OBGYN: Hypercoagulablity, Rh, Multiple Gestations

Question 1

leading cause of maternal death

Answer 1

hemorrhage

Question 2

what kind of state is being pregnant

Answer 2

Hypercoaguable state

Question 3

hypercoaguable state also called

Answer 3

thrombophillia

Question 4

list ways pregnancy cause hypercoaguable state (4)

Answer 4

1. pregnancy causes decreased venous outflow bc of growing uterus, 2. hormonal changes,
2. decreased mobility and
3. incr in concentration of factors VII, VIII, X and fibrinogen in clotting cascade

Question 5

incr in what clotting factors during pregnancy

Answer 5

VII
VIII
X
Fibrinogen

Question 6

define thombus and thomboembolic event

Answer 6

thombus=clot

thromboembolic= obstruction of BV by a thrombus that lodged from another site in body

Question 7

what state is higher risk of clot—pregnancy or PP?

Answer 7

PP

FIRST SIX WEEKS**

Question 8

what do we NEVER give a PP woman for contraception

Answer 8

estrogen only

bc first six weeks is the highest risk of a clot and estrogen increases clots tooo

Question 9

two main causes of pregnancy-associated venous thromboembolism (VTE)

Answer 9

DVTs and PE

Question 10

most imp RF for VTE in pregnancy is?

Answer 10

history of thrombosis

Question 11

do women require anti-coagulation during pregnancy

Answer 11

no—– the risk outweight its benefits

Question 12

what woman would benefit from anti-coagulation during pregnancy

Answer 12

hx of thrombosis or hx of inherited thrombophillia

Question 13

what is disseminated intravascular coagulation

• characteried by?
• what can cause obstetric DIC (6)

Answer 13

DIC

• life-threatening
• arise from obstetrical or nonobstetrical causes

Characterized by:
*systemic activation of blood coagulation–>results in generation and deposition of fibrin–>microvascular thrombi in various orans form

*all these clots use up the clotting factors and platelets–>results in a life-threatening hemorrhage because there are NO CLOTTING FACTORS AND PLATELETS LEFT TO STOP BLEEDING

CAUSES

• amniotic fluid embolism
• abrupto placentae
• acute peripartum hemorrhage
• retrained stillbirth
• septic abortion
• acute fatty liver of pregnancy

Question 14

two important blood group systems

Answer 14

ABO blood group

Rh blood group

Question 15

Rh system contains?

Answer 15

• proteins—-antigens— on the surface of RBCs

* *proteins are referred to as Rh Factor

Question 16

what is the Rh factor

Answer 16

antigens or proteins on the surface of RBCs

Question 17

describe a Rh+

Answer 17

when Rh factor is present on the surface of RBC

Question 18

describe Rh-

Answer 18

when Rh factor is NOT on the surface of RBCs

Question 19

what happens when you are RH- and blood mixes with Rh+

Answer 19

immune system will react to the Rh factor by making ANTIBODIES to destroy it
——Rh Sensitization

Question 20

Rh sensitization?

Answer 20

when a RH- person’s blood mixes with RH+ blood—- the RH- immune system will create antibodies against the RH+ and destroy it

Question 21

what is dangerous:
1. Rh- mom and Rh+ fetus
or
2. Rh+ mom and Rh- fetus

*when does mixing occur

Answer 21

Rh- MOM and Rh+ fetus

Mixing occurs RARELY in uterus and will mix at delivery

Question 22

when does mom start making anti-Rh antibodies when she is RH- and baby is Rh+

is the first baby affected?

Answer 22

when the bloods mix—- so DELIVERY is when her body starts–>post delivery mom is considered sensitized and stay in her blood

***this means that the first baby is not affected

Question 23

second child of a sensitized mom and Rh+ fetus— what happens to fetus

Answer 23

antibodies made during first delivery will attack the Rh+ baby–>it attacks the fetus’s RBCs –>anemia, jaundice or other serious problems

Question 24

if mom is Rh-, what two things are always checked

Answer 24

1. father’s Rh type—— bc if he also has Rh-, then the fetus will be Rh- and no issue
2. presence of anti-Rh antibodies in the mother—- meaning she is sensitized

Question 25

if mom is Rh- and fetus is determiend to be Rh+, the baby is evaluated for?

Answer 25

fetal hydrops

Question 26

fetal hydrops

• define
• outcome

Answer 26

serious condition that is caused by the Rh isoimmunization of the fetus—-aka when the mom’s Rh antibodies attack baby’s RBCs

outcome=is poor with high mortality and morbidity

Question 27

what is the goal if the mom never been sensitized?

Answer 27

to keep her from ever becoming sensitized

Question 28

how do we get mom to never become sensitized

Answer 28

give her—RhoGAM aka Rh immune globulin

Question 29

unsensitized moms get prophylaxis RhoGAM at what periods during pregnancy (5)

Answer 29

• 28 weeks gestation
• within 72 hours of delivery of a rh- baby
• after a miscarriage
• after abortion
• after ectopic pregnancy

Question 30

during what scenarios do we give RhoGAM in the first trimester (1-12 weeks)

Answer 30

ectopic pregnancy abortion or miscarriage

Question 31

define multiple gestation

Answer 31

two or more embryos or fetuses occupy the uterus simultaneously

Question 32

multiple gestation is considered? frequently ends in?

Answer 32

a complication of pregnancy

*frequently ends in pre-term deliveries

Question 33

monozygotic

• define
• how does it occur

Answer 33

ID twins (one egg, one sperm)

OCCURS
*when a single fertilized egg (embryo) splits

• same placenta
• different amniotic sacs

Question 34

dizygotic
-define
-

Answer 34

fraternal twins (two eggs, two sperm)

• each twin has its own–
  1. placenta
  2. chorion
  3. amnion

Question 35

in monozygotic twins, the fetal membranes and placentas present depends on?

Answer 35

when the embryo splits—- earlier the split—the more separate the membranes and placentas

Question 36

chorion

Answer 36

placenta

Question 37

amnion

Answer 37

sac/membranes

Question 38

dichorionic

Answer 38

two placentas for monozygotic

Question 39

Diamniotic

Answer 39

two sacs

Question 40

Monochorionic

Answer 40

one placenta

Question 41

monoamniotic

Answer 41

one sac

Question 42

twin to twin transfusion syndrome occurs with

Answer 42

monochorionic (one placenta) twins

Question 43

define twin to twin transfuion syndrome

Answer 43

imbalance in circulations of the fetuses

causes significant transfer of blood from one twin (donor) to the other (recipient)–resulting in TTTS

Question 44

Donor twin complications and recipient twin complications

Answer 44

DONOR: the most imp organs (brain and heart) get the blood and the rest of the body is shuntted—-cannot produce urine—leaves amniotic sac with less fluid—>OLIGOHYDRAMINOS

RECIPIENT: this twin will be overloaded with blood and urinating excessively—leaving the amniotic sac with more fluid—>POLYHYDRAMINOS

Question 45

how to diagnose TTTS

Answer 45

measuring amniotic fluid

Question 46

donor twin is at risk for developing?

Answer 46

organ failure due to inadequate blood flow

Question 47

what hapens to the other twin if one dies during monochorionic situation

Answer 47

the other twin faces significant risk of dying…. because they are sharing the placenta

70-80% of TTTS twins will die

Question 48

one tx for TTTS

Answer 48

laser surgery

Question 49

list the risk to mom with multiple gestations (3)

Answer 49

1. gestational diabetes
2. Placenta and bleeding problems
3. Preterm labor***

Question 50

risks to the fetus during mutliple gestations (3)

Answer 50

1. stillbirth
2. premature birth
3. low birth weight

Question 51

number one risk of multiple gestation?

Answer 51

preterm delivery