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OB/GYN Scanning > High Risk & Multiple Gestation > Flashcards

High Risk & Multiple Gestation Flashcards

1
Q

Twin gestation account for how many of all live births in the US?

A

3.2%

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2
Q

Twins have a __ times greater chance of perinatal death than a singleton.

A

5

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3
Q

Clinically, twin pregnancies present with symptoms of…

A
  1. increased MS-AFP
  2. earlier and more severe pelvic pressure causing hemorrhoids, constipation, backaches, shortness of breath
  3. increased fetal activity
  4. increased uterine size
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4
Q

T/F? The baby closer to the cervix is designated as Twin A.

A

true

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5
Q

Twins are either monozygotic or dizygotic, depending on…

A

the number of eggs fertilized at conception.

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6
Q

The term ‘zygosity’ refers to…

A

the number of zygotes involved.

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7
Q

The term ‘chorionicity’ refers to…

A

the type of placentation in a twin pregnancy.

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8
Q

T/F? The second trimester is the best time to determine chorionicity and amnionicity in multiples.

A

FALSE, first

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9
Q

In the first trimester, what do you look at to determine chorionicity?

A

The number of gestational sacs, amnions, and yolk sacs.

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10
Q

In the 2nd & 3rd trimester, what do you look at to determine chorionicity?

A

The genders, the number of placentas, the appearance of the dividing membrane.

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11
Q

If differing genders or two distinct placentas are noted then __chorionic placentation has occured.

A

di-

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12
Q

If the same gender and one placenta are noted, then what can we determine about the placentation?

A

It could be anything!! Look at the membranes next to narrow it down.

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13
Q

T/F? The dividing membrane in a di-di gestation is only two layers thick.

A

FALSE, four layers

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14
Q

T/F? The dividing membrane in a mono-di gestation is only two layers thick.

A

true

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15
Q

A cut-off level of greater than __ in septal thickness suggests dichorioncity.

A

2 mm

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16
Q

The type of chorionicity in monozygotic twinning is determined by…

A

how early the twins divided from the single zygote.

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17
Q

Identical twins occur when the embryo splits between __ and __ days post conception.

A

2 and 14

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18
Q

Identical twinning occurs in about __ pregnancies.

A

1/250

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19
Q

If the embryo splits before day 3, what kind of chorionicity results?

A

di-di

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20
Q

If the embryo splits between days 4 and 7, what kind of chorionicity results?

A

mono-di

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21
Q

If the embryo splits between 8 and 13 days, what kind of chorionicity results?

A

mono-mono

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22
Q

If the embryo splits after 14 days, what kind of chorionicity results?

A

mono-mono conjoined twins :(

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23
Q

Di-di twins occur when the embryo splits before day…

A

3.

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24
Q

Mono-di twins occur when the embryo splits between day…

A

4 and 7.

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25
Q

Mono-mono twins occur when the embryo splits between day…

A

8 and 13.

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26
Q

Conjoined twins occur when the embryo splits after day…

A

14.

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27
Q

Mono-di twins have how many placentas?

A

one

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28
Q

Di-di twins have how many placentas?

A

Either two separate placentas or one big fused one.

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29
Q

From the __ weeks, the number of sacs and/or placentas is an accurate method for determining chorionicity.

A

6th through 10th

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30
Q

Diamnionicity occurs in __% of cases.

A

90%

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31
Q

Amnionicity is established by the number of…

A

yolk sacs and/or amniotic sacs.

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32
Q

If it’s too early to identify the amnion, what can you use to determine amnionicity?

A

the number of yolk sacs

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33
Q

Mono-di twins have how many yolk sacs?

A

two

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34
Q

Mono-mono twins have how many yolk sacs?

A

one (or sometimes one partially divided yolk sac)

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35
Q

T/F? Identification of a single placenta differentiates between a monochorionic and a dichorionic gestation.

A

FALSE, does not differentiate

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36
Q

In the 2nd/3rd trimester, what ‘sign’ can we use to identify di-di twins?

A

‘twin peak’ or ‘lamba’ sign

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37
Q

T/F? Identification of two placentas differentiates between a monochorionic and a dichorionic gestation.

A

true

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38
Q

This is the most common kind of twinning.

A

mono-di

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39
Q

This is the least common kind of twinning.

A

mono-mono

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40
Q

The presence of more than three vessels in a cord is a strong indication of __ twins.

A

conjoined

41
Q

With conjoined twins: the later the division of the embryo, the __ the number of shared organs.

A

greater

42
Q

Conjoined twins are described by the…

A

site of union.

43
Q

Thoracopagus twins are joined at the…

A

chest.

44
Q

Pygopagus twins are joined at the…

A

sacrum.

45
Q

Craniopagus twins are joined at the…

A

head.

46
Q

Omphalpagus twins are joined at the…

A

abdominal wall.

47
Q

Ischiopagus twins are joined at the…

A

pelvis.

48
Q

The prognosis for conjoined twins is…

A

poor. Most are born prematurely, 40% are stillborn, and 35% die within a day.

49
Q

Of the conjoined twins that survive, the riskiest separations involve a shared…

A

liver or heart.

50
Q

Dizygotic (‘fraternal’) twins occur in about __ pregnancies.

A

1:83

51
Q

Some factors associated with dizygotic twinning include…

A
  1. recent cessation of long term oral contraceptives
  2. maternal family history of multiples
  3. maternal age 35-40
  4. assisted reproduction
52
Q

Is monozygotic or dizygotic twinning more common?

A

dizygotic

53
Q

Dizygotic twinning is more common among __ than among caucasians.

A

african-americans

54
Q

Women over __ have a higher incidence of dizygotic twinning.

A

40

55
Q

Fetal growth discrepancy is defined as a greater than __ difference in the twins’ estimated weight, __ or greater difference in the AC, and __ or greater difference in femur length.

A

20%, 20 mm, 5 mm

56
Q

Fetal growth discrepancy is generally caused by…

A
  1. placental insufficiency
  2. death of one twin after week 16
  3. chromosomal abnormalities
57
Q

Fetal growth discrepancy can be described as mild (weight differences of __%) or severe (weight differences of __%).

A

15-25%, > 25%

58
Q

This treatment consists of serial amniocenteses to normalize the intrauterine pressure, prevent premature labor, and relieve maternal symptoms.

A

therapeutic amniocentesis

59
Q

The stress of a multiple pregnancy can affect the maternal respiratory, GI, renal & musculoskeletal systems causing…

A
  1. preeclampsia
  2. HTN
  3. placenta abruption
  4. hemorrhage
  5. anemia
  6. UTIs
60
Q

This is the resorption of a non-viable fetus in a twin gestation.

A

vanishing twin

61
Q

Sonographically, a vanishing twin is seen as…

A
  1. a lack of multiple sacs on follow-up u/s
  2. failure of sac growth in one twin
  3. irregularly marginated sac
  4. the ‘vanishing’ sac may mimic an implantation bleed in the cavity
62
Q

This is a serious condition that occurs in monozygotic twins with a shared placenta.

A

twin to twin transfusion syndrome (TTTS)

63
Q

TTTS is also known as…

A

‘cross transfusion’ or ‘third circulation’

64
Q

This results when the vascular supply of the twins develops an artery-to-vein anastomosis.

A

TTTS

65
Q

T/F? Both twins are at risk of dying with TTTS.

A

true

66
Q

Sonographically, the donor twin in TTTS is seen as…

A
  1. small for dates
  2. oligohydramnios
  3. a ‘stuck’ twin with empty bladder and restricted movement**
67
Q

The ‘stuck’ twin syndrome usually manifests itself between __ weeks gestation.

A

16-26

68
Q

Sonographically, the recipient twin in TTTS is seen as…

A
  1. hydropic (swollen)
  2. ascites
  3. enlarged liver, heart, and kidneys
  4. polyhydramnios
69
Q

This is the passage of thromboplastic material from a dead monochorionic twin to the remaining living twin through shared intraplacental vasculature.

A

twin embolization syndrome

70
Q

Twin embolization syndrome can result in __ for the living twin.

A

neurological, GI, or genitourinary deficits***

71
Q

Sonographically, the twin embolization syndrome is seen as…

A
  1. intrauterine death of one twin**
  2. hydrops
  3. polyhydramnios
  4. intraparenchymal hemorrhage
  5. encephaly
  6. enlarged, echogenic kidneys
72
Q

This is a form of monozygotic twinning in which a severely malformed acardiac twin is perfused by the normal twin.

A

acardiac twin

73
Q

Acardiac twin is also known as…

A

parabiotic twin.

74
Q

The acardiac twin is often also…

A

aencephalic.

75
Q

Perfusion of the acardiac twin is accomplished through what two kinds of anastomoses?

A

one vein-to-vein and one artery-to-artery

76
Q

T/F? The normal co-twin in an acardiac pair has a typical level of risk.

A

FALSE, higher risk for CHF and hydrops

77
Q

In this condition, the acardiac/acephalic twin receives all of its blood supply from the normal ‘pump’ twin.

A

Twin reversed arterial perfusion (TRAP sequence)

78
Q

In TRAP sequence, blood enters the acardiac/acephalic twin through its umbilical __ and exits through the umbilical __.

A

artery/vein

79
Q

T/F? TRAP sequence occurs only in a monochorionic gestation.

A

true

80
Q

TRAP complicates approximately __ of monochorionic twins and 1:__ births.

A

1%, 1:35,000

81
Q

Sonographically, TRAP sequence is seen as…

A
  1. polyhydramnios
  2. mono-di or mono-mono gestation
  3. extremely malformed acardiac twin
  4. hydropic pump twin
82
Q

This is characterized by a macerated fetus, resulting from fetal death after it was too large to be reabsorbed.

A

fetus papyraceous

83
Q

This is the term for when, hours after death, the skin of the fetus detaches from the underlying tissues.

A

‘skin slippage’

84
Q

This is a system designed to detect fetal asphyxia and assess fetal well being.

A

biophysical profile (BPP)

85
Q

The BPP parameters are…

A
  1. fetal breathing movements
  2. gross body movements
  3. fetal tone
  4. amniotic fluid volume
  5. non-stress test
86
Q

In a BPP, fetal breathing must last at least…

A

30 seconds over a 30 minute period.

87
Q

In a BPP, at least __ episodes of fetal body and/or limb movements must be seen over 30 minutes.

A

3

88
Q

In a BPP, all fetal extremities should appear __ and the fetal chin __ OR at least __ episode of limb extension/flexion.

A

flexed, tucked to the chest; one

89
Q

In a BPP, the amniotic fluid volume should exceed…

A

5 cm.

90
Q

In a BPP, at least __ episodes of pulse acceleration of greater than __ over 30 minutes.

A

two, 15 bpm for 15 seconds

91
Q

Fetal Doppler plays a vital role in the diagnosis of __ and in the assessment of __.

A

fetal cardiac defects and other non-cardiac malformations; the hemodynamic responses to hypoxia and anemia

92
Q

Fetal Doppler measures the resistance of blood flow within the…

A

placenta.

93
Q

Fetal Doppler has a good correlation between the absence of effective diastolic flow and…

A

poor outcomes.

94
Q

This has a characteristic saw-tooth appearance of arterial flow in one direction and continuous umbilical venous flow in the other.

A

umbilical artery flow

95
Q

With advancing gestation umbilical arterial Doppler wave forms demonstrate a progressive rise in __ and a decrease in __.

A

end-diastolic velocity, pulsatility index

96
Q

Fetal Doppler of the umbilical vein showing pulsations later in pregnancy is an ominous sign that indicates…

A

CHF in a compromised fetus.

97
Q

Cervical cerclage is most often recommended between __ weeks of pregnancy.

A

14-16

98
Q

In this cervical condition, there are changes in the length and shape of the inner cervical os.

A

cervix funneling

OB/GYN Scanning (14 decks)

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