High risk Pregnancy Flashcards
List some risk factors for multiple pregnancy:
IVF / assisted conception Family history on maternal side increasing maternal age Geography Ethnicity (higher rates in african origin) Tall women > small women Multiparity
What type of twins are the highest risk and why?
Monochorionic monozygotic (monoamniotic)
i.e. identical twins sharing on placenta and amniotic sac
Biggest risk of twin-twin transfusion syndrome
How regularly should a mother with monochorionic twin pregnancy be scanned?
Every two weeks
It is extremely important to prevent TTTS
In a multiple pregnancy, what is checked for in the fortnightly scans?
Deep vertical pool depth
Umbilical artery
Bladder
What is Twin Twin transfusion syndrome?
This is when one twin receives a significantly higher proportion of blood supply.
Well supplied twin will have an increased urine output, polyhydramnios, polycythaemia and eventually heart failure
The poorly supplied twin will have restricted growth, poor urine output, oligohydramnios and anaemia.
Can dichorionic pregnancies result in identical twins?
Yes roughly 30% of dichorionic pregnancies will have been monozygotic eggs
What might be an early sign of multiple pregnancy?
Exaggerated pregnancy symptoms e.g. hyperemesis gravidarum
What are some of the main risks to the mother in a multiple pregnancy? (at least 4)
Miscarriage Hyperemesis Anaemia Pre eclampsia Gestational diabetes Antepartum haemorrhage Placenta previa Operative delivery Post natal depression
What are the main risks to the foetus in a multiple pregnancy?
(at least 4)
Preterm labour IUGR Intrauterine death Twin twin transfusion syndrome Congenital anomalies Malpresentation Cerebral palsy (8x more likely)
What will occur if a monozygotic egg splits later than day 13?
Conjoined twins
At what point after fertilization when the egg splits will the foetus be monozygotic and monochorionic?
Days 8-13
What is the rate of multiple pregnancy in natural conception? (not assisted)
1/ 80 twins
1/10000 triplets
What clinical signs would be suggestive of a multiple pregnancy? (3 points)
Large for dates uterus
Raised Alpha fetoprotein
Multiple foetal poles
Why is hyperemesis gravidarum more common in multiple preganancy?
The level of hCG is directly linked to the severity of hyperemesis gravidarum, therefore multiple foetus = higher hCG.
What are the risks attached to a prolonged pregnancy?
Stillbirth
Meconium aspiration
Large for dates baby - obstetric complications during delivery
Respiratory distress
What vessels do we observe using USS in the 3rd trimester in high risk pregnancies and why?
umbilical artery - an increase in resistance is indicative of foetal hypoxia
Foetal middle cerebral artery - an increase in peak systolic volume is indicative of foetal anaemia
Other than USS, what investigative imagery is considered safe?
MRI
What is the most common, direct cause of maternal mortality?
Venous thromboembolism
What is the most common indirect cause of maternal mortality?
Cardiac causes
What is the leading cause of maternal death within the first year post partum?
Suicide
A pregnant lady is brought in following a collapse at home. There is obvious respiratory distress with O2% at 87%, her lips are blue and her JVP is raised. There are signs of anaphylaxis and pulmonary hypertension. What is the potential cause?
Amniotic fluid embolism
What is the management for an amniotic fluid embolism?
REsuscitation and coagulopathy correction
Immediate delivery once stable
Supportive management once stabilised
