Fetal Biochemical Screening

Fetal Biochemical Screening

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Overview

Fetal biochemical screening is a non-invasive method used to estimate the risk of chromosomal abnormalities, including Trisomy 21 (Down syndrome), Trisomy 18, and Trisomy 13. It involves analyzing specific biochemical markers in maternal blood during pregnancy. This screening does not diagnose a condition but identifies those pregnancies at higher risk who may benefit from further diagnostic testing such as CVS or amniocentesis.

First Trimester Screening (11–13+6 weeks)

First trimester screening combines maternal serum markers — free β-hCG and PAPP-A — with nuchal translucency (NT) measurement via ultrasound. This integrated result estimates the risk for Trisomy 21 and 18. The presence of nasal bone, ductus venosus Doppler, and tricuspid valve flow may also be incorporated to improve screening accuracy.

Second Trimester Quadruple Screening (15–22 weeks)

The quadruple test includes four serum markers: Alpha-fetoprotein (AFP), total hCG, unconjugated estriol (uE3), and inhibin-A. It assesses the risk of Trisomy 21, Trisomy 18, and neural tube defects. It is most accurate between 16–18 weeks but can be performed up to 22 weeks gestation.

Cell-Free DNA Screening (cfDNA / NIPT)

Cell-free fetal DNA testing, also known as Non-Invasive Prenatal Testing (NIPT), analyzes fetal DNA fragments circulating in maternal blood. It provides a highly accurate screening for common trisomies (21, 18, 13), sex chromosome aneuploidies, and selected microdeletions. It can be performed from 10 weeks onwards and is especially useful in high-risk pregnancies.

Interpretation and Follow-up

A positive biochemical screening result indicates increased risk and should be followed by confirmatory diagnostic tests such as chorionic villus sampling (CVS) or amniocentesis. The final interpretation should always consider maternal age, gestational age, ultrasound findings, and previous pregnancy history.

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Note: Select English or Hindi; answer accordingly. / अंग्रेजी या हिंदी चुनें; उसी में उत्तर दें।

1. Which maternal serum marker is increased in open neural tube defects? 1. खुले न्यूरल ट्यूब दोषों में कौन‑सा मातृ सीरम मार्कर बढ़ा हुआ होता है?
A. Alpha‑fetoprotein (AFP)
B. Low hCG
C. Low AFP
D. High inhibin‑A only

2. The combined first‑trimester screening includes nuchal translucency and which biochemical markers? 2. संयुक्त प्रथम तिमाही स्क्रीनिंग में नचाल पारदर्शिता और कौन‑से बायोकेमिकल मार्कर शामिल होते हैं?
A. Free β‑hCG and pregnancy‑associated plasma protein‑A (PAPP‑A)
B. AFP only
C. Inhibin‑A only
D. Maternal glucose

3. In the second‑trimester quad screen, which pattern is typical for Down syndrome (Trisomy 21)? 3. द्वितीय तिमाही क्वाड स्क्रीन में डाउन सिंड्रोम (ट्राइसोमी 21) के लिए किस पैटर्न की आमतौर पर सूचना मिलती है?
A. Low AFP, high hCG, low uE3, high inhibin‑A
B. High AFP, low hCG, high uE3, low inhibin‑A
C. All markers normal
D. Only AFP elevated

4. Cell‑free fetal DNA (cfDNA / NIPT) is best described as: 4. सेल‑फ्री भ्रूणीय DNA (cfDNA / NIPT) को सबसे अच्छा कैसे वर्णित किया जाता है?
A. A high‑sensitivity noninvasive screening test analyzing fetal DNA fragments in maternal plasma
B. A diagnostic invasive test equivalent to amniocentesis
C. A test that measures maternal antibodies only
D. A fetal ultrasound parameter

5. Which factor does NOT affect maternal serum marker MoM (multiples of the median)? 5. कौन‑सा कारक मातृ सीरम मार्कर MoM को प्रभावित नहीं करता?
A. Maternal weight
B. Gestational age at sampling
C. Maternal ethnicity
D. Paternal eye color

6. A high maternal serum AFP with a normal fetal anatomy scan suggests which next step? 6. सामान्य भ्रूणीय एनाटॉमी स्कैन के साथ उच्च मातृ सीरम AFP किस अगले कदम का सुझाव देता है?
A. Repeat dating/confirm gestation, evaluate for multiple pregnancy, consider targeted anatomic reassessment and neural tube defect evaluation
B. Immediate chemotherapy
C. Ignore result
D. Only maternal glucose test

7. Which statement about screening vs diagnostic tests is correct? 7. स्क्रीनिंग बनाम डायग्नोस्टिक परीक्षणों के बारे में कौन‑सा कथन सही है?
A. Screening estimates risk and may require confirmatory diagnostic testing (CVS/amniocentesis) if positive
B. Screening provides a definitive genetic diagnosis
C. Diagnostic tests are always noninvasive
D. No screening is ever useful

8. Integrated screening combines first‑trimester and second‑trimester markers. Its advantage is: 8. एकीकृत स्क्रीनिंग पहले‑तिमाही और दूसरे‑तिमाही मार्करों को मिलाती है। इसका लाभ क्या है?
A. Higher detection rate for trisomies compared with either test alone
B. Instant diagnostic result
C. Eliminates need for ultrasound
D. Always cheaper than single tests

9. A positive cfDNA/NIPT result should be followed by: 9. सकारात्मक cfDNA/NIPT परिणाम का अनुसरण किससे किया जाना चाहिए?
A. Diagnostic confirmation with CVS (if early) or amniocentesis before definitive decision‑making
B. Immediate termination without confirmation
C. No further action required
D. Maternal dietary change only

10. Key counseling points about fetal biochemical screening should include: 10. भ्रूणीय बायोकेमिकल स्क्रीनिंग के बारे में प्रमुख परामर्श बिंदुओं में क्या शामिल होना चाहिए?
A. These are screening tests (not diagnostic), performance varies by test and gestation, results influenced by maternal factors, and positive screens need confirmatory diagnostic testing and counseling
B. They diagnose all fetal anomalies with 100% accuracy
C. No follow‑up is necessary after screening
D. Only maternal shoe size matters

Monochorionic Monoamniotic Twin

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Figer-1

📄 Report Sample Line- Monochorionic Monoamniotic Twin
A monochorionic monoamniotic twin gestation, characterized by the presence of a single shared placenta and the absence of an intertwin dividing membrane. Both fetuses are seen within a common amniotic sac with free-floating umbilical cords, raising risk for cord entanglement. Each fetus demonstrates appropriate biometric measurements for gestational age, with normal cardiac activity and symmetrical growth. Amniotic fluid volume is adequate and appears evenly distributed. Doppler studies including umbilical artery, ductus venosus, and middle cerebral artery are within normal limits for both twins.”


Conclussion: 📋 Findings are consistent with a monochorionic monoamniotic twin pregnancy with appropriate fetal growth, normal Doppler parameters, and no evidence of discordance or complications at the time of this scan. High-risk configuration due to shared amniotic cavity and increased risk of cord entanglement.
Recommendation: Serial ultrasound and Doppler assessments every 1–2 weeks

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Note: Select English or Hindi; answer accordingly. / अंग्रेजी या हिंदी चुनें; उसी में उत्तर दें।

1. Monochorionic monoamniotic (MCMA) twins are characterized by: 1. मोनोकोरियोनिक मोनोएमनिओटिक (MCMA) जुड़वाँ किस चीज़ से पहचाने जाते हैं?
A. Single chorion and single amniotic sac (shared placenta and sac) with no intertwin membrane
B. Separate placentas and separate sacs
C. Always conjoined twins
D. Dichorionic diamniotic configuration

2. The single greatest antenatal risk specific to MCMA twins is: 2. MCMA जुड़वाँ का एकल सबसे बड़ा प्रसवपूर्व जोखिम क्या है?
A. Cord entanglement and cord accident leading to sudden fetal death
B. Maternal gestational diabetes only
C. Placenta previa only
D. Low risk compared with singletons

3. On ultrasound, how is MCMA diagnosed? 3. अल्ट्रासाउंड पर MCMA कैसे निदान किया जाता है?
A. Single placenta, absence of intertwin membrane, and same fetal sex with close fetal positions; confirm with color flow for cord entanglement if suspected
B. Two separate placentas with thick dividing membrane
C. Presence of amniotic band only
D. By maternal blood test only

4. Which complication is less common in MCMA compared with monochorionic diamniotic twins? 4. मोनोकोरियोनिक डाइएमनिओटिक जुड़वाँ की तुलना में MCMA में कौन‑सी जटिलता कम आम है?
A. Twin‑to‑twin transfusion syndrome (TTTS) is less typical in monoamniotic twins
B. Cord entanglement
C. High perinatal mortality from cord accidents
D. Need for inpatient monitoring

5. Recommended antenatal surveillance for MCMA twins often includes: 5. MCMA जुड़वाँ के लिए अनुशंसित प्रसवपूर्व निगरानी अक्सर किसे शामिल करती है?
A. Intensive surveillance with serial ultrasound, fetal movement monitoring, frequent NST/CTG (often inpatient from ~24–28 weeks in many centers)
B. No different surveillance than singletons
C. Only one ultrasound at 12 weeks
D. Immediate delivery at 20 weeks always

6. Optimal timing of delivery usually recommended for MCMA twins (if stable) is approximately: 6. MCMA जुड़वाँ के लिए सामान्यतः अनुशंसित वितरण का आदर्श समय (यदि स्थिर हो) लगभग कब है?
A. 32–34 weeks gestation (institutional practice may vary) to balance prematurity vs risk of in utero sudden death
B. Term 39–40 weeks only
C. Immediate delivery at 24 weeks always
D. Never deliver before 42 weeks

7. Which intrapartum management is generally preferred for MCMA twins? 7. MCMA जुड़वाँ के लिए सामान्यतः कौन‑सा प्रसवकालीन प्रबंधन पसंद किया जाता है?
A. Planned cesarean delivery in most centers due to risk of cord entanglement and need for rapid neonatal care
B. Home vaginal delivery without monitoring
C. Water birth always
D. Delayed cord clamping for hours

8. Prenatal ultrasound sign that suggests cord entanglement is: 8. कॉर्ड एंटैंगलमेंट का संकेत देने वाला प्रसवपूर्व अल्ट्रासाउंड संकेत क्या है?
A. Visualization of intertwined umbilical cords and color Doppler showing crossing vessels around fetal trunks
B. Isolated placental lakes only
C. Increased femur length only
D. Maternal leg pain only

9. Counseling parents expecting MCMA twins should include which key points? 9. MCMA जुड़वाँ की अपेक्षा करने वाले माता‑पिता को परामर्श में कौन‑से प्रमुख बिंदु शामिल होने चाहिए?
A. Explain high‑risk nature (cord entanglement, higher perinatal mortality), need for intensive surveillance, likely preterm delivery and neonatal support availability
B. Assure routine pregnancy with no added risks
C. Recommend immediate termination in all cases without discussion
D. Only discuss maternal diet

10. After delivery of MCMA twins, important neonatal considerations include: 10. MCMA जुड़वाँ के वितरण के बाद महत्वपूर्ण नवजात विचार क्या हैं?
A. Prepared neonatal resuscitation team, evaluate for cord injury/entanglement, monitor for anemia or hypoxic injury and coordinate NICU care
B. Immediate discharge home without assessment
C. No cord clamp needed
D. Routine bathing immediately without assessment

Dichorionic Diamniotic Twin

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Figer-1

📄 Report Sample Line- Dichorionic Diamniotic Twin
Two distinct placental masses are visualized (or a single fused placenta with a thick intertwin membrane), with the presence of the ‘twin peak’ (lambda) sign at the intertwin membrane insertion site, confirming dichorionicity. Each fetus is housed in a separate amniotic sac with independent and normal amniotic fluid volumes. Both fetuses demonstrate appropriate biometric measurements for gestational age with no evidence of growth discordance, structural anomalies, or amniotic fluid abnormalities. Umbilical artery Doppler studies for both twins are within normal limits.


Conclussion: 📋 Findings are consistent with an uncomplicated dichorionic diamniotic twin pregnancy. Fetal growth is appropriate for gestational age, with no current sonographic evidence of growth restriction, fluid imbalance, or twin-related complications
Recommendation: Serial growth monitoring every 4 weeks

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Note: Select English or Hindi; answer accordingly. / अंग्रेजी या हिंदी चुनें; उसी में उत्तर दें।

1. Dichorionic diamniotic (DCDA) twins are characterized by: 1. डाइकोरियोनिक डाइएमनिओटिक (DCDA) जुड़वाँ किस तरह पहचाने जाते हैं?
A. Each twin has its own chorion and amnion (separate placentas or fused placentas); intertwin membrane present
B. Shared single sac without membrane
C. Always conjoined twins
D. Only seen in triplet pregnancies

2. The ultrasound sign most helpful to identify dichorionicity in the first trimester is: 2. प्रारंभिक तिमाही में डाइकोरियोसिटी की पहचान के लिए सबसे सहायक अल्ट्रासाउंड संकेत क्या है?
A. Lambda (twin peak) sign at the placental junction
B. T‑sign (no lambda)
C. Visualization of cord entanglement
D. Only maternal serum test

3. Compared with monochorionic twins, DCDA twins have which relative risk profile? 3. मोनोकोरियोनिक जुड़वाँ की तुलना में DCDA जुड़वाँ का जोखिम प्रोफ़ाइल कैसा होता है?
A. Lower risk of twin‑to‑twin transfusion syndrome (TTTS) and intertwin vascular complications
B. Higher risk of TTTS
C. Guaranteed normal outcome
D. Always lethal

4. When is chorionicity best determined by ultrasound? 4. अल्ट्रासाउंड द्वारा चोरियोसिटी कब सबसे अच्छी तरह निर्धारित की जाती है?
A. First trimester (ideally 6–13 weeks) when membranes and placenta are most distinct
B. Only after 30 weeks
C. At delivery only
D. Chorionicity cannot be determined

5. A common management recommendation for uncomplicated DCDA twins is: 5. अनसुस्पष्ट DCDA जुड़वाँ के लिए एक सामान्य प्रबंधन सिफारिश क्या है?
A. Routine antenatal surveillance with growth scans and individualized care; delivery usually later than monochorionic twins (often 37–38 weeks if stable)
B. Immediate delivery at 28 weeks always
C. No antenatal scans needed
D. Routine cord entanglement checks

6. Which complication is still more common in twin pregnancies (including DCDA) than in singletons? 6. जुड़वाँ गर्भधारणों (DCDA सहित) में कौन‑सी जटिलता एकल गर्भधारण की तुलना में अभी भी अधिक सामान्य है?
A. Preterm birth and growth discordance
B. Lower risk of preterm birth than singletons
C. Always normal placental function
D. No need for maternal care

7. The presence of two separate placentas on ultrasound always guarantees dichorionicity. True or false? 7. अल्ट्रासाउंड पर दो अलग प्लेसेंटास की उपस्थिति क्या हमेशा डाइकोरियोसिटी की गारंटी देती है? सच्चा या गलत?
A. Generally true — two separate placentas indicate dichorionicity, but fused placentas can rarely appear as single placental mass; early scan is best
B. Always false
C. Only maternal blood test can tell
D. Placental number is irrelevant

8. Which twin complication is uncommon in DCDA but common in monochorionic twins? 8. कौन‑सी जुड़वाँ जटिलता DCDA में असामान्य है परन्तु मोनोकोरियोनिक जुड़वाँ में आम है?
A. Twin‑to‑twin transfusion syndrome (TTTS)
B. Preterm birth
C. Cesarean delivery
D. Maternal nausea

9. Counseling points for parents expecting DCDA twins should include: 9. DCDA जुड़वाँ की उम्मीद करने वाले माता‑पिता के लिए परामर्श बिंदुओं में क्या शामिल होना चाहिए?
A. Explain chorionicity, risks higher than singletons (preterm birth, growth discordance), surveillance schedule, and likely delivery timing; reassure lower risk of TTTS compared with monochorionic twins
B. Assure no extra risk and no special scans
C. Immediate recommendation for termination
D. Only maternal diet changes

10. Typical surveillance schedule for uncomplicated DCDA twins often includes: 10. अनकंप्लिकेटेड DCDA जुड़वाँ के लिए विशिष्ट निगरानी अनुसूची में सामान्यतः क्या शामिल होता है?
A. Growth scans every 3–4 weeks from mid‑trimester and antenatal visits with individualized frequency; consider delivery ~37–38 weeks if stable
B. No scans after booking
C. Daily fetal MRI
D. Immediate delivery at 28 weeks

Monochorionic–Diamniotic Placentation

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Figer-1

📄 Report Sample Line- Monochorionic–Diamniotic Placentation
single placental mass and a thin intertwin dividing membrane, consistent with monochorionic–diamniotic placentation. The membrane insertion at the placenta demonstrates a T-sign, indicating absence of chorionic tissue between the layers. Each fetus is housed in a separate amniotic sac, with distinct fetal movements and fluid spaces. No signs of twin-to-twin transfusion syndrome (TTTS), twin anemia-polycythemia sequence (TAPS), selective intrauterine growth restriction (sIUGR), or amniotic fluid discordance are currently noted. Both fetuses demonstrate concordant growth and normal Doppler waveforms (umbilical artery, MCA, and ductus venosus).


Conclussion: 📋 Findings are consistent with a monochorionic–diamniotic twin pregnancy in the second/third trimester. Fetal growth, amniotic fluid volumes, and Doppler parameters are within normal limits. No evidence of TTTS, TAPS, or sIUGR at this time.
Recommendation: Intensive surveillance with ultrasound every 2 weeks from 16 weeks onwards is recommended due to the increased risk of intertwin complications in monochorionic pregnancies.

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Note: Select English to answer in English, या हिंदी चुनें तो प्रश्नों के उत्तर हिंदी में दीजिए।

1. What defines a monochorionic–diamniotic (MCDA) twin pregnancy? 1. मोनोकोरिओनिक–डायएमनियोटिक (MCDA) ट्विन गर्भावस्था किससे परिभाषित होती है?
A. Two chorions, two amnions
B. Single chorion with two separate amniotic sacs
C. Single chorion and single amniotic sac
D. Two placentas that are always fused

2. Which early ultrasound sign favors monochorionicity (as opposed to dichorionic)? 2. कौन सा प्रारंभिक अल्ट्रासाउंड संकेत मोनोकोरिओनिसिटी को पसंद करता है (डाइकोरिओनिक के विपरीत)?
A. Lambda (twin peak) sign
B. T-sign (thin inter-twin membrane insertion)
C. Thick inter-twin membrane (>2 mm)
D. Two separate placental disks clearly separated

3. Which major complication is characteristically associated with MCDA pregnancies? 3. कौन सी प्रमुख जटिलता MCDA गर्भधारण से खासकर जुड़ी रहती है?
A. Twin-to-twin transfusion syndrome (TTTS)
B. Neural tube defect in both twins
C. Always severe congenital infection
D. Placental abruption is exclusive to MCDA

4. Best time to determine chorionicity by ultrasound? 4. अल्ट्रासाउंड द्वारा कोरियोनिसिटी निर्धारित करने का सर्वोत्तम समय कब है?
A. First trimester (around 11–14 weeks)
B. After 28 weeks
C. At term during labour
D. Chorionicity cannot be determined by ultrasound

5. Compared to dichorionic-diamniotic twins, MCDA pregnancies typically have: 5. डाइकोरिओनिक–डायएमनियोटिक ट्विन्स की तुलना में, MCDA गर्भधारण आमतौर पर क्या दिखाते हैं?
A. Lower risk of complications
B. Higher risk of TTTS and perinatal complications
C. No difference in risks
D. Always need immediate delivery at 28 weeks

6. Typical surveillance schedule for uncomplicated MCDA pregnancies (once determined)? 6. साधारण MCDA गर्भधारण के लिए निगरानी अनुसूची (निर्धारित होने के बाद) क्या है?
A. Routine care same as singleton pregnancy
B. Serial ultrasound every 2 weeks from ~16 weeks to monitor for TTTS and growth discordance
C. Only one scan at 20 weeks is enough
D. Daily Doppler monitoring from 20 weeks

7. First-line fetal therapy for severe TTTS is: 7. गंभीर TTTS के लिए पहले विकल्प की भ्रूणयुग उपचार क्या है?
A. Fetoscopic laser photocoagulation of placental vascular anastomoses
B. Immediate cesarean delivery regardless of gestation
C. Maternal steroids only D. No treatment exists for TTTS

8. Which ultrasound finding argues AGAINST monochorionicity? 8. कौन सा अल्ट्रासाउंड खोज मोनोकोरिओनिसिटी के खिलाफ तर्क देती है?
A. Presence of a thick lambda (twin peak) sign between the fetal membranes
B. Thin inter-twin membrane with T-sign
C. Single placenta with vascular anastomoses on color Doppler
D. Discordant growth between twins

9. Twin anemia-polycythemia sequence (TAPS) in MCDA is best screened with: 9. MCDA में ट्विन एनीमिया-पॉलीसाइथेमिया सीक्वेंस (TAPS) की सही स्क्रीनिंग किससे होती है?
A. Maternal serum AFP only B. Middle cerebral artery peak systolic velocity (MCA-PSV) Doppler in each twin
C. Amniotic fluid volume measurement alone D. Fetal MRI

10. For an uncomplicated MCDA pregnancy, recommended timing of delivery to reduce risk of stillbirth is usually around: 10. एक असम्प्रदायिक MCDA गर्भधारण के लिए, स्ट्रिलबर्थ के जोखिम को कम करने हेतु आमतौर पर प्रसव का अनुशंसित समय कब होता है?
A. 34 weeks B. 37 weeks (often recommended) C. 40 weeks D. Post-term beyond 42 weeks

Dichorionic Placentation

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Figer-1

📄 Report Sample Line- Dichorionic Placentation
Two separate placental masses are identified (or a single bilobed placenta with a thick inter-twin membrane), with a clearly visualized thick dividing membrane and twin peak (‘lambda’) sign at the placental insertion site, confirming dichorionicity. Each fetus lies in a separate amniotic sac with independent amniotic fluid volumes. Both fetuses exhibit appropriate growth parameters for gestational age, with no evidence of growth discordance or structural anomalies. Doppler studies are within normal limits for both twins.


Conclussion: 📋 Findings are consistent with a dichorionic diamniotic twin pregnancy with appropriate fetal growth, normal amniotic fluid volumes, and unremarkable Doppler assessments. No evidence of twin-related complications at the time of scan.
Recommendation: Routine follow-up scans every 4 weeks to monitor fetal growth and well-being.

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Note: Select English to answer in English, या हिंदी चुनें तो प्रश्नों के उत्तर हिंदी में दीजिए।

1. What defines a dichorionic–diamniotic (DCDA) twin pregnancy? 1. डाइकॉरिओनिक–डायएमनियोटिक (DCDA) ट्विन गर्भावस्था किससे परिभाषित होती है?
A. Two separate chorions and usually two placentas
B. Single chorion and single amniotic sac
C. Always monochorionic
D. Two fetuses sharing one amniotic sac

2. Which ultrasound sign favors dichorionicity? 2. कौन सा अल्ट्रासाउंड संकेत डाइकॉरिओनिसिटी की ओर इशारा करता है?
A. Lambda (twin peak) sign at the inter-twin membrane
B. Thin T-sign
C. Single placenta with vascular anastomoses
D. Shared umbilical cord insertion

3. Best time to assess chorionicity by ultrasound? 3. अल्ट्रासाउंड द्वारा कौरियोनिसिटी का आकलन करने का सर्वोत्तम समय कब है?
A. First trimester (around 11–14 weeks)
B. After 28 weeks
C. At term
D. Only postpartum

4. Compared to MCDA twins, DCDA twins generally have: 4. MCDA ट्विन्स की तुलना में DCDA ट्विन्स में आमतौर पर क्या देखा जाता है?
A. Higher risk of TTTS
B. Lower risk of vascular complications like TTTS
C. Always fused placentas
D. Require laser therapy routinely

5. Which finding on early scan argues strongly for dichorionic gestation? 5. प्रारंभिक स्कैन पर कौन सी खोज डाइकॉरिओनिक गर्भावस्था के लिए मजबूत तर्क देती है?
A. Lambda sign between the membranes
B. T-sign at membrane insertion
C. Single placenta only
D. Identical fetal sex always

6. If two placentas are seen and well separated, this suggests: 6. यदि दो प्लेसेंटा दिखाई देते हैं और अच्छे से अलग हैं, तो यह क्या संकेत देता है?
A. Dichorionic pregnancy
B. Monochorionic pregnancy
C. Twin-to-twin transfusion syndrome
D. Conjoined twins

7. Surveillance for uncomplicated DCDA twins is typically: 7. असम्प्रदायिक DCDA ट्विन्स के लिए निगरानी सामान्यतः कैसी होती है?
A. Same as singleton with no extra scans
B. Serial growth scans (eg every 2–4 weeks) and routine antenatal care
C. Immediate delivery at 32 weeks
D. No ultrasound after diagnosis

8. Which complication is less likely in DCDA compared to MCDA? 8. MCDA की तुलना में DCDA में कौन सी जटिलता कम संभावित है?
A. Twin-to-twin transfusion syndrome (TTTS)
B. Placental abruption
C. Growth restriction in one twin
D. Preterm labour

9. Which sign suggests the membranes arise from different chorionic plates? 9. कौन सा संकेत बताता है कि मेम्ब्रेन अलग-अलग कोरियोनिक प्लेट्स से उत्पन्न होते हैं?
A. Thick inter-twin membrane and lambda sign
B. Thin T-sign
C. Single thin membrane only
D. Shared umbilical vessels on color Doppler

10. Timing of delivery for uncomplicated DCDA twins is commonly recommended around: 10. असम्प्रदायिक DCDA ट्विन्स के लिए प्रसव का सामान्यतः अनुशंसित समय कब होता है?
A. 37–38 weeks
B. 34 weeks
C. 40 weeks
D. Immediate delivery at 28 weeks

Monochorionic placentation

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Figer-1

📄 Report Sample Line- 00
A single placental mass is identified without an intervening dividing membrane reaching the chorionic plate, consistent with monochorionicity. The dividing membrane is thin and T-shaped at the placental insertion. No signs of twin-to-twin transfusion syndrome (TTTS), discordant amniotic fluid volumes, or inter-twin growth discordance are noted at present. Both fetuses demonstrate appropriate biometric measurements and normal Doppler parameters


Conclussion: 📋 Monochorionic placentation coresponding to 28 weks.
Recommendation: Close surveillance is advised with serial ultrasound evaluations every 2 weeks due to the increased risk of complications ( TTTS, TAPS, sIUGR).

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Note: Select English to answer in English, या हिंदी चुनें तो प्रश्नों के उत्तर हिंदी में दीजिए।

1. What is the defining feature of monochorionic placentation? 1. मोनोकोरिओनिक प्लेसेंटेशन की परिभाषित विशेषता क्या है?
A. Two separate chorions
B. Single chorion shared by both fetuses
C. Always two separate placentas
D. Presence of a thick inter-twin membrane

2. Which ultrasound sign is most suggestive of monochorionicity? 2. कौन सा अल्ट्रासाउंड संकेत मोनोकोरिओनिसिटी का सबसे अधिक संकेत देता है?
A. T-sign (thin inter-twin membrane insertion)
B. Lambda (twin peak) sign
C. Two separate placentas clearly separated
D. Thick septate membrane (>2 mm)

3. Major vascular complication unique to monochorionic pregnancies: 3. मोनोकोरिओनिक गर्भधारणों के लिए विशिष्ट प्रमुख संवहनी जटिलता कौन-सी है?
A. Twin-to-twin transfusion syndrome (TTTS)
B. Ectopic pregnancy
C. Placenta previa
D. Umbilical cord prolapse always

4. Which Doppler parameter helps screen for twin anemia–polycythemia sequence (TAPS)? 4. ट्विन एनीमिया–पॉलीसाइथेमिया सीक्वेंस (TAPS) के लिए स्क्रिनिंग में कौन सा डॉपलर पैरामीटर मदद करता है?
A. Middle cerebral artery peak systolic velocity (MCA-PSV)
B. Umbilical artery pulsatility index only
C. Maternal heart rate
D. Fetal breathing movements

5. Ideal surveillance frequency for uncomplicated monochorionic twins to detect TTTS early? 5. TTTS का जल्दी पता लगाने के लिए असम्प्रदायिक मोनोकोरिओनिक ट्विन्स के लिए आदर्श निगरानी आवृत्ति क्या है?
A. Every 2 weeks starting ~16 weeks
B. Once at 20 weeks only
C. Monthly starting 12 weeks
D. Daily scans from 14 weeks

6. First-line treatment for severe TTTS (Quintero stage II–IV) is: 6. गंभीर TTTS (क्विन्टेरो स्टेज II–IV) के लिए पहला उपचार क्या है?
A. Fetoscopic laser photocoagulation of placental anastomoses
B. Immediate termination
C. Expectant management only
D. Maternal antibiotics

7. Which finding on color Doppler supports monochorionicity? 7. रंगीन डॉपलर पर कौन सी खोज मोनोकोरिओनिसिटी का समर्थन करती है?
A. Vascular anastomoses across the placental surface
B. Two completely separate placentas with no connections
C. Thick inter-twin membrane
D. Absence of umbilical cords

8. Which condition is more common in monochorionic than dichorionic twins? 8. मोनोकोरिओनिक और डाइकोरिओनिक ट्विन्स की तुलना में कौन-सी स्थिति अधिक सामान्य है?
A. Twin-to-twin transfusion syndrome (TTTS)
B. Independent placental function in each twin
C. Lower risk of selective IUGR
D. Fewer perinatal complications

9. Optimal timing of delivery for uncomplicated monochorionic twins to reduce stillbirth risk is often recommended around: 9. बिना जटिलताओं वाले मोनोकोरिओनिक ट्विन्स के लिए स्ट्रिलबर्थ के जोखिम को कम करने हेतु प्रसव का आदर्श समय आमतौर पर कब अनुशंसित है?
A. 34–36 weeks
B. 40 weeks
C. 28 weeks
D. Post-term beyond 42 weeks

10. Which of the following is NOT true about monochorionic placentation? 10. निम्नलिखित में से कौन सी मोनोकोरिओनिक प्लेसेंटेशन के बारे में सत्य नहीं है?
A. It carries increased risk of TTTS
B. Vascular anastomoses between twins are possible
C. Chorionicity can never be determined on first trimester ultrasound
D. Requires closer surveillance than dichorionic twins

Vanishing Twin Syndrome

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Figer-1

📄 Report Sample Line- Vanishing Twin Syndrome
a dichorionic diamniotic twin pregnancy with a single viable intrauterine fetus demonstrating appropriate crown-rump length (CRL) and cardiac activity. Adjacent to the viable gestational sac, a collapsed second gestational sac is visualized with irregular margins, absence of fetal pole or cardiac activity, and sonographic signs suggestive of involution. These findings are consistent with Vanishing Twin Syndrome.


Conclussion: 📋 Sonographic features are consistent with Vanishing Twin Syndrome in a previously confirmed twin gestation. One twin shows normal development, while the second gestational sac has regressed with no evidence of a viable embryo or cardiac activity.
Recommendation: Continue routine antenatal care with serial ultrasound monitoring for the surviving twin

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Note: Select English to answer in English, या हिंदी चुनें तो प्रश्नों के उत्तर हिंदी में दीजिए।

1. What is the vanishing twin syndrome? 1. वैनिशिंग ट्विन सिंड्रोम क्या है?
A. Loss of one twin early in pregnancy with partial or complete resorption
B. Conjoined twins
C. Twins born with same weight
D. Twin-to-twin transfusion syndrome

2. When is vanishing twin most commonly detected by ultrasound? 2. वैनिशिंग ट्विन सबसे आम रूप से अल्ट्रासाउंड द्वारा कब पकड़ा जाता है?
A. First trimester (often before 12 weeks)
B. Second trimester only
C. At term during labour
D. After delivery

3. Common ultrasound appearance of a vanishing twin in early pregnancy? 3. प्रारंभिक गर्भावस्था में वैनिशिंग ट्विन का सामान्य अल्ट्रासाउंड स्वरूप क्या होता है?
A. Empty gestational sac or a non-viable embryo/fetal pole
B. Two healthy fetuses with normal heartbeats
C. Always large subchorionic hematoma
D. Placenta previa

4. Which factor increases the incidence of vanishing twin? 4. कौन सा कारक वैनिशिंग ट्विन की घटना बढ़ाता है?
A. Assisted reproductive technologies (ART) such as IVF
B. Multiparity only
C. Maternal age < 20 years
D. Exclusive vaginal bleeding in third trimester

5. Does early vanishing twin generally affect the surviving co-twin's long-term outcome? 5. क्या प्रारंभिक वैनिशिंग ट्विन सामान्यतः जीवित सह-ट्विन के दीर्घकालिक परिणाम को प्रभावित करता है?
A. Usually not, especially if loss occurs early in first trimester
B. Always causes severe neurological damage
C. Always causes congenital malformations
D. Guarantees preterm delivery at 28 weeks

6. Vanishing twin diagnosed after 14 weeks is more likely to be associated with: 6. 14 सप्ताह के बाद निदान किया गया वैनिशिंग ट्विन किसके साथ अधिक संभावना है?
A. Complications for the surviving twin including growth restriction or neurologic injury
B. No possible complications ever
C. Always twin-to-twin transfusion syndrome
D. Guaranteed monochorionicity

7. What is a post-vanishing twin sonographic finding in the surviving twin's placenta/uterus? 7. शेष ट्विन के प्लेसेंटा/यूटेरस में वैनिशिंग ट्विन के बाद कौन सी सोनोग्राफिक खोज हो सकती है?
A. Intrauterine debris, echogenic remnants or membrane remnants
B. Always two live fetal heartbeats
C. Consistently normal placenta with no changes
D. Placenta accreta

8. How should biochemical prenatal screening (eg. NT, first-trimester screening) be interpreted after a vanishing twin? 8. वैनिशिंग ट्विन के बाद जैव रासायनिक प्रसवपूर्व स्क्रीनिंग (जैसे NT, प्रथम-त्रैमासिक स्क्रीनिंग) की व्याख्या कैसे की जानी चाहिए?
A. Results can be affected; counseling should include possibility of false-positive/altered markers
B. Always normal and unaffected
C. Screening is irrelevant and should be omitted
D. Guarantees abnormal karyotype

9. Recommended management after early vanishing twin with a surviving co-twin? 9. जीवित सह-ट्विन के साथ प्रारंभिक वैनिशिंग ट्विन के बाद अनुशंसित प्रबंधन क्या है?
A. Continue routine antenatal care with appropriate surveillance and counseling
B. Immediate termination of pregnancy
C. Mandatory fetal MRI every week
D. No follow-up needed ever

10. What is the approximate incidence of vanishing twin in early ultrasound-detected twin gestations? 10. प्रारंभिक अल्ट्रासाउंड-निहित ट्विन गर्भधारण में वैनिशिंग ट्विन की अनुमानित घटना क्या है?
A. Up to 30–50% of twin conceptions detected very early
B. <1% only
C. 100%
D. Never occurs

Stuck Twin Syndrome

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Stuck Twin Syndrome (typically seen in TTTS Stage I or II)
Figer-1

📄 Report Sample Line- Stuck Twin Syndrome
The a monochorionic diamniotic twin pregnancy. There is a significant amniotic fluid discordance between the two gestational sacs:The donor twin is noted to be severely growth-restricted, with deepest vertical pocket (DVP) <2 cm, and is positioned immobile and closely opposed to the uterine wall. The bladder of the donor twin remains visible, suggesting preserved but reduced urine output. The recipient twin demonstrates polyhydramnios with DVP >8 cm, a distended bladder, and normal to increased fetal growth parameters.No abnormal Doppler velocimetry is noted at this stage. These findings are consistent with the “Stuck Twin” appearance, a hallmark of early-stage Twin-to-Twin Transfusion Syndrome (TTTS).


Conclussion: 📋 Findings are indicative of Stuck Twin Syndrome, suggestive of Quintero Stage I Twin-to-Twin Transfusion Syndrome. The donor twin exhibits features of oligohydramnios and restricted mobility, while the recipient twin shows signs of polyhydramnios.
Recommendation: Consider fetoscopic​.

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Note: Select English to answer in English, या हिंदी चुनें तो प्रश्नों के उत्तर हिंदी में दीजिए।

1. What is "stuck twin" syndrome in twin pregnancies? 1. ट्विन गर्भधारण में "स्टक ट्विन" सिंड्रोम क्या है?
A. A donor twin in severe TTTS that is compressed against the uterine wall due to oligohydramnios
B. A twin with conjoined anatomy
C. Both twins stuck together by cord entanglement
D. A twin with placenta previa

2. Stuck twin syndrome is most commonly seen in association with: 2. स्टक ट्विन सिंड्रोम सबसे अधिक किसके साथ जुड़ा होता है?
A. Twin-to-twin transfusion syndrome (TTTS) with severe oligohydramnios in the donor sac
B. Dichorionic twins with polyhydramnios only
C. Ectopic pregnancy
D. Placental abruption

3. Ultrasound appearance of a 'stuck twin' typically includes: 3. 'स्टक ट्विन' का अल्ट्रासाउंड रूप अक्सर किसे दर्शाता है?
A. Compression of the donor fetus against the uterine wall with minimal or absent amniotic fluid around it
B. Large free-floating donor twin with polyhydramnios
C. Always two placentas on opposite sides
D. Multiple fetal anomalies

4. Immediate sonographic intervention that can temporarily relieve a stuck twin's condition is: 4. तुरंत सोनोग्राफिक हस्तक्षेप जो अस्थायी रूप से एक स्टक ट्विन की स्थिति को कम कर सकता है वह क्या है?
A. Amnioreduction of the recipient sac (drainage of excess amniotic fluid)
B. Immediate cesarean delivery in all cases
C. Maternal antibiotics
D. External cephalic version

5. Definitive therapy to treat the underlying cause of stuck twin in TTTS is: 5. TTTS में स्टक ट्विन के मूल कारण का इलाज करने के लिए निर्णायक उपचार क्या है?
A. Fetoscopic laser photocoagulation of placental vascular anastomoses
B. Intravenous fluids for the mother only
C. Immediate postpartum hysterectomy
D. No treatment exists

6. Which Doppler finding may be seen in the donor (stuck) twin? 6. डोनर (स्टक) ट्विन में कौन सा डॉपलर निष्कर्ष देखा जा सकता है?
A. Abnormal umbilical artery flow or absent/reversed end-diastolic flow indicating fetal compromise
B. Normal MCA-PSV indicating polycythemia
C. Maternal uterine artery waveform only
D. No Doppler changes are possible

7. Which statement about prognosis is true for a stuck twin if timely treatment is given? 7. यदि समय पर उपचार किया जाए तो स्टक ट्विन के लिए कौन सा भविष्यफल सत्य है?
A. Survival and neurological outcome may improve with timely laser therapy or appropriate intervention
B. Outcome is uniformly fatal regardless of treatment
C. Always results in congenital infection
D. No effect of any intervention on outcome

8. Which management may be chosen if fetoscopic laser is not available and TTTS is severe? 8. यदि फेटोस्कोपिक लेज़र उपलब्ध नहीं है और TTTS गंभीर है तो कौन सा प्रबंधन विकल्प चुना जा सकता है?
A. Therapeutic amnioreduction as a temporising measure
B. Immediate induction of labor at any gestation
C. High-dose maternal steroids only
D. No monitoring is required

9. Which twins are at risk of stuck twin syndrome? 9. किस प्रकार के ट्विन्स स्टक ट्विन सिंड्रोम के जोखिम में हैं?
A. Monochorionic diamniotic twins with TTTS (donor twin becomes stuck)
B. Dichorionic twins only
C. Monoamniotic twins only
D. Triplets only

10. Key ultrasound sign that differentiates a stuck twin from normal donor twin is: 10. एक स्टक ट्विन को सामान्य डोनर ट्विन से अलग करने वाला प्रमुख अल्ट्रासाउंड संकेत क्या है?
A. Oligohydramnios in donor sac with fetus abutting uterine/placental surface
B. Polyhydramnios around donor twin
C. Two well-separated sacs with normal liquor each
D. Increased fetal movements in donor sac