Multiple Gestation

Front 1

What are some U/S markers of dizygotic (fraternal) twins?

Back 1

a dividing membrane over 2 mm thick

twin peak (lambda) sign

different fetal gender

two separate placentas (A/P)

Front 2

What are the two basic type of twinning placentas?

Back 2

dichorionic and monochorionic

Front 3

What type of placentas do dizygotic twins show?

Back 3

dichorionic

Front 4

Depending on the timing of the zygote division, monozygotic identical twins can have either di or monochorionic placentas

Back 4

. Diamniotic monochorionic placentation occurs with division between days 4 and 8 post-fertilization. Monoamniotic, monochorionic placentation occurs with division between days 8 and 12 post fertilization. Division at or after day 13 results in conjoined twins

Front 5

What is the best option for delivery if you have one twin breech and the other vertex?

Back 5

C section

Front 6

This mostly applies to the PRESENTING twin though.

Back 6

ok

Front 7

What are some things that are higher risk in twin gestation than singleton/

Back 7

congenital anomalies-especially in monozygotic twins

preterm labor

SGA

Front 8

What happens to alpha fetoprotein levels with twin gestation/

Back 8

they are elevated

Front 9

What is a PE finding that would be a clue toward twin gestation?

Back 9

fundal height larger than expected

Front 10

Obviously, they would want to r/o other causes of high AFP like NTDS, IUFD, cystic hygroma, abdominal wall defects etc.

Back 10

ok

Front 11

What is the twin infant death rate compared to singleton rate?

Back 11

it's about twice as high

Front 12

What is the big risk for untreated twin to twin transfusion syndrome?

Back 12

neuroloogic sequellae

Front 13

The perinatal mortality rate for untreated TTTS is 70 to 100%

Back 13

Either twin can die in utero

Front 14

The recipient twin receives excessive volume resulting in cardiomegaly, tricuspid regurg, ventricular hypertrophy, and hydrops

Back 14

the donor twin gets anemia, hypovolemic, and retarded growth

Front 15

Either twin can develop hydrops

Back 15

ok

Front 16

What is the most concerning complication related to triplets?

Back 16

preterm birth- it occrus in over 90% of triplet pregnancies

Front 17

Pre-eclampsia, IUGR, Preterm birth, Gestational diabetes, and abnormal placentation can al occur with multi-gestation

Back 17

but preterm birth is the most dangerous

Front 18

so what is actually the biggest risk of preterm birth?

Back 18

RDS

Front 19

But also

Back 19

CP
intracranial hemorrhage
blindness
LBW

Front 20

IUFD
IUGR
pre-eclampsia
SAB
congenital anomalies

Back 20

all more common with multi gestation

Front 21

Is TtTS more common in di or monozygotic twins?

Back 21

monozygotic, monochorionic twins!

Front 22

Mono dichorionic are not

Back 22

at risk

Front 23

The recipient twin is larger and surrounded by polyhydramnios.

Back 23

The donor twin is small, surrounded by oligohydramnios

Front 24

Are fraternal twins at risk for transfusion syndrome

Back 24

no

Front 25

To have a dichorionic monozygotic twinning, when does the zygote have to split?

Back 25

within 3 days of fertilization- at the morula stage

Front 26

If the zygote divides at 4 to 8 days post fertilization, then you have monochorionic

Back 26

If you divide between 8 and 12 days you can get a monoamniotic monochorionic placenta

Front 27

If you divide after 13 days

Back 27

you get conjioned twins

Front 28

What is superfecudation?

Back 28

it's when sperm fertilize two different eggs from one cycle but they occur at different times of intercourse

Front 29

Prematurity is a major cause for M&M in twin gestations, but

Back 29

intervention to prevent prematurity has been largely unsuccessful

Front 30

What is one factor however that has been demonstrated to help prevent preterm/

Back 30

good early weight gain (like within the first 20 weeks()

Front 31

Bed rest on the other hand

Back 31

has not been shown to reduce premature birth

Front 32

Why do they think that early weight gain is preventive?

Back 32

because it promotes good healthy placental development

Front 33

How much weight should they gain?

Back 33

at least 24 lb

Front 34

Tocolytics was a good idea but have not been shown to help actually

Back 34

ok

Front 35

What has been the cause of increasing multi-gestations in recent hx?

Back 35

assisted reproductive technology

Front 36

Is IVF more likely to result in multiple gestation in younger or older women?

Back 36

young

Front 37

Also, Clomid and other ovulation inducers increase the incidence of multiple gestation

Back 37

Also elevated FSH corresponds with higher multi gestation births as well