High Risk Multiple Pregnancies Lecture Powerpoint

Question 1

Abortion definition

Answer 1

Expulsion of fetus less than 16 weeks

Question 2

Perinatal period

Answer 2

From 16 weeks to 28 days after birth

Question 3

Risks for perinatal death not caused by congenital anomalies (7)

Answer 3

• breech position
• placental separation
• pre-eclampsia eclampsia
• pyelonephritis
• hydramnios
• placenta previa
• twins

Question 4

Dizygotic (fraternal) twins

Answer 4

Originate from 2 zygotes, account for about 2/3 of twins, rates increase with age, can be same or different sex, and having one set increases likelihood of having it happen again

Question 5

Thick seputm and 2 zygotes on ultrasound indicates…

Answer 5

….dizygotic twins

Question 6

Dizygotic twins have __ amnion and chorions, the monozygotic varies based on when the zygotes divide during development

Answer 6

2

Question 7

Monozygotic (identical) twins, when do they become conjoined?

Answer 7

one fertilized ovum, cleavage before 72 hours results in dichorionic diamniotic (best outcome) twins, between days 4-8 monochorionic diamnionic (2nd best) twins, and if 8-13 monochorionic and monoamnionic (worst) twins. Cleavage after day 13 will result in conjoined twins***

Question 8

Vanishing twins

Answer 8

Occurs when ultrasound of first trimester finds twins 12% of all conceptions but only 1-2% of all births

Question 9

Maternal risks of twins (6)

Answer 9

• physiologic changes occurring are exaggeration of what occurs in single
• preterm labor
• hypertension
• increased c section rate
• abruption
• anemia
• postpartum hemorrhage

Question 10

Infant complications of twins (4)

Answer 10

• prematurity
• congenital anomalies increased 2-3x
• discordance (unequal weights due to altered surface area of placenta or twin to twin transfusion donation (smaller gives more to larger)
• typically larger twin does worse

Question 11

Twin complications

Answer 11

• vanishing fetus
• locking twins (one breech and 2nd cephalic preventing chins from passing each other)
• dead fetus syndrome (
• delayed delivery of one twin
• cord intertwining (high risk for sudden stillbirth in monoamniotic monozygotic twins)
• abruption
• acardiac twin (parasitic growth but no actual 2nd twin present)

Question 12

Maternal weight gain with twins or triplets

Answer 12

at least 30 lbs, at least 50 lbs in triplets

Question 13

Prevention of preterm labor (3)

Answer 13

• bed rest NO longer advised
• early work leave okay at 36 weeks or so
• corticosteroids can help with lung maturity

Question 14

Ultrasound cervix length

Answer 14

25mm or less at 24 weeks predicts preterm delivery

Question 15

Any 12+ (adult) who has even 2 recurrent seizures unprovoked by proximate insult is considered ___, in children they can be due to ___ as well

Answer 15

epilepsy, fevers

Question 16

Epilepsy and pregnancy

Answer 16

90% of women have a normal pregnancy, not a contraindication, however increased risk for perinatal complications

Question 17

Perinatal epileptics are at increased risk for these conditions (6)

Answer 17

• maternal death
• need for c section
• antepartum hemorrhage
• preterm labor
• stillbirth
• SUPEP (sudden unexpected death in epilepsy) - most were taking lamotrigine!

Question 18

Sudden unexpected death in epilepsy (SUPEP)

Answer 18

Sudden unexpected witnessed or unwitnessed non traumatic or non drowning death with or without evidence for seizure excluding status epilepticus which does not have autopsy reveal structural or toxicologic cause of death

Question 19

__% of all pregnancies are unplanned

Answer 19

50%

Question 20

Antiepileptic drug lower ___ putting developing infant at increased risk for ___

Answer 20

folic acid, neuro tube defects

Question 21

All pregnant women should be on __ mg folic acid, epileptics should be on ___

Answer 21

.4-.8, 4mg

Question 22

If pregnant and been 2 years since last seizure, should they withdraw?

Answer 22

No, wait till the pregnancy is over

Question 23

Valproate and pregnancy

Answer 23

Antiepileptic contraindicated in pregnancy because of high teratogenicity unless already established pregnancy (don’t want to have seizure occur during change over)

Question 24

Drug of choice for seizure abortion in delivery

Answer 24

Lorazepam

Question 25

Lactation and antiepileptic drugs

Answer 25

Present in breast milk, not a concern to the newborn but avoid sedating ones such as phenobarbitol

Question 26

Fetal hydantoin syndrome

Answer 26

Caused by phenytoin (antiepileptic )use in pregnancy can result in craniofacial anomalies, IUGR, developmental delay, cleft lip/palate, etc

Question 27

Spinal bifida

Answer 27

a birth defect that occurs when the spine and spinal cord don't form properly. It's a type of neural tube defect. The neural tube is the structure in a developing embryo that eventually becomes the baby's brain, spinal cord and the tissues that enclose them, treated thru surgery

Question 28

Keppra (levetiracetam)

Answer 28

Antiepileptic drug that is the safest for women of reproductive age as it has the lowest incidence of birth defects (same as unexposed pregnancies)

Question 29

Anticoagulants in pregnancy

Answer 29

Heparins are the safest choice, lovonox (lmw heparin) is used throughout with switch to unfractionated heparin in the last month of pregnancy since it is more quickly reversed, anticoagulated patients are not eligible for epidural analgesia,does not cross the placenta so no worry about harming the fetus

Question 30

Goal aPTT range in pregnant woman

Answer 30

1.5-2.5x control (30-40 seconds is control, so like 45-120)

Question 31

Warfarin in pregnancy

Answer 31

Embryopathic in first trimester, passes the placenta and fetus is anticoagulated may cause fetal hemorrhage, can switch to after birth

Question 32

Pregnancy coagulability

Answer 32

Pregnancy is a hypercoaguable state with increased factor II, VII, VIII, X, and XII and decreased protein S

Question 33

Most DVT occur in the __ leg in pregnancy

Answer 33

left

Question 34

5 inherited autosomal thrombophilias

Answer 34

-factor v leidan -prothrombin gene mutation -hyperhomocystinemia -protein C deficiency Protein S deficiency

Question 35

PE diagnostic studies (4)

Answer 35

- D dimer (nonspecific) - pulmonary angiography - spiral CT (gold standard in pregnancy) - duplex scan/compression ultrasound