Week 2- DMS 242 Multiple GS, IUGR, and 1st Trim Complications

amnionicity

number of amniotic mem

chronicity

number of chorionic mem/ ges sacs

dizygotic

two zygotes as a result of two fertilized ova

gamete intrafallopian transfer (GIFT)

mixing ovum and sperm within the FT

hypervolemic

high blood volume

hysterotomy

incision into the uterus

intracytoplasmic sperm injection (ICSI)

injection of sperm into oocyte

in vitro fertilization (IVF)

fertilization of ovum outside of the body

macrosomic

large fetus in 90th percentile or grater

monoamniotic

one amnion

monochorionic

one chorion

monozygotic

one zygote

morbidity

incidence of death

mortality

death rate due to specific disease

nonimmune hydrops

edema; accumulation of fluid in tissues and peritoneal cavity

plethoric

abundant

thermocoagulation

use of heat to seal tissue

zygote

fertilized ovum with 23 pairs of chromosomes

multiple gestation is increased because of:

maternal age

assisted repro therapy

race

genetics

mothers nutrition/BMI

list come clinical associations of multiple gestation:

LGA

multiple heart beats

MSAFP greater than 2.5

the chorion is the ________________________ membrane

outer

the amnion is the _________________ membrane

inner

what is dizygotic twinning?

fertilization of two ova

dizygotic twinning is influenced by:

genetics

environment

maternal age

ART

dizygotic twinning has ___________ placentas and sets of membranes

2

membrane configuration of dizygotic twinning:

Di/Di

what is monozygotic twinning?

single ovum division that takes place randomly

membrane configuration of monozygotic twinning:

Di/Di

Mono/Di

Mono/Mono

list some fetal complications of multiple gestation:

morbidity and mortality

preterm birth

IUGR

fetal anomalies

low birth weight

vasa previa twin

list some maternal complications of multiple gestation:

morbidity and mortality

preeclampsia

HTN

placenta previa

postpartum hemorrhage

anemia

diabetes

PROM

when is determination of amnionicity and chorionicity most accurate?

7 weeks

two sacs is a ___________________________

Di/Di

one sac is ___________chorionic and may be ________________ or ____________________

monochorionic

diamniotic or monoamniotic

when there is two sac the ________________ sign is seen

twin peaks

lambda

monochorionic pregnancies are usually:

Mono/Mono

Mono/Di

one placental site may have a T-sign meaning it is a ___________________ pregnancy or will not have T-sign meaning it is a __________________ pregnancy

Mono/Di

Mono/Mono

two placental sites will be a ______________ pregnancy and will show the ________________________ sign

Di/Di

twin peak

if the intertwin membranes are thick they measure over _______mm and there is a _____________ pregnancy

1.5

Di/Di

if the intertwin membranes are thin they measure under _________mm and there is a _____________________ pregnancy

1

Mono/Di

if there are NO intertwin membranes there is a _____________________ pregnancy

Mono/Mono

if fetuses have different placenta, membranes and genders they are ____________ twins

Di/Di

sonographic assessment of multiple gestation should include:

number of fetuses

fetal lie

number of placentas

chronicity/amnionicity

standard biometry/anatomy

AFI

color/PW on UA

if the zygote splits before day 4 it is likely that it will be a ____________ pregnancy

Di/Di

Twin A is _________________________

presenting

Twin B is _______________________

not presenting

twin growth rates are similar in the first _____ weeks

30

after 30 weeks ___________ and _______________ may lag

BPD and AC

twins usually have a ____________ birth weight

lower

why are twin birth weights lower than singletons?

late ges growth lag

discordant growth between twins

early delivery

_____% of twin pregnancies result in singleton delivery

20

vanishing twin may be caused by:

spontaneous abortion

embryonic malformation

nonviable pregnancy

fetus papyraceous

death of one fetus that is preserved in utero

theory of cause of fetus papyraceous:

compression of one fetus

higher order multiples

more than two fetuses

any placental or membrane combination possible

Twin Reversed Arterial Perfusion (TRAP) includes a:

pump twin/amorphous twin

the ________________ twin is hemodynamically dependent on other twin

acardiac

TRAP is a complication of ______________________ twin pregnancy

monochorionic

with TRAP the placenta will have:

arterial-to-arterial and venous-to-venous anastomoses

in TRAP the lower extremities of the acardaic twin develop because of:

perfusion of lower body only

sonographic findings of TRAP:

found as early as 11 weeks

possible hydrops in pump twin

sonographic findings of acardiac twin in TRAP:

malformed

no cardiac structures

flow reversal in umbilical vessels

treatment of TRAP:

hysterotomy with early delivery of amorphous twin

flow occlusion

TTTS occurs in _____________________ pregnancies

monochorionic

in TTTS the recipient twin has _______________________ and the donor twin has ________________________________

polyhydramnios

oligohydramnios

with TTTS there are ______________________-to-________________________ anastomoses within the shared placenta

arterial-to-venous

sonographic findings of donor twin in TTTS:

IUGR

hypovolemic

anemic

sonographic findings of recipient twin in TTTS:

macrosomic

hypervolemic

plethoric

possible hydrops

sonographic diagnosis of TTTS includes:

single placenta

velamentous cord insertion

same sex

20% or greater weight difference

amniotic fluid volume discrepancy

Stage I TTTS:

oligohydramnios- donor

fetal bladder visualized

stage II TTTS:

no bladder- donor

stage III TTTS:

absent or reversed EDV of UA- donor

reversed flow in ductus venosus- donor

pulsatile flow in UV- donor

stage IV TTTS:

recipient twin develops hydrops

stage V TTTS:

in utero demise of one or both twins

maternal complications are increased by x____ with multiple gestation

3

treatment of TTTS:

possible termination

serial reduction amniocentesis

septostomy

laser ablation of anastomoses

septostomy

needle inserted through dividing membranes creating a monoamniotic pregnancy which equalizes fluid levels

conjoined twins

share a body area

thoracopagus

thorax joined

omphalopagus

abd wall joined

conjoined twins are a result of late monozygotic division after day ______

13

conjoined twins occur in ___________________ gestation

mono/mono

conjoined twins are always the same _______________

gender

conjoined twins are more common in

girls

sonographic findings of conjoined twins:

no separating mem

inability to separate fetal bodies/heads

more than 3 vessel cord

polyhydramnios

monoamniotic twins develop with a _____________________ twin gestation

monozygotic

what are the main causes of death in monoamniotic twins

cord entanglement

preterm birth

selective reduction is only done with _____________ pregnancies

Di/Di

selective termination is used to treat:

fetus with birth defect

higher order multiples

injection of potassium chloride is injected into the:

fetal heart

umbilical vein

fetus in fetu

grows within body of twin similar to tumor

parasitic twin

type of conjoined twin when one fetus stops developing but remains attached

aneuploidy

abnormal number of chromosomes

biophysical profile (BPP)

combined observation of four separate fetal biophysical variables by US

fetal biophysical variables

breathing

movement

tone

AFI

IUGR

fetal weight or AC less than the 10th percentile for GA

hypoxemia

low oxygen blood level

idiopathic

no known cause

low birth weight

below 2500g or 5lb 8oz

nonstress test

assessing fetal wellbeing by observing heart rate accelerations

placental mosaicism

discrepancy between the chromosomal makeup of the fetus and placenta