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ENRP > Twins and Malpresentation > Flashcards

Twins and Malpresentation Flashcards

1
Q

What is Multiple Gestation?

A

Any pregnancy where the uterus is occupied by 2+ fetus/embryos

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2
Q

What has increased the incidence of multiple gestation?

A

Assisted reproductive technology

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3
Q

What are the risks for having Dizygotic (fraternal) Twins?

A
  • Family history

- Maternal age > 35

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4
Q

What are the risks for having Monozygotic (identical) Twins?

A

Frequency is constant across all populations

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5
Q

Dizygotic (fraternal) Twins

A

2 ova are fertilized by 2 separate sperm

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6
Q

How will the setup be in the uterus for Dizygotic (fraternal) twins?

A

Dichorionic Diamnionic

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7
Q

Monozygotic (identical) Twins

A

Cleavage of 1 ova that was fertilized by 1 sperm

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8
Q

What does the setup in the uterus depend on for Monozygotic Twins?

A

The time at which cleavage (separation) occurs

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9
Q

If Monozygotic twins split between 0-3 days, what is the setup?

A

Dichorionic Diamnionic

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10
Q

If Monozygotic twins split between 4-8 days, what is the setup?

A

Monochorionic Diamnionic

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11
Q

If Monozygotic twins split between 9-12 days, what is the setup?

A

Monochorionic Monoamnionic

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12
Q

If Monozygotic twins split after 13 days, what is the setup?

A

Conjoined twins

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13
Q

What is the most common setup in the uterus for Monozygotic (identical) twins?

A

Monochorionic Diamnionic (split at 4-8 days)

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14
Q

What is the most dangerous setup for Monozygotic twins and why?

A 
Monochorionic Monoamnionic (split between 9-12 days)
=> risk of cord entanglement
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15
Q

If Conjoined Twins are present, where are the usually attached?

A

(>13 day split)

- Joined at chest wall (thoracopagus)

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16
Q

Why is it important to determine Zygosity?

A

Major factor for prognosis and morbidity of twins

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17
Q

Which Zygosity is at the highest risk for issues and abnormalities?

A

Monozygotic Twins

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18
Q

How do you determine Zygosity?

A

Ultrasound

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19
Q

How do you determine Zygosity?

A

Ultrasound

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20
Q

What will be seen on ultrasound with Dizygotic Twins?

A
  • 2 genders maybe

- Thick amnion-chorion septum with a peak/inverted V at base

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21
Q

If you see a thick amnion-chorion septum with a peak/inverted V at the base, what zygosity are the twins?

A

Dizygotic (fraternal)

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22
Q

What will be seen on ultrasound with Monozygotic Twins?

A

THIN dividing membrane

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23
Q

If you see a thin dividing membrane on ultrasound, what zygosity are the twins?

A

Monozygotic (identical)

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24
Q

If ultrasound is unable to determine zygosity of the twins, what are 2 other ways?

A

DNA analysis

Inspection of the placenta after delivery

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25
Q

Twin Twin Transfusion Syndrome is an abnormality seen with Identical twins. How does it occur?

A

Arteriovenous malformation deep in monochorionic placenta

=> net transfer of blood flowing from 1 twin to the other

26
Q

Donor twin attributes with TTTS

A

Hypovolemia
Hypotension
Anemia
Decreased growth

27
Q

Recipient twin attributes with TTTS

A 
Hypervolemia
Hypertension
Polycythemia
Polyhydramnios
Edema
28
Q

What are BOTH twins at risk for with TTTS?

A

Demise due to heart failure

29
Q

What will the donor twin look like on ultrasound with TTTS?

A

Small and oligohydramnios

30
Q

What will the recipient twin look like on ultrasound with TTTS?

A

Polyhydramnios and large

31
Q

How do you treat TTTS?

A

Laser photocoagulation of anastomosing vessels

32
Q

Acardiac twin is an abnormality that can be seen with Identical twins. How does it arise?

A

Arterial to Arterial anastomoses

=> Arterial blood from one twin enters arterial circulation of other twin

33
Q

Which twin is the Acardiac twin?

A

Recipient twin

– receives blood from other twins artery

34
Q

The Acardiac twin is perfused with poorly oxygenated blood and fails to develop. How will it present?

A

Fully formed LE

NO structures above the abdomen

35
Q

With Retained Dead Fetus Syndrome, it involves single fetal death. What occurs if gestation is before and after 12 weeks gestation respectively?

A

< 12 weeks = dead fetus resorbed = “vanishing twin syndrome”

> 12 weeks = dead fetus flattened and shrinks = “fetus papyraceus”

36
Q

When should Monoamniotic Twins delivery and why?

A

32 weeks

– cord entanglement risk

37
Q

A Majority of twins delivery around 35/36 weeks. When should you recommend they are delivered by?

A

38 weeks

38
Q

What is the best and normal presentation for delivery of twins?

A

Vertex - Vertex

39
Q

What is the most favorable presentation of twins for vaginal delivery?

A

Vertex - Vertex

40
Q

Which 2 presentations for twins can potentially be delivered by vaginal or C-section?

A

Vertex - Transverse

Vertex - Breech

41
Q

Which 2 presentations for twins can NOT be delivered vaginally and must be delivered by C-section?

A

Breech - Vertex

Breech - Breech

42
Q

What is Fetal Malpresentation?

A

Any fetal position other than Vertex!

43
Q

What is the most common fetal malpresentation?

A

Breech

44
Q

Frank Breech

A

Hips are flexed and knees extended up

– most common

45
Q

Complete Breech

A

Hips are flexed and knees are flexed

46
Q

Incomplete Breech

A

1 or both hips are extended with 1 or both feet below butt

47
Q

Breech occurs with the fetal butt or LE presents into the maternal pelvis. What is a major associated factor?

A

Prematurity

48
Q

With a breeched baby, what can you try at 36 weeks if there are no contraindications?

A

ECV

= External Cephalic Version

49
Q

What is External Cephalic Version?

A

With a breeched baby, apply pressure to mom’s abdomen to turn the fetus to achieve Vertex position

50
Q

What are 2 contraindications for performing External Cephalic Version?

A

Placenta Previa

Non-reassuring fetal monitoring

51
Q

What is the most common delivery option for a breeched baby? What can you do but is risky?

A

Usually = C-section

– Vaginal delivery is possible but risky

52
Q

In order to do a vaginal delivery of a breeched baby, it must be frank/complete and head flexed. Describe the steps.

A
  • Delivery to scapulae
  • ER of each thigh with pelvis rotation to delivery legs
  • Push arms to chest to deliver arms
  • Maintain head flexion with pressure on fetal MAXILLA
53
Q

Where should you maintain pressure on the fetus with a breeched vaginally delivery to ensure head flexion? What forceps can be used?

A

Pressure on the maxilla

– Piper forceps can be used for head flexion

54
Q

Brow Malpresentation

A

Presenting part is between facial orbits and anterior fontanelle

55
Q

Face Malpresentation

A

Extension of neck and head to where baby’s occiput is against upper back

56
Q

With Face Malpresentation, when can you deliver vaginally?

A

Mentum (chin) ANTERIOR

57
Q

Compound Malpresentation

A

Fetal extremity is prolapsed alongside presenting fetal head

58
Q

Fetal extremity is prolapsed alongside presenting fetal part, usually the head

A

Compound Malpresentation

59
Q

How should most Malpresentations be delivered?

A

C-section

60
Q

How should you delivery a Face Malpresentation with Mentum Posterior?

A

C-section

ENRP (45 decks)

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