Week 5

Question 1

Monozygotic twins can be

Answer 1

DC/DA, MC/DA, MC/MA

Question 2

If the morula splits at day 3-6, you have a

Answer 2

Monochorical, diamnostic twin

Question 3

Monochorical twins have a ..-sign

Answer 3

T-sign

Question 4

Which anastamosis between twins is problematic and why?

Answer 4

Artery-vein anastamosis: difference in pressure, so it goes 1 way. In this is the risk of complications.

Question 5

Which variant of monochronic twin pregnancy is the most common?

Answer 5

Monochorical diamniotic. (3/4)

Question 6

What are risk factors for getting twins?

Answer 6

Ethnicity, maternal age, Family history, assisted reproduction, BMI

Question 7

How can you determine chorinicity?

Answer 7

<10 weeks you can see thick intertwin membrane, 10-14 weeks T-/lambda sign, fetal sex, placental mass/location, thickness intertwin membrane.

Question 8

Why do twin pregnancies have more chance of preterm birth?

Answer 8

Because of stretch of the uterus, this induces > gapjunctions, upregulation of oxytocine receptors, production of inflammatory cytokines en prostaglandines.

Question 9

What are fetal complications in monochorionic twins?

Answer 9

Twin To Twin Transfusion syndrome (TTTS, 10-15%), Twin Anemia Polychythemie Sequence (TAPS, 5%), Selective Intrauterine Growth Restriction (sIUGR, 10-15%)

Question 10

How can you measure TTTS?

Answer 10

Flow irregulations in a. umb, ductus and vein umb.

Question 11

What can you see with twins with TAPS?

Answer 11

Child with anemia: enlarged heart

Child with thick blood: Necrose perifere.

Question 12

How can you make the diagnosis pre-eclampsia?

Answer 12

Combination of high blood pressure AND proteinuria OR fetal growth restriction OR Maternal organ disfunction (kidney’s, liver, neurolgical or hematological).

Question 13

What is the etiology of pre-eclampsia?

Answer 13

Placental development & spiral artery don’t get as wide as they should be.

Question 14

What are the three functions of the placenta?

Answer 14

1. Transport: oxygen/gas, nutritions.
2. Protection: against infections and graft VS host reaction
3. Production: Papp, HPL

Question 15

What is the treatment of pre-eclampsia?

Answer 15

Stabelize the mother and fetus! Than plan when is the optimal time for birth. When RR ^ 150/95 you can give anti-hypertensia

Question 16

What is happening if the mother has symptoms of headache, light flits and tingling fingers?

Answer 16

Symptoms of neurological disfunction -> Insult or brain damage! You should give anti-hypertensia and magnesiumsulfate.

Question 17

What 2 medication can you give to prevent pre-eclampsia?

Answer 17

Calcium (especially in vegans) and aspirine.

Question 18

Higher risk on pre-eclampsia?

Answer 18

Previous pre-eclampsia, chronic kidney disease, hypertension, DM, Auto-immune disorders, first pregnancy, age of 40 or more, BMI >35, multiple pregnancy.

Question 19

What is HELLP-syndrome

Answer 19

Syndrome caused by pre-eclampsia: Heamolysis, elevated liver enzymes, low platelets.

Question 20

According to Barker, what does low birth weight lead to?

Answer 20

Insulin resistence, type 2 diabetes, hypertension, CVR.

Question 21

Exposure to hunger early in pregnancy

Answer 21

Normal birthweight, but later obesity, dyslipedemia en increased risk cardiovascular disease.

Question 22

Exposure to hunger late in pregnancy leads to

Answer 22

Low birthweight, but later obesity, DM2 risk and glucose intolerance.

Question 23

What is the difference between SGA en IUGR

Answer 23

SGA= Fetus/ neonate with biometry

Question 24

What are the four causes of SGA?

Answer 24

1. Fetal
2. Maternal (chronic disease, abnormal placentation)
3. Placental (mozaicsm, uterus anomalies)
4. External factors

Question 25

Describe Early IUGR?

Answer 25

Low incidence, very difficult to manage. Highly corelated to maternal disease (pre-eclampsia).

Question 26

What are the adjustments in the right order of the fetus to pre-eclampsia?

Answer 26

First fetal growth, then aortic flow and cerebral flow, abnormal FMR trace, abnormal DV flow

Question 27

Which arteries can you use diagnostically for IUGR?

Answer 27

1. A. uterina: look for notch
2. A. umbilical
3. Middel cerebral artery

Question 28

Why is the ductus venosus important?

Answer 28

Is the connection between v. umbilicalis and right atrium. Last stadium of compensation mechanisms.

Question 29

Welke 3 onderzoeken om te kijken hoe het met baby gaat?

Answer 29

Doppler a. umbilicalis, doppler ductus venosus and CTG (of mother, baby and uterus contractions).

Question 30

What is the protocol by severe IUGR <32 weeks?

Answer 30

cCTG en DV should be used and delivery undertaken when one of these is abnormal.

Question 31

What is the protocol with late IUGR?

Answer 31

Doppler of UA and MCA. Ratio of <1.08 centralization of cardiac output.

Question 32

Describe late IUGR?

Answer 32

High incidence, UA doppler normal, fetal movements are less in late stadium.

Question 33

What to do with detaching placenta?

Answer 33

CS or initiate vaginal birth

Question 34

What is chronical hypertension?

Answer 34

voor de zwangerschap al hoge bloeddruk. Dit zie je al voor de 20 weken. In deze periode gaat het fysiologisch omlaag, wat het maskeert

Question 35

What is the difference in pregnancy high blood pressure and pre-eclampsia?

Answer 35

Na 20 weken heb je zwangerschapsbloeddruk

Bij pre-eclampsie heb je deelname van meer organen.

Question 36

… higher cardiovascular mortality in women with

Hypertensive pregnancy disorders

Answer 36

2-3x

Question 37

Cardiovascular mortality risk … x higher when HPD

combined with preterm birth and/or IUGR

Answer 37

5x