Antenatal Growth Chart, Multiple Gestation, Eclampsia and Labour Analgesia

Question 1

list some causes for a small baby (estimated fetal weight < 10th centile)

Answer 1

• uteroplacental insufficiency
• chromosomal abnormalities
• fetal abnormalities
• fetal infections

Question 2

list some causes for a big baby (estimated fetal weight > 90th centile)

Answer 2

• gestational diabetes
• insulin-dependent diabetes

Question 3

what is eclampsia?

Answer 3

Eclampsia is when severe pre-eclampsia is complicated by generalised convulsions.
- can happen in antepartum (50%), intrapartum (30%) or postpartum (20%) period.

Question 4

what is pre-eclampsia?

Answer 4

a hypertensive disorder of pregnancy with multi-organ involvement characterised by new onset, raised blood pressure and proteinuria, usually seen after 20 weeks of gestation.

Question 5

what causes eclampsia?

Answer 5

happens as a result of cerebral edema and/or cerebral haemorrhage

Question 6

clinical features of eclampsia

Answer 6

• headache
• BP > 160 systolic
• hyperreflexia
• visual changes
• tonic clonic seizures

Question 7

eclampsia management

Answer 7

• ABC approach: get a secure airway, IV access and take bloods (LFTs, U&Es, coagulation, FBC)

Management:
- magnesium sulfate
- antihypertensives - labetolol, hdralazine
- delivery of child

Question 8

how does magnesium sulfate work to treat and prevent eclampsia?

Answer 8

• causes cerebral dilatation
• competitively blocks calcium at synaptic nerve endings
• should be continued for 24 hrs after delivery

Question 9

if toxicity from magnesium sulfate develops, what antidote is given?

Answer 9

calcium gluconate

Question 10

list the complications of eclampsia

Answer 10

• HELLP syndrome
• Disseminated intravascular coagulation (DIC)
• ARDS
• pulmonary oedema
• aspiration
• fetal hypoxia
• increased maternal mortality

Question 11

what medication is given to decrease the risk of pre-eclampsia in subsequent pregnancies?

Answer 11

low-dose aspirin from 12 weeks gestation

Question 12

list the resons for multiple gestation

Answer 12

• if more than 1 egg released during 1 menstrual cycle
• if the zygote divides after fertilisation > identical twins
• IVF treatments > often transfer more than 1 embryo to uterus

Question 13

describe amnionicity

Answer 13

• the no. amnions (inner membranes) that surround babies in a multiple pregnancy
• pregnancies with 1 amnion aredescribed as monoamniotic; pregnancies with 2 amnions are diamnitoic.

Question 14

describe chorionicity

Answer 14

• the no. chorionic (outer) membranes (placenta) that surround babies in a multiple pregnancy.
• if there is only 1 membrane, the pregnancy is described as monochorionic; if there are 2, the pregnancy is dichorionic.

Question 15

list some maternal complications of multiple births

Answer 15

• pre-term labour
• hyperemesis
• anameia in pregnancy
• hypertension
• gestational diabetes
• postpartum haemorrhage

Question 16

list some fetal complications of multiple gestation

Answer 16

• growth restriction
• prematurity
• increased birth complications
• increased perinatal mortality/morbidity

Question 17

what are some complications specific to monochorionic twins?

Answer 17

• twin-twin transfusion syndrome: when blood moves from one baby to the other due to a shared placenta, that baby then loses blood and is called the donor twin.
• selective growth restriction
• twin anaemia polycythaemia sequence
• twin reversed arterial perfusion (TRAP)
• single twin death

Question 18

what does antenatal care for multiple gestation consist of?

Answer 18

• routine care including trisomy 21 screening/structural scans
• specialist clinic with regular scans to monitor growth and identify complications
• dichorionic diamniotic require at least 8 AN visits
• monochorionic require at least 11 AN visits
• monitor BP/commence oral iron if required

Question 19

list some drug-free pain relief techniques used during labour

Answer 19

• use of birthing ball
• birthing pool
• TENS machines
• hypnobirth
• aromatherapy

Question 20

list some simple drug therapies used for pain relief in labour

Answer 20

• entonox (gas and air), used when contractions start, not used in between contractions
• diamorphine

Question 21

benefits of entonox (gas and air)

Answer 21

• widely used
• safe
• you are in control
• works quickly
• wears off quickly

Question 22

disadvantages of entonox

Answer 22

• can make you feel dizzy, dry mouth, nausea
• helps you cope but does not take all pain away
• takes practise to time breathing of entonox with contractions

Question 23

benefits of diamorphine used as pain relief in labour

Answer 23

• works in 30 mins
• lasts up to 4 hours
• helps relieve pain, relaxes you and helps you cope with pain better

Question 24

disadvantages of diamorphine use in labour

Answer 24

• can make you feel sick, sleepy and slows breathing
• has similar effects on baby

Question 25

list some advanced pain relief techniques used during labour

Answer 25

- remifentanil patient controlled analgesia (PCA) pump - epidural

Question 26

benefits of remifentanil PCA used during labour

Answer 26

- you are in control - works quickly, wears off quickly - strong pain relief

Question 27

disadvantages of remifentanil PCA used during labour

Answer 27

- may slow breathing - extra oxygen and monitoring - drowsy, sick, itchy - cannot use if you have had diamorphine withing last 4 hours

Question 28

benefits of epidural

Answer 28

- 8/10 women works really well - unlikely to affect baby - you are in control - can be used in theatre

Question 29

disadvantages of epidural

Answer 29

- can slow pushing phase - increased risk of needing forceps/suction cup - drop in blood pressure - itching, fever - sore area on back - headache 1/100 - rare severe complications ranging from nerve problems to infection in back