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Obstetric And Gynecology > HYDRAMNIOS AND MULTIPLE PREGNANCY > Flashcards

HYDRAMNIOS AND MULTIPLE PREGNANCY Flashcards

1
Q

Define polyhydramnios and state the clinical threshold for diagnosis.

A

Polyhydramnios is diagnosed when amniotic fluid exceeds 2,000 mL.

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2
Q

Describe the origin of amniotic fluid during early pregnancy.

A

Amniotic fluid originates from maternal plasma in early pregnancy.

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3
Q

What is the primary contributor to amniotic fluid volume after 20 weeks of gestation?

A

Fetal urine contributes the most after 20 weeks.

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4
Q

Fill in the blank: The turnover rate of liquor amnii is approximately ________ mL per hour.

A

1,000 mL per hour.

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5
Q

What is the average amniotic fluid volume at term?

A

800 mL on average at term.

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6
Q

List three functions of amniotic fluid.

A

Cushioning, temperature regulation, and fetal movement support.

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7
Q

What is the specific gravity and pH of amniotic fluid?

A

Specific gravity: 1.008, pH: 7.2.

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8
Q

Describe the ultrasonographic criteria for diagnosing polyhydramnios.

A

A single fluid pocket >8 cm indicates polyhydramnios.

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9
Q

Fill in the blank: An amniotic fluid index (AFI) greater than ________ suggests hydramnios.

A

18.0 cm.

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10
Q

What are two maternal causes of polyhydramnios?

A

Diabetes mellitus, iso-immunization.

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11
Q

Name two fetal causes of polyhydramnios.

A

Multiple gestations, congenital anomalies.

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12
Q

What are the symptoms of acute hydramnios?

A

Vomiting, difficulty breathing, abdominal pain.

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13
Q

List two differential diagnoses for hydramnios.

A

Hydatidiform mole, multiple pregnancy.

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14
Q

What is the management approach for asymptomatic hydramnios without fetal anomalies?

A

Conservative management with monitoring.

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15
Q

What are two complications of hydramnios?

A

Preterm labor, cord prolapse.

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16
Q

Define multiple pregnancy.

A

Presence of more than one fetus in the uterus.

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17
Q

Differentiate between dizygotic and monozygotic twins.

A

Dizygotic: two ova fertilized; monozygotic: one zygote splits.

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18
Q

Fill in the blank: Monozygotic twins arise from the splitting of a ________.

A

Zygote.

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19
Q

What is the most common chorionicity in monozygotic twins?

A

Monochorionic-diamniotic.

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20
Q

Fill in the blank: The incidence of monozygotic twins is approximately ________ per 1,000 births worldwide.

A

~4 per 1,000 births.

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21
Q

State the incidence of dizygotic twins in Nigeria.

A

54 per 1,000 births.

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22
Q

What physiological changes are exaggerated in multiple pregnancies?

A

Anemia, PIH, preterm labor.

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23
Q

List three clinical features suggestive of multiple pregnancy.

A

Excessive nausea, large abdomen, breathlessness.

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24
Q

What investigation is key in diagnosing multiple pregnancies?

A

Ultrasonography.

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25
Q

Why is early determination of chorionicity important in multiple pregnancies?

A

To predict risks and guide management.

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26
Q

Name a rare complication of monochorionic twinning.

A

Twin reversed arterial perfusion (TRAP).

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27
Q

What is twin-to-twin transfusion syndrome (TTTS)?

A

Blood shunting between twins via placental connections.

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28
Q

Fill in the blank: In TTTS, the donor twin often develops ________, while the recipient twin develops ________.

A

Oligohydramnios; polyhydramnios.

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29
Q

What is the management for TTTS?

A

Amnioreduction, fetoscopic laser ablation.

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30
Q

Define twin reversed arterial perfusion (TRAP) sequence.

A

Abnormal flow from one twin to another, causing incomplete development.

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31
Q

List three maternal complications of multiple pregnancy.

A

Anemia, PIH, preterm labor.

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32
Q

Fill in the blank: The perinatal mortality rate in twins is ________ times higher than in singletons.

A

Five times higher.

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33
Q

Name three fetal complications of multiple pregnancies.

A

Congenital anomalies, preterm delivery, IUGR.

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34
Q

What dietary advice is given to women with multiple pregnancies?

A

High-calorie, balanced diet with supplements.

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35
Q

What is the preferred mode of delivery for twins with a vertex-vertex presentation?

A

Vaginal delivery if twin A is vertex.

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36
Q

Describe the role of ultrasonography in managing multiple pregnancies.

A

Growth monitoring, detecting abnormalities.

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37
Q

Fill in the blank: Pregnant women with multiple gestations should aim for a weight gain of ________ kg.

A

16–20 kg.

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38
Q

What is the management for monoamniotic twins?

A

Close monitoring, early delivery.

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39
Q

List two differential diagnoses for multiple pregnancies.

A

Hydramnios, macrosomic baby.

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40
Q

Why is cord prolapse more common in multiple pregnancies?

A

Higher incidence of malpresentation.

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41
Q

What is the role of amnioreduction in polyhydramnios?

A

Removes excess amniotic fluid to reduce symptoms.

42
Q

State two indications for cesarean delivery in twin pregnancies.

A

Non-vertex twin A, monoamniotic twins.

43
Q

What is the significance of fundal height in diagnosing multiple pregnancies?

A

Larger-than-expected fundal height.

44
Q

List three symptoms of hyperemesis gravidarum.

A

Severe nausea, vomiting, dehydration.

45
Q

Define intrauterine growth restriction (IUGR) and its prevalence in twins.

A

Restricted growth due to uterine or placental factors, common in twins.

46
Q

Fill in the blank: Preterm births occur in ________% of twin pregnancies.

A

0.48

47
Q

What is the significance of fetal scalp electrodes during twin labor?

A

Accurate monitoring of the first twin during labor.

48
Q

Describe a scenario requiring manual rotation in twin delivery.

A

To correct abnormal lie of twin B.

49
Q

What are the risks of fetoscopic laser ablation in TTTS?

A

Infection, preterm labor, vessel injury.

50
Q

List three findings on ultrasound indicating dizygotic twins.

A

Separate placentas, thick membranes, different sexes.

51
Q

How does maternal age influence the incidence of dizygotic twinning?

A

Increases with maternal age.

52
Q

Name a condition associated with large for gestational age in multiple pregnancies.

A

Gestational diabetes.

53
Q

What is the role of prostaglandin synthetase inhibitors in managing polyhydramnios?

A

Reduces amniotic fluid but risks fetal kidney function.

54
Q

How is monochorionicity confirmed in the first trimester?

A

Thick membranes or separate yolk sacs.

55
Q

What are the components of antenatal care for multiple pregnancies?

A

Frequent visits, supplements, rest.

56
Q

List two risks associated with rapid release of amniotic fluid in hydramnios.

A

Placental abruption, cord prolapse.

57
Q

Define conjoined twins.

A

Incomplete division of a zygote.

58
Q

What is the incidence of conjoined twins in monozygotic pregnancies?

A

1 in 200,000 births.

59
Q

What are the complications of cord entanglement in monoamniotic twins?

A

Cord entanglement can cause fetal death.

60
Q

Fill in the blank: The specific gravity of amniotic fluid is ________.

A

1.008.

61
Q

What is the definition of amniotic fluid index (AFI)?

A

Total depth of four fluid pockets.

62
Q

Differentiate between oligohydramnios and polyhydramnios based on AFI.

A

Oligohydramnios: AFI <5 cm; polyhydramnios: AFI >18 cm.

63
Q

Name one rare maternal complication of polyhydramnios.

A

Maternal respiratory distress.

64
Q

Explain why ultrasonography is critical in diagnosing multiple pregnancies.

A

Confirms number and growth of fetuses.

65
Q

What is the management of dichorionic-diamniotic twins?

A

Routine antenatal care, growth monitoring.

66
Q

What is the difference between the donor and recipient twin in TTTS?

A

Donor: growth-restricted; recipient: fluid overload.

67
Q

Fill in the blank: An amniotic pocket less than ________ cm is diagnostic of oligohydramnios.

A

2 cm.

68
Q

Describe the complications of abruptio placenta in hydramnios.

A

Severe bleeding, uterine rupture.

69
Q

List three presentations of twin A and twin B in delivery scenarios.

A

Vertex-vertex, vertex-breech, breech-vertex.

70
Q

What is the significance of the “stuck twin” in TTTS?

A

Oligohydramnios in the donor twin.

71
Q

How does nutrition influence the incidence of dizygotic twins in Nigeria?

A

High gonadotropins in yam-based diets.

72
Q

List three risk factors for preterm labor in multiple pregnancies.

A

Uterine overdistension, infections, short cervix.

73
Q

Why is early hospital admission recommended in multiple pregnancies?

A

To manage complications early.

74
Q

What is the importance of continuous fetal monitoring in twin labor?

A

Detects fetal distress in both twins.

75
Q

Name two structural anomalies associated with monozygotic twins.

A

Congenital heart defects, neural tube defects.

76
Q

Define fetoscopic laser ablation.

A

Ablation of placental vessels in TTTS.

77
Q

What is the ideal gestational age for delivering twins?

A

37–38 weeks.

78
Q

What complications arise from delivering higher-order multiples?

A

Preterm delivery, IUGR, delivery trauma.

79
Q

What is the role of chorionicity in perinatal counseling?

A

Determines risks of complications.

80
Q

Fill in the blank: Twin pregnancies are at ________ times higher risk for fetal anomalies than singletons.

A

Four times higher.

81
Q

What is the function of iron and folic acid supplementation in multiple pregnancies?

A

Prevents anemia and malformations.

82
Q

Describe a locked twins scenario.

A

Twins interlocked during delivery.

83
Q

What are two common postpartum complications in multiple pregnancies?

A

Postpartum hemorrhage, infections.

84
Q

Define monochorionic-monoamniotic twins.

A

Twins sharing one placenta and one amniotic sac.

85
Q

Name three risk factors for anemia in multiple pregnancies.

A

Increased blood demands, poor nutrition, repeated pregnancies.

86
Q

How does fetal malpresentation affect delivery in twins?

A

Requires cesarean delivery in non-vertex positions.

87
Q

List three complications unique to TRAP sequence.

A

Pump twin heart failure, poor growth in the perfused twin.

88
Q

What is the recommended management for a pump twin in TRAP?

A

Cord occlusion for the perfused twin.

89
Q

Describe the physiological basis of uterine overdistension in multiple pregnancies.

A

Stretches uterine capacity, causing preterm labor.

90
Q

What is the preferred delivery method for conjoined twins?

A

Cesarean section.

91
Q

List three ways ultrasound can assess fetal well-being in multiple pregnancies.

A

Growth, amniotic fluid, and chorionicity.

92
Q

Why is the umbilical cord clamped after delivering twin A?

A

Prevents hemorrhage in twin B.

93
Q

Explain the role of epidural anesthesia in twin delivery.

A

Aids pain control and emergency procedures.

94
Q

How does advanced maternal age impact multiple pregnancies?

A

Increases risk of complications.

95
Q

List two clinical features of discordant growth in twins.

A

Different amniotic fluid volumes, unequal growth rates.

96
Q

How does hyperemesis gravidarum present differently in multiple pregnancies?

A

More severe due to high hCG levels.

97
Q

What is the purpose of amnioreduction in hydramnios?

A

Relieves maternal symptoms and prolongs pregnancy.

98
Q

Describe complications related to the use of ovulation-inducing agents.

A

High-order multiples, prematurity.

99
Q

How can fetofetal transfusion syndrome lead to perinatal death?

A

Causes anemia, growth issues, or death.

100
Q

Fill in the blank: In Lagos, the incidence of twin births is approximately ________.

A

~1 in 45 births.

Obstetric And Gynecology (26 decks)

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