OBGYN Lesson 3

Question 1

What is the leading cause of maternal death?

Answer 1

Hemorrhage

Question 2

Why is being pregnant a hyper coagulable state (thrombophilia)?

Answer 2

Because pregnancy causes decreased venous outflow, hormonal changes, decreased mobility and an increase in factors VII, VIII, X, and fibrinogen in clotting cascade.

Question 3

How many times more likely are women to have a blood clot or thromboembolic event during pregnancy?

Answer 3

4-5 x

Question 4

How many times higher is the risk of a clot in post partum during the first six weeks after delivery?

Answer 4

20-80 x

Question 5

What do you never give post partum women?

Answer 5

Estrogen based contraception.

Question 6

What % of pregnancy associated venous thromboembolism (VTE) is DVT and how much is PE?

Answer 6

75% and 20-25%

Question 7

What is the most important risk factor for VTE in pregnancy?

Answer 7

History of thrombosis.

Question 8

Who are the only women who can benefit from anticoagulation?

Answer 8

History of thrombosis or a history of inherited thrombophilia.

Question 9

Disseminated intravascular coagulation (DIC)?

Answer 9

Life threatening situation characterized by systemic activation of coagulation which results in generation and deposition of fibrin, leading to microvascular thrombi in various organs. Creating all of these clots uses up the clotting factors and platelets and then results in a life-threating hemorrhage because there are no clotting factors and platelets left to stop the bleeding.

Question 10

What obstetric calamities can lead to DIC?

Answer 10

Amniotic fluid embolism, abruptio placentae, acute prepartum hemorrhage, retained stillbirth, septic abortion, and acute fatty liver of pregnancy.

Question 11

What is Rh sensitization?

Answer 11

If you are Rh - but your blood mixes with Rh + blood your immune system will react to the Rh factor by making antibodies to destroy it.

Question 12

What is the MC way Rh + and Rh- blood mixes?

Answer 12

When an Rh - mother has a Rh + baby during delivery.

Question 13

What two things are checked in Rh - mothers?

Answer 13

Fathers Rh type bc if the he is also negative, the baby will be negative and there will be no problem with blood mixing AND the presence of anti RH antibodies in the mother already.

Question 14

What do you do if mother is already sensitized?

Answer 14

Rh type of fetus must be determined.

Question 15

What do you do if mother is sensitized and fetus is Rh +?

Answer 15

Evaluate fetus for fetal hydros a serious condition that is caused by the Rh isoimmunization of the fetus (when the mom’s anti-Rh antibodies attack the baby’s RBCs).

Question 16

How do you keep a mother from ever being sensitized?

Answer 16

Give the mom Rh immune globulin (RhoGAM) at key points throughout the pregnancy and then during each subsequent pregnancy. In addition, the mother is given RhoGAM if there are any signs of blood mixing.

Question 17

When do you give unsensitized moms prophylactic RhoGAM?

Answer 17

28 weeks gestation
Within 72 hours of delivery of a Rh-positive fetus
After a miscarriage
After an abortion (usually only if 10+ weeks)
After an ectopic pregnancy

Question 18

Doses of RhoGAM in pregnancy?

Answer 18

1st trimester (1-12 wks) --> IM of 50 mcg.
2nd and 3rd --> 300 mcg.

Question 19

Multiple gestation?

Answer 19

Any pregnancy in which two or more embryos or fetuses occupy the uterus.

Question 20

What do multiple gestation pregnancies frequently end in?

Answer 20

Pre-term deliveries.

Question 21

Monozygotic?

Answer 21

Identical twins (one egg, one sperm). Single embryo splits thus fetal membranes and placenta present depends on when the embryo splits. The earlier the split the more separate the membranes and placentas will be.

Question 22

Dizygotic?

Answer 22

Fraternal twins (two eggs, two sperm). Distinct pregnancies in a single uterus but each fetus has its own amnion, chorion and placenta.

Question 23

Chorion?

Answer 23

Placenta

Question 24

Amnion?

Answer 24

sac/membrane

Question 25

What type of twins have a risk of Twin to Twin Transfusion Syndrome (TTTS)?

Answer 25

Monochorionic twins.

Question 26

What does TTTS result from?

Answer 26

Imbalance in circulations of fetuses that causes a significant transfer of blood from one twin (“donor”) to the other (“recipient”).

Question 27

What happens when one fetus does not have enough blood and oxygen?

Answer 27

It emphasizes the blood flow to the most important organs (brain and heart) and shutting down less vital organs like kidneys. Thus, the donor twin will not make urine, which will leave the amniotic sac with less fluid (oligohydramnios).

Question 28

What happens to the recipient twin when there is too much blood?

Answer 28

The recipient twin will be overloaded with blood and urinating excessively, which will leave the amniotic sac with more fluid (polyhydramnios).

Question 29

Diagnose TTTS?

Answer 29

Measure amniotic fluid.

Question 30

What is the donor twin at risk for with TTTS?

Answer 30

Organ failure due to inadequate blood flow.

Question 31

What happens if one twin dies in TTTS?

Answer 31

Since both twins are connected to one placenta, the other twin will face significant risk of death or damage to vital organs and w/o tx, 70-80% of twins with TTTS will die.

Question 32

Tx for TTTS?

Answer 32

Laser surgery in which a fetoscopic laser is used to eliminate the extra/abnormal vascular connections. When this is done, survival rates for at least one twin are greater than 85% and for both twins is about 60%.

Question 33

What are the risks to the mother with multiple gestations?

Answer 33

Gestational diabetes
Placenta & bleeding problems
Preterm labor

Question 34

What are the risks of a fetus if part of a multiple gestation?

Answer 34

Stillbirth
Premature birth
Low birth weight