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FRCR 2A (Crack The FRCR 2A) > 4. Obstetrics > Flashcards

4. Obstetrics Flashcards

1
Q

Pregnancy - vocab (3)

A

Menstrual age = Embryologic age + 14 days
Embryo = 0-10 weeks menstrual age
Foetus = >10 weeks menstrual age

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2
Q

Abortion - vocab (5)

A

Threatened abortion = Bleeding with closed cervix.
Inevitable abortion = cervical dilatation and/or placental and/or foetal tissue hanging out
Incomplete abortion = residual products in uterus.
Complete abortion = all products out
Missed abortion = Foetus is dead, still in uterus

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3
Q

Intradecidual sign (4)

A

Earliest gestational sac.
When covered by echogenic decidua, it’s characteristic of early pregnancy.
Can be seen around 4-5 weeks.
Want to see a thin echogenic line of the uterine cavity passes by (not stops at) the sac to avoid calling a little bit of fluid in the canal a sac.

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4
Q

Double decidual sac sign (4)

A

Another positive sign of early pregnancy.
Produced by visualising layers of decidua.
Decudua Vera (thicker, outer) and Decidua Capsularis (thinner, inner), with small amount of fluid inbetween.

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5
Q

Yolk sac (4)

A

First visible structure within the gestational sac.
Seen when GS measures 8mm in diameter.
Should be oval or round, fluid filled and <6mm.
Yolk sac is located in chorionic cavity, connected to umbilicus of the embryo by vitelline duct.

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6
Q

Yolk sac pathology (2)

A

Shouldn’t be too big (>6mm) or too small (<3mm).
Shouldn’t be solid or calcified.

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7
Q

Amnion (2)

A

Membranes of the amnionic sac and chorionic space typically remain separated by thin layer of fluid until 14-16 weeks, when they fuse.
If amnion is disrupted before 10 weeks, foetus may cross into chorionic cavity and get tangled up in fibrous bands (amniotic band syndrome), can cause decapitation, limb amputation etc.

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8
Q

Double bleb sign (2)

A

Earliest visualisation of the embryo.
2 fluid filled sacs (yolk and amniotic), with flat embryo in the middle.

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9
Q

Crown Rump length (2)

A

Typically used to estimate gestational age, more accurate than menstrual history.
Embryo normally visible at 6 weeks.

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10
Q

Anembryonic pregnancy (2)

A

Gestational sac without an embryo.
If seen, it’s either very early pregnancy or non viable pregnancy.
Should see the yolk sac at 8mm. Large gestational sac (>8-10mm) without a yolk sac, and a distorted contour is pretty reliable for non viable pregnancy.

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11
Q

Pseudogestational sac (2)

A

Seen in presence of ectopic pregnancy.
A little blood in the uterine cavity with surrounding bright decidual endometrium (stimulated by pregnancy hormones)

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12
Q

Guidelines for foetal demise (8)

A

Diagnostic of pregnancy failure
- Crown-rump length of <7mm and no heart beat
- Mean sac diameter of >25mm and no embryo
- No embryo with heartbeat >11 days after scan showing gestational sac with yolk sac.
- No embryo with heartbeat 2 weeks after a scan showing gestational sac without a yolk sac
Suspicious for pregnancy failure
- No embryo >6 weeks after last menstrual period.
- Mean sac diameter of 16-24mm and no embryo
- No embryo with heartbeat 13 days after a scan that showed a gestational sac without a yolk sac
- No embryo with heartbeat 10 days after a scan that showed a gestational sac with a yolk sac

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13
Q

Subchorionic haemorrhage (4)

A

Common. Percentage of placental detachment is most important prognostic factor for foetal survival.
>2/3 circumference haematoma has 2x risk of abortion.
Women over 35 have worse outcomes
Implantation bleeding: small subchorionic haemorrhage occurring at the attachment of the chorion to the endometrium.

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14
Q

Risk factors for ectopic pregnancy (6)

A

Hx of PID,
Tubal surgery,
Endometriosis,
Ovarian induction,
Previous ectopic,
Use of an IUD

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15
Q

Ectopic pregnancy (4)

A

Usually (95%) occurs near fallopian tube, usually isthmus.
Can rarely occur in the developing portion of the tube which passes through the uterine wall (termed Interstitial).
Interstital ones are high risk, can grow large before rupture, causing catastrophic haemorrhage.
Can also rarely have implantation sites in the abdominal cavity, ovary and cervix.
Consider ectopic if positive bHCG. Normal doubling time makes ectopic less likely.

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16
Q

Ectopic pregnancy - diagnosing (3)

A

If positive bHCG:
Live pregnancy/yolk sac outside the uterus = diagnostic for ectopic.
Nothing in the uterus + anything on the adnexa (other than corpus luteum) = 75-85% PPV for ectopic.
Nothing in the uterus + moderate free fluid = 70% PPV (more risk if fluid is echogenic.

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17
Q

Tubal ring sign (2)

A

Echogenic ring surrounding an inruptured ectopic pregnancy.
Useful sign of ectopic pregnancy, 95% specific.

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18
Q

Heterotopic pregnancy (2)

A

Baby in uterus and baby in tube (or other ectopic location).
Rare, usually only seen in women taking ovulation drugs or previous Hx of PID.

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19
Q

Foetal growth (5)

A

4 standard measurements of foetal growth used in 2nd and 3rd trimesters
- Biparietal diameter
- Head circumference
- Abdominal circumference
- Femur length

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20
Q

Biparietal diameter (2)

A

Recorded at level of thalamus, from outermost edge of near skull to inner table of far skull.
Affected by shape of foetal skull (false large from brachycephaly, false small from dolichocephaly)

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21
Q

Head circumference (2)

A

Recorded at same slice as BPD. Does NOT include skin.
Affected less by head shape.

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22
Q

Abdominal circumference (2)

A

Recorded at level of junction of umbilical vein and left portal vein.
Does NOT include subcutaneous soft tissues.

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23
Q

Femur length (2)

A

Longest dimension of the femoral shaft.
Femoral epiphysis NOT included.

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24
Q

Estimated foetal weight. (2)

A

Calculated by machine based on
- BPD and AC
OR
- AC and FL

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25
Q

Gestational age (GA) (3)

A

USS estimates gestational age are most accirate in early pregnancy (becoming less precise in later portions).
Age in first trimester is made from crown rump length (accurate to 0.5 weeks)
Second and third trimester estimates are usually done using BPD, HC, AC and FL (referred to as composite GA). Accurate to 1.2 weeks (12-18 weeks) or 3.1 weeks (36-42 weeks)

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26
Q

Intrauterine growth restriction - suggestive features (6)

A

Estimated fetal weight below 10th centile
Femur length/Abdominal circumference ratio (F/AC) >23.5
Umbilical artery systolic/diastolic ratio >4.0

If above but doppler is normal, mostly the child is OK just small.
If measuring small + oligohydramnios (AFI < 5) or polyhydramnios, prognosis is poor.
Commonest cause of oligohydramnios during third trimester = foetal growth restriction associated with placental insufficiency.

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27
Q

Asymmetrical IUGR (4)

A

Restriction of weight followed by length. More common than symmetrical.
Normal size head, body is small, sometimes called “head sparing” as body tries to preserve the brain.
Seen mainly in 3rd trimester due to extrinsic factors.
Classic Hx of normal growth in first 2 trimesters, then normal head and small body in 3rd, with mother having high BP/pre-eclampsia.
Causes include HTN, Malnutrition, Ehler-Danlos

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28
Q

Symmetric IUGR (7)

A

Global growth restriction, does NOT spare head.
Seen throughout pregnancy, including 1st trimester.
Head and body both small.
Much worse prognosis as brain doesn’t develop normally.
Causes:
- TORCH
- Fetal alcohol syndrome/drug abuse
- Chromosomal abnormalities
- Anaemia

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29
Q

Biophysical profile (6)

A

Initially developed to look for acute and chronic hypoxia.
2 points for normal, 0 for abnormal. Score of 8-10 is normal. Abnormal must be so for 30 mins.
Components (normal):
Amniotic fluid: At least one pocket that measures 2cm or more in a vertical plane.
Fetal movement: 3 discrete movements.
Fetal tone: 1 episode of fetal extension from flexion
Fetal breathing: 1 episode of breathing motion lasting 30 seconds.
Non-stress test: 2 or more fetal heart rate accelerations of at least 15 beats per minute and/or 30 seconds or longer

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30
Q

Umbilical artery systolic/diastolic ratio (4)

A

Resistance should progressively decrease with age. Should be 2-3 at 32 weeks, should not be >3 at 34 weeks.
Elevated ratio means high resistance.
High resistance is seen in pre-eclampsia and IUGR.
Absent or reversed diastolic flow is associated with very poor prognosis.

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31
Q

Macrosomia (3)

A

Babies too big (>90th centile).
Maternal diabetes (usually gestational) is common cause. T1DM mothers can also have babies too small due to hypoxia from microvascular disease of placenta.
Complications during delivery (shoulder dystocia, brachial plexus injury) and after delivery (neonatal hypoglycaemia, meconium aspiration).

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32
Q

Erb’s palsy (2)

A

Injury to upper trunk of brachial plexus (C5-6) most commonly seen in shoulder dystocia. Macrosomia is a risk factor.
Aplastic or hypoplastic humeral head/glenoid in kid, think about this.

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33
Q

Amniotic fluid (4)

A

Early on, the amniotic and chorionic fluid is due to filtrate from membranes.
After 16 weeks, fluid is made by fetus (urine).
Balance between too much and too little is controlled by swallowing urine and renal function, i.e. polyhydramnios caused by GI/swallowing issue, oligohydramnios caused by poor renal function.
Common cause of polyhydramnios is also high maternal sugars.
Fine particulate in the fluid is normal, especially 3rd trimester.

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34
Q

Amniotic fluid index (3)

A

Measures vertical height of deepest pocket in each quadrant of the uterus, then summing them.
Normal is 5-20.
Oligohydramnios defined as AFI < 5cm. Poly defined as AFI >20cm or single pocket >8cm.

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35
Q

Normal development - brain (2)

A

Choroid plexus is large and echogenic. Should be <3mm separation of choroid plexus from medial wall of lateral ventricle (more suggests ventriculomegaly).
Cisterna magna should be 2-11mm (small suggests Chiari II, large suggests Dandy Walker)

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36
Q

Normal development - face and neck

A

“Fulcrum” of upper lip is normal, should not be called cleft lip

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37
Q

Normal development - Lungs

A

Normally homogenously echogenic, similar in appearance to liver.

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38
Q

Normal development - Heart (2)

A

Papillary muscle can calcify (echogenic foci in ventricle).
No significance in itself but associated with increased risk of Downs

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39
Q

Normal development - abdomen (3)

A

Only one artery adjacent to the bladder = 2 vessel cord.
Bowel should be <6mm in diameter. Can be moderately echogenic in 2nd and 3rd trimester, not more than bone.
Adrenals are large in newborns, 20x their relative adult size.

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40
Q

2 vessel cord (2)

A

2 main ways to be shown:
Single vessel running lateral to the bladder, down by cord insertion.
Cord in cross section with 2 vessels.

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41
Q

Cystic rhombencephalon (2)

A

Normal rhombencephalon is present as cystic structure in posterior fossa around 6-8 weeks.
Not a Dandy Walker malformation

42
Q

Physiologic mid gut herniation (2)

A

Midgut normally herniates into umbilical cord around 9-11 weeks. NOT an amphalocele

43
Q

Normal placenta (4)

A

Start to see on US at around 8 weeks (focal thickening along the periphery of the gestational sac).
Should be shaped like a disc around 12 weeks.
US: “granular” with smooth cover (chorion).
Underneath basal surface is normal retroplacental complex of decidual and myometrial veins.

44
Q

Normal placenta aging

A

As it ages, it gets hypoechoic areas, septations and randomly distributed calcifications.

45
Q

Venous lakes (2)

A

Incidental findings. Look like focal hypoechoic areas under the chorionic membrane or within placenta.
Can sometimes see flow within them.

46
Q

Placental thickness DDx (8)

A

Too thin (<1cm)
- Placental insufficiency
- Maternal HTN or DN
- Trisomy 13 or 18
- Toxaemia of pregnancy
Too thick (>4cm)
- fetal hydrops
- Maternal DM or severe anaemia
- Congenital fetal cancer
- Congenital infeciton
- Placentla abruption

47
Q

Variant placental morphology (6)

A

Bilobed placenta
- 2 equal sized lobes.
- Increased risk of type 2 vasa previa, post partum haemorrhage from retained placental tissue, and velamentous insertion of the cord.
Succenturiate lobe
- One or more small accessory lobes.
- Increased risk of type 2 vasa previa, post partum haemorrhage from retained placental tissue
Circumvallate placenta
- Rolled placenta edges with smaller chorionic plate
- High risk for placental abruption and IUGR.

48
Q

Placenta previa (3)

A

Low implantation of placenta, covering part or all of internal cervical os.
“Painless vaginal bleeding in third trimester”
Need to have empty bladder to see on US (full bladder creates false positive)

49
Q

Placental abruption (4)

A

Premature separation of placenta from myometrium.
Classically Hx of maternal cocaine use. Also occurs in maternal HTN.
Subchorionic haemorrhage (marginal abruption) technically in same category.
Haematoma will appear as anechoic or mixed echogenicity beneath the placenta (often extending beneath chorion).
Buzzword - Disruption of the retroplacental complex.

50
Q

Placental abruption vs Myometrial contraction/fibrois (2)

A

Placental abruption will DISRUPT the retroplacental complex of blood vessels.
Myometrial contractions/fibroids will DISPLACE the retroplacental complex.

51
Q

Placenta creta (4)

A

Abnormal insertion of placenta, invading the myometrium.
Risk factors include prior C-section, placenta previa, advanced maternal age.
Sonographic appearance varies, depending on severity, but generally speaking includes “moth eaten” or “swiss cheese” appearance of placenta, into myometrium, (with turbulent flow on Doppler) and thinning of myometrium.
Can cause life threatening bleeding, sometimes needing hysterectomy.

51
Q

Placenta Creta - spectrum (3)

A

Placenta Accreta - commonest (75%), mildest. Villi attach to the myometrium without invading
Placenta Increta - Villi partially invade the myometrium
Placenta Percreta - Villi penetrate through the myometrium or beyond serosa, sometimes invasion of bladder or bowel

52
Q

Placenta Chorioangioma (4)

A

Essentially a hamartoma of the placenta, most common benign placental tumour.
Usually well circumscribed, hypoechoic masses near cord insertion.
Flow within the mass pulsatile at foetal heart rate is diagnostic (perfused by foetal circulation).
Usually harmless, but if large (>4cm) and multiple, can sequester platelets and cause high output failure (hydrops).

53
Q

Placental chorioangioma vs placental hamartoma

A

Chorioangioma has pulsating doppler flow, hamartoma doesn’t.

54
Q

Umbilical cord - normal

A

Normal cord should have 3 vessels (2 arteries, 1 vein).

55
Q

2 vessel cord (3)

A

Normal variant, seen in 1%. Usually left artery is missing.
More common in twin pregnancies and maternal diabetes.
Also associated with chromosomal anomalies and foetal malformations.

56
Q

Velamentous cord insertion (3)

A

Cord inserts into foetal membranes outside placental margin, then travels back through membranes to the placenta (between amnion and chorion).
More common with twins.
Increases risk of IUGR and growth discordance among twins.

57
Q

Marginal cord insertion (2)

A

Almost a velamentous insertion (cord within 2cm of placental margin).
More common in twin pregnancies.

58
Q

Vasa previa (3)

A

Foetal vessels that cross (or almost cross) the internal cervical os. Seen more in twins and variant placental morphologies.
2 types:
Type 1: foetal vessels connect to velamentous cord insertion within the main body of placenta
Type 2: Foetal vessels connect to bilobed placenta or succenturiate lobe

59
Q

Nuchal cord

A

Cord wrapped around the neck of foetus. Can cause obvious problems during delivery.

60
Q

Umbilical cord cyst (4)

A

Common (3%), usually single but can be multiple.
Can be subdivided into true and false cysts. True are less common.
Omphalomesenteric duct cyst is usually peripheral, allantoic cyst is usually central.
If cyst persists into 2nd or 3rd trimester, may be associated with trisomy 18 or 13.

61
Q

Concerning US findings for Downs (4)

A

Congenital heart disease
- More than half of Downs have congenital heart disease, most commonly AV canal and VSD.
Duodenal atresia
- Commonest intra-abdominal pathology associated with Downs
Short femur length - non specific
Echogenic bowel - non specific (can be due to obstruction, CF, infection, ischaemia)
Choroid plexus cyst - Non specific, more common in trisomy 18
Nuchal translucency - translucency >3mm in first trimester
Nuchal fold thickness - >6mm in second trimester, also seen with Turners
Echogenic focus in cardiac ventricle - non specific but increases Downs risk x4

62
Q

Nuchal lucency (2)

A

Measured between 9-12 weeks, anechoic area between neck/occiput and skin should be <3mm.
Also associated with other chromosomal anomalies.
Positioning of the neck is important to avoid false positives.

63
Q

Amniotic band syndrome (3)

A

If amnion gets disrupted, foetus can get into chorionic cavity and get caught in sticky fibrous septa. Can cause decapitation or limb amputation.
X-ray of hand or baby showing amputated fingers or arm, remaining exam normal.
Foetal US with bands entangling arms or legs of a foetus.

64
Q

Hydrops (3)

A

Can be immune or non-immune causes.
Commonest cause is Rh sensitisation from prior pregnancy, others include TORCH, turners, twin related, Alpha thalassaemia.
US: presence of 2: Pleural effusion, pericardial effusion, subcutaneous oedema.

65
Q

Lemon sign (2)

A

Indented frontal bone, classically seen in Chiari II, and also spina bifida.
Seen before 24 weeks, usually disappears after 24 weeks.

66
Q

Banana sign (4)

A

Cerebellum wraps around the brainstem due to spinal cord tethering and migrates downward, looking like a banana.
Cisterna magna is obliterated and cerebellum looks like a banana.
Seen with Chiari II and spina bifida.
Anterior curving of cerebellar hemispheres with obliteration of cisterna magna is called banana sign.
Other findings in spina bifida include small biparietal diameter and ventricular enlargement.

67
Q

Choroid plexus cyst

A

Incidental, but more likely in trisomy 18, trisomy 21, turners, Klinefelters.

68
Q

Facial clefts (3)

A

Commonest foetal facial anomaly.
30% associated with chromosome anomaly.
80% have cerebral palsy.
Can see cleft lips, but cleft palate in isolation is difficult to see.

69
Q

Cystic hygroma (2)

A

Complex cystic mass in posterior neck in antenatal period.
Associated with Downs and Turners

70
Q

Ventriculomegaly (4)

A

Multiple causes (Hydrocephalus (communicating and non communicating), cerebral artophy included.
Aquaductal stenosis is commonest cause of non communicating hydrocephalus in neonate.
Ventricular atrium diameter >10mm = too big.
“Dangling choroid” hanging off the wall by more than 3mm.

71
Q

Anencephaly (2)

A

Most common neural tube defect, total absence of cranial vault and brain above the level of the orbits.
Not compatible with life.

72
Q

Pleural effusion

A

Often caused by Hydrops in neonate, multiple other causes exist.

73
Q

Congenital diaphragmatic hernias (3)

A

Usually left sided.
Causes high mortality due to association with pulmonary hypoplasia.
Causes gut malrotations.
Usually shown on newborn CXR or 3rd trimester MRI.

74
Q

Echogenic Intracardiac Focus (3)

A

Calcification seen in papillary muscle, usually left ventricle.
Seen more commonly in trisomy 21 and trisomy 13.
Also occurs in normal population (5% vs 12% in Downs).

75
Q

Abnormal heart rate

A

Tachycardia defined as >180bpm. Bradycardia is <100bpm.

76
Q

Double bubble (2)

A

Shown on antenatal US or MRI.
Suggests duodenal atresia.

77
Q

Echogenic bowel (5)

A

Can be normal variant, but associated with:
- CF
- Downs
- Trisomies
- Viral infections
- Bowel atresia.
Normal bowel is isoechoic to liver. If equal to iliac crest bone, it’s too bright.

78
Q

Sacrococcygeal teratoma (6)

A

Commonest tumour of foetus or infant.
Solid or cystic masses, usually large, found on prenatal imaging or at birth.
Can cause mass effect on GI system, hip dislocation, nerve compression causing incontinence and high output cardiac failure.
Can cause issues with premature delivery, dystocia and haemorrhage of the tumour.
Usually benign (80%). Higher malignant potential when presenting in older infants.
Located wither external to pelvis (47%P, internal to pelvis (9%) or dumbbell protruding inside and out.

79
Q

Autosomal recessive polycystic kidney disease

A

Massively enlarged bilateral kidneys with oligohydramnos.

80
Q

Posterior urethral valves

A

Bilateral hydro on either foetal US or 3rd trimester MRI.

81
Q

Short femur

A

Short femur (below 5th centile) suggests skeletal dysplasia.

82
Q

Incompetent cervix (2)

A

Shortened cervix, associated with high risk of premature delivery.
Endocervical canal <2.5cm in length.

83
Q

Hydronephrosis (2)

A

Occurs in 80% of pregnancy due to mechanical compression of ureters.
More often right sided (dextrorotation of pregnant uterus).

84
Q

Fibroids (3)

A

Tend to grow in early pregnancy due to elevated oestrogen.
Progesterone will have opposite effect, inhibiting growth later in pregnancy.
Stretching of uterus may affect arterial blood supply and promote infarcts and cystic degeneration.

85
Q

Uterine rupture (3)

A

Commonest in 3rd trimester at site of prior C-section.
Other risk factors: Unicornate uterus, prior uterine curettage, trapped uterus (persistent retroflexion from adhesions) and interstitial implantation

86
Q

HELLP syndrome (3)

A

Haemolysis, Elevated Liver enzymes, Low Platelets.
Most severe form of pre-eclampsia, favours young primigravid women in their third trimester.
20-40% end up with DIC.
Seen as subcapsular hepatic haematoma in pregnant or recently pregnant woman.

87
Q

Peripartum cardiomyopathy (3)

A

Dilated cardiomyopathy, seen in last month of pregnancy to 5 months post-partum.
Cardiac MRI findings include global depressed function, and non-vascular territory subepicardial late enhancement - corresponding to cellular lymphocyte infiltration

88
Q

Sheehan syndrome (4)

A

Pituitary apoplexy, seen in post partum female suffering from large volume haemorrhage.
Pituitary grows during pregnancy, and hypotensive episode can cause ischaemia.
MR appearance depends on time period, acutely is usually T1 bright.
Ring enhancement of an empty sella is a late look.

89
Q

Ovarian vein thrombophlebitis (3)

A

Cause of post partum fever, risk factors include C-section and endometritis.
RIght side is affected 5x more than the left.
Enlarged ovary with thrombosed adjacent ovarian vein

90
Q

Retained products of conception (5)

A

Typical clinical story of continued bleeding after delivery (or induced abortion). Commonest appearance is echogenic mass within uterine cavity.
Varied presence or absence of flow.
Irregular thickening of the endometrium with some reflective structures and shadowing, representing foetal parts.
Can also be considered if endometrial thickness is >5mm following D&C.
Associated with medical termination, second trimester miscarriage and placenta accreta

91
Q

Endometritis (3)

A

Inflammation or infection of endometrium.
Hx will be fever, uterine tenderness and C-section (prolonged labour).
US will show thickened, heterogenous endometrium without fluid or air.

92
Q

Placentation terminlogy (4)

A

Monozygotic twins (identical),
Dizygotic twins (not identical).
Dizygotics are always dichorionic and diamniotic.
Monozygotic have more varied placenta, depending on timing of fertilized ovum splitting (before 8 days = diamniotic, after = mono).
Late splitting after 13 days can cause conjoined twin.
Later split = worse outcomes.

93
Q

Monochorionic vs dichorionic (5)

A

Membrane thickness
- Thick = easy to see (1-2mm), thin = hard to see.
- Thick suggests 4 laters = dichorionic
Twin peak sign
- Beak like tongue between 2 membranes of a dichorionic diamniotic fetus.
- Excludes monochorionic foetus.
T-sign: Absence of twin peak sign. No chorion between membrane layers. Suggests monochorionic.

94
Q

Twin growth (3)

A

Normal growth charts in first and second trimester (not third).
Femur length tends to work best for aging twins in later pregnancy.
More than 15% difference in foetal weight or abdominal circumference is considered significant

95
Q

Twin-twin transfusion (4)

A

Occurs in monochorionic, when vascular communication exists in the placenta.
End up with one larger twin taking all the blood and nutrients.
Larger twin ends up doing worse, getting hydrops and more mortality.
Unequal fluid in amniotic sacs with donor twin having severe oligohydramnios and sometimes “stuck to the wall” of the uterus.
Larger twin floats freely in the polyhydramniotic sac.
Donor twin also has high resistance umbilical artery spectrum.

96
Q

Twin reversed arterial perfusion syndrome (4)

A

Intraplacental shunting resulting in a “pump” twin, who pumps blood to the other twin. Other twin ill not develop a heart and referred to as an acardiac twin.
Acardiac twin ends up with deformed upper body, whilst pump twin usually does OK.
If acardiac twin is >70% of foetal weight of co-twin, the strain usually kills the pump twin.
Can show as doppler with umbilical artery flow towards the acardiac twin, or vein flow away from acardiac twin

97
Q

One dead twin (2)

A

Bigger problem for surviving twin if it occurs later in pregnancy.
Foetal papryaceous is a pressed flat dead foetus

98
Q

Twin-twin embolisation syndrome (3)

A

Embolysed necrotic dead baby being transferred to living foetus.
Can result in DIC, tissue ischaemia and infarct.
Can only occur in monochorionic pregnancy.

99
Q

Things that grow during pregnancy (4)

A

Babies.
Splenic artery aneurysms.
Renal AMLs.
Fibroids.

FRCR 2A (Crack The FRCR 2A) (55 decks)

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