Multiple Pregnancy


Not true of perinatal mortality in twin pregnancy


A. Dichorionic diamniotic twins- 4.8%
B. Monochorionic diamniotic twins – 16%
C. Monochorionic monoamniotic twins -29%
D. Conjoined twins – 44%



Not true of diamniotic monochorionic twins


A. Division occurs between days 4 and 8 post-fertilization
B. Monozygotic twins occurs in mothers who are themselves one of monozygotic twins
C. Late (blastocyst) embryo transfer may be a cause
D. The intervening membranes consist of single layer of amnion



Most serious maternal complication in multiple pregnancy is


A. Pregnancy-induced hypertension
B. Gestational diabetes
C. Anemia
D. Postpartum hemorrhage



All of the following are risk factors for vanishing twins except


A. Advanced maternal age (usually more than 30 years)
B. Chromosomal abnormalities in the deceased twin
C. Large placenta
D. Teratogenic agents



All are true of Fetus papyraceous except


A. Three times more common in case of uniovular twin
B. Zygosity rather than chorionicity determines the risk of mortality and the morbidity for both mother and fetus
C. Chromosomal analysis of the surviving twin is generally normal
D. Elevated maternal serum alpha-fetoprotein is seen



Which is generally not a finding in discordant growth of twins


A. Twin-twin transfusion syndrome
B. Higher incidence with single umbilical artery
C. Higher incidence with a velamentous cord insertion
D. Higher incidence of pre-eclampsia in MC than DC twins



In Short


  • The twin peak sign (also known as the lambda (λ) sign) is a triangular appearance of the chorion insinuating between the layers of the intertwin membrane and strongly suggests a dichorionic twin pregnancy.

  • Early determination of placentation (the ultrasonographic finding of the so-called lambda sign has a 100% sensitivity and 86% specificity in diagnosing a dichorionic placenta)

  • The “T sign” used in ultrasound assessment of a multifetal pregnancy refers to the lack of chorion extending between the layers of the intertwin membrane, denoting a monochorionic pregnancy. The intertwin membrane comes to an abrupt halt at the edge in a T configuration.

  • Monochorionic placentae are associated with highly increased and specific risks.

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