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Penny - OB CH > Chapter 31 - Multiple Gestations > Flashcards

Chapter 31 - Multiple Gestations Flashcards

1
Q

An abnormally developed twin that has as absent upper body and no heart; also referred to as parasitic twin; also referred to as twin-reversed arterial perfusion sequence

A

Acardiac twin

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2
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

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3
Q

Related to the number of amnions in a multiple gestation

A

Amnionicity

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4
Q

Fluid-filled space, created by the amnion, surrounding surrounding the developing embryo or fetu

A

Amniotic sac

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5
Q

Vascular connections

A

Anastomoses

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6
Q

The condition of having a deficient number of red blood cells

A

Anemia

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7
Q

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

A

Chorion

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8
Q

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

A

Chorionicity

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9
Q

The division of a cell

A

Cleavage

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10
Q

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

A

Conjoined twins

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11
Q

Twins joined at the cranium

A

Cranipagus

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12
Q

Having two amniotic sacs

A

Diamniotic

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13
Q

Having two placentas

A

Dichorionic

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14
Q

Having two placentas and two amniotic sacs

A

Dichorionic
Diamniotic

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15
Q

Asymmetric fetal weight between twins

A

Discordant Fetal growth

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16
Q

Two ova are fertilized by two sperms

A

Dizygotic

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17
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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18
Q

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

A

Fetus Papyraceus

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19
Q

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

A

Fraternal Twin

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20
Q

An abnormal accumulation of fluid at least two fetal body cavities

A

Hydrops

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21
Q

A shortage of oxygen or decreased oxygen in the blood

A

Hypoxia

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22
Q

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

A

Identical twins

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23
Q

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

A

Lambda Sign

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24
Q

Having one amniotic sac

A

Monoamnitoic

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25
Q

Having one chorion

A

Monochorinic

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26
Q

Having one placenta and two amniotic sacs

A

Monochorionic
Diamniotic

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27
Q

Having one placenta and one amniotic sac

A

Monochorionic Monoamniotic

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28
Q

Coming from one fertilized ovum or zygote

A

Monozygotic

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29
Q

The relative frequency of occurrence of a disease

A

Morbidity

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30
Q

The rate of actual deaths

A

Motality

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31
Q

Conjoined twins attached at the abdomen

A

Omphalopagus

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32
Q

An unfertilized egg

A

Ovum

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33
Q

Formation or structure of a placenta, structural organization, and mode of attachment of fetal to maternal tissues during placental formation

A

Placentation

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34
Q

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

A

Porencephaly

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35
Q

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

A

Pyopagus

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36
Q

36
A single developing fetus

A

Singleton pregnancy

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37
Q

Dead at birth

A

Stillborn

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38
Q

When a twin fetus, suffering from twin-twin transfusion syndrome, experiences severe oligohydroamnios and is closely adhered to the uterine wall

A

Stuck twin

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39
Q

Type of amniocentesis used to remove a large amount of amniotic fluid around a fetus suffering from polyhydroamnios

A

Therapeutic Amniocentesis

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40
Q

Conjoined twins attached at the chest

A

Thoracopagus

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41
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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42
Q

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

A

Twin-twin transfusion syndrome

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43
Q

The death and reabsorption of a twin

A

Vanishing twin

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44
Q

Relates to the number of zygotes (fertilized ova)

A

Zygosity

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45
Q

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

A

Zygote

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46
Q

patients with multiple gestations may present with the clinical indication of large for dates and also an elevated ______ blood level compared to a singleton pregnancy

A

hcG

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47
Q

twins have a 4x higher risk of fetal ____ and a 6x higher neonatal ______ rate

A

mortality
morbidity

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48
Q

what has been shown to increase the probability of multiple gestations:

A

a maternal history of multiple gestations, ART (assisted reproductive therapy, ovulation induction drugs, advanced maternal age, and maternal obesity

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49
Q

twins can be either _____ or ________

A

monozygotic
dizygotic

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50
Q

monozygotic twins arise from a ___________ whereas dizygotic twins form from __________

A

single zygote
two speerate zygotes

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51
Q

the ________, the structure that forms the placenta, develops before the amnion

A

chorion

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52
Q

twins who have one shared placenta are referred to as ______ whereas twins who have two separate placentas are called __________

A

monochorionic
dichorionic

53
Q

___________ refers to how many amnions or amniotic sacs are present

A

amnionicity

54
Q

twins who share the same amniotic sac are referred to as __________, whereas twins who have their own individual amniotic sac are ________

A

monoamniotic
diamniotic

55
Q

_________ are the most common form of twinning, arise from two separate fertilized ova

A

dizygotic

56
Q

dizygotic twins are referred to as ________ because they have their own genetic structure

A

fraternal twins

57
Q

dizygotic twinning always results in __________, there are two placentas, there must be two amnions

A

diachronic diamnotic twins

58
Q

_____________ arise from a single zygote that splits

A

monozygotic twins `

59
Q

monozygotic twins are always:

A

identical twins

60
Q

three categories of monozygotic twins:

A

monochorionic diamniotic
dichorionic diamniotic
monochorionic monoamniotic

61
Q

result of dichorionic diamniotic twins: (dizygotic)

A

description: two separate fertilized ova
appearance: fraternal

(each twin has their own chorionic and amniotic sac)

62
Q

result of monochorionic diamniotic twins: (monozygotic)

A

description: one zygote splits between 4 and 8 d
appearance: identical

(identical twins who share a placenta (monochorionic) but each have their own inner sac (diamniotic)

63
Q

result of dichorionic diamniotic twins: (monozygotic)

A

description: one zygote splits prior to day 4
appearance: identical

64
Q

result of monochorionic monoamniotic: (monozygotic)

A

description: one zygote splits late
appearance: identical

(twins are those who share both the chorionic and amniotic sacs)

65
Q

most common form of monozygotic twins:

A

monochorionic diamniotic

66
Q

most common form of monozygotic twins:

A

monochorionic monoamniotic twins

67
Q

because of the shared amniotic sac, monochorionic monoamniotic carries the additional risk of:

A

conjoined twins

68
Q

the presence of one yolk sac and two fetuses is indicative of a __________ gestation, whereas the presence of two yolk sac is indicative of a __________ gestation

A

monoamniotic
diamniotic

69
Q

a triangular extension of the placenta at the base of the diving membrane is indicative of a dichorionic diamniotic pregnancy. this is referred to as:

A

twin peak sign, lambda sign, or delta sign

70
Q

with a monochorionic diamniotic pregnancy, the membrane will be thin and seen separating at the junction point with the placenta, a sonographic sign referred to as the:

A

“T sign”

71
Q

if the twins are different sexes, then one can assume that the twins are:

A

Dichorionic

72
Q

same-sex fetuses that have a single placenta and a thin membrane separating them are almost certainly:

A

Monochorionic

73
Q

a complication that carries a high mortality rate for monochorionic twins is:

A

Twin-twin transfusion syndrome (TTTS)

74
Q

What is TTTS?

A

the twin that shunts blood to the other is called the “donor” twin and is often smaller than the twin receiving extra blood, the “recipient twin”

75
Q

with TTTS, the donor twin will suffer from ____________ and the recipient twin experiences _______

A

anemia and growth restriction
hydrops and congestive heart failure

76
Q

treatment options for TTTS:

A

therapeutic amniocentesis and endoscopic-guided laser photocoagulation of the communicating placental vessels

77
Q

stuck twin refers to:

A

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

78
Q

sonographic findings of twin-twin syndrome: (TTTS) (5)

A
  1. monochorionic twinning
  2. discordant fetal growth
  3. oligohydramnios around the donor twin
  4. polyhydramnios around recipient twin
  5. recipient may be hydropic
79
Q

abnormal anastomoses (a cross-connection between adjacent channels, tubes, fibers, or other parts) of placental vessels may result in:

A

a parasitic twin or acardiac twin- this is considered to be a severe form of TTTS

80
Q

acardiac twinning may also be referred to as ___________ or __________

A

TRAP syndrome (twin-reversed arterial perfusion)
or
acardiac parabiotic twinning

81
Q

with acardiac twinning, there is one normal fetus, “__________” and an abnormally developed fetus containing ___________

A

“pump twin”
no heart

82
Q

sonographic findings of acardiac twin: (2)

A
  1. normal pump twin
  2. acardiac twin - absent upper body, absent heart, hydrops
83
Q

the most common forms of conjoined twinning are ________ and __________ which is attached at the chest and

A

abdomenthoracopagus and omphalopagus

84
Q

twin embolization syndrome can result from the death of a ___________ twin

A

monochorionic

85
Q

________ and ______ are common in the survivor of twin embolization syndrome

A

hydrocephalus and porencephaly

86
Q

mothers expecting multiple gestations have an increased risk of developing?

A

reeclampsia and anemia

(preeclampsia-high blood pressure during pregnancy)

87
Q

the median gestational age of delivery for twins is:

A

35 weeks

88
Q

infants born with low birth weight, and specifically before 32 weeks’ gestation, often suffer from ___________ with episodes of _______

A

pulmonary hypoplasia- (incomplete development of the lungs)
hypoxia- (body does not receive enough oxygen)

89
Q

which of the following is not a sonographic sign of a dichorionic diamniotic gestation?
a. twin peak sign
b. lambda sign
c. delta sign
d. T sign

A

D

90
Q

twins that have the threat of being conjoined are:
a. monochorionic monoamniotic
b. monochorionic diamniotic
c. dizygotic
d. dichorionic diamniotic

A

A

91
Q

which of the following would be a newborn most likely suffer from if he or she were born prior to 32 weeks as a result of multiple gestation complications?
a. ascites
b. pulmonary hypoplasia
c. amnionitis
d. preeclampsia

A

B

92
Q

the inner membrane surrounding the fetus is referred to as the:
a. placenta
b. chorion
c. amnion
d. yolk sac

A

C

93
Q

twins that result from the fertilization of two separate ova are called:
a. diamniotic
b. dizygotic
c. monozygotic
d. monochorionic

A

B

94
Q

what condition is pregnant-induced maternal high blood pressure and excess protein in the urine after 20 weeks’ gestation?
a. gestational diabetes
b. preeclampsia
c. porencephaly
d. maternal mirror syndrome

A

B

95
Q

the outer membrane of the gestation is referred to as the:
a. placenta
b. chorion
c. amnion
d. yolk sac

A

B

96
Q

which of the following would not increase the likelihood of multiple gestations?
a. gestational diabetes
b. maternal age > 40 yrs
c. maternal history of twins
d. ART

A

A

97
Q

twins whose bodies are connected at some point are said to be:
a. fraternal
b. conjoined
c. identical
d. stuck

A

B

98
Q

the term that indicates the presence of two separate amniotic sacs is:
a. dichorionic
b. bichorionic
c. monoamniotic
d. diamniotic

A

D

99
Q

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

A

D

100
Q

what is it called when a twin fetus, suffering from TTTS, experiences severe oligohydramnios and becomes closely adhered to the uterine wall?
a. acardiac monster
b. vanishing twin
c. acardiac twin
d. stuck twin

A

D

101
Q

which term relates the number of amniotic sacs?
a. chorionicity
b. placentation
c. amnionicity
d. embryology

A

C

102
Q

twins have one placenta and one amniotic sac are referred to as:
a. dichorionic monoamniotic
b. dichorionic diamniotic
c. monochorionic diamniotic
d. monochorionic monoamniotic

A

D

103
Q

which term relates the number of placentas?
a. chronionicity
b. zygocity
c. amnionicity
d. cleavage

A

A

104
Q

identical twins result from:
a. monozygotic twinning
b. dizygotic twinning
c. heterotopic pregnancies
d. monochorionic pregnancies

A

A

105
Q

the sonographic examination of twins reveals a triangular extension of the placenta at the base of the membrane. this finding is indicative of:
a. monochorionic monoamniotic twins
b. monochorionic diamniotic twins
c. dichorionic diamniotic twins
d. monochorionic diamniotic twins

A

C

106
Q

asymmetry in fetal weight between twins is indicative of:
a. discordant growth
b. preeclampsia
c. dichorionic diamniotic twinning
d. intrauterine infections

A

A

107
Q

twins having two placentas and two amniotic sacs are referred to as:
a. monochorionic diamniotic
b. biamniotic dichorionic
c. dichorionic diamniotic
d. dichorionic biamniotic

A

C

108
Q

typically, the first sonographic manifestation of TTTS is:
a. oligohydramnios
b. polyhydramnios
c. dichorionic twinning
d. discordant fetal growth

A

D

109
Q

conjoined twins that are attached at the abdomen are referred to as:
a. omphalopagus
b. thoracopagus
c. ileopagus
d. craniopagus

A

A

110
Q

monozygotic twins result from:
a. a single zygote that splits
b. two zygotes that are fertilized by the same sperm
c. two morulla
d. a single zygote that is fertilized by two sperm

A

A

111
Q

the demise of a twin during the second or third trimester can lead to:
a. TTTS
b. twin embolization syndrome
c. twin peak sign
d. acardiac twinning

A

B

112
Q

the term that indicates the presence of two separate placentas is:
a. dichorionic
b. bichorionic
c. monoamniotic
d. diamniotic

A

A

113
Q

what is a treatment that separates abnormal placental vascular connections between twins that are suffering from TTTS?
a. cleavage-laser resection treatment
b. endoscopic-guided laser photocoagulation
c. endemic translocation of the placental vessels
d. circumvallate resection of shared placental vasculature

A

B

114
Q

the shunting of blood from one twin to the other is termed:
a. TTTS
b. twin embolization syndrome
c. twin peak sign
d. conjoined twins

A

A

115
Q

factors that increase the likelihood of having multiple gestations include all of the following except:
a. advanced maternal age
b. ovulation induction drugs
c. poor nutritional state
d. maternal predisposition for twins

A

C

116
Q

TRAP syndrome may also be referred to as:
a. TTRS
b. vanishing twin syndrome
c. twin embolization syndrome
d. acardiac twinning

A

D

117
Q

which of the following can occur as a result of dizygotic twinning?
a. monochorionic diamniotic twins
b. monochorionic monoamniotic twins
c. dichorionic diamniotic twins
d. all of the above

A

C

118
Q

the abnormal twin in acardiac twinning is also referred to as the:
a. pump twin
b. parasitic twin
c. stuck twin
d. vanishing twin

A

B

119
Q

the twin that will appear larger in TTTS is the:
a. donor
b. recipient
c. both will be the same
d. both will be demised

A

B

120
Q

fraternal twins result from:
a. monozygotic twinning
b. dizygotic twinning
c. heterotopic pregnancies
d. monochorionic pregnancies

A

B

121
Q

what is the term for conjoined twins attached at the sacral region?
a. sacralpagus
b. omphalopagus
c. pyopagus
d. thoracopagus

A

C

122
Q

which of the following can occur as a result of monozygotic twinning?
a. monochorionic diamniotic twins
b. monochorionic monoamniotic twins
c. dichorionic diamniotic twins
d. all of the above

A

D

123
Q

the most common for of monozygotic twins is:
a. monochorionic diamniotic
b. dichorionic monoamniotic
c. monochorionic monoamniotic
d. none of the above

A

A

124
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

125
Q

acardiac twinning results from:
a. poor maternal nutrition
b. dizygotic gestations
c. abnormal links between the placental vessels
d. twin embolization syndrome

A

C

126
Q

ovulation induction drugs not only increase the likelihood of multiple gestations, but also increase the likelihood of:
a. maternal diabetes
b. ovarian prolapse
c. heterotopic pregnancies
d. choriocarcinoma

A

C

127
Q

which form of monozygotic twinning is least common?
a. monochorionic diamniotic
b. monochorionic monoamniotic
c. dichorionic diamniotic
d. dichorionic biamniotic

A

B

128
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

Penny - OB CH (18 decks)

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