moms belly to turn baby
36 weeks
In order for breeched baby to be vaginally delivered, what 4 things must happen with regards to baby position?
Must be frank or complete breech
Older than 37 weeks
3500-4000 grams
Fetal head must be flexed
What is standard of care in all practices to deliver all breech babies?
C section
What forceps can be used in breech presentations?
Piper
What will a brow presentation look like? What two other presentations can they convert to and how to deliver those? Persistent brow presentations must be delivered how?
Between eye and anterior fontanelle
Will convert to face or vertex maybe half the time and can deliver normally
If brow persists c section
What does face presentation look like? What are the two face presentation types and how are they delivered?
Full extension of baby head and neck.
Mental anterior deliver vaginally
Mental posterior deliver c section
What is compound presentation and how do you deliver?
This is when an Extremity, usually the hand, presents along side the presenting part. Can resolve on its own when delivering. If it doesn’t or labor delivery doesn’t progress, c section.
