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MIDW 305 > CBL 4 - Twins and vaginismus and PPD > Flashcards

CBL 4 - Twins and vaginismus and PPD Flashcards

1
Q

What should you include in assessment of clients w chronic pelvic pain? (4)

A
  • Building a therapeutic relationship – validate.
  • Pain History OLDCARTS
  • Psychosocial factors
  • Assessment of gynecological pain contributors
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2
Q

What twin care is in our scope?

A

Di di w consultation

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3
Q

Incidence of twin birth in Canada?

A

2-3 %

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4
Q

How often does twin pregnancy occur spontaneously?

A

1/80-90 all pregnancies

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5
Q

Factors that predispose spontaneous twinning? (6)

A

Familial – through maternal
Higher Nutritional status
Elevated pituitary gonadotropins
Maternal parity
35 or older
African descent

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6
Q

Risks of multifetal gestation? (13)

A

Major: PTL (40-50%)
Twin to twin transfusion
IUGR
Hypertensive disorders preg
PPH (2x)
Umbilical cord accidents
Fetal demise
Vasa previa
Uterine antony
Malpresentation
Polyhydramnios
Discordant growth
Fetal anomalies

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7
Q

Maternal risk of twins (concise)? (3)

A

HDP (hypertension)
PPH
++Discomforts of preg

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8
Q

Fetal risk of twins (concise)? (8)

A
  • PTB
  • IUGR both or one
  • TTTS (twin to twin)
  • Congenital abnormalities
  • Polyhydramnios
  • Malpresentation
  • Cord prolapse
  • Perinatal mortality
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9
Q

When does the evidence show twins should be induced?

A

Uncomplicated didi 37+6
Monomono by 34

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10
Q

Management of twin vag labour?

A

EFM
IV access
And lots of other stuff lol

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11
Q

Surprise twin steps? (6)

A
  • Call for help obvi
  • Delivery twin A clamp and cut cord (mark as twin A)
  • Assess Twin B’s lie and get them longitudinal, no Ves
  • Wait for EMS, IV, cont doppler, draw blood
  • If twin b born double clamp and cut cord
  • THEN active mgmt and double CCT
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12
Q

Ideal length bw twins?

A

<30 mins (controversial)
Faster if ab FHR

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13
Q

What is zygosity for twins?

A

Number of fertilized ova

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14
Q

What is placentation classification for twins?

A

Number of placentas
Chorionic and amnionic sacs

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15
Q

What are monozygotic twins?

A

One fertilized ovum, identical
30%

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16
Q

When optimal timing to diagnose chroionicity of twins?

A

10-14 wks

17
Q

What is the recommendation for twin birth with midwives?

A

In a hospital with OB and OR, nurses, anaesthesia, neonatal staff present and trained in twin delivery

18
Q

How many twins will remain undiagnosed until labour without US?

A

20 %

19
Q

Common maternal discomforts of twin birthers?

A

More nausea/vomiting
More acid reflux
More anemia
More aches and pains
More wait gain/edema
More fetal activity

20
Q

Additional T1 tests offered to twin birthers?

A

Enhanced first trimester screen (looking at placentation and NT?)

21
Q

Twin monitoring?

A

Early establish if mono mono, mono di, didi etc
Routine
AND 16-20 for fetal anomalies
AND T3 serial US
EFM in labour

Monomono - every 2 weeks after 16 wks

22
Q

Associated maternal complications twin birthers? (4)

A

GDM
Pyelonephritis
Antepartum hemorrhage
Hypertensive disorders of pregnancy

23
Q

What are some indications your client is twinning without US?(6)

A
  • Measuring large for GA, yet no fetal movement detected yet
  • More broad and round growth
  • Inexplicable weight gain
  • Hyperemesis gravidarum
  • Feeling multiple poles, parts feel smaller than you’d expect
  • 2 distinct FHR readings
24
Q

Who is twin A who is twin B?

A

Twin A – who is presenting lower in uterus
Twin B – who is presenting higher in uterus
Keep track going forward (fetal sex can help)

25
Q

What are dizygotic twins?

A

2 distinct ova fertilized (fraternal)
70 %

26
Q

What is a mono di twin?

A

Monochorionic, diamniotic
Share the same placenta but have different amniotic sacs (amnion)
Most monozygotic are mono di >70 %

27
Q

What are mono mono twins?

A

Monochorionic, monoamniotic
Share the same placenta and the same sac (amnion)
Must be identical
1 % super rare

28
Q

What are di di twins?

A

Dichorionic, diamniotic
Have distinct placentas and sacs (amnions)
Sometime placentas fuse
All dizygotic twins are didi, 30 % monozygotic twins are didi

29
Q

Perinatal mortality of the monomono twins?

A

50-60 % :0

30
Q

Historical defn vaginismusus and dyspurnia?

A

Vaginismusus – involuntary spasm of outer third of vagina that interferes w intercourse
Dyspurnia – pain with insertion into pelvic area

31
Q

Prevelance of pelvic pain with insertion?

A

5-17 % (but way more actually)

32
Q

Up to date pelvic pain term?

A

CPP chronic pelvic pain

-multifactorial, needs a multidisciplinary approach

33
Q

EPDS Scoring?

A

Total score 14 or more – MH specialist
12-13 -Monitor and support
Anxiety – 6 or more monitor, support, and offer education
Self harm (10) – assessment and intervention and consider MH referral

34
Q

Who could be considered for vag twin birth?

A

Di di
Mono di

-multifactorial, needs a multidisciplinary approach

MIDW 305 (13 decks)

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