Multiple Pregnancies + others

Question 1

What do monozygotic and dizygotic mean?
What % of births are twins?

Answer 1

Mono (identical) - Single egg fertilised, splits

Dizygotic - 2 separate eggs fertilised simultaneously

3% births

Question 2

What are the 3 different arrangements for placenta and sac?
%?
placentas? sacs?

Answer 2

Dichorionic diamniotic (70%)
2 placentas and 2 sacs

Monochorionic diamniotic (25%)
1 placenta and 2 sacs

Monochorionic monoamniotic (5%)
1 placenta and 1 sac

Question 3

RF for twins?

Answer 3

fHx, IVF use, idiopathic

Question 4

Dx for twins?

Answer 4

USS =
Di-di (2 sign)
Mono-di = T sign

Question 5

What is a complication of mono chorionic pregnancies?
What % twins suffer from it?

Answer 5

Twin to twin transfusion syndrome
10-15%

Question 6

What is TTTS?

Answer 6

1 baby has increased blood flow + the other is starved
Donor twin (small) pumps blood to recipient twin

Question 7

What are each foetus, donor and recipient, at risk of developing?

Answer 7

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

Question 8

Tx for TTTS?

Answer 8

Fetoscopic laser ablation
deliver at 34-36+6 weeks

Question 9

Other comps of twin pregnancies?

Answer 9

Low birth weight
high perinatal mortality
spontaneous Preterm birth (60%)
Pre eclampsia (30%)
hyperemesis

Question 10

When should early delivery be considered?

Answer 10

for mono-di and mono-mono twins

Question 11

Pregnancy Tx for:
hyperthyroid
Hypothyroid
Post partum thyroiditis

Answer 11

propylthiouracil + propranolol

levothyroxine

Only treat hyperthyroid phase (propranolol) high-low- resolves within a year

Question 12

Tx for VZV?
What do we check?
Before and after 20 weeks?

Answer 12

Check VZ Ig

Then 20 weeks or less - VZ Ig

More than 20 weeks + within 24hr rash - PO aciclovir

Question 13

Parvovirus B19
What can it precipitate?

Answer 13

can precipitate aplastic crisis in baby if pre existing haem anemia (eg. sickle cell)

Question 14

What do give for GBS?

Answer 14

IV Benzylpenicillin intrapartum

Question 15

when is UTI tested for and why?
What Tx for UTI?

Answer 15

High UTI incidence in pregnancy (20-30x)
Test at Booking + 3/3
If +ve, Ddx=ASB, Give nitrofurantoin

Question 16

Contraception
If lactating?
If not lactating?

Answer 16

If lactating - Ameorrhoeic for 6 months, very effective

If not lactating - LOCHIA period (vag bleeding after birth)
~21 days later

Question 17

When should lochia stop by?
what are the different types?
what to do if It persists?

Answer 17

by 6 weeks
Rubra - red
serosa - pink
alba - white
do USS if persists

Question 18

What is the VTE risk in a preg vs non preg female?
RF?
Tx? Until when?

Answer 18

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

Question 19

What are the 3 types of mental health issues pregnant women suffer from?

Answer 19

Baby blues
Postnatal depression
Postnatal Psychosis

Question 20

What are baby blues?
common?
when it occurs?
Sx?
Tx?

Answer 20

very common
<1 week birth
vague low mood + tearful
up to 50%
Reassure - self resolve

Question 21

What is postnatal depression?
common?
when it occurs?
Sx?
Tx?

Answer 21

10%
around 3 months PP (peak)
2+ weeks of low mood, low energy, + amenorrhoea
EDINBURGH SCALE (10+)
Tx = CBT, CMHT, Consider SSRI (eg. sertraline)

Question 22

what is PP Psychosis?
common?
when it occurs?
Sx?
Tx?
Reoccurrence?

Answer 22

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

Question 23

Endometritis
Sx?
causative organisms?
Dx?
Tx?

Answer 23

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

Question 24

Amniotic fluid embolism?
Sx?
what is it?
Tx?

Answer 24

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

Question 25

What 2 tests are done for reduced foetal movements?

Answer 25

1. hand held doppler
2. USS (Better than CTG as will show HR + Foetal growth)

Question 26

Maternal anemia
When is it tested for?
can increase risk of?
Tx cut offs for each trimester?
Tx? and how long?

Answer 26

Test at booking + 28 weeks

PPH

1/3 = <110
2/3 = <105
3/3 = <100

Ferrous sulphate PO for 3 months PP

Question 27

Epidural:
What is it, what is given and what vertebral levels?

Answer 27

Infection of local anaesthetic into epidural space around L3-4 or L4-5 vertebral level
Meds given: lidocaine and fentanyl

Question 28

Epidural:
SE and risks?

Answer 28

Maternal Hypotension
Low pressure headache afterwards
Epidural haemotoma

Question 29

Epidural:
When is it contraindicated?

Answer 29

Hypovolemia
High intracranial pressure
Hypotension
Infection at site
Coagulopathy
Low platelet count