Multiple Gestation

Question 1

Incidence of multiple gestation is ?

Answer 1

3% and it continues to increase due to fertility treatment

Question 2

Risk for multiple gestation pregnancy is ?

Answer 2

Increase the maternal complication 2 folds
Increase neonatal morbidity and mortality

Question 3

The rate of triplites and quadruplet reduced due to ?

Answer 3

Limit in the transferred embryo number

Question 4

Fetal complication of multiple gestation ?

Answer 4

-prematurity
-growth restriction
-monochorionicity
-still birth
-sever handicaps

Question 5

Mean duration of pregnancy in twin /triplets and quadreplets?

Answer 5

Twin 35
Triples 32
Quad 29

Question 6

The maternal complication of multiple gestation ?

Answer 6

-hypertension
-placental abruption
-preeclampsia
-anemia
Help syndrome
-premature rapture of membrane

Question 7

Difference between dizygotic and monozygotic ?

Answer 7

-fertilization f two separate ovam -di
-fertalization for single ovum that separate into 2separate individual -mono

Question 8

Dizygotic end to have di chorionic di amniotic

Answer 8

Okay 👍

Question 9

In monozygotic twin time of separation decided the placentation ?

Answer 9

1- Diamniotic di chorionic - if separation appears with in 3 days of fertilization
2- mono chorionic mono amniotic if division happened with in 8-12 days
3- diamniotic mono chorionic between 4-8days.

Question 10

Factor influencing the incidence of dizygotic twins ?

Answer 10

Use of fertility drugs
Maternal age
Race

Question 11

Sign and symptoms of multiple gestation ?

Answer 11

Rapid uterine growth
Excessive weight gain
Abdominal palpation of excessive number of fetal parts
Ausculatation of two separate fatal heart b 0 beats different

Question 12

All women with a twin pregnancy should offered an ultra sound examination at week 10-13 to assess ?

Answer 12

Viability ,chorionocity ,nucal translucency

Question 13

Visulaization of multiple gestational sac by week ?

Answer 13

5 week

Question 14

Visualization of multiple fetal heart at week ?

Answer 14

6 weeks

Question 15

What suggest dichorinocity o ultrasound at week 8 ?

Answer 15

• Clearly separated gestational sac
  -each surrounded with thick echogenic ring

Question 16

What is lambda sign ?

Answer 16

Triangular projection of placenta between layers of deviding membrane suggest di chorionic twins 👯‍♀️

Question 17

T sign is

Answer 17

Appearance of thin inter-twin membrane forming 90 degree with the placenta that indicate mono chorionic twins

Question 18

The most accurate method to assess fetal growth in multiple gestation is ?

Answer 18

Ultrasound its accurate until week 30-32 of gestation

Question 19

When the growth discordance is considered abnormal ?

Answer 19

Greater than 20%

Question 20

The antenatal diagnostic list to avoid the preterm delivery in multiple gestation ?

Answer 20

Cervical length at week 16-24 should be more than 2 cm

Question 21

So the anterpartum management include

Answer 21

-cervical length at week 16
- us to assess growth and complication

Question 22

Risk of preterm delivery at twins and triplets

Answer 22

Twins -50%
Triplets 75%
Specially when the the cervical length is less than 20 mm(10 folds for preterm labor at week 32 )

Question 23

Interventions to prevent preterm labor and prolong delivery in multiple gestation ?

Answer 23

Prophylactic cervical cerclage
Progesterone
Tocolytics
Bed rest

Question 24

The serial fetal surveillance (sonograpic assessment ) should start at

Answer 24

• Week 18 every 3 to 4 weeks in dc or every 2 weeks if there’s a complication
  -week 16 in mono every week

Question 25

Fetal sonography assessment includes?

Answer 25

Biophysical profile
Non stress test
Doppler velocimetry (umbilical artery )

Question 26

Tim of delivery

Answer 26

Uncomplicated dichorionic -37-38
Uncomplicated mono chorionic di amniotic 36-37
Mono amniotic -32

Question 27

The fetal heart for monitoring the twins should be done by ?

Answer 27

Scalp electrode for the first one
External monitor for the second one

Question 28

Intrapartum manegment includes ?

Answer 28

-continuous heart monitoring
-epidural
-continues us

Question 29

When the cesarean delivery is recommended ?

Answer 29

When the the second twin is larger than the first
When the first twin is non vertex

Question 30

When the vertex non vertex twins are allowed to have vaginal delivery chance ?

Answer 30

If the second is breech

Question 31

The most common delivery complication in the monoamniotic twin is ?

Answer 31

Cord entanglement

Question 32

What is twin to twin syndrome ?