Multifetal Gestation and Malpresentation

Question 1

What is the avg age of delivery for twins, triplets, and quads

Answer 1

Twins = 35 wks
Triplets = 32 wks
Quads = 30 wks

Question 2

How are Fraternal twins formed

Answer 2

2 ova and 2 sperm (Dizygotic)

Question 3

What factors influence incidence of dizygotic twins

Answer 3

Maternal age (2x increase > 35 yo)
FH
Ethnicity

Question 4

What sign will Dizygotic twins show on US

Answer 4

“Peak” or “Inverted V”

Question 5

B/w what days do dichorionic diamniotic twins cleave

Answer 5

0-3 days

Question 6

B/w what days do monochorionic diamniotic twins cleave

Answer 6

4-8 days

Question 7

B/w what days do monochorionic monoamniotic twins cleave

Answer 7

9-12 days

Question 8

After what day do conjoined twins cleave

Answer 8

> 13 days

Question 9

Which type of monozygotic twinning is most common and which is most dangerous

Answer 9

Common = Monochorionic Diamniotic
Dangerous = Monochorionic Monochorionic

Question 10

How do ACARDIAC twins form

Answer 10

Arterial-Arterial malformations causing one twin to be transfused in reverse direction

Question 11

What would an ACARDIAC twin look like

Answer 11

Developed LE’s but no ab or cephalic structures

Question 12

Def = umbilical cord attaches at a site distant form the placenta

Answer 12

Velamentous umbilical cord

Question 13

If one twin fetus dies at < 12 wks gestation, what happens to it

Answer 13

Gets reabsorbed (vanishing twin)

Question 14

If one twin fetus dies at > 20 wks gestation, what happens to it

Answer 14

Is retained in the uterus

Question 15

If one twin fetus dies b/w 12-20 wks gestation, what happens to it

Answer 15

Becomes Fetus Papyraceus

Question 16

How often are prenatal visits for the 1st/2nd trimesters during twin pregnancies

Answer 16

Visits q 2 wks

Question 17

At what point in the twin pregnancy does the mother get put on bed rest

Answer 17

3rd trimester

Question 18

At what gestational age are monoamniotic twins delivered

Answer 18

32 wks

Question 19

Def = any presentation other than vertex

Answer 19

Malpresentation

Question 20

What are the criteria needed to allow a breech delivery

Answer 20

> 37 wks 
Frank/Complete
B/w 2500-4000g
Head flexed
Adequate maternal pelvis

Question 21

Who are candidates for external cephalic version

Answer 21

Pts > 36 wks not in labor

Question 22

When is it ok to deliver a baby in the “face” presentation

Answer 22

If the head is fully extended and the mentum is anterior