CHAPTER 48: MULTIFETAL PREGNANCY

Question 1

Multifetal pregnancy results from?

Answer 1

1. 2 or more fertilization events
2. Single fertilization followed by splitting of the zygote
3. Noth

Question 2

Problems encountered by the mother when having multiple gestation

Answer 2

High rate of mortality and morbidity
Risk for pre-eclampsia
Postpartum hemorrhage
Maternal death

Question 3

Problems encountered by the fetus in multifetal gestation

Answer 3

High mortality rate
Increased rate of very low birthweight
Congenital malformation
Preterm birth

Question 4

What do you call when during a multifetal pregnancy, one or more fetuses may die simultaneously or sequentially

Answer 4

Fetal demise

Question 5

What do you call a twin that dies early

Answer 5

Vanishing twin

Question 6

Does the survivor twin has increases risk of death after the first trimester and requires additional surveillance?

Answer 6

No

Question 7

What do you call when the dead fetus compressed appreciably

Answer 7

Fetus compressus

Question 8

What do you call a dead fetus that is flattened remarkably through desiccation

Answer 8

Fetus papyraceus

Question 9

The neurological prognosis for the surviving co twin is greatly influenced by:

Answer 9

Chorionicity

Question 10

What is recommended weight gain for women with twins according to Institute of Medicine

Answer 10

37 to 54 lb weight gain

Question 11

What is the daily recommended augmented caloric intake for women with twins?

Answer 11

40 to 45 kcal/kg/d

Question 12

What is given to women at high risk for preeclampsia

Answer 12

Low dose aspirin prophylaxis 81 mg oral daily dose initiated between 12 and 28 weeks of gestation

Question 13

What to use in screening structural anomalies and when it is usually done

Answer 13

Mid pregnancy using a anatomic sonography survey

Question 14

How to assess the amniotic fluid volume

Answer 14

Using a quantified deepest vertical pocket

Question 15

Oligohydramnios is considered when?

Answer 15

A measurement of <2 cm

Question 16

Hydramnios is considered when

Answer 16

A measurement of >8 cm

Question 17

Factors that could influenced preterm birth

Answer 17

Prior preterm birth
Adolescence
Obesity
Diabetes
Nulliparity

Question 18

Cervical length that is accurate in predicting birth before 34 weeks gestation

Answer 18

<20 mm

Question 19

Other name for dizygotic twins

Answer 19

Fraternal twins

Question 20

Other name for monozygotic twin

Answer 20

Identical twin

Question 21

Twins of the opposite sex is always dizygotic

Answer 21

Yes

Question 22

Monozygotic twins does not have the equal sharing of protoplasmic material

Answer 22

Yes

Question 23

Outcome of monozygotic twinning when zygotes divide within 72 hours after fertilization

Answer 23

Two embryos
Two amnions
Two chorions
Monozygotic dichrionic diamnionic

Question 24

Outcome of monozygotic twinning when division occurs between 4 to 8 days

Answer 24

Monozygotic monochrionic diamnionic twin pregnancy

Question 25

Outcome of monozygotic twinning when division occurs at day 8

Answer 25

Monozygotic monochorionic monoamnionic

Question 26

Outcome of monozygotic twinning when division occurs at later than 8 days

Answer 26

Conjoined twins

Question 27

Factors that affect twinninh

Answer 27

Infertility treatment Maternal age Race Heredity Size

Question 28

What infertility treatment is most commonly associated with twinning

Answer 28

Ovulation induction with clomiphene citrate or with follicle stimulating hormone plus human chorionic gonadotrophin

Question 29

Why is advancing maternal age and delayed childbearing increases the risk for twinning

Answer 29

FSH levels rise with age and lead to greater ovarian stimulation

Question 30

Heredity, which side has most affect

Answer 30

Maternal

Question 31

Maternal size is another risk factor which includes the

Answer 31

Taller and heavier woman

Question 32

What is superfecundation

Answer 32

Fertilization of two ova within the same menstrual cycle but not in the same coitus nor necessarily by the sperm from the samke make

Question 33

Superfecundation leads to

Answer 33

Heteropaternity

Question 34

What is superfetation

Answer 34

When a second pregnancy occurs during an initial pregnancy

Question 35

What is used to diagnose a multifetal gestation

Answer 35

Accurate fundal height Palpation of two fetal heads Doppler may detect two fetal heartbeats distinct from each other and from the mother

Question 36

Twin gestation is not diagnosed until

Answer 36

26 weeks gestation

Question 37

Dizygotic is also known as

Answer 37

Double ovum- fraternal twins

Question 38

What weeks we will able to detect the chrorionicity of the pregnancy

Answer 38

24 weeks

Question 39

What are the sonographic features to assess the chorionicity

Answer 39

Number of placenta masses= 2 separate placenta suggests dichorionicity Presence of intervening membrane=>2mm supports presumed diagnosis of dichorionicity while <2mm supports monochorionic Thickness of the membrane= seen in second trimester Fetal gender

Question 40

What do you call the twin peak sign that appears as triangular projection of placental tissue

Answer 40

Lambda or delta

Question 41

What do you call the sign between membrane and placenta without apparent extension of placenta between the dividing membrane

Answer 41

T sign

Question 42

Why are radiographs limited in diagnosing twins

Answer 42

Limited especially when the twins move

Question 43

Are there biochemical test that identifies multifetal gestations

Answer 43

No