Week 5 Flashcards
Monozygotic twins can be
DC/DA, MC/DA, MC/MA
If the morula splits at day 3-6, you have a
Monochorical, diamnostic twin
Monochorical twins have a ..-sign
T-sign
Which anastamosis between twins is problematic and why?
Artery-vein anastamosis: difference in pressure, so it goes 1 way. In this is the risk of complications.
Which variant of monochronic twin pregnancy is the most common?
Monochorical diamniotic. (3/4)
What are risk factors for getting twins?
Ethnicity, maternal age, Family history, assisted reproduction, BMI
How can you determine chorinicity?
<10 weeks you can see thick intertwin membrane, 10-14 weeks T-/lambda sign, fetal sex, placental mass/location, thickness intertwin membrane.
Why do twin pregnancies have more chance of preterm birth?
Because of stretch of the uterus, this induces > gapjunctions, upregulation of oxytocine receptors, production of inflammatory cytokines en prostaglandines.
What are fetal complications in monochorionic twins?
Twin To Twin Transfusion syndrome (TTTS, 10-15%), Twin Anemia Polychythemie Sequence (TAPS, 5%), Selective Intrauterine Growth Restriction (sIUGR, 10-15%)
How can you measure TTTS?
Flow irregulations in a. umb, ductus and vein umb.
What can you see with twins with TAPS?
Child with anemia: enlarged heart
Child with thick blood: Necrose perifere.
How can you make the diagnosis pre-eclampsia?
Combination of high blood pressure AND proteinuria OR fetal growth restriction OR Maternal organ disfunction (kidney’s, liver, neurolgical or hematological).
What is the etiology of pre-eclampsia?
Placental development & spiral artery don’t get as wide as they should be.
What are the three functions of the placenta?
- Transport: oxygen/gas, nutritions.
- Protection: against infections and graft VS host reaction
- Production: Papp, HPL
What is the treatment of pre-eclampsia?
Stabelize the mother and fetus! Than plan when is the optimal time for birth. When RR ^ 150/95 you can give anti-hypertensia
What is happening if the mother has symptoms of headache, light flits and tingling fingers?
Symptoms of neurological disfunction -> Insult or brain damage! You should give anti-hypertensia and magnesiumsulfate.
What 2 medication can you give to prevent pre-eclampsia?
Calcium (especially in vegans) and aspirine.
Higher risk on pre-eclampsia?
Previous pre-eclampsia, chronic kidney disease, hypertension, DM, Auto-immune disorders, first pregnancy, age of 40 or more, BMI >35, multiple pregnancy.
What is HELLP-syndrome
Syndrome caused by pre-eclampsia: Heamolysis, elevated liver enzymes, low platelets.
According to Barker, what does low birth weight lead to?
Insulin resistence, type 2 diabetes, hypertension, CVR.
Exposure to hunger early in pregnancy
Normal birthweight, but later obesity, dyslipedemia en increased risk cardiovascular disease.
Exposure to hunger late in pregnancy leads to
Low birthweight, but later obesity, DM2 risk and glucose intolerance.
What is the difference between SGA en IUGR
SGA= Fetus/ neonate with biometry
What are the four causes of SGA?
- Fetal
- Maternal (chronic disease, abnormal placentation)
- Placental (mozaicsm, uterus anomalies)
- External factors
Describe Early IUGR?
Low incidence, very difficult to manage. Highly corelated to maternal disease (pre-eclampsia).
What are the adjustments in the right order of the fetus to pre-eclampsia?
First fetal growth, then aortic flow and cerebral flow, abnormal FMR trace, abnormal DV flow
Which arteries can you use diagnostically for IUGR?
- A. uterina: look for notch
- A. umbilical
- Middel cerebral artery
Why is the ductus venosus important?
Is the connection between v. umbilicalis and right atrium. Last stadium of compensation mechanisms.
Welke 3 onderzoeken om te kijken hoe het met baby gaat?
Doppler a. umbilicalis, doppler ductus venosus and CTG (of mother, baby and uterus contractions).
What is the protocol by severe IUGR <32 weeks?
cCTG en DV should be used and delivery undertaken when one of these is abnormal.
What is the protocol with late IUGR?
Doppler of UA and MCA. Ratio of <1.08 centralization of cardiac output.
Describe late IUGR?
High incidence, UA doppler normal, fetal movements are less in late stadium.
What to do with detaching placenta?
CS or initiate vaginal birth
What is chronical hypertension?
voor de zwangerschap al hoge bloeddruk. Dit zie je al voor de 20 weken. In deze periode gaat het fysiologisch omlaag, wat het maskeert
What is the difference in pregnancy high blood pressure and pre-eclampsia?
Na 20 weken heb je zwangerschapsbloeddruk
Bij pre-eclampsie heb je deelname van meer organen.
… higher cardiovascular mortality in women with
Hypertensive pregnancy disorders
2-3x
Cardiovascular mortality risk … x higher when HPD
combined with preterm birth and/or IUGR
5x
