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Penny ob/gyn > Ch. 31 Multiple Gestations > Flashcards

Ch. 31 Multiple Gestations Flashcards

1
Q

shunting of venous or arterial blood from one twin to another through placental circulation

A

twin–twin transfusion syndrome (TTTS)

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2
Q

asymmetric fetal weight between twins

A

discordant growth

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3
Q

an abnormal accumulation of fluid in at least two fetal body cavities

A

hydrops

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4
Q

type of amniocentesis used to remove a large amount of amniotic fluid around a fetus suffering from polyhydramnios

A

therapeutic amniocentesis

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5
Q

a treatment that uses lasers to separate abnormal placental vascular connections between twins that are suffering from twin–twin transfusion syndrome

A

endoscopic-guided laser photocoagulation

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6
Q

when a twin fetus, suffering from twin–twin transfusion syndrome, experiences severe oligohydramnios and is closely adhered to the uterine wall

A

Stuck twin

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7
Q

Sonographic Findings of ___________

1.Monochorionic twinning
2.Discordant fetal growth
3.Oligohydramnios around donor twin
4.Polyhydramnios around recipient twin
5.Recipient may be hydropic

A

Twin–Twin Transfusion Syndrome

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8
Q

With TTTS, the twin that shunts blood to the other is called the “_______” twin and is often _________than the twin receiving extra blood, the “_______” twin.Treatment options include therapeutic amniocentesis and endoscopic-guided laser photocoagulation of the communicating placental vessels.

A

donor; smaller; recipient

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9
Q

A complication that carries a high mortality rate for __________twins is twin–twin transfusion syndrome (TTTS)

A

monochorionic

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10
Q

With TTS, the donor twin often suffers from ________ and ________, whereas the recipient experiences _______ and __________

A

anemia and growth restriction; hydrops and congestive heart failure

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11
Q

discordant growth, which is described as a _____ to ______ ________ in the estimated fetal weight of the smaller fetus compared to the larger.

A

15% to 25% reduction

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12
Q

vascular connections

A

anastomoses

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13
Q

an abnormally developed twin that has an absent upper body and no heart

A

acardiac twin

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14
Q

________ refers to severe oligohydramnios surrounding a twin that appears to be closely associated with the uterine wall

*seen with TTTS

A

Stuck twin

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15
Q

Abnormal anastomoses of placental vessels may result in a parasitic twin or _______. This is considered to be a severe form of TTTS.

A

acardiac twin

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16
Q

Acardiac twinning may also be referred to as ____________ sequence or acardiac parabiotic twinning.

A

twin-reversed arterial perfusion (TRAP)

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17
Q

another name for acardiac twinning

A

twin-reversed arterial perfusion (TRAP)

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18
Q

Sonographic Findings of ________

1.Normal pump twin
2.Acardiac twin—absent upper body, absent heart, and hydrops

A

Acardiac Twin

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19
Q

With acardiac twinning, there is one normal fetus, the “_________,” and an abnormally developed fetus containing no________. The normal fetus maintains the growth of the parasitic twin. Abnormally developed fetus also has absent upper body, and hydrops

A

pump twin; no heart

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20
Q

The pump twin has a perinatal mortality of 50% to 55%, secondary to _________ and ________.

A

polyhydramnios and prematurity

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21
Q

Conjoined twins can result from ____________twinning.

A

monochorionic monoamniotic

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22
Q

conjoined twins attached at the chest

A

thoracopagus

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23
Q

conjoined twins attached at the abdomen

A

omphalopagus

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24
Q

The most common forms of conjoined twinning are _______ and _________, which is the attachment at the chest and abdomen, respectively.

A

thoracopagus;omphalopagus

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25
Q

twins joined at the cranium

A

craniopagus

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26
Q

conjoined twins joined back-to-back in the sacral region

A

pyopagus

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27
Q

dead at birth

A

stillborn

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28
Q

Conjoined twins may also be joined at the cranium (___________) or back-to-back in the sacral region, which is termed __________.

A

(craniopagus); pyopagus

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29
Q

The prognosis is poor for conjoined twins. They have a 40% chance for being _________, with many dying within the first 24 hours.

A

stillborn

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30
Q

The death of a twin, and subsequent reabsorption of the embryo during the first trimester, is termed a __________

A

vanishing twin

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31
Q

the death and reabsorption of a twin

A

vanishing twin

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32
Q

the death of one fetus in a twin pregnancy that is maintained throughout the pregnancy; actually means paperlike fetus

A

fetus papyraceus

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33
Q

If the fetus dies in the first trimester and is maintained throughout the pregnancy, it is referred to as ______________. With dichorionic twins, the surviving twin is rarely affected by the death of the other. However, the death of a _________ twin during the first trimester frequently leads to the death of the other twin.

A

fetus papyraceus; monochorionic

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34
Q

The death of a ________ twin during the second or third trimester can lead to life-threatening problems in the surviving twin. Potential troubles exist as a consequence of the breakdown of the demised twin.

A

monochorionic

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35
Q

Vascular products, as a result of the breakdown of tissues, travel from the demised twin to the surviving twin by means of the common vascular channels within the shared placenta, a complication known as __________

A

twin embolization syndrome

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36
Q

Twin embolization syndrome can result from the death of a __________ twin.

A

monochorionic

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37
Q

when vascular products travel from a demised twin to the surviving twin by means of the common vascular channels within the shared placenta

A

twin embolization syndrome

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38
Q

the development of a cystic cavity within the cerebrum; may be the result of an intraparenchymal hemorrhage

A

porencephaly

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39
Q

In the death of a monochorionic twin, particularly the __________ and the __________ are affected in the surviving twin, with a documented 25% risk of death or neurologic damage for the survivor. Intracranial abnormalities such as hydrocephalus and porencephaly are common in the survivor as well

A

central nervous system and kidnyes

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40
Q

Triplet pregnancies can manifest with different combinations of ________ and ________. For example, triplets can be trichorionic triamniotic and dichorionic triamniotic. Most triplet and quadruplet pregnancies result from the use of ovulation induction or in vitro fertilization

A

chorionicity and amnionicity;

41
Q

Unfortunately, multiple gestations beyond twins have an increased likelihood of discordant growth, miscarriage, and perinatal death. When assisted reproduction is used, resulting in a high number of multifetal pregnancies, multifetal __________ may be used. With sonographic guidance, a needle punctures the fetal heart and potassium chloride is injected.

A

reduction

42
Q

pregnancy-induced maternal high blood pressure and excess protein in the urine after 20 weeks’ gestation

A

preeclampsia

43
Q

the condition of having a deficient number of red blood cells

A

anemia

44
Q

underdevelopment of the lungs

A

pulmonary hypoplasia

45
Q

a shortage of oxygen or decreased oxygen in the blood

A

hypoxia

46
Q

Mothers expecting multiple gestations have an increased risk of developing _________ and ________. The risk for _______ delivery is increased 7 to 10 times more compared to a singleton pregnancy, with an associated ______ birth weight. The median gestational age of delivery for twins is 35 weeks, and for triplets and beyond, the gestational age of delivery is even earlier.

A

preeclampsia and anemia; preterm; low; 35 weeks

47
Q

Infants born with low birth weight, and specifically before 32 weeks’ gestation, often suffer from _____________ with episodes of ________. _______ at the time of birth can cause tiny, fragile blood vessels within the immature brain to rupture, leading to intracranial hemorrhage and possible irreversible neurologic complications or death.

A

pulmonary hypoplasia; hypoxia; Hypoxia

48
Q

Terminology associated with conjoined twins

Conjoined Terminology: __________

Area of Union:
Joined at the head

A

Craniopagus

49
Q

Terminology associated with conjoined twins

Conjoined Terminology: __________

Area of Union:
Joined at the thorax (chest)

A

Thoracopagus

50
Q

Terminology associated with conjoined twins

Conjoined Terminology: __________

Area of Union:
Joined at the abdomen

A

Omphalopagus

51
Q

Terminology associated with conjoined twins

Conjoined Terminology: __________

Area of Union:
Joined at the pelvis (spine connected at a 180 degree angle, facing away from one another)

A

Ischiopagus

52
Q

Terminology associated with conjoined twins

Conjoined Terminology: __________

Area of Union:
Joined at the sacral region or back-to-back

A

Pyopagus

53
Q

With a ______________pregnancy, the membrane will be thin and seen separating at the junction point with the placenta, a sonographic sign referred to as the “T sign.”

A

monochorionic diamniotic

54
Q

If separate placentas are noted, then the pregnancy must be ___________. In addition, noting a triangular extension of the placenta at the base of the dividing membrane is indicative of a _____________pregnancy. This is referred to as the twin peak sign, lambda sign, or delta sign

A

dichorionic diamniotic

55
Q

a triangular extension of the placenta at the base of the membrane and is indicative of a dichorionic diamniotic pregnancy; also referred to as the delta sign or twin peak sign

A

lambda sign, twin peak sign, delta sign

56
Q

If the twins are _______ sexes, then one can assume that the twins are dichorionic. Same-sex fetuses that have a single placenta and a thin membrane separating them are almost certainly __________

A

different; monochorionic

57
Q

The presence of _____ yolk sac and two fetuses is indicative of a monoamniotic gestation, whereas the presence of ______ yolk sacs is indicative of a diamniotic gestation.

A

one; two

58
Q

During the first trimester, ________ twins will have a thick membrane separating the two amniotic sacs, whereas __________twins will have a thin membrane or no membrane at all between them

A

dichorionic; monochorionic

59
Q

Monozygotic twins arise from a _______ zygote that splits. Thus, monozygotic twins are always _________ twins because they share their design from only one fertilized egg. It depends on the time at which this division, or ________, takes place as to how many placentas and amnions may be present with monozygotic twins

A

single; identical; cleavage

60
Q

twins that result from the split of a single zygote and share the same genetic structure

A

identical twins

61
Q

the division of a cell

A

cleavage

62
Q

What are the 3 types of monozygotic twins?

A

(i) monochorionic diamniotic, (ii) dichorionic diamniotic, and (iii) monochorionic monoamniotic

63
Q

_______________twins are the most common form of monozygotic twins.

A

Monochorionic diamniotic

64
Q

It is important to note that when two fetuses share the _______placenta, complications are more likely to occur.

A

same

65
Q

The least probable monozygotic twinning to occur is _________________twins. A late split, beyond day 8 postconception, will result in _______________twins. Because of the shared amniotic sac and this delayed division, monochorionic monoamniotic carries the additional risk of ______________.

A

monochorionic monoamniotic; monochorionic monoamniotic; conjoined twins

66
Q

monoamniotic, monochorionic twins that are attached at the head, thorax, abdomen, or lower body

A

conjoined twins

67
Q

___________, the most common form of twinning, arise from two separate fertilized ova.

A

Dizygotic twins

68
Q

Dizygotic twins are referred to as ________ twins because they have their own genetic structure and can differ from each other in many ways.

A

fraternal

69
Q

Dizygotic twinning always results in ___________ twins. That means, if there are _____ placentas, there must be ______ amnions. However, in early gestation, the placentas may fuse and appear as one large placenta with sonography.

A

dichorionic diamniotic; two; two

70
Q

twins that result from the fertilization of two separate ova and have dissimilar characteristics

A

fraternal twins

71
Q

an unfertilized egg

A

ovum

72
Q

the cell formed by the union of two gametes; the first stage of a fertilized ovum

A

zygote

73
Q

relates to the number of zygotes (fertilized ova)

A

zygosity

74
Q

_________ twins arise from a single zygote, whereas ________ twins form from two separate zygotes.

A

Monozygotic; dizygotic

75
Q

coming from one fertilized ovum or zygote

A

monozygotic

76
Q

two ova are fertilized by two sperms

A

dizygotic

77
Q

The fertilization of a single ovum that eventually divides, or the fertilization of several ova, can produce _______gestations. A fertilized egg is referred to as a ______. In multiple gestations, the term _________ refers to the number of eggs that are fertilized.

A

multiple; zygote; zygosity

78
Q

the outer membrane of a gestation that surrounds the amnion and developing embryo

A

chorion

79
Q

the inner sac that contains the embryo and amniotic fluid; echogenic curvilinear structure that may be seen during the first trimester within the gestational sac

A

amnion

80
Q

Chorionicity, often referred to as placentation, relates to how many ________ are present.

A

placentas

81
Q

relates to the number of chorions and the type of placentation in a multiple gestation

A

Chorionicity

82
Q

________ refers to how many amnions or amniotic sacs are present. Twins who share the same amniotic sac are referred to as _______, whereas twins who have their own individual amniotic sac are _________.

A

Amnionicity; monoamniotic; diamniotic

83
Q

Patients with multiple gestations may present with the clinical indication of_________ and also an _______human chorionic gonadotropin blood level compared to a singleton pregnancy.

A

large for dates; elevated

84
Q

When compared with singleton pregnancies, twins have a four times higher risk of fetal _____ and a six times higher neonatal ____ rate.

A

mortality; morbidity

85
Q

the rate of actual deaths

A

mortality

86
Q

the relative frequency of occurrence of a disease; condition of suffering from that disease

A

morbidity

87
Q

A maternal ____of multiple gestations, assisted reproductive therapy (ART), ovulation _____ drugs, _____ maternal age, and maternal _____ have all been shown to increase the probability of multiple gestations

A

history; induction; advanced; obesity

88
Q

techniques used to treat infertility

A

assisted reproductive therapy (ART)

89
Q

a maternal age of 35 years or older

A

advanced maternal age

90
Q

coexisting ectopic and intrauterine pregnancies

A

heterotopic pregnancies.

91
Q

It has been reported that as many as 43% of triplets and higher order pregnancies are linked with _____. Thus, patients with a history of ovulation induction drugs or ART should be evaluated systematically, because they are more likely to have not only multiple gestations but also __________.

A

ART;heterotopic pregnancies

92
Q

Zygosity:
________

Description:
Two separate fertilized ova

Result:
Dichorionic diamniotic

Appearance:
__________

A

Dizygotic; fraternal

93
Q

Zygosity:
Monozygotic

Description:
One zygote splits between 4 and 8 d

Result:
_________

Appearance:
Identical

A

Monochorionic diamniotic

94
Q

Zygosity:
Monozygotic

Description:
One zygote splits before day 4

Result:
_________

Appearance:
Identical

A

Dichorionic diamniotic

95
Q

Zygosity:
Monozygotic

Description:
One zygote splits late

Result:
_________

Appearance:
Identical

A

Monochorionic monoamniotic

96
Q

All of the following complications are associated with multiple gestations except:
a. preterm delivery
b. high birth weight
c. maternal anemia
d. maternal preeclampsia

A

b. high birth weight

97
Q

The demise of a twin can lead to the development of neurologic complications in the living twin as a result of:
a. twin embolization syndrome
b. TTTS
c. TRAP syndrome
d. dichorionicity

A

a. twin embolization syndrome

98
Q

Twins having two placentas and one amniotic sac are referred to as:
a. monochorionic diamniotic
b. monoamniotic dichorionic
d. dichorionic monoamniotic
d. This does not occur

A

d. This does not occur

Penny ob/gyn (18 decks)

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