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63 Cards in this Set
- Front
- Back
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In twins are perinatal complications more common
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yes
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What are some complications that occur in twins
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preterm labor, htn, polyhydraminois, oligohydramnios, IUGR, malpresentation, fetal demise, abruption, previa
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What are dyzogtic twin
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two ova by two sperm
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Are monozygotic twins always identical
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no
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Why should you not refer to a monozytotic twin as identical
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they are not always identical
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Are dizygotic twins dichorionic
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yes
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If the fetus are dichorionic what does that mean
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they are not identical
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Can monozygotic twins be dichorionic
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yes (1/3 of cases if they cleave early)
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What happens to the monozygotic twins that cleave early
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they are dichorioinic
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What happens to the twins that cleave later
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they are monochorionic (and mono or diamniotic depending on when they split)
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Are all dizygotic twins dichorionic
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yes
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Are all monozygotic twins monchorionic
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no ( mono or di)
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Are dichorionic twins monozygotic or dizygotic
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either
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Are all monochorionic twins monozygotic
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yes
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How do you recognize dichorionic twins on US
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a wedge of echogenic tissue seperating twins
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What is the twin peak sign
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this is a triangular shaped membrane seperating two amniotic sacs (dichorionic and diamniotic)
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When is the twin peak sign seen
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dichorionic and diamniotic fetus (they go hand and hand bc if they are dichorionic they have to be diamniotic)
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What does monochorionic diamniotic twins look like on US
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two thin sacs seen with the sacs forming a very thing membrane
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What is the big determining factor when differentiating dichorionic and monochorionic diamniotic twin
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membrane thickness (the membrane is much thinner with monochroionic diamniotic twins)
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What can you do if you can not tell the membrane thickness is indeterminate
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look at the sex of the fetuses (if opposite it is dichorionic)
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Why is it important to tell the difference between monochorionic and dichorionic
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because there are differences in complications that occur
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If two fetuses are different in size and weight does it mean there is twin twin transfusion
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no, it can be unequal placental sharing
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What type of complication is associated with monochorionic twins
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twin twin transfusion
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how many placentas in monochorionic babies
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1 placenta
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What is the etiology of twin complications of monochorionic placentation
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placental intravascular connections
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What are syndromes associated with monochorionic placentation?
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twin/twin transfusion
twin embolization syndrome acardiac twins/TRAP sequence |
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What is the MC monochorionic twin complication
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twin/twin (10-20%)
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What is the manifestation of twin twin transfusion
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donor fetus that is typically smaller and hypovolemic, recipient fetus that is volume overloaded
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What is the prognosis of twin twin transfusion
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very poor for both
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On US what is how do you determine if twins have a twintwin transfusion
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they have to be monochorionic
concomominant oligo and poly hydramnios disparity in size size of bladders |
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What is the definition of oligohydraminois
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less than 2 cm in the deepest pocket
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What is the definition of polyhydraminois
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greater than 8cm in the deepest pocket
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What is the ddx for twin twin transfusion
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causes of oligo (renal abnormalities, PROM)
causes of poly (hydrops, GI tract, macrosomia, neural tube defect) |
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What is the bladder size in the receipient
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large
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What is a stuck twin
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this is when a twin is stuck to the uterine wall and is proof of diamionicity
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What is stuck twin associated with
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twin twin transfusion
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What is twin embolization syndrome
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infarction or ischemic injury of the remaining when the other twin has died
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What is thought to be the cause of twin embolization syndrome
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the changes in circulation that occur when one twin dies.
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What organs are typically involved in the twin embolization syndrom
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spleen, kindey, brain bowel
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What is an acardiac parabiotic twin (aka TRAP twin reversed arterial perfusion)
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this is the result of an acardiac twin that recieves it blood supply via aterial-arterial connection.
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When does acardiac twins occur
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only during monochorionic pregnancies
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What do you expect to see in acardiac twin
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anechphalic, microcephalic or acephalic, diffuse edema, cystic hygromas,
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What will the doppler show on ultrasound
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reveral of arterial flow with blood being pumped into the acardiac twin,
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What is the healthy fetus analaogus to
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a pump for the other fetus.
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What are some risk to the viable fetus in TRAP syndrome
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hydrops, polyhydramnios with risk of PTL
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What is the treatment of TRAP
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ablation of the vesels connecting the twins
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What portion of the fetus makes the majority of the amniotic fluid
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the renal system
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How is the amniotic fluid index measured
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divide the uterus into 4 quadrants and measure the deepest vertical true AP diameter in each
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What is the normal amniotic fluid index
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5-24
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What increases as the degree of polyhydraminois increases
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the risk of structual anomaly
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What is the ddx for polyhydramnios
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CNS abnormalities
High gut obstructions twin-twin transfusion Acardiac twins vascular tumors hypokinisia syndrome some UPJ obstructions some severe facial clefts |
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What type of vascular tumors may lead to polyhydramnios
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teratoma, chorioangioma
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What if you do not see a stomach on US and the fetus has polyhydraminos
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may be secondary to esophageal atresia
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What are 3 GI cause of high gut obstructions that cause polyhydramnios
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esophageal atresia
doudenal atresia diaphragmatic hernia |
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Is a sacrococcygeal teratoma associated with polyhydramnios
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yes
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What is an AFI indicative of oligohydramnios
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less than 5
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What are some causes of oligohydramnios
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PROM
post date fetus GU abnormalities |
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What would lead you to believe there is a bladder obstruction leading to oligohydramnios
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a large bladder
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What are some causes of bladder outlet obstruction
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posterior urethral valves
cloacal malformation urethral atresia ureterocele megacystis hypoperistalsis |
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What causes a keyhole configuration on ultrasound
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posterior urethral valves
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What GU abnormalities cause oligohydramnios but not a large bladder
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MCDK
renal agenesis ARPCKD |
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What does a ARPCKD look like
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echogenic kidneys without visible cyst on US
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What does multicystic dysplastic kidney sydrome look like
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multiple discrete cysts in both kidneys
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