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WorksheetsMultifetal gestation
Total questions: 15
Worksheet time: 15mins
All except which of the following complications are increased in multifetal gestations?
Preeclampsia
Hysterectomy
Maternal death
Postterm delivery
A 37-year-old G1 comes to establish prenatal care with you after being discharged from her reproductive endocrinologist. This pregnancy was conceived via single embryo transfer in vitro fertilization. Which one of the following is true regarding her situation?
Assisted reproductive technology increases the incidence of monozygotic twins two- to fivefold
If a single zygote splits 8 days post fertilization, a monochorionic diamnionic twin gestation results.
Because this pregnancy is known to have begun with one embryo, you can be certain that she will have monochorionic twins, bur amnionicity depends on timing of split.
All of the above
Which of the following factors increases the risk for monozygotic twinning?
Maternal age
Increased parity
Race and family history
None of the above
Which hormone is the most likely underlying cause of increased twinning seen in some racial and ethnic
groups?
Estrogen
Progesterone
Luteinizing hormone
Follicle stimulating hormone
Which of the following statements regarding atypical twinning is not true?
Monochorionic twins are never dizygocic.
Twins of opposite sex are not always dizygocic
Monochorionic twins are not always the same sex.
None of the above is true
Maternal physiological adaptation to twin pregnancy in comparison to a singleton pregnancy is accurately described in which of the following statements?
Cardiac output increases 40% above that of a woman carrying a singleton fetus.
Blood volume expansion averages 70%, which is greater than the 40-50% seen in women carrying a singleton.
The increased cardiac output in twin gestation is primarily due to increased stroke volume rather than increased heart rate.
All of the above
A 34-year-old G2P 1 at 12 weeks' gestation presents to discuss aneuploidy screening. This pregnancy started out with dichorionic twins, but spontaneously reduced to singleton at 7-8 weeks' gestation. Which of the following is the most appropriate?
First-trimester screening is not recommended
Since the cotwin demise occurred prior to 9 weeks, routine first-trimester screening is not affected and remains a valid option.
Since it has been at least 4 weeks since cotwin demise, routine first-trimester screening is not affected and remains a valid option.
Second-trimester maternal serum alpha fetoprotein will be falsely elevated, so a detailed anatomy ultrasound is recommended to assess for neural tube defect
Among the complications that may be seen in twin pregnancies, which of the following may be seen in dichorionic twin pregnancies?
Fems-in-fem
Acardiac twin
Twin-twin transfusion syndrome
Complete mole with coexisting normal twin
Which is the most common form of vascular anastomoses seen in monochorionic twin placentas?
Deep vein-to-vein
Deep artery-to-vein
Superficial artery-to-vein
Superficial artery-to-artery
A pair of monochorionic twins present at 20 weeks' gestation with sonographic findings that suggest twin-twin transfusion syndrome. There is significant growth and fluid discordance, no bladder is visualized in the smaller twin, neither twin has abnormal umbilical artery Doppler studies, and neither twin has ascites or hydrops. How would you assign Quintero stage based on this information?
Stage I
Stage II
Stage III
Stage IV
Which of the following are not beneficial interventions for complicated monochorionic twin pregnancies?
Immediate delivery of surviving twin to prevent neurological damage after finding of cotwin demise.
Intentional septostomy to equalize fluid and pressure for Quintero stage II twin-twin transfusion syndrome.
Selective feticide via intracardiac injection of potassium chloride when lethal anomaly is found in one twin.
All of the above
Which of the following methods of antepartum fetal surveillance is the most evidence-based strategy to improve outcome in a twin pregnancy?
Nonstress test
Biophysical profile
Doppler velocimetty of the umbilical artery
Sonographic evaluation of monochorionic twins at least every 2 weeks
Which of the following modalities provide reassurance of a lower risk for preterm birch in a twin gestation?
Closed cervix on digital examination
Cervical length over 20 mm, measured at 22-24 weeks by transvaginal ultrasound
Cervical length over 20 mm, measured serially in the second trimester by transvaginal ultrasound
All of the above
Which of the following interventions has been shown to decrease preterm birth in twin pregnancies?
Tocolysis of preterm labor
Prophylactic cerclage placement in the early second trimester
Weekly intramuscular injection of 17 alpha-hydroxyprogesterone caproate when initiated prior to 18 weeks
None of the above
A 34-year-old G1 presents with spontaneous conception
of a trichorionic-triamnionic triplet gestation. Which of the following is not an appropriate aspect of her early pregnancy counseling?
Selective fecal reduction can be performed with ultrasound-guided intracardiac injection of potassium chloride.
She is counseled that elective fetal reduction from triplet to twin gestation carries a 4.5% risk for loss of the entire pregnancy.
She is counseled that elective reduction should be performed because it will result in a lower rate of maternal complications, preterm birth, and neonatal death.
All of the above are appropriate aspects of your counseling.
