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For each aspect A–E, of multiple pregnancy (twins, triplets etc), select the most appropriate option from the following list of obstetrical terms. 

1. Individual fetal mass. 

2. Total mass of all fetuses. 

3. Fetal prematurity. 

4. Neonatal mortality. 

5. Placental adequacy. 

6. Assisted reproduction. 

7. Perinatal mortality. 

A. A mother with multiple pregnancies is more likely to have an inappropriately early (premature) onset of labour. 

B. Since there is always a risk of loss of the fetus in early pregnancy, starting with two or more embryos increases the chance of at least one reaching maturity. 

C. Multiple pregnancies decrease the likelihood of delayed labour due to inadequate size of the birth canal. 

D. Multiple births are associated with an increased risk of neonatal jaundice and, more seriously, difficulty in overcoming surface tension forces during inspiration (respiratory distress syndrome). 

E. The chances of surviving problems in the weeks before and after birth are less for a twin than a single birth, less still for a triplet and even less for a quadruplet.

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A. Option 2 Total mass of all fetuses. Despite each fetus being small for its age, the total mass is exceptionally large, exaggerating the likelihood of labour before completion of the usual nine months of gestation. 

B. Option 6 Assisted reproduction. Insertion of early embryos into the uterus as a means of treating infertility is a common cause of multiple birth; such embryos are at increased risk of abortion, so it is usual to insert several. 

C. Option 1 Individual fetal mass. Each fetus of a multiple set is smaller than average at the time of labour, so is less likely to be hindered by a relatively small birth canal. 

D. Option 3 Fetal prematurity. The more premature the fetus, the less mature is its liver, and the less able is it to conjugate the bilirubin load after birth; more seriously, it is also much more likely not to have developed the capacity to produce adequate surfactant to reduce the otherwise punishing effect of surface tension forces in the newborn lung. 

E. Option 7 Perinatal mortality. This term refers to the risk of death in late pregnancy and early infancy; it mounts dramatically with the number of fetuses because of the combined effects of placental inadequacy, prematurity, and the problems of dealing with multiple infants at one delivery

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