General Pregnancy Flashcards
Risk factors with AMA
chromosomal abnormalities miscarriage PTL PET IUGR GTN HTN GDM Praevia PPH SB
Risk factors with multiple pregnancy
miscarriage chromosomal abnormalities PTL IUGR HTN/PET/HELLP SB Anaemia PPH TTS/TAPS/TRAP PND Feeding difficulties
lambda sign
DIDI
T sign
MCDA
Additional management with twins
Early USS
additional anaemia screening at 24 weeks
8 antenatal appointments
MDT input for twin pregnancy
Obsetrics Tertiary scanning/experience sonographers Perinatal mental health professional PT Lactation consultant Dietician MFM if any complications
MCDA twin monitoring
2 weekly scans from 16 weeks
Increase to weekly if differences in AFI (DVP >4cm or more)
MCA PSV to monitor for TAPS - weekly for those at risk (TTTS treated w laser, sFGR)
Complications of MCDA pregnancies
TTTS
TAPS
sFGR
TRAP (pump twin)
Twin intrapartum considerations
Centre of care/NICU capabilities Timing of birth Mode of birth analgesia during labour continuous fetal monitoring
Timing of birth twin pregnancies
DCDA - 37
MCDA 36
MCMA 32-34
Triplets 35
Ok to try for vag birth for twins
> 32 weeks gestation and uncomplicated
cephalic lead twin
no significant size discordance between twins
no obstetric contraindications to labour
Women with cervical risk factors but no previous hx loss managment
HVS & MSU - treat any infection
cervical length at 16/40 - if >3cm no further scans
25mm-30mm - commence two weekly scans
<25mm prog +/- cerclage if ongoing shortening
women with previous 2nd trimester loss or delivery before 34 weeks
HVS & MSU - treat any infection
consider progesterone
cervical length at 14/40 - two weekly scanning
<25mm prog +/- cerclage if ongoing shortening
3 or more preterm births <34 weeks
HVS & MSU - treat any infection
history indicated cerclage at 12-14 weeks
two weekly scans until 24 weeks
cervical os fully effaced & more than 1cm dilated
consider emergency cervical cerclage
consider steroids depending on gestational age
if contracting - manage as TPTL