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DMS 400 OB/GYN > Class 13: Multiples > Flashcards

Class 13: Multiples Flashcards

1
Q

type of twinning that is fertilized by 1 ovum & 1 sperm, then splits into 2

A

monozygotic/identical twins

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2
Q

percentage of twinning that makes up monozygotic twins?

A

30%

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3
Q

are monozygotic twins hereditary?

A

no – random

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4
Q

monozygotic twins are always the ___ sex & ____ genetic make up

A

same sex; identical genetic make up

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5
Q

type of twinning that is fertilized by 2 ovum & 2 sperm

A

dizygotic/fraternal twins

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6
Q

percentage of twins that make up dizygotic twins

A

70%

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7
Q

dizygotic twins are always the same sex. T/F?

A

false

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8
Q

dizygotic twins have ___ genetic make up

A

different

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9
Q

dizygotic twins always have separate placentas. T/F?

A

true

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10
Q

race with higher incidence of twinning?

A

black

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11
Q

race with the lowest incidence of twinning?

A

asian

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12
Q

age that has a higher incidence of twinning?

A

older maternal age – 35-39 yo

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13
Q

what type of twin is hereditary?

A

dizygotic twins

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14
Q

does the maternal or paternal side carry the genes for twinning?

A

maternal

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15
Q

what type of infertility drugs increases the chance for twinning?

A

pergonal & clomid

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16
Q

2 layers of placental membranes

A
  1. chorion
  2. amnion
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17
Q

list the types of placentas & membranes

A
  1. dichorionic diamniotic
  2. monochorionic diamniotic
  3. monochorionic monoamniotic
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18
Q

how many placentas & yolk sacs are in a di-di pregnancy?

A

2 placentas, 2 yolk sacs

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19
Q

how many placentas & yolk sacs are in a mo-di pregnancy?

A

1 placentas & 2 yolk sac

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20
Q

how many placentas & yolk sacs are in a mo-mo pregnancy?

A

1 placenta & 1 yolk sac

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21
Q

what type of placentation can dizygotic twins have?

A

only dichorionic diamniotic

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22
Q

what type of placentation can monozygotic twins have?

A

can have all 3 types depending on when division occurred

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23
Q

monozygotic twins must be separated between ____ days after conception for them to have dichorionic diamniotic placentation

A

0-4 days

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24
Q

monozygotic twins must be separated between ____ days after conception for them to have monochorionic diamniotic placentation

A

4-8 days

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25
Q

monozygotic twins must be separated between ____ days after conception for them to have monochorionic monoamniotic placentation

A

8-13 days

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26
Q

incomplete separation occurs if monozygotic twins haven’t separated after ____ days after conception. this is also called ____

A

13 days; conjoined twinning

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27
Q

which type of placentation exhibits a twin peak/lambda sign?

A

dichorionic diamniotic

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28
Q

which type of placentation exhibits a T-sign?

A

monochorionic diamniotic

29
Q

which fetus would you label “fetus A” on U/S?

A

the presenting fetus (closest to cervix)

30
Q

4 types of twin abnormalities?

A
  1. vanishing twin syndrome
  2. fetus papyraceus
  3. conjoined twinning
  4. fetus in fetu
31
Q

what is vanishing twin syndrome?

A

seeing twin gestation early in pregnancy but only having a singleton at birth

32
Q

what can be the etiology for vanishing twin syndrome?

A

one gestation was an anembryonic or nonviable pregnancy & was able to be reabsorbed

33
Q

US appearance of vanishing twin syndrome

A
  • GS smaller than other according to LMP
  • GS with irregular borders
  • GS crescent-shaped with incomplete trophoblastic ring
34
Q

what is fetus papyraceus?

A

when a dead fetus is too large to be reabsorbed and is preserved in a distorted shape

35
Q

during which trimester(s) of pregnancy can fetus papyraceus occur?

A

2nd or 3rd tri

36
Q

what is a probable cause for fetus papyraceus?

A

polyhydramnios of larger twin compresses smaller twin

37
Q

what type of pregnancy & placentation can fetus papyraceus occur in?

A

monozygotic pregnancy with monochorionic diamniotic placentation

38
Q

what is the most common type of abnormal twinning?

A

conjoined twins

39
Q

what type of pregnancy and placentation can conjoined twinning occur in?

A

monozygotic pregnancy with monochorionic monoamniotic placentation

40
Q

conjoined twins can be different sexes

A

false

41
Q

conjoined twins are 70% male

A

false – 70% female

42
Q

how does conjoined twinning occur?

A

if division of ovum occurs after 13 days from conception

43
Q

what is the most common type of conjoined twinning?

A

thoracopagus

44
Q

what is fetus in fetu?

A

a rare type of conjoined twinning where one twin is in the body of co-twin

45
Q

where is the location of the parasitic twin in fetus in fetu?

A

typically in upper retroperitoneum of co-twin; usually seen as an abdominal mass

46
Q

differential diagnosis of fetus in fetu?

A

teratoma

47
Q

U/S appearance of fetus in fetu?

A

complex mass in abdomen

48
Q

what does PROM stand for?

A

premature rupture of membranes

49
Q

what is the most common complication in the 3rd trimester for multiple gestations?

A

premature labor with PROM

50
Q

what is the cause of premature labor with PROM?

A

overdistension of uterus

51
Q

some complications associated with premature labor with PROM?

A
  • bleeding due to increase risk for placenta previa, placental abruption, velamentous cord insertion
  • maternal HTN
  • anemia
  • preeclampsia
  • eclampsia
  • pyelonephritis
52
Q

what is preeclampsia?

A

maternal hypertension, proteinuria, and edema after 20th week

53
Q

what is another name of eclampsia?

A

toxemia of pregnancy

54
Q

what is IUGR?

A

intrauterine growth restriction
- discordant growth between the 2 twins

55
Q

weight difference of twins with IUGR?

A

15-20%
500+ gram difference at birth

56
Q

what measurement is best to assess for IUGR?

A

abdominal circumference (>20mm)

57
Q

what is TTTS?

A

twin to twin transfusion syndrome
abnormal arteriovenous circulation in the placenta with abnormal shunting of blood from one fetus to another

58
Q

in TTTS the ____ system of donor pumps blood to ____ system of recipient

A

arterial system; venous system

59
Q

other names for donor twin?

A

pump twin; stuck twin

60
Q

what type of placenta can TTTS occur in?

A

monochorionic only

61
Q

in TTTS, what are characteristics of the pump twin?

A

smaller, oligohydramnios, IUGR, anemic

62
Q

in TTTS, what are characteristics of the recipient twin?

A

bigger, polyhydramnios, too much blood, possible CHF

63
Q

what does TRAP stand for?

A

twin reversed arterial perfusion

64
Q

other names for TRAP?

A

acardiac/acephalic twin

65
Q

TRAP is a form of TTTS. T/F?

A

true

66
Q

what type of placentation is most common with TRAP?

A

monochorionic monoamniotic

67
Q

what is interlocking twin syndrome?

A

a mo-mo pregnancy where one twin is breeched and the other is cephalic

68
Q

selective termination can only occur with ____ pregnancies

A

dichorionic

69
Q

most common method for selective termination?

A

injection of potassium chloride into fetus’ heart

DMS 400 OB/GYN (21 decks)

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