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Fetal Complications Flashcards

1
Q

How common is multiple pregnancy?

A

>Incidence because of assisted fertility treatment

1/80 pregnancies are twins

1/4000 pregnancies are triplets

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2
Q

Splitting of the embryo at 0-3 weeks results in what class of twins?

A

(Separate chorion and amnion)

Dichorionic and diamniotic

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3
Q

Splitting of the embroy at 3-8 weeks results in what type of twins?

A

(Shared chorion)

Monochorionic and diamniotic

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4
Q

Splitting of the embryo at 8-12 weeks results in what class of twins?

A

(Shared amnion and chorion)

Monochorionic and monoamniotic

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5
Q

Splitting of the embryo at 12+ weeks results in what class of twins?

A

Shared body, conjoined

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6
Q

What is the chorion?

A

Placenta

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7
Q

What is the amnion?

A

Amniotic sac

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8
Q

Give the maternal complications of multiple pregnancy

A

Miscarriage

Hyperemesis

Anaemia

Pre-eclampsia

Gestational diabetes

Operative delivery

Post-natal depression

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9
Q

Give the fetal complications of multiple pregnancy

A

Twin-twin transfusion syndrome

Congenital Abnormalities

Malpresentation

Locked Twins

IUD

IUGR

Preterm labour and low birth weight

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10
Q

What is twin-twin transfusion syndrome?

A

Anastomosis between vessels occurring in shared placenta/Mono-chorionic twins

Recipient gets cardiac failure, polyhydramnios

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11
Q

What is intrauterine growth restriction (IUGR)?

A

Low birthweight infants (below 10th centile), may be constitutionally small or growth restricted due to pathological process

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12
Q

What can cause IUGR?

A

Maternal

  • Poor nutrition
  • Smoking
  • Alcohol and drug abuse
  • Maternal disease

Fetal

  • Abnormality
  • Infection

Placental

  • Failure of trophoblast invasion, leading to reduced oxygen transfer to the fetus
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13
Q

What is assessed on US to diagnose IUGR?

A

Fetal size

Oligohydramnios

Doppler for blood supply

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14
Q

What is intrauterine death?

A

Birth of an infant >24 weeks gestation with no signs of life

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15
Q

How common is IUD?

A

1/200 births

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16
Q

Give fetal causes of IUD

A

Chromosomal abnormalities

Infection

Umbilical cord accidents

Twin-twin transfusion syndrome

17
Q

Give maternal causes of IUD

A

Chronic disease

Obstetric cholestasis

Rhesus disease

Thrombophilia

18
Q

Give placental causes of IUD

A

Abruption

Pre-eclampsia

Smoking

19
Q

What is reduced fetal movements?

A

<10 movements within 2 hours in pregnancies >28 weeks gestation is indication for further assessment

20
Q

When should fetal movements be established?

A

By 24 weeks

Usually occurs between 18-20, which increases until 32 weeks gestation where they begin to plateau

21
Q

Give risk factors for reduced fetal movements

A

Posture

  • More prominent lying down and less when sitting and standing

Placental position

  • Patient with anterior placentas prior to 28 weeks gestation may have decreased awareness of movements

Medication

  • Alcohol
  • Opiates
  • Benzodiazepines

Fetal position

  • Anterior fetal position means movements are less noticeable

>BMI

  • Less likely to feel prominent fetal movements

Amniotic fluid volume

  • Oligohydramnios
  • Polyhydramnios

Fetal size

22
Q

What investigations are used in reduced fetal movements?

A

Doppler to confirm fetal heartbeat

CTG for 20 minutes if heartbeat detectable

Immediate US if no detectable heartbeat

23
Q

What is the most common cause of early-onset severe infection in the neonatal period?

A

Group B Streptococcus (GBS)

24
Q

What is the management for women who have had GBS detected in previous pregnancies?

A

Offered intrapartum antibiotic prophylaxis (IAP) or testing in late pregnancy and then antibiotics if still positive

25
Q

When are GBS swabs carried out?

A

35-37 weeks or 3-5 weeks prior to the anticipated delivery date

26
Q

When should IAP (intrapartum antibiotic prophylaxis) be offered (GBS)?

A

To women with a previous baby with early or late onset GBS disease

To women in preterm labour regardless of their GBS status

Women with a pyrexia during labour (>38ºC)

27
Q

What is the antibiotic of choice in GBS prophylaxis?

A

Benzylpenicillin

28
Q

Give risk factors for GBS

A

Prematurity

Prolonged rupture of the membranes

Previous sibling GBS infection

Maternal pyrexia, for example secondary to chorioamnionitis

29
Q

What causes oligohydramnios?

A

Premature rupture of membranes

Fetal renal problems e.g. renal agenesis

Intrauterine growth restriction

Post-term gestation

Pre-eclampsia

30
Q

Give risk factors for sudden infant death syndrome

A

Prone sleeping

Parental smoking

Bed sharing

Hyperthermia and head covering

Prematurity

Reproduction (18 decks)

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