Multiple Pregnancies + others Flashcards
What do monozygotic and dizygotic mean?
What % of births are twins?
Mono (identical) - Single egg fertilised, splits
Dizygotic - 2 separate eggs fertilised simultaneously
3% births
What are the 3 different arrangements for placenta and sac?
%?
placentas? sacs?
Dichorionic diamniotic (70%)
2 placentas and 2 sacs
Monochorionic diamniotic (25%)
1 placenta and 2 sacs
Monochorionic monoamniotic (5%)
1 placenta and 1 sac
RF for twins?
fHx, IVF use, idiopathic
Dx for twins?
USS =
Di-di (2 sign)
Mono-di = T sign
What is a complication of mono chorionic pregnancies?
What % twins suffer from it?
Twin to twin transfusion syndrome
10-15%
What is TTTS?
1 baby has increased blood flow + the other is starved
Donor twin (small) pumps blood to recipient twin
What are each foetus, donor and recipient, at risk of developing?
Twin anemia - polycythemia + selective growth restriction
Both foetuses at risk of developing heart failure + hydrops
Donor twin suffers from high cardiac output failure as a result of severe anemia
Recipient twin suffers from fluid overload due to excess blood volume
Tx for TTTS?
Fetoscopic laser ablation
deliver at 34-36+6 weeks
Other comps of twin pregnancies?
Low birth weight
high perinatal mortality
spontaneous Preterm birth (60%)
Pre eclampsia (30%)
hyperemesis
When should early delivery be considered?
for mono-di and mono-mono twins
Pregnancy Tx for:
hyperthyroid
Hypothyroid
Post partum thyroiditis
propylthiouracil + propranolol
levothyroxine
Only treat hyperthyroid phase (propranolol) high-low- resolves within a year
Tx for VZV?
What do we check?
Before and after 20 weeks?
Check VZ Ig
Then 20 weeks or less - VZ Ig
More than 20 weeks + within 24hr rash - PO aciclovir
Parvovirus B19
What can it precipitate?
can precipitate aplastic crisis in baby if pre existing haem anemia (eg. sickle cell)
What do give for GBS?
IV Benzylpenicillin intrapartum
when is UTI tested for and why?
What Tx for UTI?
High UTI incidence in pregnancy (20-30x)
Test at Booking + 3/3
If +ve, Ddx=ASB, Give nitrofurantoin
Contraception
If lactating?
If not lactating?
If lactating - Ameorrhoeic for 6 months, very effective
If not lactating - LOCHIA period (vag bleeding after birth)
~21 days later
When should lochia stop by?
what are the different types?
what to do if It persists?
by 6 weeks
Rubra - red
serosa - pink
alba - white
do USS if persists
What is the VTE risk in a preg vs non preg female?
RF?
Tx? Until when?
4x higher risk then non preg female
4 or more RFs - eg. PMHx, breast CA, htn, >30 BMI, 35+ y/o, Smoking, IVF, C section, >3 multiparty, immobility
Give LWMH till 6 weeks PP
What are the 3 types of mental health issues pregnant women suffer from?
Baby blues
Postnatal depression
Postnatal Psychosis
What are baby blues?
common?
when it occurs?
Sx?
Tx?
very common
<1 week birth
vague low mood + tearful
up to 50%
Reassure - self resolve
What is postnatal depression?
common?
when it occurs?
Sx?
Tx?
10%
around 3 months PP (peak)
2+ weeks of low mood, low energy, + amenorrhoea
EDINBURGH SCALE (10+)
Tx = CBT, CMHT, Consider SSRI (eg. sertraline)
what is PP Psychosis?
common?
when it occurs?
Sx?
Tx?
Reoccurrence?
0.2%
around 2-3 weeks PP
Severe mood swings, auditory hallucinations, intent/thoughts to harm baby
Tx - admit to mum + baby ward
25-50% reoccurrence
Endometritis
Sx?
causative organisms?
Dx?
Tx?
Pyrexia 38+ within 72 hrs PP with lower abdo pain and offensive discharge
GBS + KEEPS resp E.Coli
Dx = Blood cultures, vag swabs, IV Abx, TV USS
Tx = Hosp referral for IV clindamycin + gentamicin
Amniotic fluid embolism?
Sx?
what is it?
Tx?
Sudden onset shock + SOB Sx PP
Coagulopathy + hypotension
Anaphylaxis from amniotic fluid entering mothers circulation
Tx - ABCDE, fluid + ITU monitoring
Blood transfusion (group + save) + FFP
What 2 tests are done for reduced foetal movements?
- hand held doppler
- USS (Better than CTG as will show HR + Foetal growth)
Maternal anemia
When is it tested for?
can increase risk of?
Tx cut offs for each trimester?
Tx? and how long?
Test at booking + 28 weeks
PPH
1/3 = <110
2/3 = <105
3/3 = <100
Ferrous sulphate PO for 3 months PP
Epidural:
What is it, what is given and what vertebral levels?
Infection of local anaesthetic into epidural space around L3-4 or L4-5 vertebral level
Meds given: lidocaine and fentanyl
Epidural:
SE and risks?
Maternal Hypotension
Low pressure headache afterwards
Epidural haemotoma
Epidural:
When is it contraindicated?
Hypovolemia
High intracranial pressure
Hypotension
Infection at site
Coagulopathy
Low platelet count
