Twin Gestation
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| Fertilization of 2 ova by 2 different fathers with only a short time between | Superfecundation
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| Ovulation occurs when pregnancy already exists. One month difference in gestational age | Superfetation
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| What are 2 types of twins? | Monozygotic and Dizygotic
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| Maternal, occurs from fertilization of one egg. The egg divides into 2 zygotes after fertilization | Monozygotic
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| What is the Monozygotic incidence around the world? | 3.5 per 1,000 pregnancies
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| Fraternal, two ovum are released at ovulation. Each are fertilized and are different individuals with same parents | Dizgotic
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| What is the Dizgotic incidence in different parts of the world? | Nigeria 1 in 20-25
US 1 in 100
Japan 1 in 150
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| What is amniocity? | Number of amniotic sacs
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| What is Chorionicity? | Number of placentas
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| Are always diamniotic and dizygotic | Dizygotic twins
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| May be either diamniotic or monoamniotic and dichorionic or monochorionic, depending on the time of cleavage | Monozygotic twins
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| Means two placentas/sacs | Di/amnicotic or chorionic
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| Means one | Mono
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| Timing of events for trophoblast | Differentiate at 4 to 6 days post-fertilization
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| Timing of events for amnion | Differentiates at approx 8 days post-fertilization
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| If the zygote divides before 4-6 day it will be | dichorionic and diamniotic this account for 1/3 of all monozygotic twins
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| If the zygote divides between 6-8 days it is | monochorionic and diamniotic this accounts for 2/3rd of all monozygotic
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| If the zygote divides after the 8th day it is | monoamniotic and monochorionic and accounts for less than 1% of monozygotic twins
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| If the zygote divides after day 13 you will have | Siamese twins
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| Conjoined twins accounts for about | 1 in 70,000 delivers in the US
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| Siamese twins may have more than a | 3 vessel cord
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| Name four classifications of conjoined twins | Thoracopagus
Craniopagus (cephalic)
Pygopagus (posterior)
Ischiopagus (caudal)
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| Will have one placenta or two placentas? one sac or two depending on the time of cleavage | Monozygotic
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| TROPHOBLAST CELLS IMMATURE, DIFFERENTIATES AT 4-6 DAYS POST FERT, THEY KNOW WHAT THEY WILL BECOME | PLACENTA
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| On day 8th these cell know what they will become | Amnion (sac) cells
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| It's important to note the number of | placentas and amniotic sacs
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| two placentas may be laying close together so look at the | location and gender of each twin
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| Record what two things for each twin | Growth and measurements
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| With one amnotic sac, the umbilical cord may get | twisted, rate of death is 50-70%
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| Pathology, a twin pregnancy is considered a | High risk
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| Rare, occurs in monozygotic twins, they share a placenta wit each having their own umbilical cord. There is an arterio-venous shunt With in placenta. Arterial blood of one twin (the donor) is pumped into the venous blood of the other twin | Twin to twin transfusion syndrome
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| Twin to twin transfusion syndrome risk factors | Donor may become hydropic/anemic and grwoth retarded. Receipent may be normal orhydropic. Affects growth of both. Hydramnios in receipents sac. Donor may have 2 vessel cord and may be 20% difference in weight
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| What is the Stuck-Twin syndrome | 1. One twin is in a severly oligohydramniotic sac
2. One twin is in a polyhydramniotic sac
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| Stuck-Twin syndrome is manages by | serial amniocentesis and possible complications in survivors from sac
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| Selective Reduction of fetuses in Mult gestations is done in the | 1st trimester, sac injected with potassium chloride to cause death
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| What is the selection process to reduce number of fetuses | Anomalous fetus/small GS/monochorionic twins Both/Most accessible sac: high and anterior in the fubdus/ Do NOT select a predenting embryo/reduce # to twins
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| Joined at the chest, most common | Thoracopagus
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| Joined at the head | Craniopagus
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| Joined posteriorly at the back | Pygopagus
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| Joined at the caudal of their bodies | Ischiopagus
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| One twin does not have a heart, blood from donor pumps blood into the body of the | Acardiac Monster
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| Acardiac Monster can cause | CHF i donor twin
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