STILLBIRTH UMBILICAL CORD PROLAPSE/ FETAL GROWTH DISORDERS/ POST TERM PREGNANCY

PROM, PREMATURE LABOR, MULTIFETAL PREGNANCY

Timing of delivery

Dizygotic or Fraternal Fertilization of 2 ova

twins

Monozygotic or Identical Fertilization of 1 ova

twins that then divides into
2

Monozygotic dichorionic Zygote division at morula 38 -38 6/7 weeks AOG

diamniotic first 72 hours

DD

Monozygotic Zygote division at 4-8 blastocyst 34-37 6/7 weeks AOG

monochorionic days
diamniotic

MD

Monozygotic Zygote division at Implanted 32-34 weeks AOG

monochorionic 8-13 days blastocyst
monoamniotic

MM

Conjoined twins Zygote division at Formed embryonic

>13 days disc
SOME MULTIFETAL PREGNANCY COMPLICATIONS
Due to DONOR RECIPIENT

TWIN TWIN TRANSFUSION Anemic (pale) Polycythemia (volume excess)

SYNDROME (TTTS)
Small Large

Circulatory overload + heart failure

Large central artery-to-vein (Hydrops)
connections
Restrictive growth
Hyperviscosity + occlusive
complications →
hyperbilirubinemia + kernicterus

Oligohydramnios (Poly)hydramnios

TWIN ANEMIA POLYCYTHEMIA Anemic Polycythemic

SYNDROME (TAPS)
Small/restricted growth Large

NO AMNIOTIC FLUID DISCREPANCY

Tiny peripheral artery-to-vein UTZ: discordant MCA peak systolic velocities
connections

TWIN REVERSED ARTERIAL Grossly normal Malformed

PERFUSION SEQUENCE Large artery-to-artery placement
(TRAPS) aka ACARDIAC Cardiomegaly & heart failure No heart
shunt +/- vein-to-vein shunt
TWINNING
Higher arterial perfusion Receives deoxygenated blood