Uncomplicated pregnancy L2 Flashcards
(217 cards)
1
Q
what basic changes occur in the uterus during pregnancy?
A
1) uterine vascularity increases; BVs dilate
2) hyperplasia
3) hypertrophy
4) development of decidua
2
Q
hyperplasia
A
new muscle fibers/tissue
3
Q
hypertrophy
A
enlargement of existing muscle fibers
4
Q
decidua
A
thick layer of mucus membrane that lines the uterus during pregnancy and is shed after birth
5
Q
what is the fundus?
A
the top of the uterus
6
Q
describe changes in fundal height that occur throughout pregnancy
A
12 weeks: @ symphysis pubis
16 weeks: between symphysis pubis and umbilicus
20 weeks: @ umbillicus
36 weeks: @ xiphoid process
7
Q
what is nullipara?
A
a woman who has never given birth
8
Q
what is multipara?
A
a woman who has given birth before
9
Q
when does the uterus drop down into the pelvis?
A
nullipara - 2 weeks before the onset of labor
multipara - @ the start of labor
10
Q
ballottement
A
a technique of palpating a floating structure (fetus and amniotic sac) by bouncing it gently and feeling it rebound.
* can be done at between 16 and 18 weeks
11
Q
what happens to the center of gravity of the uterus during pregnancy?
A
center of gravity is altered: uterus enlarges and tilts against the anterior abdominal wall
12
Q
what are Braxton Hicks contractions?
A
“practice contractions” that facilitate an increase in blood flow to the uterus
* they can be felt at about 16 weeks and will last until real labor begins
13
Q
how does a fetus get O2?
A
O2 is extracted from maternal blood to oxygenate fetus and increases as pregnancy progresses
14
Q
endovascular trophoblasts
A
cells that invade and modify uterine spiral arteries
* increase blood flow to placenta
15
Q
how do endovascular trophoblasts increase blood flow to placenta?
A
they dilate and uncurl uterine spiral arteries reducing resistance and increasing blood flow
16
Q
what does additional blood flow to the placenta do?
A
increases gas exchange and the amount of nutrients to the placenta and fetus
17
Q
what are changes that occur with the cervix during pregnancy?
A
1) Hegar’s sign
2) Chadwick’s sign
3) friability
4) operculum “mucus plug”
18
Q
Hegar’s sign
A
softening of the lower uterine segment that occurs at about 6 weeks of pregnancy
19
Q
Chadwick’s sign
A
bluish color to cervix, vagina, and labia that occurs at about 8 weeks and results from increased blood flow
20
Q
describe friability of the cervix during pregnancy
A
tissue easily damaged and can lead to bleeding after intercourse
21
Q
describe operculum “mucus plug” that forms during pregnancy
A
forms to protect the intrauterine environment
22
Q
what changes occur with the vagina during pregnancy?
A
1) increased vaginal discharge - leukorrhea
2) changes in vaginal pH
3) increased vascularity
23
Q
what can changes in the pH of vaginal secretions that occur due to pregnancy increase the risk of?
A
lower, acidic pH can increase the risk of yeast infections
24
Q
leukorrhea
A
thick white vaginal discharge
25
what can increased vascularity of the vagina cause?
* changes in arousal
* edema to area
* varicosities later in pregnancy
26
what changes to the breasts does increased estrogen and progesterone cause?
* increased sensitivity of breasts and nipples
* feeling of firmness, heaviness, and nipples become erect
* nipples and areola become more pigmented
27
describe the changes that increased blood flow to the breasts causes
* vessels below skin dilate
* lactogenesis stage 1 completes @ about 16 weeks
28
describe what occurs in lactogenesis stage 1
* may leak colostrum
* lactation is inhibited by high levels of progesterone
29
TAB
therapeutic abortion
30
SAB
spontaneous abortion
31
pregnancy causes these changes associated with the CV system:
1) heart itself
2) CO
3) pulse rate
4) blood volume
5) blood composition
6) BP
32
what happens to the heart itself during pregnancy?
1) slight hypertrophy due to increased blood flow
2) position changes due to changes in diaphragm position
3) transient murmurs may be auscultated
33
changes in CO related to pregnancy:
CO increased by 30-50% by week 32 due to increased SV and heart rate
34
changes in BV related to pregnancy:
* plasma volume increases 40-50% (1500mL)
plasma - 1000mL
RBC - 450mL
35
physiologic anemia - hemodilution of cells
blood plasma increases at a faster rate than RBCs which causes a dilution of blood and reduced ability for blood to carry gasses
36
changes in blood composition due to pregnancy
* circulation time decreases by week 32
* increase in WBCs
* Virchow's triangle: increased venous stasis, increased coagulability factors, and increased endothelial damage
- increased risk for thrombosis
37
what lab values indicate anemia?
* Hgb under 10g/dl
* Hct under 35%
38
changes in BP throughout pregnancy:
* 1st trimester: no change
* 2nd trimester: is decreased 5-10mmHg
* 3rd trimester: returns to 1st trimester values
* supine hypotensive syndrome can occur
39
supine hypotensive syndrome
when the uterus restricts blood flow in the inferior vena cava causing a drop in BP
* can occur at about 24+ weeks
* CO is reduced 25-30%
* a drop in SBP can be 30mmHg or more and cause reflex bradycardia cutting CO 50%
* pregnant person feels faint and it can cause fetal heart rate decels
40
what position change often causes supine hypotensive syndrome?
when a patient is moved from left lateral to supine
41
changes in the respiratory system related to pregnancy:
1) physiologic changes in rib position
2) respiratory changes
3) O2 requirement
4) upper airway vascularity
5) basal metabolic rate (BMR)
6) acid-base balance
42
what happens to the ribs during pregnancy?
ribs flare out
43
what changes in respiration occur during pregnancy?
* pregnant women switch from abdominal to thoracic breathing
* deeper breathing as a result of progesterone causes increased tidal volume
44
what happens to O2 requirements during pregnancy?
increased oxygen demand
45
describe changes in upper airway vascularity during pregnancy:
* can cause nasal and sinus stuffiness due to **estrogen**
* epistaxis (nose bleeds)
* changes in voice
46
what happens to BMR during pregnancy?
increases by 15-20% at term due to increased O2 demand from increased tissue mass of the uterus and fetal needs
47
describe the changes in acid-base balance in a pregnant woman:
respiratory alkalosis is compensated by metabolic acidosis
* this facilitates maternal-fetal O2-CO2 transfer
48
how much is respiration rate increased during pregnancy?
RR increases 2 breaths per minute and there is an increased awareness to breath
49
why is there a heat intolerance in pregnancy?
increased BMR produces excess heat
50
what causes changes in the renal system?
1) increased estrogen and progesterone
2) increased uterus size
3) increased blood volume
51
what anatomical changes occur in the kidneys during pregnancy?
1) dilation of ureters, pelvises, and renal calyces
2) urine flow rate decreases and leads to stasis/stagnation
3) urethra lengthens
4) bladder is pushed above pelvic brim
52
what functional changes occur in the kidneys during pregnancy?
1) renal plasma flow is increased
2) increased GFR (~50%) (increased creatinine clearance and decreased serum creatinine)
3) reabsorption system easily overstressed by which leads to pooling of fluids
4) protein leakage ~+1
5) tubular reabsorption of sodium is increased
6) tubular reabsorption of glucose is decreased (increased glucose in urine)
53
what can stasis/stagnation in the kidneys cause?
infection. pooled urine can be a medium for bacteria to grow
54
what happens to urinary frequency during pregnancy?
what causes it?
urinary frequency is increased because:
* the enlarged uterus puts pressure on bladder
* bladder sensitivity increases
55
where does the bladder move during pregnancy and when does this occur?
bladder is pulled up into the abdomen in the 2nd trimester
56
what happens to a urethra during pregnancy and what procedure does this affect?
it lengthens due to the repositioning of the bladder.
* need to account for the added length of the urethra while inserting a urinary catheter after epidural placement
57
what position increases perfusion to kidneys and facilitates better electrolyte balance?
left lateral position
58
what happens when a pregnant woman consumes too much sodium?
tubular sodium reabsorption increases to maintain sodium levels. too much sodium can cause the system to become overstressed which leads to edema in legs
59
what effect does pooling fluids in the legs have on the kidneys?
how do you treat it?
* causes less blood flow to the kidneys.
* elevating the legs is preferable over diuretics
60
how much protein leakage into the urine is acceptable during pregnancy?
a slight protein leakage of +1 is acceptable
61
what changes occur to the integumentary system due to pregnancy?
1) hyperpigmentation due to melanotropin release from anterior pituitary
2) stretching
3) vascular changes
4) changes to the hair and nails
62
what occurs due to pregnancy related hyperpigmentation?
1) linea nigra
2) melasma
3) darkening of the nipples, areolas, vulva, and thighs
63
linea nigra
a dark vertical line from the symphysis pubis to the fundus
* starts as linea alba (before pigmentation)
* not present in all pregnant women
64
linea alba
less pigmented vertical line that runs from the symphysis pubis to the fundus (becomes more visible when it becomes pigmented)
65
melasma/chloasma
brownish facial pigmentation that is exacerbated by the sun
* usually fades after pregnancy
66
striae gravidarum
stretch marks
* occur on the abdomen, breasts, and thighs
* occurs due to separation of collagen
* 50-90% of women will have these stretch marks
67
does the mother or the fetus grow the placenta?
the fetus
68
what does the woman's body see the placenta as?
a foreign invader due to fathers genetic material
69
how does the placenta protect itself from the mothers immune system?
before the mothers immune system has a chance to attack, the outer layer of the placenta hides it from the mothers body
70
HCG
a hormone produced by the placenta that causes the lining of the uterus to produce a protein/milk as a snack for the placenta/embryo until a blood supply is obtained
* this is the hormone detected in pregnancy tests
71
how is a blood supply obtained for the placenta?
* the placenta invades the uterine wall with tentacles that absorb blood.
* the uterus toughens to keep them from traveling all the way through
72
whos DNA does the placenta contain?
the offspring its housing
73
when the placenta cant break through the uterus and cant get enough blood what does it do?
the placenta produces a protein that serves as a distraction in another area of the uterus causing immune cells to relocate giving it an opportunity for the placenta to break through to a blood supply
74
human placental lactogen
a hormone secreted by the placenta that causes the nutrients in the mothers blood to remain in the blood giving the placenta the opportunity to absorb nutrients
75
preeclampsia
high BP caused by the placenta forcing the mothers heart to pump more blood
* emergency*
76
what does pregnancy do to the hair and nails?
* excessive hair growth
* accelerated nail growth (hirsutism)
* scalp hair loss is decreased
77
hirsutism
accelerated nail growth
78
what are the vascular changes to the integumentary system associated with pregnancy?
1) spider angiomas
2) palmar erythema
3) increase in perspiration related to increased blood supply
79
spider angiomas
vascular spiders
80
palmar erythema
blotches on hands
81
changes to the musculoskeletal system associated with pregnancy:
1) increased body weight
2) lordosis
3) increased mobility of pelvic joints
4) separation of abdominal muscles
82
lordosis
center of gravity is more forward
83
what causes changes to the mobility of pelvic joints?
what do these changes do to gait?
the ovarian hormone **relaxin** causes relaxation and increased mobility of pelvic joints
* causes mother to have a waddling gait
84
diastasis recti abdominis
persistent separation of the muscles of the abdominal wall
85
NSAIDs and pregnancy
no NSAIDs are allowed during pregnancy because it can cause renal anomolies and premature closure of ductus arteriosis
86
ductus arteriosis
temporary blood vessels that connect the aorta and pulmonary artery to a fetus
87
what are treatments for diastasis recti abdominis?
1) rest
2) ice
3) heat
4) massage/PT
5) tylenol
6) CAM
7) yoga/exercise
88
what are some neurologic system changes that occur in pregnancy?
1) sciatica
2) carpal tunnel syndrome
3) headaches
4) syncope, lightheadedness, faintness
5) muscle cramps
89
sciatica
compression of pelvic nerves
90
what causes carpal tunnel in pregnancy?
edema around peripheral nerves
91
what are Sx of carpal tunnel syndrome?
burning, paresthesia, and pain from hand to elbow
92
what sort of headaches are associated with pregnancy?
migraines and tension headaches
93
describe headaches associated with pregnancy
* migraines - may increase or decrease
* tension headaches - may increase or decrease
94
EDD
estimated delivery date
95
LMP
last menstrual period
96
what phase of pregnancy is syncope common in?
in early stages of pregnancy
97
what are common causes of syncope, lightheadedness, and faintness during pregnancy?
1) hypoglycemia
2) postural hypotension
3) vasomotor instability
98
what are pregnancy related muscle cramps often due to?
hypocalcemia
99
changes in appetite related to pregnancy:
* hunger and cravings
* nausea and vomiting (morning sickness or hyperemesis gravidarum)
* pica
100
pica
craving for non-food material
101
when does morning sickness usually end?
the beginning of the 2nd trimester
102
changes with the mouth related to pregnancy:
1) ptyalism
2) gum hypertrophy-->bleeding gums
103
is dental care covered under Medi-Cal?
yes
104
ptyalism
excessive salivation
105
changes with the esophagus, stomach, & intestines related to pregnancy:
1) regurgitation/heartburn
2) hiatal hernia
106
how many pregnant women experience hiatal hernia?
up to 20%
107
changes to the gallbladder & liver related to pregnancy:
1) cholelithiasis
2) cholecystitis
3) cholestasis
4) increased gallbladder emptying time and thickening of bile
108
cholelithiasis
gallstones
109
cholecystitis
inflammation of the gallbladder
110
why do pregnant women get heartburn?
delayed stomach emptying related to increased hormones
111
what causes changes in pregnant women's mouths?
increased estrogen
112
what is a common cause of abdominal discomfort in pregnant women?
constipation
113
purpose of prolactin in pregnant women?
prepares breasts for milk production
114
purpose of oxytocin in pregnant women?
* stimulates uterine contractions
* stimulates milk ejection (let down)
115
source of prolactin and oxytocin?
pituitary gland
116
purpose of parathyroid hormone in pregnant women?
Ca and Mg regulation
117
purpose of cortisol in pregnant women?
* stimulates production of insulin
* increases peripheral resistance to insulin
118
purpose of aldosterone in pregnant women?
* stimulates reabsorption of excess sodium from the renal tubules
119
source of cortisol and aldosterone?
adrenal glands
120
purpose of additional insulin secretion from pancreas?
production of insulin increased to compensate for insulin antagonism caused by placental hormones
121
what hormones are secreted by the placenta?
progesterone and estrogen
122
what hormones are secreted by the corpus luteum?
progesterone and estrogen
123
gravidity
person who is pregnant
124
nulligravida
never been pregnant
125
primigravida
first time pregnant
126
multigravida
2 or more pregnancies
127
parity
number of births after 20 weeks of gestation
128
nullipara
has never completed a pregnancy past 20 weeks
129
primipara
completed 1 birth at later than 20 weeks
130
multipara
2 or more births at later than 20 weeks
131
do fetal/neonatal deaths count for parity?
yes
132
what is G P?
gravidity & parity
133
pre-term
neonate born before 37 weeks (up to 36+6)
134
term
child born 37+0 - 41+6
135
post-date
child born 40+0 - 41+6
136
post-term
child born after 42 weeks of gestation
137
G
T
P
A
L
G - gravida
T - term
P - preterm
A - abortion (can be therapeutic abortion or spontaneous abortion(miscarriage))
L - living children
138
Chances of survival @
21 weeks or less
22 weeks
23 weeks
24 weeks
25 weeks
26 weeks
27 weeks
30 weeks
34 weeks
139
are infants born between 22-25 weeks viable?
they are on the cusp of viability and are at increased risk of neurological injury if they survive
140
viability
ability to live outside the womb; begins at about 22 weeks
141
hCG
early biological marker of pregnancy
142
when does hCG production begin?
at implantation
143
when is hCG detectable in maternal serum or urine?
7-8 days before expected menstrual period
144
difference between qualitative and quantitative pregnancy tests (hCG tests):
qualitative: +/-
quantitative:
* measures hCG levels
145
how do hCG levels rise and fall
rises until peak at50-70 days of pregnancy and then decreases
146
quickening
being able to feel the fetus move in belly
147
what are presumptive signs of pregnancy?
1) breast changes
2) amenorrhea
3) nausea & vomiting
4) urinary frequency
5) fatigue
6) quickening
148
what are probable signs of pregnancy?
1) positive preg test
2) Goodell, Chadwick, Hegar signs
3) Braxton hicks contractions
4) ballottement
149
what are positive signs of pregnancy?
1) ultrasound
2) fetal heart tones via doppler
3) fetal movements
150
look over slide 27 PP2 for other causes that can cause signs of pregnancy
151
EDD
estimated delivery date
152
LMP
last menstrual period
153
how do you calculate EDD?
LMP - 3 months + 7 days (adjust year as needed)
154
when is the initial prenatal visit typically?
in the first trimester (0-13 weeks)
155
time frame of the first trimester
0-13 weeks
156
what is involved with prenatal history taking in the initial visit?
1) ob/gyn hx
2) nutritional hx
3) meds (include OTC)
4) supplements
5) family hx
6) social/environmental factors
7) occupational hx
157
what is done at initial visit for pregnancy?
1) prenatal history taking
2) medical history
3) reason for seeking care
4) other health concerns
5) review S/Sx
6) coping
7) labs
158
what are screenings for fetal chromosomal abnormalities?
* nuchal translucency check via ultrasound @ around 12 weeks
* labs for free beta hCG and PAPP-A
**increased NT, increased free beta hCG, and decreased PAPP-A can suggest aneuploidy
159
NT
nuchal translucency
160
hCG
human chorionic gonadotropin (hormone)
161
PAPP-A
pregnancy associated plasma protein A
162
what lab tests are involved in the initial prenatal visit?
1) CBC
2) blood type and Rh factor
3) rubella titer
4) HIV screen
5) HbsAG screen
6) RPR/VDRL
7) Tay-Sachs
8) sickle cell
9) cystic fibrosis
10) glucose tolerance test HgbA1c
11) pelvic
12) pap smear
13) culture for STIs
14) TB skin test
163
first trimester priority education:
1) schedule for prenatal visits
2) anticipatory guidance for discomforts of pregnancy
3) S/Sx to report immediately
4) Kegal exercises
5) nutritional needs
164
S/Sx that pregnant women should report immediately
1) vaginal bleeding/cramping
2) syncope
3) intractable nausea/vomiting
165
what is included with nutritional needs education for pregnant women?
1) adequate but not accessive weight gain
2) begin prenatal vitamins (especially Folic acid)
3) things to avoid consuming
166
what should pregnant women avoid consuming?
1) raw foods (sushi, shellfish, beef, tartare, soft cheeses
2) deli meats and salads (egg/potato salad)
3) high-mercury containing fish
4) limit caffeine
5) alcohol (no safe amount)
6) medications/herbs/supplements (unless reviewed with MD/CNM)
167
what is the time frame of the 2nd trimester?
14-26 weeks
168
what is included in a second trimester prenatal visit?
1) VS
2) physical exam
3) auscultate FHT
4) discuss birth plans
5) labs
169
how much weight should a pregnant woman gain during pregnancy?
about 1lb/week (25-35lbs total)
170
what is an especially important VS to watch out for in second trimester prenatal visits?
BP: elevated BP could be an indication of developing gHTN or preeclampsia
171
what blood pressures would be alarming in a second trimester prenatal visit?
* above 140/90
* an increase in systolic higher than 30 over baseline
* an increase in diastolic higher than 15 over baseline
172
when we do a urine dip in a second trimester prenatal visit, what are we looking for?
protein or glucose higher than specs
173
what is involved with a physical exam at a 2nd trimester prenatal visit?
1) assess breasts and nipples and ask about their feeding preferences
2) ask about quickening (starts at approx 20 weeks)
174
what lab tests are involved with a 2nd trimester prenatal visit?
1) urine dip ( for protein and glucose)
2) quad screen (15-20 weeks)
3) amniocentesis (prn)
175
what is quad screen used to detect?
* down syndrome
* neural tube defects such as spina bifida and anencephaly
* other chromosomal defects
176
what is measured in a quad screen?
* MSAFP
* hCG
* UE
* Inhibin A
177
priority education topics in the second trimester:
1) ongoing care needs
2) S/Sx of potential complications
178
S/Sx of potential complications in pregnancy (2nd trimester)
1) bleeding
2) decreased fetal activity
3) preeclampsia S/Sx
4) PPROM
5) infections
179
S/Sx of preeclampsia
1) headache
2) blurred vision/visual disturbance
3) epigastric pain
4) swelling in face/fingers
5) muscular irritability
180
PPROM
PROM - prelabor rupture of membrane
PPROM - preterm PROM
181
S/Sx of PPROM
amniotic fluid discharge
182
S/Sx of infections
* chills
* fever
* burning with urination
183
how to measure fundal height between weeks 24-36
* measured from symphysis pubis to top of uterus in CM
* should be equal to weeks of gestation between weeks 24-36
184
what can decreased fundal height indicate?
* IUGR- intrauterine growth restriction
* SGA - small for gestational age
* fetal death
185
what can increased fundal height indicate?
* macrosomia - big baby
* multifetal gestation - twins or more
* polyhydramnios - too much amniotic fluid
186
interventions for common discomforts (headaches)
* rest
* hydration
* acetaminophen
187
interventions for common discomforts (constipation)
* hydration
* exercise
* prune juice
188
interventions for common discomforts (varicose veins)
* elevate legs
* support stockings
189
interventions for common discomforts (food cravings)
* small meals help keep blood sugar steady
190
interventions for common discomforts (heartburn)
* small meals
* sit up after eating
* no spicy foods
* antacids (tums)
191
interventions for common discomforts (joint/ligament pain)
* support garments
* abdominal binder
* prenatal yoga and/or massage
192
what is involved in a third trimester prenatal visit?
1) VS
2) fundal height measurement
3) physical exam (may include vaginal/cervical exam toward end of pregnancy)
4) labs
5) Rhogam
193
when is Group beta strep culture done?
35-37 weeks
194
Rhogam injection
given between 26-28 weeks for Rh - moms
195
what is included in third trimester labs?
1) GBS ~35-27 weeks
2) GTT (26-28 weeks)
3) STI screen
4) urine dip for protein/glucose
196
GTT
glucose tolerance test
197
what time frame is the 3rd trimester?
27-40 weeks
198
what education is involved with a 3rd trimester prenatal visit?
1) interventions for discomforts (same as 2nd trimester)
2) discuss S/Sx of onset of labor & when do call OB triage/head to hospital
3) how to manage mood swings
4) parenting role
5) planning for birth and newborn (C/S vs vaginal)
199
S/Sx that indicate a need to call or head to the hospital
1) regular, strong contractions
2) ROM
3) loss of mucus plug
4) bloody show
5) high kick counts (10/2)
6) S/Sx of preeclampsia
200
what are the three phases of psychological development when a woman is pregnant?
1) accepts biological fact - "I am pregnant"
2) accepts need to nurture fetus - "I am going to have a baby"
3) prepares for role of parent - "I am going to be a mother"
201
state of mood in the 3rd trimester?
1) may be dealing with rapid mood changes
2) may have feelings of ambivalence (mixed feelings)
202
Couvades syndrome
sympathetic pregnancy - father feels some of the same (psychosomatic) symptoms as pregnant partner
203
fathers may begin to identify with their new role as a father. what can affect this?
may be influenced by how their own father was
204
grandparent responses:
1) if only in 30s or 40s may lack interest; may be non-supportive
2) may see pregnancy as a renewal of their youth
3) pregnancy may help bridge a previous estrangement
205
sibling adjustment
1) may feel replaced (first crisis for child)
2) consistancy in their life helps them accept the new arrival
3) they need to be prepared to be big brother or sister
206
what are some special considerations related to immunization for the pregnant women?
* no live, or live attenuated viral vaccines
* flu, TDAP, and covid vaccines recommended
207
what are some special considerations related to traveling during pregnancy?
1) air travel may be restricted toward end of pregnancy due to increased risk of DVT (avoid after 7 months)
2) if traveling via car for long periods of time make sure to stop frequently and walk around to avoid venous stasis
208
hot tubs and saunas while pregnant?
avoid hot tubs and saunas for long periods of time
209
what areas should pregnant women avoid?
areas with zika virus or covid hotspots
210
seat-belt use while pregnant
should be worn under belly, not over
211
what are some maternal concerns related to multifetal pregnancies?
1) increased BV--> increased strain on CV system
2) increased anemia
3) increased uterine distension--> increased separation of abdominal muscles
4) increased risk for placenta previa
5) increased risk for separation of placenta
6) lack of preparation (financial, emotional, educational, space)
7) possible need for selective reduction
8) risk of prematurity
9) PROM
212
selective reduction
when one or more fetuses are aborted in a multifetal pregnancy to increase the chances the other fetuses will survive
213
dizygotic twins
originates from 2 fertilized ova and 2 sperms (will see 2 corpus luteum)
214
monozygotic twins
originates from 1 ovum
* increased risk of congenital malformations
215
dichorionic twins
wont know if they're identical or fraternal until delivery
216
monochorionic twins
if the egg divides before day 5 = diamniotic
if the egg divides between day 7 -13 = monoamniotic
217
