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Multiple Gestation Ch 14. 2009-2010 Academic Year MSIII Ob/Gyn Clerkship Self-Directed Study. Case Study.

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multiple gestation ch 14

Multiple GestationCh 14

2009-2010 Academic Year

MSIII Ob/Gyn Clerkship

Self-Directed Study

USUHS MSIII Ob/Gyn

Clerkship Self Directed Studies

case study
Case Study

A 41 year old Lt. Colonel, G1, presents to the OB clinic for her initial OB visit. She is very happy to have undergone IVF treatment with the military and was told by her reproductive doctor that she had twins.

USUHS MSIII Ob/Gyn

Clerkship Self Directed Studies

questions to consider
Questions to Consider
  • 1. What are the patient’s risk factors for twins?
    • IVF (Ovarian stimulation, multiple embryo transfer)
    • Age (>35 yo with double risk of a 25 yo)
  • 2. Are assisted reproductive techniques associated with twinning?
    • YES!!!!!!!

USUHS MSIII Ob/Gyn

Clerkship Self Directed Studies

apgo educational topic 20
APGO Educational Topic 20
  • A. Discuss the etiology of monozygotic, dizygotic, and multizygotic gestation.
  • B. Describe the altered physiologic state with multifetal gestation.
  • C. Describe the potential complications associated with multifetal gestation.

USUHS MSIII Ob/Gyn

Clerkship Self Directed Studies

etiology of twinning
Etiology of Twinning
  • Monozygotic Twinning: splitting of 1 embryo
  • Dizygotic Twinning: fertilization of 2 eggs in a single menstrual cycle.
  • Multizygotic: fertilization of more than 2 eggs

USUHS MSIII Ob/Gyn

Clerkship Self Directed Studies

timing of monozygotic twinning
Timing of Monozygotic Twinning

Adapted from Essentials of Obstetrics and Gynecology, 4th ed; Hacker et al, page 183.

USUHS MSIII Ob/Gyn

Clerkship Self Directed Studies

slide7

Figure 14-1 Diagrammatic representation of the major types of twin placentas found with monozygotic twins. Redrawn from Benirschke K, Driscoll SG: Pathology of the Human Placenta. New York, Springer-Verlag, 1974, p 263.

USUHS MSIII Ob/Gyn

Clerkship Self Directed Studies

Downloaded from: StudentConsult (on 15 June 2009 09:55 PM)

© 2005 Elsevier

slide8

Diamniotic

Dichorionic

Monoamniotic

Monochorionic

USUHS Radiology

http://www.obgyn.net/us/gallery

Twin Peak Sign

USUHS MSIII Ob/Gyn

Clerkship Self Directed Studies

maternal physiologic adaptations
Maternal Physiologic Adaptations

System

Singleton

Multiples

 risk

For anemia

And low Fe

And Folate

Compresses

Lungs.

Compresses

Vena Cave.

Compressed

ureters

USUHS MSIII Ob/Gyn

Clerkship Self Directed Studies

associated complications
Associated Complications

Maternal

Fetal

Adapted from Hacker et al, 4th ed.

USUHS MSIII Ob/Gyn

Clerkship Self Directed Studies

other tidbits of info
Other Tidbits of Info
  • Twins = 1% of all births in USA
  • Dizygotic twinning is dependant on FMHx, ethnicity ( Nigeria), and maternal age (with age >35 yo is 2x’s that of 25 yo) while monozygotic twinning rates is constant.
  • ART (Assisted Reproductive Technology) increases multifetal gestation.
    • Clomid = 6-8% incidence of multiples
    • Gonadotropins = 20-30% incidence of multiples

USUHS MSIII Ob/Gyn

Clerkship Self Directed Studies