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OB 2 > Twins > Flashcards

Twins Flashcards

1
Q

What are clinical associations for a twin pregnancy?

A

Large for gestational age (LGA), multiple heartbeats, SMAFP levels at > 2.5 MOM (multiple of median)

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2
Q

What are the membrane configurations with twins?

A

Chorionic and amniotic

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3
Q

What is dizygotic twinning?

A

The fertilization of 2 ovum (dichorionic/diamniotic)

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4
Q

What is dizygotic twinning influenced by?

A

Genetics, environment, age and ART

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5
Q

What is monozygotic twinning?

A

A random event resulting in single ovum division

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6
Q

What are placental and membrane configurations with monozygotic twins?

A

Varies and has membrane configurations of: Di/Di, Mono/Di, and Mono/Mono

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7
Q

What is the sonographic assessment for twins?

A

Fetal lie/number, # placentas, membranes? standard anatomy (biometry), AF - MVP (maximal vertical pocket), pulsed/color doppler

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8
Q

Which type of pregnancy has an increased rate of obstetric complications?

A

Monochorionic

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9
Q

What is dichorionic/diamniotic comprised of?

A

2 layers of chorion, 2 layers of amnion

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10
Q

How does Di/Di appear on ultrasound in the first trimester?

A

A thick echogenic layer of chorion surrounding each embryo

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11
Q

How does Di/Di appear on ultrasound in the 2nd/3rd trimester?

A

2 placentas, twin peak/lambda sign

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12
Q

How does the twin peak/lamda sign appear on ultrasound?

A

A wedge shape of chorionic tissue going into the base of the thick inter-twin membrane

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13
Q

What happens with the amnion after 14-16 weeks?

A

It’s no longer seen separate from the chorion

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14
Q

How does Mono/Di appear in the 1st trimester?

A

2 yolk sacs, embryos within same chorionic sac

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15
Q

How does Mono/Di appear in the 2nd/3rd trimester?

A

Thin inter-twin membrane, no twin peak sign, one placenta, same gender

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16
Q

What are the risks of Mono/Di pregnancy?

A

Twin-twin transfusion, evaluation of cord insertion for each twin

17
Q

How does Mono/Mono pregnancy appear?

A

1 chorionic layer, 1 amniotic layer and 1 placenta

18
Q

What is the majority problem with Mono/Mono pregnancy?

A

Cord entanglement (evaluate w/doppler)

19
Q

How does Mono/Mono appear in 1st trimester?

A

2 embryos with 1 yolk sac (after 7 weeks)

20
Q

How does Mono/Mono appear in 2nd/3rd trimester?

A

Same gender/no inter-twin membrane

21
Q

What causes vanishing twin?

A

Spontaneous abortion, embryonic malformation, nonviable pregnancy (20%)

22
Q

What is fetus papiraceus?

A

Death/preserved fetus due to compression

23
Q

What are maternal complications from fetus papiraceus?

A

Increased mortality/cesarian, hypertension, postpartum hemorrhage

24
Q

What are fetal complications from fetus papiraceus?

A

Low birth weight, congenital anomalies, vasa previa (overlying cervix, into amniotic membrane)

25
Q

What is twin reversed arterial perfusion (acardiac twinning)?

A

An acardiac twin dependent on other (pump twin)

26
Q

What happens in the placenta with acardiac twinning?

A

Anastomoses of arterial to arterial and venous to venous systems

27
Q

What are sonographic findings in acardiac twinning?

A

Possible hydrops (pump twin), malformed fetus w/no cardiac structures and flow reversal in cord (acardiac twin)

28
Q

What is twin to twin transfusion syndrome?

A

Blood shunting from arterial/venous anastomoses in shared placenta causing a perfusion imbalance between fetuses

29
Q

Which type of pregnancy may have twin to twin transfusion syndrome?

A

Monochorionic and diamniotic

30
Q

What are the amniotic fluid discrepancies in twin to twin transfusion syndrome?

A

Recipient twin has polyhydramnios, the donor twin has oligohydramnios

31
Q

What happens to the donor twin with twin to twin transfusion syndrome?

A

Growth restriction, hypovolemic (dilated cardiomyopathy/pericardial effusion) and anemia

32
Q

What happens to the recipient twin with twin to twin transfusion syndrome?

A

Macrosomic, hypervolemic (cardiomegaly, biventricular hypertrophy, tricuspid regurgitation) plethoric (red-faced) and possible hydrops

33
Q

What are sonographic diagnoses for twin to twin transfusion syndrome?

A

Single placenta, same-sex, fluid volume discrepancy, and 20% weight difference

34
Q

What type are the majority of conjoined twins?

A

Thoracopagus (thorax) and omphalopagus (abdominal wall) mostly female

35
Q

What are conjoined twins the result of?

A

Late monozygotic division (mono/mono) after day 13

36
Q

What must be differentiated with parasitic twin (fetus in fetu)?

A

Teratoma (malignancy) upper abdomen,

hemartoma (benign) lower abdomen

37
Q

What occurs with selective reduction in Di/Di pregnancies?

A

Termination with multiples or birth defects by injecting potassium chloride into fetal heart or umbilical cord

OB 2 (3 decks)

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