OB 4 Flashcards
- What is the MC type of multiple gestation?
- What 5 things increase the likelihood of multiple gestation?
- Dizygotic Twins (Fraternal) (70%)
- Fertility tx
- Advanced maternal age
- Increasing parity
- Fam hx (either parent)
- Obese (BMI >30) + Tall (>5’4”)
Describe Dizygotic “Fraternal Twins”
- How many oocytes are ovulated & fertilized?
- How many chorions & amniotic sacs?
- 2 oocytes are fertilized
- 2 chorions / 2 amniotic sacs
Describe Monozygotic “Identical Twins”
- Ovulation & fertilization of how many oocytes?
- What determines “placentation?”
- How many chorions & amniotic sacs?
- A single oocyte is ovulated/fertilized
- Timing of egg division determines placentation
- 1 chorion, 1 amniotic sac = monoamniotic
- 1 chorion, 2 amniotic sacs = diamniotic
- What is the ONLY method for DEFINITIVE dx of multiple gestation?
- What are the 2 different “signs” you can see?
-
Ultrasound
- Gives accurate gestational age
- Determines chorionicity/amnionicity
- Best if done in 1st trimester >7 weeks
- “Lamda Sign” = Dichorionic twins
- “T Sign” = Monochorionic twins
What is this?
Multiple Gestation
- US of intertwin membrane showing “Lambda Sign” = Dichorionic twins
- Fraternal Twins (Dizygotic)
- Diamniotic = 2 amniotic sacs
What is this?
Multiple Gestation
- US of intertwin membrane showing “T Sign” = Monochorionic twins
- Identical Twins (Monozygotic)
- Diamniotic (2 amniotic sacs)
Multiple Gestation
- What are the 7 complications?
- Which 2 complications are MC?
- Preterm delivery** (60% before 37 weeks)
- Low BW** (57% are <5.5 lbs)
- Gestational diabetes
- Pregnancy induced HTN
- Pre-eclampsia
- Post-partum hemorrhage
- Higher C-section rate
“PL - HHCG”
What is the MOST SERIOUS complication of multiple gestation?** (probably on exam)
Describe it…
Twin-Twin Transfusion Syndrome
- Only occurs w/ monochorionic gestation (fetuses share 1 placenta & blood supply is unevenly distributed)
- One fetus is small w/ little amniotic fluid
Definition of what? Dx criteria?
- Cervical shortening which can lead to preterm spontaneous delivery
Cervical Incompetence
- US to see cervical length in 2nd trimester
- 20mm or less in women w/ NO prior pre-term delivery
- 25mm or less in women WITH a prior pre-term delivery
What is the tx for cervical incompetence?
- Placement of cervical cerclage
- Removed at 37 weeks gestation or onset of rupture of membranes
Which type of HTN?
- >140/90 PRIOR to 20 weeks gestation
Chronic HTN
Which type of HTN?
- New HTN (>140/90) presenting AFTER 20 weeks gestation w/ NO proteinuria
Pregnancy-Induced HTN
Which type of HTN?
- New onset HTN & Proteinuria AFTER 20 weeks
- BP reading criteria for dx?
Pre-Eclampsia
- BP readings elevated on at least 2 occasions, at least 6 hours apart
- Systolic 140+ or Diastolic 90+
Which type of HTN?
- HTN, Proteinuria, & seizures in woman w/ pre-eclampsia
Eclampsia
What are some RFs for Pre-Eclampsia?
- Nulliparity
- Pre-eclampsia in prev pregnancy
- Advanced maternal age
- Multiple gestation
- Diabetes
- Chronic HTN
- Chronic renal dz
- Family hx of pre-eclampsia
- Obesity
- HTN
- Epigastric pain
- HA
- Visual sxs: blurred vision, flashing lights, sparks
- Edema
- Hyper-reflexia
- Oliguria
Dx?
Pre-eclampsia
Describe criteria for Mild Pre-eclampsia
- Systolic BP 140+ OR diastolic 90+
- AND proteinuria of 0.3g+ in 24-h urine specimen
Describe criteria for severe pre-eclampsia
- Systolic 160+ or Diastolic 110+
- Oliguria <500cc in 24 hrs
- 3+ proteinuria (5+ grams on 24 h urine)
- End organ damage
- Fetal compromise
- SBP 160+ or DBP 110+
- Severe HA “worse ever had”
- Pulmonary Edema
- AMS
- Photopsia, scotomata, retinal vasospasm
Dx?
Severe features/Complications of Pre-eclampsia
What are 3 possible findings in Pre-Eclampsia or Eclampsia?
HELLP
- Hemolysis
- Elevated Liver enzymes
- Low Platelet count
- What labs/imaging should be done for Pre-Eclampsia?
- How often?
- CBC, Creatinine, Liver enzymes
- 24hr urine & Urine dipstick
- Fetal NST
- US (amniotic fluid volume / fetal weight)
Repeat weekly IF NO SIGNS of severe features
- Obese pregnant women 36 y/o w/ DM and HTN presents w/ blurred vision, flashing lights, HTN, epigastric pain, oliguria, proteinuria 5g, and “worse HA she’s ever had.”
- BP is 162/112
Dx & Tx?
Severe Pre-Eclampsia
- Tx is ALWAYS indicated if severe (to ↓ maternal stroke)
- Use Beta Blockers (IV Labetalol)
- AVOID: ACE, ARB, diuretics
T/F
- All antihypertensive meds cross the placenta
True!
Use Beta Blockers (=
DO NOT USE: ACE, ARB, diuretics )=
What are the 3 causes of mortality for the mother w/ pre-eclampsia?
- Acute MI
- Stroke
- Cardiac failure