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chapter17part_2.pdf Flashcards
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chapter17part_2.pdf Flashcards
p1-5
Study
1
Question
What is multiple pregnancy?
Answer
When more than one fetus simultaneously develops in the uterus, it is called multiple pregnancy.
2
Question
What is the most common variety of multiple pregnancy?
Answer
Twins, which involves the simultaneous development of two fetuses in the uterus.
3
Question
What are the rare developments in multiple pregnancy after twins?
Answer
Triplets (three fetuses), quadruplets (four fetuses), quintuplets (five fetuses), or sextuplets (six fetuses) may occur.
4
Question
What are the two varieties of twins in multiple pregnancies?
Answer
Dizygotic (DZ) twins and Monozygotic (MZ) twins.
5
Question
What is the difference between Dizygotic (DZ) and Monozygotic (MZ) twins?
Answer
Dizygotic twins result from the fertilization of two ova, while Monozygotic twins result from the fertilization of a single ovum.
6
Question
How do Dizygotic (DZ) twins occur?
Answer
Dizygotic twins result from the fertilization of two ova, most likely ruptured from two distinct Graafian follicles by two sperms during a single ovarian cycle.
7
Question
What is another name for Dizygotic twins?
Answer
Dizygotic twins are also known as fraternal or binovular twins.
8
Question
How do Monozygotic (MZ) twins occur?
Answer
Monozygotic twins result from the twinning cleavage of a fertilized ovum, which may occur at different periods after fertilization.
9
Question
What is Zygosity in twin pregnancy?
Answer
Zygosity refers to the genetic makeup of twin pregnancy.
10
Question
What is Chorionicity in twin pregnancy?
Answer
Chorionicity refers to the placenta's membrane status, which is determined by the timing of embryo division.
11
Question
What is the difference between fraternal twins and monozygotic twins?
Answer
Fraternal twins have a fraternal resemblance while monozygotic twins are identical.
12
Question
What is zygosity in twin pregnancies?
Answer
Zygosity refers to the genetic makeup of twin pregnancies.
13
Question
How is chorionicity determined in twin pregnancies?
Answer
Chorionicity is determined by the timing of embryo division.
14
Question
How is chorionicity diagnosed in the first trimester of pregnancy?
Answer
Chorionicity is diagnosed reliably by ultrasonography (TVS) by counting the number of gestation sacs and evaluating the thickness of dividing membranes.
15
Question
What are Siamese twins, and what are the four types of fusion that can occur in them?
Answer
Siamese twins are conjoined twins, and the four types of fusion are thoracopagus, pyopagus, craniopagus, and ischiopagus.
16
Question
What kind of fusion may occur in Siamese twins?
Answer
i. Thoracopagus (most common) ii. Pyopagus (posterior fusion) iii. Craniopagus (cephalic) iv. Ischiopagus (caudal) v. Rachipagus (dorsal)
17
Question
How many layers make up the intervening membranes between the two fetal vessels in dizygotic twins?
Answer
Four layers: amnion, chorion, chorion, and amnion
18
Question
What is the difference in the placental arrangement between dizygotic and monozygotic twins?
Answer
In dizygotic twins, each fetus has its own placenta, while in monozygotic twins, the placenta is single.
19
Question
What determines the chorionicity in monozygotic twin pregnancy?
Answer
The timing of cleavage determines the chorionicity: DiamnioticDichorionic (DD) at 72 hours, DiamnioticMonochorionic (DM) at 25-30 days, MonoamnioticMonochorionic (MM) at 70-75 days, and ConjoinedSiamese at 8-12 days.
20
Question
How many layers make up the intervening membranes between the two fetal vessels in monozygotic twins?
Answer
Two layers of amnion only.
21
Question
What is a reliable method to determine monozygosity in twins of the same sex with the same genetic features?
Answer
A skin graft acceptance test or DNA microprobe technique are reliable methods to determine monozygosity.
22
Question
What is the significance of uniovular twins always being of the same sex?
Answer
Uniovular twins are always of the same sex, which indicates that they are monozygotic twins.
23
Question
How can dominant blood group and monozygosity be linked in twins?
Answer
If the fetuses are of the same sex, have the same genetic features, and share a dominant blood group, it is likely that they are monozygotic twins.
24
Question
What is a certain proof of monozygosity in twins?
Answer
Acceptance of reciprocal skin graft is almost a certain proof of monozygosity in twins.
25
Question
Which technique is the most definitive for establishing monozygosity in twins?
Answer
The DNA microprobe technique is the most definitive method for determining monozygosity in twins.
26
Question
What is the difference in the incidence of twinning between Nigeria and far Eastern countries?
Answer
The incidence of twinning is highest in Nigeria (1 in 20 pregnancies) and lowest in far Eastern countries (1 in 200 pregnancies).
27
Question
According to Hellins' 1895 rules, what is the mathematical frequency of twins in pregnancies?
Answer
According to Hellins' 1895 rules, the mathematical frequency of twins in pregnancies is 1 in 80.
28
Question
What has contributed to the increased incidence of multiple pregnancies in the present day?
Answer
The increased incidence of multiple pregnancies is attributed to early detection by ultrasound and the increasing use of induction of ovulation and assisted reproductive techniques (ARTs).
29
Question
What is the frequency of twins worldwide?
Answer
1 in 250
30
Question
According to Hellins 1895 rules, what is the mathematical frequency of multiple births for twins?
Answer
1 in 80 pregnancies
p6-10
Study
1
Question
Answer
2
Question
What is the real danger in twins during postpartum hemorrhage?
Answer
Postpartum hemorrhage is the real danger in twins.
3
Question
What are the reasons for postpartum hemorrhage in twins?
Answer
i. Atony of the uterine muscle due to overdistension of the uterus ii. Longer time taken by the big placenta to separate iii. Bigger surface area of the placenta exposing more uterine sinuses iv. Implantation of a part of the placenta in the lower segment which is less retractile
4
Question
What are the reasons for increased incidence of subinvolution during puerperium?
Answer
Bigger size of the uterus
5
Question
What are the reasons for increased incidence of infection during puerperium?
Answer
Increased operative interference, pre-existing anemia, and blood loss during delivery
6
Question
How can lactation failure during puerperium be minimized?
Answer
By reassurance and giving additional support to the mother
7
Question
What happens to the miscarriage rate with monozygotic twins?
Answer
The miscarriage rate is increased with monozygotic twins.
8
Question
What is the premature rate in twins?
Answer
80%
9
Question
What are the hazards that babies suffer from due to increased premature rate in twins?
Answer
Premature babies suffer from hazards
10
Question
What is discordant twin growth?
Answer
Some degree of discordant growth is normal in dizygotic twins.
11
Question
When are cases of true pathological discordance observed in twins?
Answer
When the estimated weight difference is 25% or more
12
Question
What are the reasons for true pathological discordance in twins?
Answer
Twin-twin transfusion syndrome, placental insufficiency, IUGR, or structural anomalies in one fetus
13
Question
What is the incidence of intrauterine death of one fetus in monozygotic twins?
Answer
More in monozygotic twins
14
Question
What happens if a loss occurs in the first trimester in twins?
Answer
The affected fetus simply vanishes by resorption
15
Question
What may form if the death of a fetus occurs during the second trimester in twins?
Answer
A fetus papyraceous or compressus may form
16
Question
What may happen if the death of a fetus occurs late in pregnancy in twins?
Answer
There may be death of the other fetus in twins
17
Question
What is considered a normal degree of discordant growth in dizygotic twins?
Answer
Some degree of discordant growth is normal in dizygotic twins.
18
Question
What cases involve true pathological discordance in twins?
Answer
Cases involving an estimated weight difference of 25 or more due to conditions like twintwin transfusion syndrome, placental insufficiency, IUGR, or structural anomalies in one fetus.
19
Question
What might happen in cases of intrauterine death of one fetus in twins?
Answer
In cases of intrauterine death, the affected fetus may simply vanish by resorption in the first trimester, while in the second trimester a fetus papyraceous or compressus may form. Death late in pregnancy may lead to death of the other fetus or complications for the mother with DIC.
20
Question
What can happen if the diagnosis of twin pregnancy is missed on initial ultrasound but later confirmed as twins?
Answer
In cases where the diagnosis of twin pregnancy is missed on initial ultrasound but later confirmed as twins, complications may arise, especially in monozygotic twins.
21
Question
How do fetal anomalies in twin pregnancies compare to singleton pregnancies?
Answer
Fetal anomalies are increased by 24 compared to singleton pregnancies, with a higher incidence in monozygotic twins. Anomalies may include anencephaly, holoprosencephaly, neural tube defects, symmelia, microcephaly, cardiac anomalies, or Downs syndrome.
22
Question
Why are complications higher in monozygotic twins compared to dizygotic twins?
Answer
Complications are higher in monozygotic twins due to increased prevalence of pre-eclampsia, malpresentation, placental abruption, and increased operative interferences. The second baby in monozygotic twins is also more at risk.
23
Question
How does the prognosis for twins compare to singleton pregnancies in terms of maternal mortality?
Answer
Maternal mortality is increased in twins compared to a singleton pregnancy.
24
Question
In monozygotic twins, fetal anomalies are increased by 24 compared to a singleton pregnancy. Name some of these anomalies.
Answer
Anencephaly, holoprosencephaly, neural tube defects, symmelia, microcephaly, cardiac anomalies, and Down syndrome.
25
Question
Why are asphyxia and stillbirth more common in monozygotic twins?
Answer
Due to the increased prevalence of pre-eclampsia, malpresentation, placental abruption, and increased operative interferences.
26
Question
Which type of twins is at higher risk for complications - monozygotic or dizygotic twins?
Answer
Complications are higher in monozygotic twins compared to dizygotic twins.
27
Question
Among monozygotic twins, which type has the highest risk of complications?
Answer
Complications are further higher in monochorionic diamniotic twins and highest in monochorionic monoamniotic twins.
28
Question
What is the main cause of maternal mortality in twins compared to singleton pregnancy?
Answer
Mainly due to hemorrhage before, during, and after delivery, pre-eclampsia, and anemia.
29
Question
Why is perinatal mortality markedly increased in twin pregnancies?
Answer
Mainly due to prematurity, which is 45 times higher than in a singleton pregnancy. It is extremely high in monoamniotic monozygotic twins due to cord entanglement.
30
Question
Why is the second baby more at risk during delivery in twin pregnancies?
Answer
Due to retraction of the uterus leading to placental insufficiency, increased operative interference, and increased incidence of cord prolapse.
p16-18
Study
1
Question
What is the significance of chorionicity diagnosis in twin pregnancy?
Answer
Maternal and perinatal outcome depends on it.
2
Question
How can chorionicity be diagnosed in twin pregnancy?
Answer
By ultrasonography in the first trimester.
3
Question
What is the recommended timing for an ultrasound examination in women with a twin pregnancy?
Answer
At 10-13 weeks of pregnancy.
4
Question
How is antenatal fetal surveillance done in multiple pregnancies?
Answer
By serial sonography at every 3-4 weeks interval, or even earlier in monochorionic twins.
5
Question
Why do women with a twin pregnancy require increased weight gain and supplementation?
Answer
Compared to singleton pregnancy, higher weight gain and supplementation with iron, folic acid, and calcium are needed.
6
Question
What complications are significant in twin pregnancy for both maternal and fetal health?
Answer
Complications of maternal and fetal health are significant.
7
Question
Why are complications higher in monochorionic twins compared to dichorionic pregnancy?
Answer
Complications are particularly significant and higher in monochorionic twins.
8
Question
What special care is needed for twin pregnancy during the antenatal period?
Answer
Maternal nutrition, hospital admission, and supplement therapy are essential.
9
Question
Is routine hospital admission for bed rest essential in twin pregnancy?
Answer
No, routine hospital admission for bed rest is not essential.
10
Question
What is not recommended for preventing preterm delivery in twin pregnancy?
Answer
Prophylactic tocolytics, cervical cerclage, or progesterone supplementation are not recommended.
11
Question
What is the recommended increased weight gain and supplementation for twin pregnancies compared to singleton pregnancies?
Answer
Increased weight gain with diet and supplementation with iron, folic acid, and calcium.
12
Question
Why are complications of twin pregnancy significant compared to singleton pregnancies?
Answer
Complications of twin pregnancy for mothers and fetuses are significant.
13
Question
What are the special considerations for monochorionic twins in terms of complications?
Answer
Complications of monochorionic twins are particularly significant and high compared to dichorionic pregnancy.
14
Question
What are some key aspects of antenatal care needed for twin pregnancies?
Answer
Twin pregnancy needs special care in the antenatal period, including maternal nutrition, hospital admission, and supplement therapy.
15
Question
Is routine hospital admission for bed rest essential in twin pregnancies?
Answer
No, routine hospital admission for bed rest is not essential.
16
Question
What measures are not recommended to prevent preterm delivery in twin pregnancies?
Answer
Prophylactic tocolytics, cervical cerclage, or progesterone supplementation are not recommended.
17
Question
What are some important factors to consider for vaginal delivery and management of twins?
Answer
Factors include an equipped hospital, adequately skilled staff, and measures to combat complications like postpartum hemorrhage.
18
Question
When is Cesarean delivery decided in twin pregnancies?
Answer
Cesarean delivery is decided when the first twin is non-vertex or when there is any obstetric indication.
19
Question
What are the important measures that have improved outcomes in multiple pregnancies?
Answer
Important measures include early diagnosis via ultrasonography, serial growth assessment, specialized antenatal care, continued surveillance, antenatal corticosteroids, planned delivery, and neonatal care.
20
Question
How should the management of the third stage of labor be in multiple pregnancies?
Answer
Management should be very prompt and active following delivery.
21
Question
What are the criteria for allowing spontaneous onset of labor in multiple pregnancies?
Answer
Spontaneous onset of labor is allowed when both fetuses are in vertex position or when the first twin is in vertex position.
22
Question
When is Cesarean delivery decided in multiple pregnancies?
Answer
Cesarean delivery is decided when the first twin is in a non-vertex position or when there is any obstetric indication.
23
Question
What are some important measures that have improved the outcome in multiple pregnancies?
Answer
A. Ultrasonography for early diagnosis and serial growth assessment. B. Specialized antenatal care. C. Continued surveillance. D. Antenatal corticosteroids. E. Planned delivery. F. Neonatal care.
24
Question
What is a major postpartum complication in multiple pregnancies?
Answer
Atonic postpartum hemorrhage (PPH) is a major postpartum complication in multiple pregnancies.
25
Question
How is the management of the third stage of labor recommended in multiple pregnancies?
Answer
Management of the third stage of labor should be very prompt and active following the delivery of the second twin.
26
Question
What is recommended to improve fetal salvage in quadruplets during delivery?
Answer
To improve fetal salvage, especially in quadruplets, it is advisable to employ liberal cesarean section and selective reduction if there are 4 or more fetuses.
27
Question
What is the average time for delivery in quadruplets?
Answer
30-31 weeks
28
Question
What is advised to improve fetal salvage in quadruplets?
Answer
Employ liberal cesarean section
29
Question
What is selective reduction in the context of multiple pregnancies?
Answer
Reduction of fetuses leaving behind only two to improve outcomes
30
Question
How is selective reduction typically performed in quadruplets?
Answer
Intracardiac injection of potassium chloride between 11 and 13 weeks under ultrasonic guidance
p11-15
Study
1
Question
What is a Battledore placenta?
Answer
A type of abnormal placenta with the insertion of the umbilical cord at the margin of the placenta.
2
Question
What is a Circumvallate placenta?
Answer
A type of abnormal placenta with a thickened ring-like membrane on the fetal surface.
3
Question
What is a Velamentous placenta?
Answer
A type of abnormal placenta where the umbilical vessels insert into the fetal membranes before reaching the placenta.
4
Question
What is a Placenta succenturiata?
Answer
A type of abnormal placenta with one or more small lobes placed at varying distances from the main placental margin.
5
Question
What is the morphology of Placenta succenturiata?
Answer
One or more small lobes of placenta, size of a cotyledon, connected to the main placenta by a leash of vessels traversing through the membranes.
6
Question
How is the accessory lobe in Placenta succenturiata developed?
Answer
It is developed from the activated villi on the chorionic laeve.
7
Question
What is placenta spuria in the absence of communicating blood vessels?
Answer
A term used to describe the accessory lobe in Placenta succenturiata when there are no blood vessels connecting it to the main placenta.
8
Question
What is the incidence of Placenta succenturiata?
Answer
Approximately 3%.
9
Question
How is the diagnosis of Placenta succenturiata made?
Answer
It is made following inspection of the placenta after its expulsion.
10
Question
What are the causes of polyhydramnios and oligohydramnios?
Answer
There are many causes, and oligohydramnios may be due to pregnancy complications.
11
Question
What is the incidence of placenta succenturiata?
Answer
About 3%
12
Question
How is the diagnosis of placenta succenturiata made?
Answer
Diagnosis is made following inspection of the placenta after its expulsion
13
Question
What are the features seen in placenta succenturiata with intact lobe?
Answer
Features have already been described
14
Question
What are the features seen in placenta succenturiata with missing lobe?
Answer
a) Gap in the chorion, b) Torn ends of blood vessels found on the margin of the gap
15
Question
How is amniotic fluid volume related to gestational age?
Answer
Amniotic fluid volume is related to gestational age and is dynamic, being replaced every 3 hours
16
Question
What are some causes of polyhydramnios?
Answer
Causes include hypertensive disorders, placental insufficiency, and idiopathic factors
17
Question
What may oligohydramnios be due to?
Answer
Oligohydramnios may be due to pregnancy complications with hypertensive disorders, placental insufficiency, or idiopathic factors
18
Question
How is amniotic fluid volume estimated clinically?
Answer
Amniotic fluid volume is estimated clinically and through ultrasound measurements of AFI (Amniotic Fluid Index) and DVP (Deepest Vertical Pool)
19
Question
What levels of AFI indicate significant perinatal morbidity and mortality in polyhydramnios?
Answer
LVP 8 cm
20
Question
What levels of AFI indicate significant perinatal morbidity and mortality in oligohydramnios?
Answer
LVP 2 cm
21
Question
What is the outcome difference between transient and persistent polyhydramnios?
Answer
Transient polyhydramnios has a more favorable outcome compared to persistent or worsened polyhydramnios
22
Question
What is recommended for cases of persistent polyhydramnios?
Answer
Investigations for fetal anomalies and genetic syndromes, as well as close monitoring, are recommended
23
Question
How can amniotic fluid volume be altered by maternal water intake?
Answer
Amniotic fluid volume can be increased or decreased by the amount of maternal water intake
24
Question
What are the main complications of polyhydramnios?
Answer
Complications include maternal and fetal complications
25
Question
What are the main complications of oligohydramnios?
Answer
Mainly fetal complications
26
Question
What is an important management issue in cases of polyhydramnios and oligohydramnios?
Answer
To detect any fetal congenital malformation. Referral to a fetal medicine unit is recommended when present, especially when associated with major structural anomalies
27
Question
What needs to be investigated in cases of persistent polyhydramnios?
Answer
Fetal anomalies and genetic syndromes
28
Question
What can increase or decrease amniotic fluid volume and AFI?
Answer
Maternal water intake
29
Question
What are the complications of polyhydramnios grouped into?
Answer
a) Maternal b) Fetal
30
Question
Where are the complications of oligohydramnios mainly seen?
Answer
Fetal