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Finals > O&G: Antenatal care > Flashcards

O&G: Antenatal care Flashcards

1
Q

pregnancy timeline

definition of Gestational Age

A

the duration of the pregnancy starting from the date of the last menstrual period

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2
Q

pregnancy timeline

definition of Gravida

A

the total number of pregnancies a woman has had

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3
Q

pregnancy timeline

definition of para

A

the number of times the woman has given birth after 24w gestation, regardless of whether the fetus was alive or stillborn

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4
Q

pregnancy timeline

G4P3

A

a pregnant woman with 3 previous pregnancies

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5
Q

pregnancy timeline

a non pregnancy woman with a previous birth of healthy twins

A

G1P1

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6
Q

pregnancy timeline

A non-pregnant woman with a previous miscarriage

A

G1 P0 +1

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7
Q

pregnancy timeline

A non-pregnant woman with a previous stillbirth (after 24 weeks gestation)

A

G1P1

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8
Q

pregnancy timeline

when is the 1st trimester

A

from the start of pregnancy until 12w gestation

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9
Q

pregnancy timeline

when is the 2nd trimester

A

13-26w gestation

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10
Q

pregnancy timeline

when is the 3rd trimester

A

from 27w - birth

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11
Q

pregnancy timeline

when do fetal movements start

A

from around 20w until birth

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12
Q

pregnancy timeline

when is the Booking clinic and what is its purpose

A

before 10w

offer a baseline assessment and plan the pregnancy

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13
Q

pregnancy timeline

when is the Dating scan

A

between 10 and 13+6

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14
Q

pregnancy timeline

what is the purpose of the dating scan

A
  • an accurate gestational age is calculated from the crown rump length (CRL)
  • and multiple pregnancies are identified
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15
Q

pregnancy timeline

when is first antenatal appointment and whats its purpose

A

16w

discuss results + plan future appointments

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16
Q

pregnancy timeline

when is the anomaly scan

A

between 18 and 20+6 weeks

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17
Q

pregnancy timeline

what is the purpose of the anomaly scan

A

an US to identify anomalies such as heart conditions

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18
Q

pregnancy timeline

when are the antenatal appointments and what are they for

A

25, 28, 31, 34, 36, 38, 40, 41 and 42 weeks

monitor the pregnancy and discuss future plans

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19
Q

pregnancy timeline

what is covered at each antenatal appointment

A
  • plans for remainder of the pregnancy + delivery
  • symphysis-fundal height: from 24w on
  • fetal presentation: from 36w on
  • urine dipstick for protein for pre-eclampsia
  • blood pressure for pre-eclampsia
  • urine for M+C for asymptomatic bacteriuria
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20
Q

pregnancy timeline

what vaccines are offered to all pregnant women

A
  • Whooping cough (pertussis) from 16w gestation

- Influenza (flu) when available in autumn or winter

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21
Q

pregnancy timeline

what vaccines are avoided in pregnancy

A

live vaccines such as the MMR

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22
Q

Placenta praevia

definition

A

when the placenta is over the internal cervical os

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23
Q

Placenta praevia

definition of a low-lying placenta

A

when the placenta is within 20mm of the internal cervical os

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24
Q

3 causes of antepartum haemorrhage

A

placenta praevia

placental abruption

vasa praevia

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25
Q

Placenta praevia

risks

A
  • antepartum haemorrhage
  • emergency caesarean section
  • emergency hysterectomy
  • maternal anaemia + transfusions
  • preterm birth and low birth weight
  • stillbirth
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26
Q

Placenta praevia

Grade 1 or Minor praevia

A

placenta is in the lower uterus but not reaching the internal cervical os

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27
Q

Placenta praevia

grade 2 or marginal praevia

A

the placenta is reaching, but not covering the internal cervical os

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28
Q

Placenta praevia

grade 3 or partial praevia

A

the placenta is partially covering the internal cervical os

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29
Q

Placenta praevia

grade 4 or complete praevia

A

the placenta is completely covering the internal cervical os

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30
Q

Placenta praevia

the grading system is outdates, what 2 descriptions are now used

A

low-lying placenta

placenta praevia

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31
Q

Placenta praevia

RFs (6)

A
  • previous caesarean sections
  • previous placenta praevia
  • older maternal age
  • maternal smoking
  • structural uterine abnormalities (e.g. fibroids)
  • assisted reproduction (e.g. IVF)
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32
Q

Placenta praevia

dx

A

the 20w anomaly scan is used to assess the position of the placenta and diagnose placenta praevia

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33
Q

Placenta praevia

presentation

A
  • many are asymptomatic
  • painless vaginal bleeding in pregnancy (antepartum haemorrhage)

bleeding usually occurs later around 36w

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34
Q

Placenta praevia

mnx of a low-lying placenta or placenta praevia if diagnosed early

A

repeat TVUS at 32 and 36w

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35
Q

Placenta praevia

mnx of low-lying placenta or placenta praevia

A

corticosteroids given between 34 and 35+6 w

planned caesarean considered between 36 and 37w

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36
Q

Placenta praevia

why is delivery planned early

A

to reduce the risk of spontaneous labour and bleeding

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37
Q

Placenta praevia

when may emergency caesarean section be required

A

with premature labour or antenatal bleeding

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38
Q

Placenta praevia

what is the main complication

A

haemorrhage before, during and after delivery

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39
Q

Placenta praevia

what urgent mnx may be required after a haemorrhage

A
  • Emergency caesarean section
  • Blood transfusions
  • Intrauterine balloon tamponade
  • Uterine artery occlusion
  • Emergency hysterectomy
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40
Q

Vasa praevia

what is it

A

a condition where the fetal vessels are within the fetal membranes (chorioamniotic membranes) and travel across the internal cervical os

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41
Q

Vasa praevia

what do the fetal vessels consist of

A

2 umbilical arteries

1 umbilical vein

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42
Q

Vasa praevia

what does the fetal membrane surround

A

the amniotic cavity and developing fetus

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43
Q

Vasa praevia

what does the umbilical cord contain

A

the fetal vessels:
2 umbilical arteries
1 umbilical vein

Wharton’s jelly

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44
Q

Vasa praevia

what is Wharton’s jelly

A

a layer of soft connective tissue that surrounds the blood vessels in the umbilical cord, offering protection

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45
Q

Vasa praevia

when can the fetal vessels be exposed, outside the protection of the umbilical cord or placenta

A
  • Velamentous umbilical cord: umbilical cord inserts into the chorioamniotic membranes and the fetal vessels travel unprotected through the membranes before joining the placenta
  • an accessory lobe of the placenta (aka succenturiate lobe) is connected by fetal vessels that travel through the chorioamniotic membranes between the placental lobes
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46
Q

Vasa praevia

what can exposed vessels leads to

A

prone to bleeding esp when membranes are ruptures during labour and at birth –> fetal blood loss + death

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47
Q

Vasa praevia

what is Type 1

A

the fetal vessels are exposed as a velamentous umbilical cord

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48
Q

Vasa praevia

what is Type 2

A

the fetal vessels are exposed as they travel to an accessory placental lobe

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49
Q

Vasa praevia

RFs

A
  • low lying placenta
  • IVF pregnancy
  • Multiple pregnancy
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50
Q

Vasa praevia

dx

A

US during pregnancy

but may present with bleeding

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51
Q

Vasa praevia

asymptomatic mnx

A
  • corticosteroids, given from 32w gestation to mature the fetal lung
  • elective caesarean section planned for 34-36w
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52
Q

Vasa praevia

mnx if antepartum haemorrhage occurs

A

emergency caesarean section is required to deliver the fetus before death occurs

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53
Q

Vasa praevia

after stillbirth or unexplained fetal compromise during deliver, why is the placenta examined

A

for evidence of vasa praevia as a possible cause

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54
Q

Placental Abruption

what is it

A

when the placenta separates from the wall of the uterus during pregnancy

the site of the attachment can bleed extensively after the placenta separates

a significant cause of antepartum haemorrhage

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55
Q

Placental Abruption

RFs

A
  • Previous placental abruption
  • Pre-eclampsia
  • Bleeding early in pregnancy
  • Trauma (consider domestic violence)
  • Multiple pregnancy
  • Fetal growth restriction
  • Multigravida
  • Increased maternal age
  • Smoking
  • Cocaine or amphetamine use
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56
Q

Placental Abruption

presentation (5)

A
  • Sudden onset severe abdominal pain that is continuous
  • Vaginal bleeding (antepartum haemorrhage)
  • Shock (hypotension and tachycardia)
  • Abnormalities on the CTG indicating fetal distress
  • Characteristic “woody” abdomen on palpation, suggesting a large haemorrhage
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57
Q

Placental Abruption

what suggests a large haemorrhage

A

characteristic ‘woody’ abdo on palpation

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58
Q

Placental Abruption

how can the severity of antepartum haemorrhage be defined

A
  • spotting
  • minor haemorrhage
  • major haemorrhage
  • massive haemorrhage
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59
Q

Placental Abruption

what is spotting

A

spots of blood noticed on underwear

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60
Q

Placental Abruption

what is a minor haemorrhage

A

<50ml of blood loss

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61
Q

Placental Abruption

what is a major haemorrhage

A

50-1000ml blood loss

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62
Q

Placental Abruption

what is a massive haemorrhage

A

> 1000ml blood loss or signs of shock

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63
Q

Placental Abruption

what is a concealed abruption

A

where the cervical os remains closed

and any bleeding that occurs remains within the uterine cavity

the severity of bleeding can be significantly underestimated with it

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64
Q

Placental Abruption

dx

A

clinical diagnosis based on presentation

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65
Q

initial mnx steps with major or massive haemorrhages

A
  • Urgent involvement of a senior obstetrician, midwife and anaesthetist
  • 2 x grey cannula
  • Bloods include FBC, UE, LFT and coagulation studies
  • Crossmatch 4 units of blood
  • Fluid and blood resuscitation as required
  • CTG monitoring of the fetus
  • Close monitoring of the mother
  • emergency caesarean if mother unstable or fetal distress
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66
Q

Placental Abruption

what is required when bleeding occurs in Rhesus-D negative women

A

anti-D prophylaxis

Kleihauer test is used to quantify how much fetal blood is mixed with the maternal blood to determine the dose of anti-D required

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67
Q

Placental Abruption

what is there an increased risk of after delivery in women with placental abruption

A

postpartum haemorrhage

active mnx of the 3rd stage is recommended

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68
Q

Placenta Accreta

what is it

A

when the placenta implants deeper, through and past the endometrium,

making it difficult to separate the placenta after delivery

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69
Q

Placenta Accreta

what are the 3 layers to the uterine wall

A
  • endometrium (inner layer)
  • myometrium (middle)
  • perimetrium (outer)
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70
Q

Placenta Accreta

what does the endometrium contain

A

connective tissue (stroma)

epithelial cells

blood vessels

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71
Q

Placenta Accreta

what does the myometrium contain

A

smooth muscle

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72
Q

Placenta Accreta

what does the perimetrium contain

A

a serous membrane similar to the peritoneum (aka serosa)

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73
Q

Placenta Accreta

why might the placenta embed past the endometrium

A

due to a defect in the endometrium:

  • previous uterine surgery: C-section or curettage procedure
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74
Q

Placenta Accreta

why might it lead to a postpartum haemorrhage

A

the deep implantation makes it very difficult for the placenta to separate during delivery leading to extensive bleeding

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75
Q

Placenta Accreta

what is superficial placenta accreta

A

the placenta implants in the surface of the myometrium, but not beyond

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76
Q

Placenta Accreta

what is placenta increta

A

where the placenta attaches deeply into the myometrium

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77
Q

Placenta Accreta

what is placenta percreta

A

where the placenta invaded past the myometrium and perimetrium, potentially reaching other organs such as the bladder

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78
Q

Placenta Accreta

RFs (6)

A
  • previous placenta accreta
  • previous endometrial curettage procedures (e.g. for miscarriage or abortion)
  • previous caesarean section
  • multigravida
  • increased maternal age
  • low lying placenta or placenta praevia
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79
Q

Placenta Accreta

presentation

A

usually asymptomatic during pregnancy

can present with bleeding (antepartum haemorrhage) in the 3rd trimester

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80
Q

Placenta Accreta

dx

A

can be diagnosed on antenatal USS

or at birth when it becomes difficult to deliver the placenta

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81
Q

Placenta Accreta

mnx if diagnosed antenatally

A

plan delivery between 35 to 36+6w

give antenatal steroids

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82
Q

Placenta Accreta

what are the options during caesarean section

A
  • hysterectomy: w/ placenta remaining in the uterus (recommended)
  • Uterus preserving surgery: resection of part of the myometrium along with the placenta
  • expectant mnx: leave the palcenta in place to be reabsorbed over time
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83
Q

Placenta Accreta

what risks come with expectant mnx

A

bleeding and infection

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84
Q

Placenta Accreta

if placenta accreta is seem when opening abdo for elective caesarean, what do you do

A

close abdo and delay delivery whilst specialist services are put in place

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85
Q

Placenta Accreta

if placenta accreta is discovered after delivery of the baby, what is recommended

A

hysterectomy

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86
Q

Breech Presentation

what is it

A

when the presenting part of the fetus is the legs and bottom

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87
Q

Breech Presentation

complete breech

A

legs are fully flexed at the hips and knees

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88
Q

Incomplete breech

A

one leg flexed at the hip and extended at the knee

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89
Q

Extended breech

A

aka frank breech

with both legs flexed at the hip and extended at the knee

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90
Q

Footling breech

A

with a foot is presenting through the cervix with the leg extended

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91
Q

Breech Presentation

mnx for babies that are breech before 36w

A

none as they often turn spontaneously

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92
Q

Breech Presentation

when is external cephalic version used in babies that are breech

A

After 36 weeks for nulliparous women

After 37 weeks in women that have given birth previously

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93
Q

Breech Presentation

mnx if the first baby in a twin pregnancy is breech

A

caesarean section

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94
Q

Breech Presentation

what is external cephalic version

A

a technique used to attempt to turn a fetus from the breech position to a cephalic position using pressure on the pregnant abdomen

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95
Q

Breech Presentation

what is given to women before ECV

A

Tocolysis with SC terbutaline to relax the uterus before the procedure

Rhesus-D negative women require anti-D prophylaxis

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96
Q

Breech Presentation

what is terbutaline

A

a beta-agonist similar to salbutamol.

It reduces the contractility of the myometrium, making it easier for the baby to turn.

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97
Q

Pre-eclampsia

what is it

A

HTN in pregnancy with end-organ dysfunction

notably with proteinuria

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98
Q

Pre-eclampsia

how many weeks gestation does it occur

A

after 20w, when the spiral arteries of the placenta form abnormally

leading to high vascular resistance in these vessels

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99
Q

Pre-eclampsia

what can it lead to if untreated

A
  • maternal organ damage
  • FGR
  • seizures
  • early labour
  • death
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100
Q

Pre-eclampsia

triad features

A
  1. hypertension
  2. proteinuria
  3. oedema
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101
Q

Pre-eclampsia

define chronic HTN

A

high BP that exists before 20w gestation and is longstanding

not caused by dysfunction in the placenta and is not classed as pre-eclampsia

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102
Q

Pre-eclampsia

define pregancy induced HTN or gestational HTN

A

HTN occurring after 20w gestation

without proteinuria

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103
Q

Pre-eclampsia

define eclampsia

A

when seizures occur as a result of pre-eclampsia

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104
Q

Pre-eclampsia

pathophysiology

A
  • high vascular resistance in the spiral arteries
  • poor perfusion of the placenta
  • causes oxidative stress in the placenta
  • and release of inflammatory chemicals into the systemic circulation
  • leading to systemic inflammation and impaired endothelial function in the blood vessels
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105
Q

Pre-eclampsia

high-risk factors (5)

A
  • pre-existing HTN
  • previous HTN in pregnancy
  • existing autoimmune condition
  • diabetes
  • CKD
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106
Q

Pre-eclampsia

moderate-risk factors (6)

A
  • > 40yrs
  • BMI>35
  • > 10 yrs since previous pregnancy
  • multiple pregnancy
  • first pregnancy
  • FH of pre-eclampsia
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107
Q

Pre-eclampsia

why are women offered aspirin

A

as prophylaxis against pre-eclampsia

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108
Q

Pre-eclampsia

when are women offered aspirin

A

from 12w gestation until birth if they have :

  • 1 high-risk factor

or

  • > 1 moderate-risk factor
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109
Q

Pre-eclampsia

symptoms

A
  • headache
  • visual disturbance / blurriness
  • N+V
  • upper abdo or epigastric pain (liver swelling)
  • oedema
  • reduced urine output
  • brisk reflexes
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110
Q

Pre-eclampsia

NICE diagnosis

A

BP >140/>90

plus any of:

  • proteinuria
  • organ dysfunction
  • placental dysfunction
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111
Q

Pre-eclampsia

examples of organ dysfunction

A
  • raised Cr
  • raised LFTs
  • seizures
  • thrombocytopenia
  • haemolytic anaemia
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112
Q

Pre-eclampsia

example of placental dysfunction

A

fetal growth restriction

abnormal Doppler studies

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113
Q

Pre-eclampsia

how can proteinuria be quantified

A

Urine protein:creatinine ratio (> 30mg/mmol is significant)

Urine albumin:creatinine ratio (>8mg/mmol is significant)

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114
Q

Pre-eclampsia

what test should be used between 20-35w gestation to rule out pre-eclampsia

A

placental growth factor (PlGF)

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115
Q

Pre-eclampsia

what is placental growth factor

A

a protein released by the placenta that functions to stimulate the development of new blood vessels

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116
Q

Pre-eclampsia

what are the levels of placental growth factor in pre-eclampsia

A

low

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117
Q

Pre-eclampsia

mnx of gestational HTN (without proteinuria)

A
  • aim for BP< 135/85
  • weekly urine dipstick
    weekly blood tests
  • monitor fetal growth by serial growth scans
  • placental growth factor testing on one occasion
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118
Q

Pre-eclampsia

at what BP should you admit a woman with gestational HTN

A

> 160/110

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119
Q

Pre-eclampsia

what scoring system is used to determine whether to admit the woman with Pre-eclampsia

A

fullPIERS or PREP-S

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120
Q

Pre-eclampsia

monitoring for pre-eclamptic women

A
  • BP monitoring every 48h

- fortnightly US monitoring

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121
Q

Pre-eclampsia

1st line medical mnx

A

labetalol

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122
Q

Pre-eclampsia

2nd line medical mnx

A

nifedipine (modified-release)

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123
Q

Pre-eclampsia

3rd line medical mnx

A

methyldopa (stop within 2d of birth)

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124
Q

Pre-eclampsia

what may be used as an antihypertensive in critical care in severe pre-eclampsia or eclampsia

A

IV hydralazine

fluid restriction

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125
Q

Pre-eclampsia

what is given during labour and in the 24h afterwards to prevent seizures

A

IV magnesium sulphate

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126
Q

Pre-eclampsia

after delivery, what medical mnx should be used

A

one or a combination of:

1st line: enalapril

1st line in black pts: nifedipine

3rd line: labetalol or atenolol

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127
Q

Pre-eclampsia

mnx of eclampsia

A

IV magnesium sulphate

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128
Q

Pre-eclampsia

what is HELLP syndrome

A

a combination of features that occurs as a complication of pre-eclampsia and eclampsia

Haemolysis
Elevated Liver enzymes
Low Platelets

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129
Q

Obstetric Cholestasis

aka?

A

intrahepatic cholestasis of pregnancy.

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130
Q

Obstetric Cholestasis

what does chole- mean

A

relates to the bile and bile ducts.

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131
Q

Obstetric Cholestasis

what does stasis refer to

A

inactivity

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132
Q

Obstetric Cholestasis

what is it characterised by

A

the reduced outflow of bile acids from the liver

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133
Q

Obstetric Cholestasis

how is this condition resolved

A

after the delivery of the baby

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134
Q

Obstetric Cholestasis

when does it develop in pregnancy

A

late (after 28w)

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135
Q

Obstetric Cholestasis

cause?

A

thought to be a result of increased oestrogen and progesterone levels

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136
Q

Obstetric Cholestasis

RFs

A

seems to be a genetic component

more common in women of South Asian ethnicity

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137
Q

Obstetric Cholestasis

where do bile acids come from

A

produced in the liver from the breakdown of cholesterol

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138
Q

Obstetric Cholestasis

where do bile acids flow

A

from the liver

to the hepatic ducts

past the gallbladder

out the bile duct

to the intestines

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139
Q

Obstetric Cholestasis

what causes the classic symptom of pruritis

A

outflow of bile acids is reduced, causing them to build up in the blood

resulting in itch

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140
Q

Obstetric Cholestasis

what does it increase the risk of

A

stillbirth

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141
Q

Obstetric Cholestasis

where does the pruritis affect

A

palms of the hands

soles of the feet

142
Q

Obstetric Cholestasis

sx

A
  • pruritis
  • fatigue
  • dark urine
  • pale, greasy stools
  • jaundice
143
Q

Obstetric Cholestasis

is there a rash

A

no! consider polymorphic eruption of pregnancy or pemphigoid gestationis

144
Q

Obstetric Cholestasis

DDx and other causes of pruritus and deranged LFTs

A
  • gallstones
  • acute fatty liver
  • autoimmune hepatitis
  • viral hepatitis
145
Q

Obstetric Cholestasis

inx and results

A
  • abnormal LFTs (ALT, AST, GGT)

- raised bile acids

146
Q

Obstetric Cholestasis

which LFT is normal to be raised in pregnancy and why

A

ALP because the placenta produces it

147
Q

Obstetric Cholestasis

primary trx

A

ursodeoxycholic acid improves LFTs, bile acids and sx

148
Q

Obstetric Cholestasis

how may the itch be managed

A
  • emollients (calamine lotion)

- antihistamines (chlorphenamine) can help sleep but not improve itch

149
Q

Obstetric Cholestasis

why can there be impaired clotting of blood

A

bile acids are important in the absorption of fat-soluble vitamins (vit K) in the intestines

a lack of bile acids can lead to vit K deficiency

Vit K is an important part of the clotting system

150
Q

Obstetric Cholestasis

what can be given if prothrombin time is deranged

A

water-soluble vit K

151
Q

Obstetric Cholestasis

monitoring mnx

A

weekly LFTs during pregnancy and after at least 10d

to ensure condition does not worsen and resolve after birth

152
Q

Obstetric Cholestasis

what mnx aims to reduce the risk of stillbirth

A

planned delivery after 37w

153
Q

Polymorphic Eruption of Pregnancy

aka?

A

pruritic and urticarial papules and plaques of pregnancy

154
Q

Polymorphic Eruption of Pregnancy

what is it

A

an itchy rash that tends to start in the 3rd trimester

155
Q

Polymorphic Eruption of Pregnancy

where does it usually begin

A

on the abdomen

156
Q

Polymorphic Eruption of Pregnancy

what is it usually associated with

A

stretch marks (striae)

157
Q

Polymorphic Eruption of Pregnancy

characteristics (3)

A
  • urticarial papules
  • wheals
  • plaques
158
Q

Polymorphic Eruption of Pregnancy

what are urticarial papules

A

raised itchy lumps

159
Q

Polymorphic Eruption of Pregnancy

what are wheals

A

raised itchy areas of skin

160
Q

Polymorphic Eruption of Pregnancy

what are plaques

A

larger inflamed areas of skin

161
Q

Polymorphic Eruption of Pregnancy

when will it get better

A

towards the end of pregnancy and after delivrey

162
Q

Polymorphic Eruption of Pregnancy

mnx

A

control sx with:

  • topical emollients
  • topical steroids
  • oral antihistamines
163
Q

Polymorphic Eruption of Pregnancy

what may be used as mnx in severe cases

A

oral steroids

164
Q

Atopic Eruption of Pregnancy

what is it

A

eczema that flares up during pregnancy

165
Q

Atopic Eruption of Pregnancy

when does it appear in pregnancy

A

in the 1st and 2nd trimester

166
Q

Atopic Eruption of Pregnancy

what are the 2 types

A
  • E-type or eczema type

- P-type or prurigo-type

167
Q

Atopic Eruption of Pregnancy

features of E-type (eczema type)

A
  • eczematous, inflamed, red itchy skin

- insides of elbows, back of legs, neck, face, chest

168
Q

Atopic Eruption of Pregnancy

features of P-type (prurigo-type)

A
  • intensely itchy papules (spots)

- abdo, back, limbs

169
Q

Atopic Eruption of Pregnancy

when will it get better

A

after delivery

170
Q

Atopic Eruption of Pregnancy

mnx

A
  • topical emollients

- topical steroids

171
Q

Atopic Eruption of Pregnancy

mnx of severe cases

A
  • phototherapy with UVB

- oral steroids

172
Q

Melasma

aka

A

mask of pregnancy

173
Q

Melasma

what is it characterized by

A

increased pigmentation to patches of the skin on the face

symmetrical and flat

affecting sun-exposed areas

174
Q

Melasma

cause

A

though to be due to the increased female sex hormones associated with pregnancy

175
Q

Melasma

apart from pregnancy, when else can it occur

A

in pts on COCP or HRT

176
Q

Melasma

what is it associated with

A
  • sun exposure
  • thyroid disease
  • FH
177
Q

Melasma

mnx

A
  • avoid sun exposure, use suncream
  • makeup
  • no active trx required
178
Q

Pyogenic Granuloma

aka

A

lobular capillary haemangioma.

179
Q

Pyogenic Granuloma

what is it

A

a benign, rapidly growing tumour of capillaries

180
Q

Pyogenic Granuloma

presentation

A
  • rapidly growing lump that develops over days to 1-2cm in size
  • red or dark
181
Q

Pyogenic Granuloma

whom do they occur more often

A
  • pregnant ladies

- pts on hormonal contraceptives

182
Q

Pyogenic Granuloma

triggers

A
  • minor trauma

- infection

183
Q

Pyogenic Granuloma

where do they occur

A

on fingers

upper chest, back, neck or head

184
Q

Pyogenic Granuloma

if injured, what may happen

A

profuse bleeding and ulceration

185
Q

Pyogenic Granuloma

what DDx needs to be excluded

A

malignancy esp nodular melanoma

186
Q

Pyogenic Granuloma

trx

A

usually resolve without trx after delivery

surgical removal

187
Q

Pyogenic Granuloma

confirmation of dx

A

histology

188
Q

Pemphigoid Gestationis

what is it

A

a rare autoimmune skin condition that occurs in pregnancy

189
Q

Pemphigoid Gestationis

pathophysiology

A
  • autoantibodies destroy connection between the epidermis and dermis
  • epidermis and dermis seperate
  • creating a space that can be filled with fluid
  • resulting in large fluid-filled blisters (bullae)
190
Q

Pemphigoid Gestationis

why does the pregnant woman’s immune system produce these autoantibodies

A

in response to placental tissue

191
Q

Pemphigoid Gestationis

when does it usually occur

A

in the 2nd or 3rd trimester

192
Q

Pemphigoid Gestationis

typical presentation

A

initially with an itchy red papular or blistering rash around the umbilicus

then spreads to other parts of the body

over several weeks, large fluid-filled blisters form

193
Q

Pemphigoid Gestationis

trx

A
  • usually resolves without trx after delivery

- topical emollients and steroids

194
Q

Pemphigoid Gestationis

mnx in severe cases

A
  • oral steroids

- immunosuppressant where steroids are inadequate

195
Q

Pemphigoid Gestationis

what may be required if infection occurs

A

abx

196
Q

Pemphigoid Gestationis

risks to the baby

A
  • fetal growth restriction
  • preterm delivery
  • blistering rash after delivery
197
Q

Pemphigoid Gestationis

why may the baby have a blistering rash after delivery

A

the maternal antibodies pass to the baby

198
Q

Acute fatty liver of pregnancy

which trimester does it occur

A

3rd

199
Q

Acute fatty liver of pregnancy

what is it

A

rapid accumulation of fat within hepatocytes causing acute hepatitis

high risk of liver failure and mortality, for both the mother and fetus.

200
Q

Acute fatty liver of pregnancy

pathophysiology

A

impaired processing of fatty acids in the placenta.

These fatty acids enter the maternal circulation, and accumulate in the liver.

result of a genetic condition in the fetus that impairs fatty acid metabolism.

201
Q

Acute fatty liver of pregnancy

most common cause

A

long-chain 3-hydroxyacyl-CoA dehydrogenase (LCHAD) deficiency in the fetus

an autosomal recessive condition

202
Q

Acute fatty liver of pregnancy

what is the LCHAD enzyme important for

A

fatty acid oxidation

breaking down fatty acids to be used as fuel.

203
Q

Acute fatty liver of pregnancy

presentation

A

hepatitis sx:

  • General malaise and fatigue
  • N+V
  • Jaundice
  • Abdominal pain
  • Anorexia
  • Ascites
204
Q

Acute fatty liver of pregnancy

what will LFTs show

A

elevated ALT + AST

205
Q

Ddx of elevated liver enzymes and low platelets

A

HELLP syndrome

Acute fatty liver of pregnancy

206
Q

Acute fatty liver of pregnancy

mnx

A

emergency

prompt delivery

207
Q

Gestational Diabetes

what is it caused by

A

reduced insulin sensitivity during pregnancy and resolves after birth

208
Q

Gestational Diabetes

what is the most significant immediate complication

A
  • large for dates fetus
  • macrosomia
    which increases risk of sholder dystocia
209
Q

Gestational Diabetes

woman has RFs, what test should she have

A

oral glucose tolerance test at 24 – 28 weeks gestation

210
Q

Gestational Diabetes

RFs that warrant testing with OGTT

A
  • previous gestational diabetes
  • previous macrosomic baby (≥ 4.5kg)
  • BMI > 30
  • black carribbean, middle eastern, south asian
  • 1st degree relative with diabetes
211
Q

Gestational Diabetes

what features may suggest gestational diabetes

A
  • large for dates fetus
  • polyhydramnios (increased amniotic fluid)
  • glucose on urine dipstick
212
Q

Gestational Diabetes

how is an OGTT performed

A
  • measure blood sugar levels (fasting)
  • drink 75g glucose
  • measure blood sugar levels 2h later
213
Q

Gestational Diabetes

what are normal results for the OGTT

A

Fasting: < 5.6 mmol/l

At 2 hours: < 7.8 mmol/l

214
Q

Gestational Diabetes

counselling

A
  • explain condition
  • learn how to monitor and track their blood sugar levels
  • 4 weekly USS to monitor fetal growth and amniotic fluid volume from 28-36w gestation
215
Q

Gestational Diabetes

mnx if fasting glucose <7

A

trial of diet and exercise for 1-2 weeks

followed by metformin, then insulin

216
Q

Gestational Diabetes

mnx if fasting glucose >7

A

start insulin ± metformin

217
Q

Gestational Diabetes

mnx if fasting glucose >6 plus macrosomia (or other complications)

A

start insulin ± metformin

218
Q

Gestational Diabetes

what medication is an option for women who decline insulin or cannot tolerate metformin

A

Glibenclamide (a sulfonylurea)

219
Q

Gestational Diabetes

what are the blood sugar level targets

A
  • Fasting: 5.3 mmol/l
  • 1 hour post-meal: 7.8 mmol/l
  • 2 hours post-meal: 6.4 mmol/l
  • Avoiding levels of 4 mmol/l or below
220
Q

Gestational Diabetes

what should women with existing diabetes take before coming pregnant

A

5mg folic acid from preconception until 12 weeks gestation.

221
Q

Gestational Diabetes

what should women with existing T1 and T2 DM aim for in insulin levels

A

the same target insulin levels as with gestational diabetes

222
Q

Gestational Diabetes

how are women with T2 managed

A

metformin and insulin

other PO diabetic meds should be stopped

223
Q

Gestational Diabetes

Pre-Existing Diabetes: what screening shortly after booking and at 28 weeks gestation.

A

Retinopathy screening

224
Q

Gestational Diabetes

Pre-Existing Diabetes: when should delivery occur

A

NICE (2015) advise a planned delivery between 37 and 38 + 6 weeks

225
Q

Gestational Diabetes

when should delivery occur

A

can give birth up to 40 + 6

226
Q

Gestational Diabetes

when is a sliding-scale insulin regime considered during labour

A

women with type 1 diabetes.

women with poorly controlled blood sugars with gestational or type 2 diabetes.

227
Q

Gestational Diabetes

when can women stop their diabetic medication

A

immediately after birth

228
Q

Gestational Diabetes

when do they need follow up after birth

A

after at least six weeks

229
Q

Gestational Diabetes

after birth what should women with pre existing diabetes do

A

lower their insulin doses and be wary of hypoglycaemia in the postnatal period.

230
Q

Gestational Diabetes

what are babies at risk of

A
  • Neonatal hypoglycaemia
  • Polycythaemia (raised haemoglobin)
  • Jaundice
  • Congenital heart disease
  • Cardiomyopathy
231
Q

Gestational Diabetes

when may babies need IV dextrose or nasogastric feeding

A

if their blood sugar <2

232
Q

Gestational Diabetes

why may babies develop neonatal hypoglycaemia

A

Babies become accustomed to a large supply of glucose during the pregnancy, and after birth they struggle to maintain the supply they are used to with oral feeding alone.

233
Q

Rubella

features of congenital rubella syndrome

A
  • deafness
  • cataracts
  • heart disease: PDA + pulmonary stenosis
  • learning disability
234
Q

Rubella

aka

A

German measles

235
Q

Rubella

what is congenital rubella syndrome caused by

A

maternal infection with the rubella virus during the first 20w of pregnancy

236
Q

Rubella

woman plans to conceive but unsure if had MMR vaccine. What should you do

A

test for rubella immunity

if no antibodies, they can be vaccinated with 2 doses of the MMR, 3m apart

237
Q

Rubella

should pregnant women receive the MMR vaccine

A

no as it’s a live vaccine

offer them it after giving birth

238
Q

Chickenpox

which virus is it caused by

A

varicella zoster virus

239
Q

Chickenpox

what can chickenpox in pregnancy lead to

A
  • more severe cases in mother: varicella pneumonitis, hepatitis or encephalitis
  • fetal varicella syndrome
  • severe neonatal varicella infection
240
Q

Chickenpox

what does a woman with positive IgG for VZV indicate

A

immunity

241
Q

Chickenpox

woman is not immune to VZV, when do you give vaccine

A

before or after pregnancy

242
Q

Chickenpox

mnx for woman not immune but was exposed to chickenpox

A

IV varicella immunoglobulins within 10d of exposure as prophylaxis

243
Q

Chickenpox

chickenpox rash starts in pregnancy mnx

A

PO aciclovir if they present within 24h and >20w gestation

244
Q

Chickenpox

when does congenital varicella syndrome occur

A

when infection occurs in the first 28 weeks of gestation

245
Q

Chickenpox

features of congenital varicella syndrome

A
  • fetal growth restriction
  • microcephaly, hydrocephalus + learning disability
  • scars + significant skin changes located in specific dermatomes
  • limb hypoplasia (underdeveloped limbs)
  • cataracts + inflammation in the eye (chorioretinitis)
246
Q

Listeria

what is it

A

an infectious gram-positive bacteria that causes listeriosis.

247
Q

Listeria

presentation of listeriosis in mother

A
  • asymptomatic
  • flu-like illness
    less commonly:
  • pneumonia
  • meningoencephalitis
248
Q

Listeria

how is listeria typically transmitted

A

unpasteurised dairy products, processed meats and contaminated foods

249
Q

Listeria

advice for pregnant women to not get listeria

A

avoid high-risk foods (e.g. blue cheese) and practice good food hygiene.

250
Q

Listeria

Listeriosis in pregnant women has a high rate of?

A
  • miscarriage
  • fetal death
  • severe neonatal infection.
251
Q

Congenital Cytomegalovirus

why does it occur

A

cytomegalovirus (CMV) infection in the mother during pregnancy.

252
Q

Congenital Cytomegalovirus

how is CMV spread

A

via the infected saliva or urine of asymptomatic children

253
Q

Congenital Cytomegalovirus

features

A
  • Fetal growth restriction
  • Microcephaly
  • Hearing loss
  • Vision loss
  • Learning disability
  • Seizures
254
Q

Congenital Toxoplasmosis

how is it spread

A

contamination with faeces from a cat that is a host of the parasite, Toxoplasma gondii

255
Q

Congenital Toxoplasmosis

classic triad

A
  • intracranial calcification
  • hydrocephalus
  • chorioretinitis (choroid and retina in the eye)
256
Q

Parvovirus B19

aka

A

fifth disease

slapped cheek syndrome

erythema infectiosum

257
Q

Parvovirus B19

what is significant exposure to parvovirus classes as

A

15 minutes in the same room, or face-to-face contact, with someone that has the virus

258
Q

Parvovirus B19

complications with infection esp in 1st and 2nd trimester

A
  • miscarriage or fetal death
  • severe fetal anaemia
  • hydrops fetalis (fetal heart failure)
  • maternal pre-eclampsia like syndrome
259
Q

Parvovirus B19

why does fetal anaemia occur

A

parvovirus infection of the erythroid progenitor cells in the fetal bone marrow and liver

these cells usually produce RBCs, but produce faulty ones that have a shorter life span when infected

260
Q

Parvovirus B19

why does hydrops fetalis occur

A

This anaemia leads to heart failure

261
Q

Parvovirus B19

Maternal pre-eclampsia-like syndrome is also known as?

A

mirror syndrome

262
Q

Parvovirus B19

presentation of Maternal pre-eclampsia-like syndrome

A

rare complication of severe fetal heart failure (hydrops fetalis)

  • hydrops fetalis
  • placental oedema
  • oedema in the mother.
  • hypertension
  • proteinuria
263
Q

Parvovirus B19

women suspected of parvovirus infection need tests for?

A
  • IgM to parvovirus
  • IgG to parvovirus
  • Rubella antibodies (as a differential diagnosis)
264
Q

Parvovirus B19

why test for IgM

A

tests for acute infection within the past four weeks

265
Q

Parvovirus B19

why test for IgG

A

tests for long term immunity to the virus after a previous infection

266
Q

Parvovirus B19

mnx

A
  • supportive

- referral to fetal medicine to monitor for complications and malformations

267
Q

Zika Virus

how is it spread

A

by host Aedes mosquitos

sex with someone infected with the virus

268
Q

Zika Virus

what sx may you get if infected

A

no symptoms, minimal symptoms, or a mild flu-like illness

269
Q

Zika Virus

presentation of congenital Zika syndrome

A
  • microcephaly
  • fetal growth restriction
  • other intracranial abnormalities: ventriculomegaly and cerebella atrophy
270
Q

Zika Virus

Pregnant women that may have contracted the Zika virus should be tested with?

A

viral PCR and antibodies to the Zika virus.

271
Q

Zika Virus

mnx for postive women

A

referred to fetal medicine for close monitoring

no trx for virus

272
Q

Rhesus incompatibility

what does it mean when she is rhesus negative

A

she doesn’t have the rhesus-D antigen present on her RBC surface

273
Q

Rhesus incompatibility

trx with rhesus-D positive women

A

none

274
Q

Rhesus incompatibility

what does it mean that the mother has become sensitised to rhesus-D antigens

A

rhesus-D negative woman with rhesus positive child

mother recognise this rhesus-D antigen as foreign, and produce antibodies to the rhesus-D antigen

275
Q

Rhesus incompatibility

what is haemolytic disease of the newborn

A

sensitised mother’s anti-rhesus-D antibodies can cross the placenta into the fetus

attacks fetus’ RBCs (haemolysis)

276
Q

Rhesus incompatibility

how does anti-D injections work

A

it attaches to rhesus-D antigens on the fetal red blood cells in the mothers circulation, causing them to be destroyed.

mother doesn’t become sensitised

277
Q

Rhesus incompatibility

mnx

A

Anti-D injection routinely:

  • at 28w gestation
  • birth (if baby is found to be rhesus-positive)
278
Q

Rhesus incompatibility

when else should Anti-D injections be given

A

at any time where sensitisation may occur:

  • antepartum haemorrhage
  • amniocentesis procedures
  • abdo trauma

within 72h

279
Q

Rhesus incompatibility

what test is performed to see how much fetal blood has passed into the mother’s blood, to determine whether further doses of anti-D are required.

A

Kleinhauer test

280
Q

Rhesus incompatibility

when is the Kleihauer Test performed

A

after any sensitising event past 20 weeks gestation

281
Q

Rhesus incompatibility

what does the Kleihauer Test involve

A
  • add acid to sample of mother’s blood
  • fetal Hb is more resistant to acid so they are protected agaisnt acidosis that occurs around childbirth
  • fetal Hb persists while mother Hb is destroyed
  • number of cells still containing Hb (the remaining fetal cells) can then be calculated.
282
Q

Small for Gestational Age

definition

A

a fetus that measures below the 10th centile for their gestational age

283
Q

Small for Gestational Age

what measurements on US are used to assess the fetal size

A

Estimated fetal weight (EFW)

Fetal abdominal circumference (AC)

284
Q

Small for Gestational Age

what are customised growth charts

A

used to assess the size of the fetus, based on the mother’s:

Ethnic group
Weight
Height
Parity

285
Q

Small for Gestational Age

definition of severe SGA

A

when the fetus is below the 3rd centile for their gestational age

286
Q

Small for Gestational Age

definition of low birth weight

A

birth weight <2.5kg

287
Q

Small for Gestational Age

The causes of SGA can be divided into two categories:

A

Constitutionally small

Fetal growth restriction (FGR), also known as intrauterine growth restriction (IUGR)

288
Q

Small for Gestational Age

what is FGR/IUGR

A

small fetus (or a fetus that is not growing as expected)

due to a pathology reducing the amount of nutrients and oxygen being delivered to the fetus through the placenta

289
Q

Small for Gestational Age

difference between SGA and FGR

A

SGA: the baby is small for the dates, without stating why. could be constitutionally small or FGR

FGR: pathology reducing the amount of nutrients and oxygen being delivered to the fetus through the placenta

290
Q

Small for Gestational Age

cause of FGR can be divided into?

A

Placenta mediated growth restriction

Non-placenta mediated growth restriction: small due to a genetic or structural abnormality

291
Q

Small for Gestational Age

causes of FGR due to placenta mediated growth restriction

A
  • Idiopathic
  • Pre-eclampsia
  • Maternal smoking
  • Maternal alcohol
  • Anaemia
  • Malnutrition
  • Infection
  • Maternal health conditions
292
Q

Small for Gestational Age

causes of FGR due to non-placenta mediated growth restriction

A
  • Genetic abnormalities
  • Structural abnormalities
  • Fetal infection
  • Errors of metabolism
293
Q

Small for Gestational Age

other signs of FGR other than the fetus being SGA

A
  • Reduced amniotic fluid volume
  • Abnormal Doppler studies
  • Reduced fetal movements
  • Abnormal CTGs
294
Q

Small for Gestational Age

short term complications of FGR

A
  • Fetal death or stillbirth
  • Birth asphyxia
  • Neonatal hypothermia
  • Neonatal hypoglycaemia
295
Q

Small for Gestational Age

long term complications of FGR

A
  • CV disease: HTN
  • T2 DM
  • obesity
  • mood + behavioural problems
296
Q

Small for Gestational Age

RFs

A
  • Previous SGA baby
  • Obesity
  • Smoking
  • Diabetes
  • Existing hypertension
  • Pre-eclampsia
  • mother >35 years
  • Multiple pregnancy
  • Low pregnancy‑associated plasma protein‑A (PAPPA)
  • Antepartum haemorrhage
  • Antiphospholipid syndrome
297
Q

Small for Gestational Age

monitoring low risk women

A
  • symphysis fundal height monitored at every antenatal appointment from 24w
  • plot SFH on customised growth chart
298
Q

Small for Gestational Age

monitoring: when do women get booked for serial growth scans with umbilical artery doppler

A
  • symphysis fundal height is less than the 10th centile
  • ≥3 minor RFs
  • ≥1 major RFs
  • Issues with measuring the symphysis fundal height (e.g. large fibroids or BMI > 35)
299
Q

Small for Gestational Age

monitoring for women at risk or with SGA

A

serial ultrasound scans measuring:

  • Estimated fetal weight (EFW) and abdominal circumference (AC) to determine the growth velocity
  • Umbilical arterial pulsatility index (UA-PI) to measure flow through the umbilical artery
  • Amniotic fluid volume
300
Q

Small for Gestational Age

mnx

A

identify cause

  • Identifying those at risk of SGA
  • Aspirin is given to those at risk of pre-eclampsia
  • Treating modifiable risk factors (e.g. stop smoking)
  • Serial growth scans to monitor growth
  • Early delivery where growth is static, or there are other concerns
301
Q

Anaemia in Pregnancy

when are women routinely screened for anaemia

A
  • Booking clinic

- 28 weeks gestation

302
Q

Anaemia in Pregnancy

why is anaemia more common

A

During pregnancy, the plasma volume increases.

This results in a reduction in the haemoglobin concentration.

303
Q

Anaemia in Pregnancy

what are the normal ranges for Hb during pregnancy at

  • booking bloods
  • 28w gestation
  • post partum
A
  • booking bloods >110g/l
  • 28w gestation >105
  • post partum >100
304
Q

Anaemia in Pregnancy

what may the following indicate:

  • low MCV
  • normal MCV
  • raised MCV
A

low: iron deficient
normal: physiological anaemia
raised: B12 or folate deficiency

305
Q

Anaemia in Pregnancy

trx for B12 deficinecy

A

Intramuscular hydroxocobalamin injections

Oral cyanocobalamin tablets

306
Q

Anaemia in Pregnancy

how much folate should pregannt women take

A

400mcg per day.

unless folate deficient: 5mg/day

307
Q

Anaemia in Pregnancy

mnx for women with a haemoglobinopathy (Thalassaemia and Sickle Cell Anaemia)

A

high dose folic acid (5mg)

close monitoring

transfusions when required.

308
Q

Stillbirth

definition

A

the birth of a dead fetus after 24w gestation

it is the result of a intrauterine fetal death

309
Q

Stillbirth

causes

A
  • unexplained (50%)
  • pre-eclampsia
  • placental abruption
  • vasa praevia
  • cord prolapse or wrapped around fetal neck
  • obstetric cholestasis
  • diabetes
  • thyroid disease
  • infection: rubella, parvovirus, listeria
  • genetic abnormalities or congenital malformations
310
Q

Stillbirth

Factors that increase the risk

A
  • FGR
  • smoking
  • alcohol
  • increased maternal age
  • maternal obesity
  • twins
  • sleeping on the back (as opposed to to either side)
311
Q

Stillbirth

3 key symptoms to report immediately

A
  • reduced fetal movements
  • abdo pain
  • vaginal bleeding
312
Q

Stillbirth

prevention

A
  • risk assessment for a baby that is small for gestational age or with FGR
  • those at risk have serial growth scans
  • sleep on side
  • aspirin if pre-eclamptic
313
Q

Stillbirth

inx of choice for diagnosing intrauterine fetal death (IUFD).

A

USS: visualise the fetal heartbeat to confirm the fetus is still alove

314
Q

Stillbirth

are fetal movement possible after IUFD

A

yes, a repeat scan is offered to confirm the situation

315
Q

Stillbirth

1st line for most women after IUFD

A

vaginal birth:

  • induction of labour
  • expectant
316
Q

Stillbirth

what does induction of labour involve

A

combination of:
- oral mifepristone (anti-progesterone)

  • vaginal or oral misoprostol (prostaglandin analogue).
317
Q

Stillbirth

what can be used to suppress lactation after stillbirth

A

Dopamine agonists (e.g. cabergoline)

318
Q

Stillbirth

with parental consent, what testing is carried out after stillbirth to determine the cause

A
  • Genetic testing of the fetus and placenta
  • Postmortem examination of the fetus (including xrays)
  • Testing for maternal and fetal infection
  • Testing the mother for conditions associated with stillbirth: diabetes, thyroid, thrombophilia
319
Q

Large for Gestational Age

definition

A

aka macrosomia

weight of newborn is >4.5kg at birth

or during pregnancy, estimated fetal weight > 90th centile

320
Q

Large for Gestational Age

causes of macrosomia

A
  • Constitutional
  • Maternal diabetes
  • Previous macrosomia
  • Maternal obesity or rapid weight gain
  • Overdue
  • Male baby
321
Q

Large for Gestational Age

risks

A
  • shoulder dystocia
  • Failure to progress
  • Perineal tears
  • Instrumental delivery or caesarean
  • Postpartum haemorrhage
  • Uterine rupture (rare)
322
Q

Large for Gestational Age

risks to baby

A
  • Birth injury (Erbs palsy, clavicular fracture, fetal distress and hypoxia)
  • Neonatal hypoglycaemia
  • Obesity in childhood and later life
  • Type 2 diabetes in adulthood
323
Q

Large for Gestational Age

inx

A
  • USS; exclude polyhydramnios + estimate fetal weight

- OGTT for gestational diabetes

324
Q

Large for Gestational Age

how may the risk of shoulder dystocia be reduced

A
  • delivery on a consultant lead unit
  • Delivery by an experienced midwife or obstetrician
  • Access to an obstetrician and theatre if required
  • Active management of the third stage (delivery of the placenta)
  • Early decision for caesarean section if required
  • Paediatrician attending the birth
325
Q

Multiple pregnancy

types: monozygotic

A

identical twins (from a single zygote)

326
Q

Multiple pregnancy

types: dizygotic

A

non-identical (from two different zygotes)

327
Q

Multiple pregnancy

types: monoamniotic

A

single amniotic sac

328
Q

Multiple pregnancy

types: diamniotic

A

2 separate amniotic sacs

329
Q

Multiple pregnancy

types: monochorionic

A

share a single placenta

330
Q

Multiple pregnancy

types: dichorionic

A

2 seperate placentas

331
Q

Multiple pregnancy

types: which types is the best outcome

A

diamniotic, dichorionic as each fetus has their own nutrient supply

332
Q

Multiple pregnancy

when is multiple preganncy diagnosed

A

on the booking USS

333
Q

Multiple pregnancy

on USS, what would dichorionic diamniotic twins show

A
  • membrane between the twins

- with a lambda sign or twin peak sign

334
Q

Multiple pregnancy

on USS, what would monochorionic diamniotic twins show

A

membrane between the twins, with a T sign

335
Q

Multiple pregnancy

on USS, what would Monochorionic monoamniotic wins show

A

no membrane separating the twins

336
Q

Multiple pregnancy

what does the lambda or twin peak sign refer to on USS

A

dichorionic diamniotic

a triangular appearance where the membrane between the twins meets the chorion, as the chorion blends partially into the membrane.

337
Q

Multiple pregnancy

what does T sign refer to on USS

A

monochorionic diamniotic

where the membrane between the twins abruptly meets the chorion

338
Q

Multiple pregnancy

risks to mother

A
  • Anaemia
  • Polyhydramnios
  • Hypertension
  • Malpresentation
  • Spontaneous preterm birth
  • Instrumental delivery or caesarean
  • Postpartum haemorrhage
339
Q

Multiple pregnancy

risks to fetuses + neonates

A
  • Miscarriage
  • Stillbirth
  • Fetal growth restriction
  • Prematurity
  • Twin-twin transfusion syndrome
  • Twin anaemia polycythaemia sequence
  • Congenital abnormalities
340
Q

Multiple pregnancy

when does twin-twin transfusion syndrome occur

A

when the fetuses share a placenta.

feto-fetal transfusion syndrome in pregnancies with more than two fetuses.

341
Q

Multiple pregnancy

what is Twin-twin transfusion syndrome

A

When there is a connection between the blood supplies of the two fetuses

one fetus (the recipient) may receive the majority of the blood from the placenta

while the other fetus (the donor) is starved of blood

342
Q

Multiple pregnancy

Twin-twin transfusion syndrome: how does the recipient present

A

fluid overloaded, with heart failure and polyhydramnios

343
Q

Multiple pregnancy

Twin-twin transfusion syndrome: how does the donor present

A

growth restriction, anaemia and oligohydramnios.

344
Q

Multiple pregnancy

Twin-twin transfusion syndrome: mnx

A

refer to a tertiary specialist fetal medicine centre.

severe: laser trx to destroy connection between the 2 blood supplies

345
Q

Multiple pregnancy

what is the difference between Twin Anaemia Polycythaemia Sequence and
Twin-twin transfusion syndrome

A

sequence is less acute.

1 twin becomes anaemic whilst the other develops polycythaemia

346
Q

Multiple pregnancy

what additional monitoring is required

A

FBC

USS

347
Q

Multiple pregnancy

when is planned birth offered

A

monochorionic monoamniotic: 32-34w

monochorionic diamniotic: 36-37

dichorionic diamniotic: 37-38

triplets: before 36w

348
Q

Multiple pregnancy

delivery of monoamniotic twins

A

elective caesarean section at between 32-34w

349
Q

Multiple pregnancy

in diamniotic twins, when is vaginal delivery possible

A

when the first baby has a cephalic presentation

Elective caesarean is advised when the presenting twin is not cephalic presentation
1st or 2nd twin

350
Q

difference in presentation between vasa praevia and placenta praevia

A

vasa praevia: bleeding during rupture of membranes and fetal bradycardia

Finals (47 decks)

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