Multiple gestation

Question 1

3 reasons for increased global rates of multiple gestation

Answer 1

Assisted fertility
Advanced maternal age
Maternal family history

Question 2

Classification of multiple gestation x4

Answer 2

Number of fetuses
Number of eggs fertilized
Number of placentas
Number of amniotic cavities

Question 3

Define bipaternization

Answer 3

2 eggs released during ovulation but fertilized at different times during two or more acts of sexual intercourse

Question 4

Cleavage at morula stage before trophoblast differentiation results in which type of twins

Answer 4

Dichorionic diamniotic

Question 5

Cleavage at blastocyst stage before amnion formation results in which type of twins

Answer 5

Monochorionic diamniotic

Question 6

Cleavage after amnion formation, at implant stage results in which type of twins

Answer 6

Monochorionic monoamniotic

Question 7

Cleavage after formed embryonic disc results in which type of twins

Answer 7

Conjoined twins

Question 8

Biological risk factors of multiple gestation x4

Answer 8

Previous multiple gestation
Advanced maternal age
Family history
African american race

Question 9

Artificial risk factors of multiple gestation x2

Answer 9

Ovulation stimulating medicines
Assisted reproductive technologies

Question 10

Importance of USS in multiple gestation x5

Answer 10

1. Diagnose number of multiples, chorionicity and amniocity
2. Nuchal translucency test
3. Early growth discordance
4. Early grading and treatment of TTTS
5. Detection of malformations
6. Detect position of multiples

Question 11

Describe nuchal translucency test

Answer 11

Measures thickness of amniotic fluid build up behind the nuchal fold
Rules out conditions such as Down’s syndrome

Question 12

6 maternal complication of multiple gestation

Answer 12

Anemia
APH, PPH
HTN disorders
Hyperemesis gravidarum
Preterm labor
Prolonged labor

Question 13

Fetal complications of multiple gestation x7

Answer 13

IUGR
TTTS
Hydrops fetalis
Prematurity
Conjoined twins
Vanishing twins
Cord entanglement

Question 14

Feature of donor in TTTS x3

Answer 14

Oligohydramnios
Anemia
IUGR

Question 15

Feature of recipient in TTTS x5

Answer 15

Polyhydramnios
Polycythemia
Pulmonary edema
Cardiomegaly
Hydrops fetalis

Question 16

Management of TTTS x5

Answer 16

Expectant management
Amnioreduction
Selective feticide
Preterm delivery
Septostomy

Question 17

Which type of twins is at a risk of TTTS

Answer 17

Monochorionic diamniotic

Question 18

2 USS signs for twins and their meaning

Answer 18

Lambda- dichorionic diamniotic
T sign- monochorionic diamniotic

Question 19

Clomiphene increases risk of wwhich type of twins

Answer 19

Dichorionic diamniotic

Question 20

Management of TTTS x2

Answer 20

1. Vessel coagulation
2. Amnioreduction to prevent uterine distennsion and prevent contractions which can cause preterm labour

Question 21

How to monitor for TTTS in Mo-Di twins

Answer 21

Serial USS every 2 weeks to measure amniotic fluid and fetal growth

Question 22

Pathophysiology of TTTs

Answer 22

Abundance of unidirectional arteriovenous connections
Inadequate bidirectional arterio-arterial and veno-venous connections or shunts

Question 23

Clinical features of the twins in TTTS x5 each

Answer 23

A- small, hypovolemia, oligohydramnios, anemic
B- large, polyhydramnios, plethoric, polycythemic, cardiomegaly, edema, ascites

Question 24

Discordant twins

Answer 24

Difference of EFW of >=20%