Fetal Heart
Primary (pre-demise) risk for pump twin in TRAP sequence
What is high-output heart failure?
p 491
Twin A DVP 9 cm, hydrops; Twin B DVP 1.5 cm.
What is TTTS, Stage IV?
p 492
In setting of Stage I TTTS and close ultrasonographic surveillance, this is risk of TTTS progression and requirement for laser therapy (+/- 5%)
What is almost 60%?
p 494
As an argument against the "routine" use of UA Doppler surveillance in all MCDA twins, the rate of abnormal findings is 20%, with spontaneous normalization in this % of cases.
What is 70%?
p 489
This is how to calculate inter-twin growth discordance
(EFW large twin - EFW small twin) / EFW large twin
p 494
Absent fetal cardiac motion in this MC complication may result in misdiagnosis of fetal demise.
What is Twin Reversed Arterial Perfusion (TRAP) Sequence?
p 491
S/P fetoscopic laser therapy, now with inter-twin MCA PSV difference > 0.7 MoM
What is TAPS, stage II?
p 492
Current recommendation for asymptomatic patients with stable, Stage I TTTS
What is expectant management with close ultrasonographic surveillance?
Current ACOG recommendation for cervical length screening
What is a baseline cervical assessment at the time of the second-trimester anatomy scan?
p 488
In Ghana, this twin is considered "senior"
What is Twin B?
Compared to the general population, this is relative risk of major heart anomalies in MC twins (+/- 2)
What is 11.6?
p 488
Numerous large-caliber a-a anastomoses that can result in rapid volume shifts and cause sudden death in 10% of the smaller twins.
What is selective fetal growth restriction, type III?
Gestational age at which fetoscopic laser therapy + amnioreduction is considered the treatment of choice for stage II - IV TTTS
p.493
Recent ultrasound surveillance recommendation change that allows early screening for spontaneous TAPS
What is ultrasound surveillance for TTTS every 2 weeks starting at 16 weeks gestation for all monochorionic gestations?
p 491
Two non-Doppler ultrasound findings in TAPS
What are dichotomous placental echogenicity and a "starry sky" appearance of one twin's liver?
p 496
Functional valvular disorder seen in TTTS recipient twin, stage III and IV
What is pulmonary stenosis or atresia?
p 492
Twin A DVP 9 cm; Twin B DVP 1.5 cm. Nonvisible bladder in donor for 60 minutes of observation. No Doppler abnormalities/hydrops/demise.
What is TTTS, Stage II?
Three reasons equatorial dichorionization is preferred method at time of laser ablation for TTTS
What are lower recurrence of TTTS, reduction in TAPS, and decreased perinatal loss rate (compared to laser alone)?
EGA at which many clinicians will recommend delivery in setting of MC twins with spontaneous single-twin demise
What is 34 weeks?
p 497
Rate of monozygotic splitting in spontaneously conceived pregnancies (+/- 2/1,000)
p 487
Risk of hypertrophic cardiomyopathy of larger twin in Type III selective FGR (+/- 5%)
What is 20%?
p 495
Inter-twin growth discordance 30%; Normal AFI x 2; AEDF in UA of smaller twin.
What is sFGR, Type II?
p 494
Risk of PPROM after a fetoscopic laser procedure (+/- 5%)
What is 30%?
p. 494
Reason why the role of laser for early-onset spontaneous TAPS is controversial
The procedure can be technically challenging as a result of the lack of polyhydramnios-oligohydramnios sequence
p 496
Most common classification (representing site of attachment) for conjoined twins
What is thoracopagus?
p 491