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Twinning & Multiple pregnancies Flashcards

(85 cards)

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1
Q

Multiple pregnancy is the presence of more than one fetus in the ____

A

Gravid uterus

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2
Q

What is the term for a multiple pregnancy involving two, three, four, five, six fetuses?

A

Twins, Triplets, Quadruplets, Quintuplets, Sextuplets

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3
Q

According to Hellin’s Law, what is the incidence of twin, triplets, quadruplets, quintuplets pregnancies?

A

1:89 (twins), 1:89² (triplets), 1:89³ (quadruplets), 1:89⁴ (quintuplets)

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4
Q

What is the estimated incidence of conjoined twins?

A

1:60,000

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5
Q

Worldwide, what is the incidence of monozygotic twinning?

A

1 in 250

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6
Q

True or False: The incidence of dizygotic twins is constant globally.

A

False, incidence of dizygotic twins varies and is increasing

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7
Q

Multiple pregnancy is most common among which racial group?

A

Negroes

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8
Q

Multiple pregnancy is associated with which maternal age? Increased or decreased

A

Increased maternal age

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9
Q

Is multiple pregnancy more common in primipara or multipara?

A

Multipara

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10
Q

A family history of multifetal gestation predisposes a woman to what?

A

Multiple pregnancy

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11
Q

Multiple pregnancy is more likely in women who are nutritionally _____

A

Well-nourished

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12
Q

Name three ovulation induction agent drug and assisted reproductive technology linked to increased incidence of multiple gestation.

A

Clomiphene citrate, Gonadotropins, IVF

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13
Q

Conception after stopping which type of medication is linked with multiple pregnancy?

A

Oral Contraceptive Pills

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14
Q

What is the most common variety of twins?

A

Dizygotic twins (2/3 of twin pregnancies)

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15
Q

Which type of twins accounts for one-third of all twin pregnancies?

A

Monozygotic twins

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16
Q

Fertilization of two ova by two sperms results in what type of twins?

A

Dizygotic twins

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17
Q

What is another name for dizygotic twins?

A

Fraternal twins or binovular twins

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18
Q

Monozygotic twins arise from fertilization of how many ovum and sperm?

A

1 ovum + 1 sperm

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19
Q

Monozygotic twins are also called?

A

Identical or uniovular twins

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20
Q

If the embryo splits within 3 days post-fertilization, what type of placental configuration results?

A

Diamniotic dichorionic

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21
Q

Splitting of the embryo between the 4th and 7th day results in what type of twin configuration?

A

Diamniotic monochorionic

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22
Q

What is the most common form of monozygotic twinning?

A

Diamniotic monochorionic

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23
Q

Embryo splitting between the 8th and 12th day leads to what twin arrangement?

A

Monoamniotic monochorionic

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24
Q

Splitting of the embryo after the 13th day results in what rare form of twins?

A

Conjoined or Siamese twins

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25
Four examples of ventral (front-facing) type of conjoined twins
Omphalopagus, Thoracopagus, Cephalopagus, Ischiopagus (caudal)
26
Example of lateral type of Siamese twins Parapagus
Parapagus
27
Two examples of dorsal (back-facing) type of Siamese twins
Craniopagus, Pygopagus
28
Siamese twins: Joined at the abdomen
Omphalopagus
29
Siamese twins: Joined at the chest
Thoracopagus
30
Siamese twins: Joined at the head and upper chest and face-to-face
Cephalopagus
31
Conjoined twins: Joined at the pelvis or lower abdomen
Ischiopagus (Caudal type)
32
Conjoined twins joined side-by-side sharing pelvis and sometimes limbs and organs
Parapagus
33
Siamese twins: joined at the skull usually back or top of the head
Craniopagus
34
Conjoined twins joined at the buttocks or sacrum
Pygopagus
35
Fertilization of two different ova released in the same cycle is called ________.
Superfecundation
36
Fertilization of two ova released in different cycles is known as ________.
Superfetation
37
Always same sex, identical features, same genetic features, and same DNA microprobe… describes what kind of twins?
Monozygotic twins
38
Twins that may be of same or opposite sex with fraternal resemblance and different genetic features with different DNA mmicroprobe?
Dizygotic twins
39
Which type of twins has a single or double placenta?
Monozygotic twins
40
Which type of twins always has a double or fused placenta?
Dizygotic twins
41
What are the two types of chorinocity with single placenta?
Dichorionic diamniotic (D/D), Monochorionic Diamniotic (M/D)
42
Thick dividing membrane > 2 mm and Twin Peak (Lambda) sign on ultrasound indicate what chorionicity?
Dichorionic diamniotic (D/D)
43
Thin dividing membrane ≤ 2 mm and T-sign on ultrasound suggest what type of twins?
Monochorionic diamniotic (M/D)
44
Based on chorionicity, origin of ______ twin is always monozygotic and ____ twin can be monozygotic or dizygotic.
M/D = always monozygotic; D/D = monozygotic or dizygotic
45
Eleven maternal complications of multiple gestations during pregnancy
Miscarriages, Hyperemesis gravidarum, Anaemia, Pre-eclampsia, Hydramnios, Antepartum hemorrahge (placental previa and placental abruption), Cholestasis of pregnancy, Malpresentations, Preterm labour, Mechanical issues (like palpitations, dysponea, varicosisties, hemorrhoids), Obstructive uropathy
46
Six maternal complications during labour in multiple gestation.
Pre-labour rupture of membranes, Cord prolapse, Incoordinate uterine contractions, Increased operative interfernce, Placental abruption after delivery of first twin, Postpartum hemorrhage (PPH)
47
Three complications during puerperium in multiple gestation.
Subinvolution, Infection, Lactation failure
48
Placental abruption and placenta previa are grouped under which maternal antenatal complication?
Antepartum hemorrhage
49
Pre-eclampsia occurs in approximately ____ of multiple pregnancies.
25%
50
Hydramnios occurs in approximately ____ of multiple pregnancies.
10%
51
Preterm labour occurs in approximately ____ of multiple pregnancies.
50%
52
Twins typically deliver at how many weeks due to risk of preterm labour?
37 weeks
53
Triplets typically deliver at how many weeks due to risk of preterm labour?
34 weeks
54
Quadruplets typically deliver at how many weeks due to risk of preterm labour?
30 weeks
55
Varicosities, haemorrhoids, dyspnoea and palpitations during pregnancy are examples of what?
Mechanical issues
56
What is the most common maternal complication during prenancy in multiple gestation?
Preterm labour
57
Fetal complication is more in which type of twins?
Monochorionic twins
58
Eleven fetal complications in multiple gestation.
Spontaneous abortion, Single fetal demise, Low birth weight, Discordant growth, Congenital anomalies, Twin-to-twin transfusion syndrome (TTTS), Twin Reversed Arterial Perfusion (TRAP) syndrome, Cord entaglement/compression, Locked twins, Asphyxia, Stillbirth
59
Two conditions that can occur in single fetal demise are?
Vanishing twin (before 10 weeks) Fetus papyraceous/compressus (2nd trimester)
60
*What term describes the death of one twin before 10 weeks with subsequent disappearance of the fetus?
Vanishing twin
61
*What is the term for a compressed mummified fetus found in the second trimester after fetal demise?
Fetus papyraceous / fetus compressus
62
List six complications that may affect the surviving twin after one twin dies.
Neurological lesions, renal lesions, anemia, Disseminated Intravascular Coagulation (DIC), Hypotension, Death
63
Complications in the surviving twin after single fetal demise depend on what factor?
Chorionicity
64
What percentage of twins experience low birth weight?
90%
65
Name two main causes of low birth weight in twins.
Prematurity (spontaneous or iatrogenic) and Fetal growth restriction (FGR)
66
Fetal growth restriction in twins occurs in the ______ trimester and is usually ______.
3rd; asymmetrical
67
Discordant growth in twins is defined by _____ weight difference, ___ in head cirucmference, ____ in abdominal circumference (AC) and ____ doppler waveforms
>25%; >5%; >20mm; abnormal
68
*What diagnostic method detects abnormal blood flow patterns associated with discordant growth?
Doppler ultrasound
69
List five causes of discordant growth in twins.
Unequal placental mass/sharing, Lower segment implantation, Genetic differences, Twin-to-twin transfusion syndrome (TTTS), Congenital anomaly in one twin
70
Name six congenital anomalies are common fetal complications in twins?
Conjoined twins, Neural tube defects (anencephaly, hydrocephaly, microcephaly), Cardiac anomalies, Down syndrome, Talipes, Dislocation of hip
71
Twin-to-Twin Transfusion Syndrome (TTTS) is caused by what abnormality in the placenta?
Arteriovenous (AV) communication/anastomoses
72
In TTTS, donor twin suffers from ____ and ____
Intrauterine growth restriction and oligohydramnios
73
In TTTS, the recipient twin is at risk of which four complications?
Overload, Hydramnios (polyhydramnios), Congestive heart failure (CHF), Intrauterine fetal death (IUFD)
74
What does TRAP stand for in fetal complications?
Twin Reversed Arterial Perfusion syndrome
75
Another name for TRAP
Acardiac twin
76
Describe the characteristic feature of TRAP syndrome.
One twin lacks a heart (acardiac twin) with arterio-arterial placental communication causing reversed blood flow from the pump twin or donor twin
77
Donor twin survives in TRAP. T or F
False, Donor twin also dies
78
Cord entanglement or compression are more common in which type of twins?
Monoamniotic twins
79
Name two causes of fetal asphyxia in multiple pregnancies.
Cord complications, Abruption
80
Stillbirth in twins can occur during which time frames?
Antepartum or intrapartum
81
Monoamniotic twins exhibit ____ and _____
High perinatal morbidity and mortality
82
Four causes of complications in monoamniotic twins leading to high perinatal morbidity and mortality
Cord entaglement, Congential anomalies, Preterm birth, Twin-to-twin transfusion syndrome (TTTS)
83
Six indications for Caesarean section in twin pregnancies
§ Non-cephalic presentation of the first twin § Monoamniotic twins § Conjoined twins § Locked twins § Other obstetric conditions or complications (**placenta previa, fetal distress) § Second twin with incorrectible lie
84
Caesarean section is indicated for ____ presentation of first twin
Non-cephalic presentation
85
Caesarean section is indicated for second twin with ____ and ____
Incorrectible lie and Closure of cervix

Embryology (12 decks)

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