High Risk Multiple Pregnancies Lecture Powerpoint Flashcards
Abortion definition
Expulsion of fetus less than 16 weeks
Perinatal period
From 16 weeks to 28 days after birth
Risks for perinatal death not caused by congenital anomalies (7)
- breech position
- placental separation
- pre-eclampsia eclampsia
- pyelonephritis
- hydramnios
- placenta previa
- twins
Dizygotic (fraternal) twins
Originate from 2 zygotes, account for about 2/3 of twins, rates increase with age, can be same or different sex, and having one set increases likelihood of having it happen again
Thick seputm and 2 zygotes on ultrasound indicates…
….dizygotic twins
Dizygotic twins have __ amnion and chorions, the monozygotic varies based on when the zygotes divide during development
2
Monozygotic (identical) twins, when do they become conjoined?
one fertilized ovum, cleavage before 72 hours results in dichorionic diamniotic (best outcome) twins, between days 4-8 monochorionic diamnionic (2nd best) twins, and if 8-13 monochorionic and monoamnionic (worst) twins. Cleavage after day 13 will result in conjoined twins***
Vanishing twins
Occurs when ultrasound of first trimester finds twins 12% of all conceptions but only 1-2% of all births
Maternal risks of twins (6)
- physiologic changes occurring are exaggeration of what occurs in single
- preterm labor
- hypertension
- increased c section rate
- abruption
- anemia
- postpartum hemorrhage
Infant complications of twins (4)
- prematurity
- congenital anomalies increased 2-3x
- discordance (unequal weights due to altered surface area of placenta or twin to twin transfusion donation (smaller gives more to larger)
- typically larger twin does worse
Twin complications
- vanishing fetus
- locking twins (one breech and 2nd cephalic preventing chins from passing each other)
- dead fetus syndrome (
- delayed delivery of one twin
- cord intertwining (high risk for sudden stillbirth in monoamniotic monozygotic twins)
- abruption
- acardiac twin (parasitic growth but no actual 2nd twin present)
Maternal weight gain with twins or triplets
at least 30 lbs, at least 50 lbs in triplets
Prevention of preterm labor (3)
- bed rest NO longer advised
- early work leave okay at 36 weeks or so
- corticosteroids can help with lung maturity
Ultrasound cervix length
25mm or less at 24 weeks predicts preterm delivery
Any 12+ (adult) who has even 2 recurrent seizures unprovoked by proximate insult is considered ___, in children they can be due to ___ as well
epilepsy, fevers
Epilepsy and pregnancy
90% of women have a normal pregnancy, not a contraindication, however increased risk for perinatal complications
Perinatal epileptics are at increased risk for these conditions (6)
- maternal death
- need for c section
- antepartum hemorrhage
- preterm labor
- stillbirth
- SUPEP (sudden unexpected death in epilepsy) - most were taking lamotrigine!
Sudden unexpected death in epilepsy (SUPEP)
Sudden unexpected witnessed or unwitnessed non traumatic or non drowning death with or without evidence for seizure excluding status epilepticus which does not have autopsy reveal structural or toxicologic cause of death
__% of all pregnancies are unplanned
50%
Antiepileptic drug lower ___ putting developing infant at increased risk for ___
folic acid, neuro tube defects
All pregnant women should be on __ mg folic acid, epileptics should be on ___
.4-.8, 4mg
If pregnant and been 2 years since last seizure, should they withdraw?
No, wait till the pregnancy is over
Valproate and pregnancy
Antiepileptic contraindicated in pregnancy because of high teratogenicity unless already established pregnancy (don’t want to have seizure occur during change over)
Drug of choice for seizure abortion in delivery
Lorazepam
