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Obstetrics > Outcomes for Pregnancy > Flashcards

Outcomes for Pregnancy Flashcards

1
Q

What are monozygotic multiple pregnancy

A

Identicle twins from a single zygote

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2
Q

What are dizygotic multiple pregnancy

A

Non-identicle twins from two different zygotes

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3
Q

What does monoamniotic mean

A

Embryo in a single amniotic sac

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4
Q

What does diamniotic mean

A

Embryo in two separate amniotic sacs

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5
Q

What does monochorionic mean

A

Embryo share a single placenta

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6
Q

What does dichorionic mean

A

Embryo have two separate placentas

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7
Q

Sign of diachorionic diamniotic twins on US

A

Lambda sign or twin peak sign - triangular appearance where the membrane meets chorion and partially blends which indicates separate placentas (membrane between twins)

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8
Q

Sign of monochorionic diamniotic twins on US

A

T sign - membrane abruptly meets the chorion indicating single placenta (membrane between twins)

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9
Q

Sign of monochorionic monoamniotic twins on US

A

There is no membranes separating the twins

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10
Q

Complications of twins

A

Anaemia, polyhydramnios, HTN, malpresentation, spontaneous preterm birth, instrumental delivery or C section, PPH

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11
Q

Risk to the fetus and neonates of multiple births

A

Miscarriage, stillbirth, fetal growth restriction, prematurity, twin-twin transfusion syndrome
twin anaemia polycythaemia sequence, congenital abnormalities

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12
Q

Antenatal care for multiple pregnancy

A

Monitoring for anaemia, additional US scans, planned birth offered, corticosteroids given before delivery to help mature lungs

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13
Q

Delivery options for twins

A

Monoamniotic twins - elective C section between 32-33+6 weeks.
Diamniotic twins - vaginal if first presentation is cephalic - C section may be required for second

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14
Q

What classifies as small for gestational age

A

Below 10th centile, two measurements on US are used to measure it - estimated fetal weight and fetal abdominal circumference

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15
Q

Causes of small for gestational age

A

Constitutionally small or fetal growth restriction - divided into placenta mediated growth restrictoin and non-placental mediated growth restriction

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16
Q

Causes of placental mediated growth restriction

A

Idiopathic, pre-eclampsia, maternal smoking, maternal alcohol, anaemia, malnutrition, infection, maternal health conditions

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17
Q

Causes of non-placental mediated growth restriction

A

Genetic abnormalities, structural abnormalities, fetal infection, errors of metabolism

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18
Q

Signs of fetal growth restriction

A

SGA, reduced amniotic fluid volume, fetal movements, abnormal doppled studies, abnormal CTGs

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19
Q

Short term complications of fetal growth restriction

A

Fetal death or stillbirth, birth asphyxia, neonatal hypothermia, neonatal hypoglycaemia

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20
Q

Long term complications of fetal growth restriction

A

CVD, HTN, T2DM, obesity, mood, behavioural problems

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21
Q

Risk factors for SGA

A

Previous SGA baby, obesity, smoking, diabetes, HTN, pre-eclampsia, mother >35, multiple pregnancy, low pregnancy associated plasma protein A, antepartum haemorrhage, antiphospholipid syndrome

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22
Q

Monitoring for SGA babies or those with risk factors

A

Serial growth scans with umbilical artery doppler

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23
Q

Monitoring for mothers with high risk factors for SGA

A

Serial US measuring - estimated growth weight and abdominal circumference to determine growth velocity, amniotic fluid volume and umbilical arterial pulsatility index (measure flow through umbilical artery)

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24
Q

What classifies as large for gestational age

A

Weight is more than 4.5kg at birth or estimated fetal weight is above 90th centile

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25
Q

Causes of LGA

A

Constitutional, maternal diabetes, previous macrosomia, maternal obesity or rapid weight gain, overdue, male baby

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26
Q

Risks of LGA babies

A

Shoulder dystocia, failure to progress, perineal tears, instrumental delivery or caesarean, PPH, uterine rupture, birth injury, neonatal hypoglycaemia, obesity in childhood and later life, T2DM

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27
Q

Management of LGA

A

US to exclude polyhydramnios and estimate fetal weight, OGTT

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28
Q

Causes of stillbirth

A

Unplained (50%), pre-eclampsia, placental abruption, vasa praevia, cord prolapse or wrapped around fetal neck, obstetric cholestasis, diabetes, thyroid disease, infections, genetic abnormalities or congenital malformations

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29
Q

Definition of stillbirth

A

Birth of a dead fetus after 24 weeks gestation - it is result of intrauterine fetal death

30
Q

Factors increasing risk of stillbirth

A

Fetal growth restriction, smoking, alcohol, increased maternal age, maternal obesity, twins, sleeping on back as opposed to side

31
Q

Diagnosis of stillbirth

A

US to visualise fetal heart beat, passive fetal movements possible after IUFD and a repeat scan is offered

32
Q

Management of stillbirth

A

Vaginal birth unless reasons for C section, choice of induction of labour or expectant management - mifepristone and vaginal or oral misoprostol, and dopamine agonists to suppress lactation after birth

33
Q

How is medical abortion carried out

A

Two treatments of mifepristone and misoprostol 1-2 days later.

34
Q

How is surgical abortion carried out

A

Involves cervical priming with misoprostol, mifepristone or osmotic dilators. Then dilation and suction of contents of uterus usually up to 14 weeks. Or dilation and evacuation using forcepts between 14-24 weeks

35
Q

Management after abortion

A

Urine pregnancy test at 3 weeks to confirm completion

36
Q

Complications of abortion

A

Vaginal bleeding and cramps intermittently, failure, damage to cervix, uterus or other structures

37
Q

Legal requirements of abortion before 24 weeks

A

Can be performed before 24 weeks if continuing pregnancy involves greater risk to the physical or mental health of the women or existing children of the family

38
Q

Legal requirements of abortion at any gestation

A

Can be performed at any time during pregnancy if continuing the pregnancy is likely to risk life of women, prevent permanent injury to physical or mental health of the woman, or substantial risk child would suffer

39
Q

What is a hydatidiform mole

A

Type of tumour which grows like a pregnancy inside the uterus. Also called molar pregnancy. There are two types

40
Q

What is a complete molar pregnancy

A

When two sperm fertilise an ovum which has no genetic material. These then combine material and cells divide to form tumour, where no fetal material will form

41
Q

What is a partial molar pregnancy

A

When two sperm fertilise a normal ovum at the same time so the cell has 3 sets of genetic chromosomes. Cell mulitplies into tumour and some fetal material may form

42
Q

Indications of a molar pregnancy rather than a normal pregnancy

A

More severe morning sickness, vaginal bleeding, increased enlargement of uterus, abnormally high hCG, thyrotoxicosis - hCG can mimic TSH

43
Q

What will an US scan show of a molar pregnancy

A

Snowstorm appearance.

44
Q

Diagnosis of molar pregnancy

A

Provisional diagnosis made by US and confirmed with histology of mole after evacuation

45
Q

Management of molar pregnancy

A

Evacuation of uterus to remove mole, patients referred to gestational trophoblastic disease centre. Levels of hCG monitored until returned to normal. Occasionally mole may metastasise

46
Q

Risk factors for ectopic pregnancy

A

Previous ectopic, previous PID, previous surgery to fallopian tubes, intrauterine devices, older age, smoking

47
Q

Features of ectopic pregnancy

A

Missed period
Constant lower abdominal pain in iliac fossa
Vaginal bleeding
Lower abdominal or pelvic tenderness
Cervical motion tenderness
Dizziness/syncope (blood loss)
Shoulder tip pain (peritonitis)

48
Q

US findings of ectopic pregnancy

A

Gestational sac containing yolk sac or fetal pole may be seen in fallopian tube, empty uterus and fluid in uterus, non-specific mass seen

49
Q

What is pregnancy of unknown location

A

When a woman has a positive pregnancy test but there is no evidence of pregnancy on US scan

50
Q

What is used to help monitor pregnancy of unknown location

A

Serum hCG tracked over time, it is repeated after 24 hours to measure change from baseline

51
Q

What happens to levels of hCG in ectopic or miscarriage

A

There is a rise of less than 63% after 48 hours

52
Q

Management of ectopic pregnancy

A

Expectant, medical or surgical management

53
Q

Criteria for expectant management of ectopic pregnancy

A

Unruptured, adnexal mass <35mm, no visivle heartbeat, no pain, hCG <1500IU/L

54
Q

Criteria for medical management of ectopic pregnancy

A

hCG level must be <5000IU/, confirmed absence of intrauterine pregnancy on US

55
Q

How is medical management of ectopic carried out

A

Methotrexate given as IM injection and patient advised not to get pregnant in following 3 months

56
Q

Criteria for surgical management of ectopic pregnancy

A

Most require surgical - Pain, adnexal mass >35mm, hCG levels >5000,visible heart beat

57
Q

How is surgical management of ectopic pregnancy carried out

A

Lap salpingectomy first line and lap salpingotomy in women at increased risk of fertility due to damage to other tube, reduced risk of removal of ectopic. Anti-rhesus D prophylaxis given if necessary

58
Q

S/E of methotrexate for ectopic treatment

A

Vaginal bleeding, nausea and vomiting, abdominal pain, stomatitis

59
Q

What classifies as a miscarriage

A

spontaneous termination of pregnancy - with early being before 12 weeks and late between 12-24 weeks

60
Q

What is a threatened misscariage

A

Vaginal bleeding with a closed cervix and fetus which is alive

61
Q

What is an inevitable misscariage

A

Vaginal bleeding with an open cervix

62
Q

What is an anembryonic misscariage

A

Gestational sac is present present but contains no embryo

63
Q

What is an incomplete misscariage

A

Retained products of conception which remain in uterus after miscarriage

64
Q

Features which sonographer uses to determine miscarriage

A

Mean gestation sac diameter, fetal pole, crown rump length and fetal heartbeat

65
Q

Management if miscarriage is less than 6 weeks in gestation

A

Presenting with bleeding they can be managed expectantly providing they have no pain or complications or risk factors. Repeat pregnancy test after 7-10 days to confirm

66
Q

Management if miscarriage is more than 6 weeks in gestation

A

Expectant management, medical management or surgical management

67
Q

Risks of having an incomplete miscarriage

A

Risk of infection

68
Q

Management of incomplete miscarriage

A

Medical management with misoprostol or surgical management by evacuation of retained products

69
Q

What defines recurrent miscarriages

A

Three or more consecutive misscariages

70
Q

When are investigations for miscarriages initiated

A

Three or more first trimester, one or more in second trimester

71
Q

Causes of miscarriage

A

Idiopathic
Antiphospholipid syndrome
Hereditary thrombophilias
Uterine abnormalities
Genetic factors ni parents
Chronic histiocytic intervillositis
Other chronic diseases - diabetes, thyroid, SLE

Obstetrics (8 decks)

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