Fetal Complications Flashcards
(30 cards)
How common is multiple pregnancy?
>Incidence because of assisted fertility treatment
1/80 pregnancies are twins
1/4000 pregnancies are triplets
Splitting of the embryo at 0-3 weeks results in what class of twins?
(Separate chorion and amnion)
Dichorionic and diamniotic
Splitting of the embroy at 3-8 weeks results in what type of twins?
(Shared chorion)
Monochorionic and diamniotic
Splitting of the embryo at 8-12 weeks results in what class of twins?
(Shared amnion and chorion)
Monochorionic and monoamniotic
Splitting of the embryo at 12+ weeks results in what class of twins?
Shared body, conjoined
What is the chorion?
Placenta
What is the amnion?
Amniotic sac
Give the maternal complications of multiple pregnancy
Miscarriage
Hyperemesis
Anaemia
Pre-eclampsia
Gestational diabetes
Operative delivery
Post-natal depression
Give the fetal complications of multiple pregnancy
Twin-twin transfusion syndrome
Congenital Abnormalities
Malpresentation
Locked Twins
IUD
IUGR
Preterm labour and low birth weight
What is twin-twin transfusion syndrome?
Anastomosis between vessels occurring in shared placenta/Mono-chorionic twins
Recipient gets cardiac failure, polyhydramnios
What is intrauterine growth restriction (IUGR)?
Low birthweight infants (below 10th centile), may be constitutionally small or growth restricted due to pathological process
What can cause IUGR?
Maternal
- Poor nutrition
- Smoking
- Alcohol and drug abuse
- Maternal disease
Fetal
- Abnormality
- Infection
Placental
- Failure of trophoblast invasion, leading to reduced oxygen transfer to the fetus
What is assessed on US to diagnose IUGR?
Fetal size
Oligohydramnios
Doppler for blood supply
What is intrauterine death?
Birth of an infant >24 weeks gestation with no signs of life
How common is IUD?
1/200 births
Give fetal causes of IUD
Chromosomal abnormalities
Infection
Umbilical cord accidents
Twin-twin transfusion syndrome
Give maternal causes of IUD
Chronic disease
Obstetric cholestasis
Rhesus disease
Thrombophilia
Give placental causes of IUD
Abruption
Pre-eclampsia
Smoking
What is reduced fetal movements?
<10 movements within 2 hours in pregnancies >28 weeks gestation is indication for further assessment
When should fetal movements be established?
By 24 weeks
Usually occurs between 18-20, which increases until 32 weeks gestation where they begin to plateau
Give risk factors for reduced fetal movements
Posture
- More prominent lying down and less when sitting and standing
Placental position
- Patient with anterior placentas prior to 28 weeks gestation may have decreased awareness of movements
Medication
- Alcohol
- Opiates
- Benzodiazepines
Fetal position
- Anterior fetal position means movements are less noticeable
>BMI
- Less likely to feel prominent fetal movements
Amniotic fluid volume
- Oligohydramnios
- Polyhydramnios
Fetal size
What investigations are used in reduced fetal movements?
Doppler to confirm fetal heartbeat
CTG for 20 minutes if heartbeat detectable
Immediate US if no detectable heartbeat
What is the most common cause of early-onset severe infection in the neonatal period?
Group B Streptococcus (GBS)
What is the management for women who have had GBS detected in previous pregnancies?
Offered intrapartum antibiotic prophylaxis (IAP) or testing in late pregnancy and then antibiotics if still positive
