Multifetal Gestation and Malpresentation

Question 1

What happens to average gestational age of the baby as you increase the number of babies gestating at once

Answer 1

it goes down

Question 2

what is a dizygotic twin

Answer 2

two separate eggs fertilized by separate sperm

-each will have own amnion, chorion, and placenta

Question 3

What is the nature of the membranes of a cleavage of 0-3 days of the embryo

Answer 3

Dichorionic, Diamniotic

Question 4

What is the nature of the membranes of a cleavage of 4-8 days of the embryo

Answer 4

monochorionic, diamniotic

Question 5

What is the nature of the membranes of a cleavage of 9-12 days of the embryo

Answer 5

monochorionic, monoamniotic

Question 6

what is the nature of the membranes of a cleavage of >13 days of the embryo

Answer 6

conjoined twins

Question 7

What is the most common monozygotic placentation

Answer 7

Monochorionic, diamniotic

4-8 day cleavage

Question 8

What complication arises from two fetuses sharing an amnion and chorion?

Answer 8

there is no separation so chord and limb entanglements can occur

net mortality 50-80%

Question 9

Where are most conjoined twins conjoined at and what is it called

Answer 9

conjoined at chest wall

called thoracopagus

Question 10

you open up a refugee clinic that takes in western nigerian women 22 of whom are pregnant. how many would you expect to have dizygotic twinning

Answer 10

1

point of this… certain cultures have higher incidence of twinning

low in asians, high in blacks

Question 11

you congratulate the mother on her new twins, what is the next step in the care of the children

Answer 11

determine zygosity

Question 12

On ultrasound of newly found twins, you note that the fetal sexes are different, thick amnion-chorion septum, and inverted V sign at the base of the septum. what is the likely zygosity

Answer 12

dizygotic

all those signs are good indicators

Question 13

what is the most common type of interplacental vascular anastomoses in monochorionic twins

Answer 13

arterial-arterial

followed by arterial-venous, venous-venous

Question 14

What is the symptom profile of the donor twin in Twin Twin Transfusion Syndrome

Answer 14

Smaller
Stuck (oligohydramnios)
hypovolemia and anemia

the recipient twin is the opposite and think polycythemia vera

Question 15

what happens to induce an acardiac twin?

Answer 15

venous return of blood from the recipient twin to the donor twin results in deoxygenated blood hindering development. Fully formed LE without torso.

Question 16

if the mother is post 20 wks gestation what complications can arise from a retained dead fetus

Answer 16

DIC

Dead fetus syndrome

Question 17

What happens to a dead fetus before 12 weeks and after 12 weeks gestation

Answer 17

before 12 weeks - twin resorbed

after 12 weeks - fetus papyraceus

Question 18

what is the perinatal mortality rate of twins compared to singletons

Answer 18

5X greater

and 2nd twin is even worse off

Question 19

What predisposed twins to higher perinatal injury compared to singleton counterparts

Answer 19

small size and lack of development

Question 20

How do you diagnoses breech presentation

Answer 20

Leopold’s maneuver, US and pelvic exams

Question 21

what is breech presentation

Answer 21

fetal buttocks or LE present into maternal pelvis

Question 22

What is the most common breech presentation

Answer 22

Frank

Looks like a fucking cannonball

Question 23

What is

external cephalic version

Answer 23

manipulation of the fetus to get it facing the right way

Question 24

What are contraindications to external cephalic version

Answer 24

Placenta previa
oligohydramnios
unable to deliver vaginally

Question 25

should you deliver a breech baby vaginally

Answer 25

probably fucking not!!!

I would look over criteria on slide 43 but he says standard of care is C-section

Question 26

what is brow presentation

Answer 26

when presenting part of fetus is between facial orbits

50-75% will resolve and deliver vertex

Question 27

Can you deliver face presentation?

Answer 27

No

seen frequently with fetal malformations (anencephaly)

Question 28

What is a compound presentation

Answer 28

when an extremity is presenting with the head most commonly the arm