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OB 2 > Chapter 31: Multiple Gestations > Flashcards

Chapter 31: Multiple Gestations Flashcards

1
Q

determination of the number of fetal amniotic membranes

A

amnionicity

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2
Q

lack of an embryo

A

anembryonic

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3
Q

measurements done on an embryo or fetus as a CRL or BPD

A

biometry

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4
Q

determination of the number of chorionic membranes adjacent to the uterus

A

chorionicity

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5
Q

two zygotes as a result of the fertilization of two ova

A

dizygotic

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6
Q

hormone that induces the growth of Graafian follicles

A

Follicle-stimulating hormone

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7
Q

mixing of the ovum and sperm within the fallopian tubes allowing for fertilization within the woman’s body

A

gamete intrafallopian transfer (GIFT)

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8
Q

increase in circulating blood volume

A

hypervolemic

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9
Q

surgical incision into the uterus

A

hysterotomy

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10
Q

injection of sperm into the oocyte

A

intracytoplasmic sperm injection

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11
Q

fertilization of the ovum outside of the uterus

A

in vitro fertilization

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12
Q

large fetus that falls into the 90th percentile for weight

A

macrosomic

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13
Q

one amnion

A

monoamniotic

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14
Q

one zygote

A

monozygotic

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15
Q

incidence of disease

A

morbidity

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16
Q

death rate because of a specific disease

A

mortality

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17
Q

edema, accumulation of fluid in tissues and in the peritoneal cavity, and chest in a fetus not affected by erythroblastosis fetalis

A

nonimmune fetal hydrops

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18
Q

low amniotic fluid levels

A

oligohydramnios

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19
Q

abundant

A

plethoric

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20
Q

too much amniotic fluid

A

polyhydramnios

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21
Q

four

A

quadruplet

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22
Q

use of heat to seal tisse

A

thermocoagulation

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23
Q

fertilized ovum with 23 pairs of chromosomes

A

zygote

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24
Q

one sac =

A

monochorionic

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25
Q

two sacs =

A

dichorionic

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26
Q

one yolk sac + two fetal poles

A

monoamniotic

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27
Q

two yolk sacs + two fetal poles

A

diamniotic

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28
Q

dichorionic/ diamnotic intertwin membrane

A

thick

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29
Q

monochorionic/diamnotic intertwin membrane

A

thin

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30
Q

TRAP sequence occurs in the _______ pregnancy

A

monochorionic/monoamniotic

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31
Q

one normal twin
one acardiac twin

A

TRAP sequence

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32
Q

Retrograde umbilical artery flow to the acardiac twin

A

TRAP sequence

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33
Q

TRAP sequence

A

Twin Reversed Arterial Perfusion sequence

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34
Q

In TRAP sequence only the ____ and _____ form in acardiac twin

A

lower pelvis
lower extremities

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35
Q

Placental arterial to arterial and venous to venous anastomoses occur which causes _____

A

TRAP sequence

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36
Q

The normal twin in TRAP sequence could have ______ because of increased load

A

congestive heart failure

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37
Q

The acardiac twin in TRAP sequence is supported by the normal fetus via _____

A

placental anastamoses

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38
Q

TTTS

A

twin to twin transfusion syndrome

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39
Q

TTTS occurs in the ______ pregnancy

A

monochorionic/diamnotic

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40
Q

arterial and venous anastamoses between placentas; flow shunting from one fetus to the other creating a perfusion imbalance

A

TTTS

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41
Q

Recipient twin
donor twin

A

TTTS

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42
Q

Sonographing findings in the ____ twin in TTTS include polyhydramnios, macrosomic, hypervolemic, plethoric, hydrops

A

recipient

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43
Q

Sonographic findings in the ____ twin in TTTS include oligohydramnios, growth restricted, hypovolemic, anemic

A

donor

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44
Q

A __% weight discordance can help in diagnosing TTTS

A

20

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45
Q

A ______ cord insertion is common in TTTS.

A

velamentous

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46
Q

joined by lower part of body, or twins in lower body and double upper body

A

terata catadidyma

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47
Q

back to back, coccyx and sacrum joined together

A

pyopagus

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48
Q

inferior parts of coccyx and sacrum fused; separate vertebral columns laying in same axis

A

ischiopagus

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49
Q

two separate heads on one body

A

dicephalus

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50
Q

two faces with one head and one body

A

diprosopus

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51
Q

single in upper body and double in lower body, or joined by some body part

A

terata anadidyma

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52
Q

fused in the cranial vault

A

cephalopagus

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53
Q

united at the face; may also be joined by the thorax

A

syncephalus

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54
Q

single head, thorax, and/or abdomen; pelvis, external genitalia, and limbs are duplicate

A

dipygus

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55
Q

united at midpoint of body

A

terata anacatadidyma

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56
Q

attached long part of thoracic wall; thoracic and abdominal organs may be abnormal

A

thoracopagus

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57
Q

attached from umbilicus to xiphoid cartilage

A

omphapagus

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58
Q

attached at the vertebral column above the sacrum

A

rachipagus

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59
Q

Conjoined twin happen in a ______ pregnancy

A

monochorionnic/monoamniotic

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60
Q

______ result from incomplete division after 13th day (stage 5)

A

conjoined twins

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61
Q

70% of conjoined twins are ____

A

females

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62
Q

The chance of multiple gestation with ART is __x higher than from natural conception

A

20

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63
Q

contributing factors to monozygotic twinning

A

maternal age, race, parity, hereditary

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64
Q

contributing facts to dizygotic twinning

A

heavily influenced by environmental factors, increase in FSH concentration

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65
Q

_____ twinning increases more often with increasing maternal age

A

Dizygotic

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66
Q

The maternal serum AFP is ___x MOM in multiple gestations

A

2.5

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67
Q

single ovum divides after fertilization; appears to be random and independent of most clinical and epidemiological factors

A

monozygotic

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68
Q

result of fertilzation of two ova; influenced by genetic factors, environmental factors, AMA, ART

A

dizygotic

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69
Q

The ____ is the outer layer of the placental membrane

A

chorion

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70
Q

The ____ is the inner layer of the placental membrane

A

amnion

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71
Q

always have 2 placentas
2 separate chorions
2 separate amnions

A

dizygotic

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72
Q

_____ twin pregnancies depends on which stage the single fertilized ovum divides

A

monozygotic

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73
Q

division of zygote before day 4 (stage 1 and 2 Carnegie stage) (25%)

A

dichorionic/diamniotic

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74
Q

division of zygote between days 4 and 8 (stage 3 and 4 Carnegie stage)

A

monochorionic/diamniotic

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75
Q

1 placenta 2 gestational sacs (75%)

A

monochorionic/diamniotic f

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76
Q

division of zygote occurs more than 8 days postfertilization (less than 1%)

A

monochorionic/monoamniotic

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77
Q

1 placenta 1 gestational sac

A

monochorionic/monoamniotic

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78
Q

division of zygote more than 13 days postfertilization

A

monochorionic/monoamniotic (conjoined twins)

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79
Q

Infant mortality is __x higher in twins

A

4

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80
Q

Infant mortality is __x higher in triplets

A

10

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81
Q

Women with multigestational pregnancies have a __x increase of severe complications

A

4

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82
Q

Fetal risk is largely dependent on ____

A

chorionicity

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83
Q

_____ twins are at a higher risk than ____ twins

A

monozygotic
dizygotic

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84
Q

Congenital anomalies in multiple gestations are __-__x more often

A

2
3

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85
Q

The most common congenital anomaly in twins is in the _____ system

A

cardiovascular

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86
Q

Most common discordant defect in MZ twin pair

A

normal fetus paired with one that has Turner Syndrome

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87
Q

most accurate time to determine amnionicity and chorionicity

A

first trimester

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88
Q

Dating is based on CRL of the ___ twin up to 13 weeks 6 days

A

larger

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89
Q

After 14 weeks, measurements of the ____ should be used from larger twin

A

HC

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90
Q

Twins conceived through IVF should be dated by _____ or embryonic age from fertilization

A

oocyte retrieval date

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91
Q

five or more days difference in CRL

A

significant discordance in first trimester

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92
Q

number of gestational sacs

A

chorionicity

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93
Q

1 gestational sac

A

monochorionic

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94
Q

2 gestational sacs

A

dichorionic

95
Q

All dichorionic twin pregnancies must be _____

A

diamniotic

96
Q

The amnion is usually visible by __-__ weeks

A

7
8

97
Q

The number of yolk sacs is consistent with the number of ____

A

amnions

98
Q

one yolk sac + 2 fetal poles

A

monoamniotic

99
Q

Determination of chorionicity and amnionicity happpens between __ and __ weeks

A

11
14

100
Q

presence of a triangular projection of placental tissue extending up into base of junction of two chorionic membranes

A

twin peak sign

101
Q

T-sign

A

monochorioncic

102
Q

lambda sign

A

dichorionic

103
Q

wedge shaped junction formed by placental tissue extending into base of chorionic membranes

A

lambda sign

104
Q

T shaped junction formed when two amniotic membranes fuse with one placenta

A

T sign

105
Q

membrane composed of two layers of chorion and two layers of amnion (more than 2mm)

A

dichorionic/diamnotic

106
Q

two layers of amnion with no interposing chorion

A

monochorionic/diamnotic

107
Q

Twins of different sex are virtually all _____ pregnancies

A

dichorionic/diamniotic

108
Q

The membrane thickness is more reliable before __ weeks

A

26

109
Q

Growth rates of normal multiples follow singletons until around __ weeks

A

30

110
Q

At around 30 weeks the ___ and ___ may start to lag behind singleton pregnancies

A

BPD
AC

111
Q

one of the most common problems encountered in multiple gestations

A

growth discordance

112
Q

fetal weight percentages that differ by more than 20%

A

growth discordance

113
Q

increased resistance to blood flow within UAs; decreased resistance in MCAs

A

IUGR

114
Q

two sacs identified early in pregnancy, but subsequent sonograms only confirm one fetus

A

vanishing twin

115
Q

viable gestational sac growth

A

0.12 cm/day

116
Q

nonviable gestational sac growth

A

0.025 cm/day

117
Q

smaller gestational sac than expected for menstrual age; irregular margin of sac; crescent-shaped sac with an incomplete trophoblastic ring

A

vanishing twin

118
Q

fetal loss in 2nd/3rd trimester of monozygotic twins; fetus becomes paperlike and preserved in a distorted form

A

fetus papyraceous

119
Q

transient polyhydramnios of one fetus in a monochorionic/diamniotic exerting lethal compressive effect on other twin

A

fetus papyraceous

120
Q

In triplet pregnancies, __% secondary to fetilization of two ova

A

60

121
Q

In triplet pregnancies, __% arise from fertilization of three ova

A

30

122
Q

In triplet pregnancies, __% arise from fertilization of a single ovum

A

10

123
Q

Maternal complications are __x higher in multiple gestation pregnancies

A

3

124
Q

primary risk factors for fetal mortality and long term morbidity

A

premature delivery
low birth weight

125
Q

Twins are __x more likely to be preterm

A

6

126
Q

Twins are __x more likely to be born before 32 weeks

A

13

127
Q

increased risk of congenital anomalies

A

monozygotic twins

128
Q

increased risk for TTTS and TRAP sequence

A

monochorionic twins

129
Q

fetal vessels overlying the cervical os because of the insertion of the umbilical cord into amniotic membrane rather than the placenta

A

vasa previa

130
Q

associated with fetal mortality resulting from rapid fetal exsanguination at time of membrane rupture

A

vasa previa

131
Q

commonly referred to as acardiac twinning

A

Twin Reversed Arterial Perfusion

132
Q

one normal twin “pump twin”
one amorphous twin “acardiac twin”

A

twin reversed arterial perfusion

133
Q

does not have a well defined cardiac structure; hemodynamically dependent on pump twin for all circulation

A

twin reversed arterial perfusion

134
Q

arterial to arterial and venous to venous anastamoses occur on surface of placenta

A

twin reversed arterial perfusion

135
Q

Blood enters the acardiac twin through _____ arteries and perfuses only the caudal aspect of the fetus

A

hypogastric

136
Q

usually only lower pelvis and extremities tends to develop; more cephalic structures completely absent or severely maldeveloped

A

twin reversed arterial perfusion

137
Q

The blood returning from the acardiac twin flows back to the placenta via the _____

A

umbilical vein

138
Q

The pump twin is at a ___% risk of morbidity or mortality secondary to developing high output congestive heart failure

A

50

139
Q

Treatment of TRAPS before __ weeks increases survival rate

A

18

140
Q

Diagnosis of TRAPS sequence can be sonographically done at __ weeks

A

11

141
Q

arterial to venous anastamoses occur within the shared placenta; returning blood from one fetus shunted directly to other fetus

A

Twin-to-Twin transfusion syndrome

142
Q

The ____ twin is larger and possibly has polyhydramnios

A

recipient

143
Q

The ____ twin is smaller and possibly has oligohydramnios

A

donor

144
Q

The donor twin may also be referred to as the ____

A

stuck twin

145
Q

The ____ twin becomes growth restricted, hypovolemic, and anemic.

A

donor

146
Q

The ____ twin becomes macrosomic, hypervolemic, and plethoric.

A

recipient

147
Q

Cardiac abnormalities that may occur with TTTS are normally

A

right sided

148
Q

results from hypertrophied ventricular heart walls and interventricular septum obstructing right ventricular outflow

A

pulmonary stenosis or atresia

149
Q

A _____ cord insertion has a risk greater than 50% for TTTS

A

velamentous

150
Q

TTTS usually presents in the ____ trimester

A

second

151
Q

If left untreated, TTTS has a mortality rate of __-___% for both twins

A

60
100

152
Q

single placenta, same sex fetuses, weight discordance greater than 20%, significant discrepancy in AFV

A

TTTS

153
Q

removing fluid from polyhydramniotic sac returning it to normal volume

A

serial reduction amniocentesis

154
Q

occurs when miniscule vascular anasatmoses occur in placenta, causes chronic and slow intertwin blood transfucion

A

twin anemia polycythemia sequence (TAPS)

155
Q

In TAPS, the donor twin is ____

A

anemia

156
Q

In TAPS, the recipient twin is ____

A

polycythemic

157
Q

Big differences in hemoglobin levels

A

TAPS

158
Q

increased peak systolic velocity in MCA is indicative of

A

anemia

159
Q

Decreased peak systolic velocity in MCA is indicative of

A

polycythemia

160
Q

increased placental thickeness and echogenicity, starry sky appearance of liver

A

TAPS

161
Q

__% of conjoined twins are stillborn

A

60

162
Q

Conjoined twin are classified by ___ and ____

A

site
pagus

163
Q

joined at buttocks

A

pyopagus

164
Q

joined at thorax

A

thoracopagus

165
Q

joined at abdominal wall

A

omphalopagus

166
Q

joined at head

A

craniopagus

167
Q

joined at ishia

A

ischiopagus

168
Q

joined at head and thorax

A

cephalothoracopagus

169
Q

70% of all conjoined twins are ____

A

cephalothoracopagus

170
Q

Conjoined twins arise from ____/_____ pregnancies

A

monochorionic/monoamniotic

171
Q

incomplete division of embryo occurring after day 13 during Carnegie Stage 5

A

conjoined twins

172
Q

lack of visualization of separating membrane between twins, inability to separate fetal bodies or heads, more than 3 vessels in a single umbilical cord, complex fetal structural anomalies

A

conjoined twins

173
Q

Conjoined twins can be diagnosed as early as __ weeks gestation

A

7

174
Q

__% of twins are thoracopagus and share a heart

A

75

175
Q

parasitic twin found within abdomen of its sibling

A

Fetus in fetu

176
Q

The tumor found in fetus in fetu is a _____

A

benign hamartoma

177
Q

Fetus in fetu happens more commonly in the _____

A

upper retroperitoneum

178
Q

direct injection of potassium chloride or lignocaine into fetal heart or umbilical vein in designated twin

A

dichorionic selective reduction

179
Q

potential exists for thromboembolic substance to be released into surviving twin

A

monochorionic selective reduction

180
Q

Multiple births increase with ____, ____, _____, _____, and the use of _____

A

delayed childbearing
race
genetics
environmental factors
ART

181
Q

______ twinning is a random event of ovum division after fertilization.

A

monozygotic

182
Q

____ twinning is influenced by by genetic factors, environmental factors, AMA, and the use of ART and is the result of two ova fertilization

A

dyzygotic

183
Q

Two placentas and membrane sets occur with dizygotic twin gestations, resulting in ________ configuration.

A

dichorionic/diamniotic f

184
Q

Number and chorionicity can be determined in the first trimester; however, as many as 20% of twin pregnancies result in a ______

A

singletone delivery

185
Q

The ______ is a lambda shaped extension of two fused placentas between the membranes, where as a ____ describes the membrane appearance with one placenta and two amnions

A

twin peak sign
T sign

186
Q

A gestational sac lacking fetal membranes is a ______ pregnancy

A

monoamniotic

187
Q

Biometric measurements for twins mimic a singleton pregnancy until approximately __ weeks, when growth may slow

A

30

188
Q

Increased resistance to blood flow within the UAs or a decreased resistance observed in the MCAs may occur in the setting of ____ with a multiple pregnancy

A

IUGR

189
Q

_____ is the demise of a fetus in a twin pregnancy, which results in the preservation of a paperlike fetus within the uterus

A

fetus papyraceous

190
Q

The risk of _____, defined as fetal vessels overlying the cervical os because of insertion of the umbilical cord into the amniotic membrane rather than the placenta, increases with multiple pregnancies and ART

A

vasa previa

191
Q

_____ or _____ is a complication seen in monozygotic twins when one twins heart supports two fetuses through arterial to arterial and venous to venous anastamoses occurring of the surface of the shared placenta

A

acardiac twinning
TRAP sequence

192
Q

The ____/_____ twin gestation is at risk for the development of TTTS, in which a shared placenta develops arterial to venous anastamoses. The perfusion imbalance of the returning blood results in disparate fetal size and fluid levels

A

monochorionic/diamniotic

193
Q

_____ are the result of the incomplete division of the embryoduring the implantation stage occuring after day 13 (carnegie stage 5)

A

conjoined twins

194
Q

What is the least related two twinning/
a. choriocarcinoma
b. IUGR
c. preterm birth
d. fetal anomalies

A

aS

195
Q

Spontaneously occurring monozygotic twinning is noted to be influenced by:

A

random factors

196
Q

A large for date uterus may be a result of all except:
a. macrosomic fetus
b. uterine fibroids
c. oligohydramnios
d. multiple gestation pregnancy

A

c

197
Q

Increased maternal serum alpha-fetoprotein (MSAFP) levels can be the result of all except:
a. fetal open neural tube defects
b. placental masses
c. fetal abdominal wall defects
d. uterine fibroids during pregnancy

A

d

198
Q

What is not a risk factor for a multiple pregnancy?
a. Decreased morbitidy
b. IUGR
c. TTTS
d. low birth weight

A

a

199
Q

A monozygotic pregnancy with two placentas and two amnions is labeled as:

A

dichorionic/diamniotic

200
Q

A pregnancy consisting of two amnions, one chorion, and one placenta is:

A

monochorionic/diamniotic

201
Q

Preeclampsia, hypertension, placental abruption, placenta previa, and postpartum hemorrhage are:
a. associated with TTTS
b. maternal complications of a multiple gestation pregnancy
c. risks of TRAP
d. fetal complications of twinning

A

b

202
Q

The risk of an adverse outcome or abnormality with multiples is greatest with:
a. dichorionic/diamniotic twins
b. monochorionic/diamniotic twins
c. monochorionic/monoamniotic twins
d. dichorionic/monoamniotic twins

A

c

203
Q

Sonographic determination of chorionicity and amnionicity is most accurate in:

A

the first trimester

204
Q

To determine chorionicity, search for all except:
a. the T sign
b. The lambda sign
c. the Y sign
d. a separating membrane of at least 1.5 mm

A

c

205
Q

An intertwin biometric discrepancyof more than 20% suggests:
a. TRTS
b. likelihood of gender difference
c. positional variation
d. discordant growth

A

d

206
Q

Growth restriction in discordant twins is assessed by evaluating all except:
a. UA with Doppler
b. MVP
c. middle cerebral artery (MCA) with Doppler
d. biometry

A

b

207
Q

The rate of spontaneous demise of a singleton and single twin demise is approximately :

A

21%

208
Q

What is least likely to contribute to an adverse outcome with a twin pregnancy?
a. a higher rate of csection
b. age
c. preeclampsia
d. diabetes

A

a

209
Q

A primary fetal risk factor for mortality and long term morbiditywith multiple gestations is:
a. postpartum hemorrhage
b. oligohydramnios
c. discordant fetal position
d. low birth weight

A

d

210
Q

An abnormality revealing a normal twin combined with a poorly defined twin possessing an irregular or no cardiac structure is:

A

TRAP sequence

211
Q

TRAP sequence is commonly referred to as:

A

acardiac twinning

212
Q

TTTS is associated with ____ cord insertion

A

velamentous

213
Q

Conjoined twins connecting at the thorax are classified as:

A

thoracopagus

214
Q

Twins of different sex originate from two separate ____ and are thus _____

A

ova
dizygotic

215
Q

If two discrete placentas can be identified on ultrasound, the pregnancy must be _____

A

dichorionic

216
Q

Monozygotic twinning is the result of a ____ ovum

A

single

217
Q

Several authors have reported that the growth rates of normal multiples in the second and third trimesters follow that of singleton pregnancies until around ___ weeks.

A

30

218
Q

Triplet or higher order gestations, biometric parameters may start to lag sooner in pregnancy, except for ______ which seems to closely follow nomograms developed for singletons

A

femur length

219
Q

An _____ resistance to blood flow within the umbilical arteries or a _____ resistance observed in the MCAs may occur in the setting of IUGR

A

increased
decreased

220
Q

ART has been shown to increase the rate of fetal vessels overlying the cervical os, also known as _____

A

vasa previa

221
Q

Concordant defects in twins is mostly related to _____ twins.

A

monozygotic

222
Q

Chorionicity and amnionicity determination utilizing ultrasound is most accurate in the ____ trimester.

A

first

223
Q

An accurate and easy method of determining the type of twinning involves counting the number of ____ sacs.

A

yolk

224
Q

The ____ sign refers to the presence of a triangular projection of placental tissue extending into the vase of the junction of two chorionic membranes.

A

twin peak

225
Q

In a twin pregnancy, fetuses measuring ___ or more days difference by CRL are considered discordant.

A

5

226
Q

Conjoined twins are the result of incomplete division of the embryo during the implantation stage occurring after day ___

A

13

227
Q

An early twin pregnancy that delivers a singleton fetus is known as a ______ pregnancy

A

vanishing twin

228
Q

All multiple gestations should be considered _____ pregnancies

A

high risk

229
Q

A gestational sac lacking fetal membranes is a _____ pregnancy

A

monoamniotic

230
Q

Periodically removing fluid from a twin polyhydramniotic sac is known as _______ amniocentesis

A

serial reduction

231
Q

The highest risk form of twinning is _____

A

monoamniotic

232
Q

Selective reduction should never be performed on a _____ pregnancy due to the risk of passing a ______ substance from demise twin into the surviving twin

A

monochorionic
thromboembolic

233
Q
A

OB 2 (17 decks)

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