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OBGYN 2 > M13: Multiples in Preg & Doppler > Flashcards

M13: Multiples in Preg & Doppler Flashcards

1
Q

SEE NORMAL TWINNING FROM OB/GYN 1

A

/

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2
Q

why does chronicity refer to

when is it best determines

A

of placentas

b/w 10-14 wks

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3
Q

most important predictor of preg outcomes in twins

what signs do we look for

A

of placentas

lambda - means dichorionic, some of the placental tissue growing up b/w the membranes

T sign - monochorionic…. would have to be Mono/Di to see this

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4
Q

what does a thicker membrane b/w the fetuses suggest

A

dizygotic twins

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5
Q

most common type of monozygotic twins

A

monochorionic, diamniotic

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6
Q

whats a structure we can look for when to determine if there are 2 membranes

A

yolk sac

1 yolk sacs mean 1 membrane

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7
Q

least common type of monozygotic twins

A

monochorionic, monoamniotic

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8
Q

describe a papyraceous fetus

A

mummified skeletal remains of a demised twin… would occur later in gestation (if the demise is earlier body would reabsorb it)

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9
Q

when would mono/mono twins be conjoined

where are they most commonly conjoined

prognosis

A

if the egg splits after day 13

chest (thoracopagus) or abdomen (omphalopagus)

more are still born or die after 1 day of life

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10
Q

the majority of conjoined twins are what gender

A

female (70%)

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11
Q

what is diprosopus

A

duplication of anatomy or a single body part

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12
Q

what does TRAP syndrome stand for

other names

A

twin reversed arterial perfusion

acardiac parabolic twin
acardiac monster

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13
Q

w/ what type of twining does TRAP occur

A

mono/mono only

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14
Q

w/ TRAP, what type of connections are formed in the placenta

A

can be artery - artery

vein - vein

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15
Q

describe how TRAP syndrome works

A

the pump/donor twin pumps deoxygenated blood from the umbilical artery to the placenta… that blood is shunted along the surface of the placenta to the second acardiac twin… the deoxygenated blood enters the acardiac twin through the umbilical artery and leaves deoxygenated through the umbilical vein.

there is reversed flow in the umbilical artery of the acardiac twin

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16
Q

how does TRAP affect the development of the acardiac twin

A

-only the lower limbs and trunk will develop due to lack of nutrients and 02
-no heart of very abnormal, often no head
… acardiac twin is completely supplied by the donor twin

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17
Q

US appearance of TRAP

A

lack of separating membrane
inability to separate fetal parts
more than 3 vessel cord
complex anomalies

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18
Q

donor twin is at high risk for developing which condition

A

hydrous due to volume overload and high cardiac output… also leads to cardiac failure

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19
Q

what is a fetus in fetu

US appearance

A

a parasitic twin w/in the abdomen of its sibling

teratoma

20
Q

what is a heterotypic preg

A

one normal preg

one ectopic

21
Q

describe superfetation

A

fertilization of 2 separate ova months apart

22
Q

on other type of abnormal twinning variation

A

hydatidiform mole w/ coexisting twin

23
Q

complications w/ twins

A 
twin to twin transfusion syndrome (TTTS)
twin embolization
premature delivery
congenital anomalies
cord accidents
24
Q

w/ what type of twinning does TTTS occur

what is TTTS

A

monochorionic only

arteriovenous fistula in the placenta (A-A, V-V, A-V), high mortality rate

25
Q

which type of fistula in the placenta is the worst

A

artery to vein due to difference is press

26
Q

describe what happens to the donor w/ a TTTS

A

small and hypotensive
oligohydramnios
stuck twin appearance
Usually anemic

27
Q

describe what happens to the recipient w/ a TTTS

A

large and hypertensive due to fluid overload
polyhydramnios
oedematous/hydropic appearance

28
Q

general US appearance of TTTS

A 
size discrepancy of >20%
disparity of amniotic fluid
single placenta
thin or non membrane seen
hydrous of one twin
29
Q

what is a stuck twin

A

when the donor twin has little to no amniotic fluid and the amniotic membrane hold the baby tight against the uterine wall

30
Q

one other cause of stuck twin other than TTTS

how can you tell the two apart

A

a dichorionic preg w/ placental insufficiency causing IUGR…

one baby will be small, the other will be normal

31
Q

describe twin embolization syndrome

A

occurs when theres a demise of a twin in monochorionic twins…. clots can pass from the demised twin to the surviving twin and cause an infarct in the live fetal brain or liver…

… or it can cause sever hypotension in the surviving twin due to the demised twins placenta becoming low pressure and allowing blood to pool in the placenta.
would lead to asphyxia

32
Q

in what type of twining is twin embolization syndrome

A

monochorionic only

33
Q

US appearance of twin embolization syndrome

A

ventriculomegaly, porencephalic cysts (from brain hemorrhage), cerebral atrophy or micoencephaly

34
Q

normal length for cervix

A

~2.5 cm

35
Q

genetic and developmental abnormalities are more common in what type of twins

A

monozygotic

36
Q

do dizygotic twins have the same risk of developing anomalies as a singleton

A

yes

37
Q

why would a fetal reduction be performed

A

improve morbidity and mortality for a successful preg

38
Q

which vessels to we do doppler on w/ a TTTS

A

for each fetus:

umbilical artery
middle cerebral artery
ductus venosus

39
Q

what are the normal waveforms for all the vessels sampled w/ doppler w/ TTTS

A

umbilical artery: low resistance w/ lots of diastolic flow

middle cerebral artery: high resistance

ductus venosus: triphasic venous flow (like the HV’s)

40
Q

w/ fetal doppler, what measurement do we use for each vessel

A

pulsatility index to look for changes in diastolic flow

41
Q

describe an abnormal waveform for the umbilical artery

A

no diastolic flow is bad

reversed diastolic flow is worse

42
Q

how to located the ductus venosus

whats its appearance w/ colour doppler

A

from the AC, find the ductus by following the umbilical vein posterior to the IVC

aliasing due to high velocity

43
Q

describe abnormal flow for the ductus venosus

why does it occur

A

reversal of the A wave

due to myocardial impairment and increased ventricular EDP from increased RV afterload

44
Q

which middle cerebral artery should you sample

at what angle

A

the one closest to the transducer

0 degrees

45
Q

what can cause an abnormal waveform of the MCA

how will it change

A

vasodilation in the fetal brain w/ brain sparing IUGR

reduced PI and increased diastolic flow

OBGYN 2 (15 decks)

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