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24 Cards in this Set
- Front
- Back
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What are dizygotic twins?
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Fraternal gestations-
– Twin fetuses resulting from the fertilization of two separate ova – Each has own amnion, chorion, and placenta |
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What are monozygotic twins?
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Monozygotic or Identical Gestations
– Twins arising from a single fertilized ovum that divides into two identical structures |
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Rx factors for dizogotic twins?
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– Race
– Maternal Age (>35 y/o) – Assisted Reproductive Technology – Fertility Drugs In nigeria 1:22 incidence |
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Depending on the time of the cleavage... name the nature of membranes? (For monozygotic twins)
a. 0-72 hrs b. 4-8 days c. 9-12 days d. >13 days |
a. dichorionic, diamniotic
b. monochorionic, diamniotic (MC type) c. monochorionic, monoamniotic d. conjoined twins |
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What are the increased incidence of probs associated with monozygotic twins?
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– Structural malformations
–Discordance – Fetal loss from cord entanglement – Fetal Demise – Twin-Twin Transfusion Syndrome (TTTS) |
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What are diamniotic monochorionic twins?
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Two emboryons develop, each having their own amniotic sacs the sacs are covered by a common chorion
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What are the monoamniotic monochorionic twins?
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two embryos within a common amniotic sac
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Which conjoined type of twins if most common?
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Thoracopagus (joined by chest wall and sometimes the heart— 35-40% incidence)
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Conjoined twins by the following...
a. joined at buttocks b. joined by chest wall c. joined by coccyx and sacrum d. joined by cranium |
a. Craniopagus
b. pyopagus c. thoracopagus d. ischiopagus |
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Maternal complaints related to twins?
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• Excessive weight gain
• Hyperemesis gravidarum (N/V of pregnancy aka “morning sickness” that results in dehydration and potential electrolyte abnormalities) • Sensation of more than one moving fetus |
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Strong clues that someone will have twins
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• Administration of Clomiphene Citrate or Gonadotropins
• Pregnancy accomplished by Assisted Reproductive Technology |
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Dx of twins?
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HCG higher than normal
- uterine size larger for gestational age - confirmed by u/s |
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Maternal complications of twins?
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• Miscarriage
• Urinary Tract Infection (UTI) • Hypertension and organ damage (preeclampsia) • Hemorrhage • Abdominal Delivery • Polyhydramnios • Placenta Abruption or Placenta Previa • Uterine Atony |
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What is twin discordance/IUGR?
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20% difference in the weight divided by the weight of the larger fetus
- 75% concordant - 20% are 15-25% discordant 5% are more than 25% discordant |
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Slides 22-26
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yep
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Tx of TTTS?
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lasering of the anastomosis
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Baby A vs. B? in twins?
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A is closest to the cervix
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When do a majority of multifetal pregnancies deliver?
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36 weeks
- beyond 38 wks are considered postdates and labor induction should be considered |
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What is normal set up for twins if one is breach position?
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Double set-up... usually 2 OB's and anesthesiologist
- NICU or appropriate pediatric care in room |
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What are the absolute indications for c-section with twins?
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- Monoamniotic twins
– Conjoined twins – Footling Breech – Abnormal placenta location (previa) |
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Relative indications for C-section delivery in twins
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– Frank breech
– Non-reassuring fetal status – Fetal discordance greater than 20% |
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MCC of higher order gestations?
Average wks of delivery of trips, quads? |
iatrogenic use of ovulation induction agents
- triplets average 33 wks and quads average 29 wks |
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dx of breech presentation
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-leopold maneuver
- vaginal exam - sonogram |
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Different types of breech...
a. frank b. incomplete |
a. legs up easy to change diaper... the baby's bottom comes first, and his or her legs are flexed at the hip and extended at the knees (with feet near the ears). 65-70% of breech babies are in the frank breech position.
b. criss cross applesauce, w/ one leg down one up c. |
