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Obs & Gynae (Obs) > High-Risk Pregnancy Part 2 > Flashcards

High-Risk Pregnancy Part 2 Flashcards

1
Q

Which is more common- monozygotic or dizygotic twins?

A

Dizygotic

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2
Q

All dizygotic twins have what chorionicity/amniocity?

A

DCDA

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3
Q

Monozygotic twins where the embryo splits at days 0-3 after fertilisation (morula stage) will have what chorionicity/amniocity?

A

DCDA

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4
Q

Monozygotic twins where the embryo splits at days 4-7 after fertilisation (blastocyst stage) will have what chorionicity/amniocity?

A

MCDA

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5
Q

Monozygotic twins where the embryo splits at days 8-14 after fertilisation (implanted blastocyst stage) will have what chorionicity/amniocity?

A

MCMA

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6
Q

Monozygotic twins where the embryo splits at days 15+ after fertilisation (formed embryonic disc stage) will have what chorionicity/amniocity?

A

Conjoined twins

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7
Q

Other than ethnic origin, what are some risk factors for having DCDA twins?

A

Family history, increasing maternal age, fertility treatment

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8
Q

Individuals of what ethnic origin are at increased risk of having DCDA twins?

A

Afro-Caribbean

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9
Q

The chorionicity of a twin pregnancy is determined by what investigation, ideally before what gestation?

A

Ultrasound, ideally before 14 weeks

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10
Q

The presence of the lambda or twin peak sign on ultrasound indicates which chorionicity of twin pregnacy?

A

Dichorionic

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11
Q

The presence of the T sign on ultrasound indicated which chorionicity of pregnancy?

A

Monochorionic

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12
Q

Which chorionicity of twins are at an increased risk of pregnancy complications?

A

Monochorionic

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13
Q

When does twin anaemia-polycythaemia sequence typically occur?

A

After foetoscopic laser ablation for twin-twin transfusion syndrome

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14
Q

What happens to the AFP in a multiple pregnancy?

A

Raised

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15
Q

How often are monochorionic twin pregnancies scanned after 24 weeks?

A

Every 2 weeks

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16
Q

How often are dichorionic twin pregnancies scanned after 24 weeks?

A

Every 4 weeks

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17
Q

In twin pregnancies, serial ultrasound growth scanning is used from what gestation?

A

24 weeks

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18
Q

A size discordance of greater than what between twins or triplets is clinically significant?

A

> 25%

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19
Q

Twin-twin transfusion syndrome only occurs in which type of twin pregnancy?

A

MCMA

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20
Q

In MCMA twin pregnancies, ultrasound scans are carried out every 2 weeks from what gestation?

A

16 weeks

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21
Q

How is twin-twin transfusion syndrome treated in early pregnancy, i.e. < 26 weeks?

A

Foetoscopic laser ablation

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22
Q

How is twin-twin transfusion syndrome treated in late pregnancy, i.e. > 26 weeks?

A

Amnioreduction or septostomy

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23
Q

How often do monochorionic twin pregnancies have antenatal appointments?

A

Every 2 weeks

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24
Q

How often do dichorionic twin pregnancies have antenatal appointments?

A

Every 4 weeks

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25
Q

What supplements should be given to women with multiple pregnancies?

A

Iron, folic acid and aspirin

26
Q

In an MCDA twin pregnancy, delivery is by induction or C-section at what gestation?

A

36 weeks

27
Q

In a DCDA twin pregnancy, delivery is by induction or C-section at what gestation?

A

37 weeks

28
Q

When is C-section recommended to mothers of twin pregnancies?

A

When the first twin is in the breech or transverse position

29
Q

When and how should MCMA twins be delivered?

A

32 weeks by C-section

30
Q

How should triplets or higher order births be delivered?

A

C-section

31
Q

When should syntocinon be given when delivering twins?

A

After the delivery of the first twin

32
Q

When delivering twins, you should aim for an inter-twin delivery time of what?

A

< 30 minutes

33
Q

Anti-D should be given to Rhesus negative women when there is vaginal bleeding after what gestation?

A

12 weeks

34
Q

Anti-D should be administered within what timeframe of the sensitising event?

A

72 hours

35
Q

After 20 weeks, what investigation must be carried out after giving anti-D to a Rhesus negative woman?

A

Kleihauer test

36
Q

One dose of anti-D provides cover for how long?

A

6 weeks

37
Q

Is prophylactic anti-D given even if the woman has already received anti-D at a sensitising event?

A

Yes

38
Q

Haemolytic disease of the newborn is caused by the passage of which type of antibody across the placenta from mother to foetus?

A

IgG

39
Q

What is the first step in investigation of haemolytic disease of the newborn, where antibody titres are significantly increased?

A

Cell-free foetal DNA testing (for blood group genotype)

40
Q

What investigation is used to detect foetal anaemia in pregnancies at risk from haemolytic disease of the newborn?

A

Doppler ultrasound of the middle cerebral artery

41
Q

What intervention is required if a baby at risk from haemolytic disease of the newborn is found to have a middle cerebral artery velocity of 1.5 times the median for the gestation?

A

Foetal blood sampling and an intra-uterine infusion

42
Q

Babies with haemolytic disease of the newborn are usually delivered at what gestation?

A

37-38 weeks

43
Q

How often can intra-uterine infusions be carried out for babies with haemolytic disease of the newborn, if there is significant anaemia and foetal compromise?

A

Weekly

44
Q

In babies receiving intra-uterine infusions for haemolytic disease of the newborn, at what gestation does the risk of the disease overtake the risk of delivery, and the baby should be delivered?

A

35 weeks

45
Q

All babies born to Rhesus negative mothers should have cord blood taken at delivery for what investigations?

A

FBC, blood group and direct Coomb’s test

46
Q

Small for gestational age is defined as an estimated foetal weight or abdominal circumference below what centile on a personalised growth chart?

A

10th

47
Q

Severe small for gestational age is defined as an estimated foetal weight or abdominal circumference below what centile on a personalised growth chart?

A

3rd

48
Q

What is the cause of the majority of small for gestational age foetuses?

A

Constitutionally small

49
Q

How is a growth restricted foetus generally picked up?

A

Symphysial-fundal height smaller than expected for the gestation

50
Q

What is a normal symphysial-fundal height?

A

It should match the gestational age in weeks to within 2cm

51
Q

Foetal weight is estimated based on ultrasound measurements of what?

A

Abdominal circumference and femur length

52
Q

Growth restriction which is mediated by the placenta is usually associated with what other complication?

A

Oligohydramnios

53
Q

Oligohydramnios is defined as a single deepest pool of amniotic fluid below what value?

A

2cm

54
Q

What investigation is used to screen for poor foetal perfusion in cases of small for gestational age foetuses?

A

Umbilical artery Doppler

55
Q

If a foetus is small for gestational age, but the umbilical artery Doppler is normal, what is done next?

A

Growth assessment every 2-4 weeks, with delivery planned for 37 weeks

56
Q

If a foetus is small for gestational age, but the umbilical artery Doppler is abnormal, what is done next?

A

Daily scans until delivery via C-section

57
Q

Stillbirth is the death in utero of a foetus from what gestation onwards?

A

24 weeks

58
Q

How is the diagnosis of stillbirth confirmed?

A

Absence of foetal heart activity on ultrasound (must be confirmed by two sonographers)

59
Q

After stillbirth, how is labour induced?

A

Mifepristone and misoprostol

60
Q

What method of delivery is generally preferred after a stillbirth?

A

Vaginal

61
Q

Is the risk of stillbirth higher in women with a previous unexplained stillbirth?

A

Yes

Obs & Gynae (Obs) (10 decks)

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