Obs

Question 1

What is the management of Molar pregnancy?

Answer 1

1. Vaginal prostaglandins
2. ERPC
3. Serial bHCG monitoring in specialist centre
4. If not trending down, methotrexate (no conception for 6m!)
5. no conception until f/u complete/normal bHCG for 6m

Question 2

What are the risks of molar pregnancy?

Answer 2

Complete mole:
1% risk of recurrance
2.5% risk of choriocarcinoma
10% of invasive mole

Question 3

How is GDM investigated antenatally?

Answer 3

2h 75g OGTT at booking if: previous GDM, glycosuria on urine dip

Otherwise at 24-28w

Question 4

What are some risk factors for GDM?

Answer 4

Previous GDM
BMI >30
Prev baby weighing >4.5kg
FHx
Asian

Question 5

What are some complications of GDM?

Answer 5

MATERNAL
risk of developing T2DM

FETAL
macrosomia
shoulder dystocia

Question 6

Management of GDM?

Answer 6

Fasting >5.6
2hr >7.8

1. diet and exercise
2. metformin
3. insulin+metformin
4. glicenclamide

insulin straight aaway if fasting >7

Targets: pre-meal = <5.3, 1h postprandial = <7.8

IOL from 37w
Hourly glucose monitoring during labour

Question 7

How is TTTS diagnosed?

Answer 7

when the difference between eaach twin is more than 25%

Question 8

What is the pathophysiology of TTTS?

Answer 8

When there is arterial to venous flow in MC twins. The doner baby becomes SGA and experiences oligohydramnios.
The recipent baby becomes LGA and experiences polyhydramnios. This baby is also at risk of hydrops fetalis

Question 9

How is TTTS monitored?

Answer 9

Sudden increase in abdo size
Growth scans every 2w from 16w
Elective delivery of MC twins from 36w

Question 10

How is TTTS managed?

Answer 10

<26w - fetoscopic lsaer ablaation of vasculaar aanastomeses

> 26w - delivery

Question 11

Classify the difference types of twin pregnancy and how they present on USS

Answer 11

DCDA - cleavage at 1-3 days = lambda sign
MCDA - cleavage at 4-8 days = T sign
MCMA - cleavage at 8-13 days = T sign
Conjoined - cleavagae at 13-15 daays

Question 12

How is Cardiac disease managed in pregnancy?

Answer 12

o	Echocardiogram at booking and at 28 weeks
o	Anticoagulation may be necessary
o	Avoid induction of labour if possible
o	Use prophylactic antibiotics
o	Ensure fluid balance
o	Avoid supine position
o	Discuss regional/epidural anaesthesia 
o	Keep the second stage short
o	Use syntocinon judiciously, avoid ergometrine