TWINNS

Question 1

twins born what week

Answer 1

37

Question 2

trips born what week

Answer 2

34

Question 3

quads born what week

Answer 3

33

Question 4

Fetal mortality rates are _____X that of singleton pregnancies

Answer 4

3-6X

Question 5

Neonatal mortality _____X that of single pregnancies.

Answer 5

7X

Question 6

why does multiple have higher fatality

Answer 6

Primarily due to much higher incidence of premature labour.

Question 7

Increased chance of dizygotic twins if:

Answer 7

increased maternal age 
frequent pregnancies 
pregnancy techniques -> hormone stimulation 
heredity -> mom is a twin 
race-> african

Question 8

if there is a single outer membrane the twins must be

Answer 8

monozygotic

Question 9

1/3 of monozygotic twins are

Answer 9

dichorionic/diamniotic

Question 10

two types of DCDA

Answer 10

seperated and fused

Question 11

0-4 days for split =

Answer 11

DCDA

Question 12

8-13 days =

Answer 12

MCMA

Question 13

why is chorionicity important

Answer 13

Monochorionic twin pregnancies have 3-5 times higher risk of perinatal mortality and morbidity than Dichorionic

Question 14

Chorionicity best evaluated in ___ trimester

Answer 14

1st

Question 15

Di chorion gives what sign

Answer 15

twin peak (lambda sign)

Question 16

how many yolk sacs in monochorionic

Answer 16

1 usually

Question 17

3 primary complications of multifetal pregnancies

Answer 17

Premature delivery
IUGR
Demise of a co-twin

Question 18

2 risks closely related to monochorionicity

Answer 18

congenital malformations and congenital heart disease

Question 19

since monochorionic twin pregnancies share the one placenta the are prone to

Answer 19

haemodynamic complications

Question 20

main monoamniotic complication

Answer 20

entangled cords

Question 21

what is twin growth discordance

Answer 21

refers to a significant size or weight difference between the two fetuses of atwin pregnancy

Question 22

To be classified as a growth discordance:

Answer 22

Weight discordance (weight disparity of greater than 15-25%)
Some consider that the estimated fetal weight (EFW)
of the smaller twin should fall under the 10thpercentile.

Question 23

weight % difference equation

Answer 23

(Larger twin EFW – Smaller Twin EFW) / Larger twin EFW * 100

Question 24

intra uterine growth restriction (IUGR) characterized by

Answer 24

impaired fetal growth and inadequate placental function

Question 25

the greater the discordance the higher the likelyhood of (4)

Answer 25

Placental insufficiency
Twin-twin transfusion syndrome
Higher incidence with avelamentous cord insertion
Higher incidence with asingle umbilical artery

Question 26

growth differences most profound > ____ _weeks

Answer 26

> 30 weeks

Question 27

A weight discordance is assessed by taking the estimated fetal weight (EFW) difference at ___-____%

Answer 27

15-25%

Question 28

twin to twin transfusion occurs in twins that are

Answer 28

identical twins that are monochorionic, diamniotic.

Question 29

what happens in twin to twin transfusion

Answer 29

single placenta contains blood vessel connections between the twins.

Question 30

is twin to twin transfusion genetic or from trauma

Answer 30

no

Question 31

what is the result of the twin getting too much blood

Answer 31

increase urine production and will have distended bladder as well as too much amniotic fluid around it (polyhdramnios)

Question 32

what happens to the donor twin

Answer 32

twin will produce less than the usual amount of urine. The amniotic fluid around the donor twin will become very low or absent (oligohydramnios).

Question 33

what is a stuck twin

Answer 33

the donor twin becoming wrapped in amniotic membrane becuase there is no fluid around it

Question 34

alternative term for twin to twin transfusion is

Answer 34

Twin Oligohydramnios/polyhydramnios syndrome

Question 35

what is Twin Reversed Arterial Perfusion sequence (TRAP)

Answer 35

A late separation of the embryonic cell mass results in a monochorionic-diamniotic twin pregnancy.
Anastomosis of vessels establishes a connection between the 2 circulations (unbalanced AA anastomosis).
Retrograde perfusion interferes with normal cardiac development, which rarely goes beyond the stage of tubular heart.
Thus the acardiac fetus becomes dependent on the perfusion of the “pump” twin.

Question 36

what happens to the acardiac twin

Answer 36

lower half of body better developed but upper half not at much

Question 37

Twin Reversed Arterial Perfusion sequence (TRAP) occurs in what type of twin

Answer 37

monochorionic-diamniotic

Question 38

acardiac twin is really just a

Answer 38

parasite (TOUGH LIFE) lol

Question 39

the pump twin in TRAP is at risk for

Answer 39

high output cardiac failure