Flashcards in Multiple pregnancy and Puerperium Deck (21):
What is the difference between dizygotic and monozygotic twins? (2)
DZ: fertilisation of two different eggs (2/3)
MZ: mitotic division of single zygote
What are the three types of monozygotic twins? (3)
Division before day 3: Dichorionic diamniotic (30%)
Division day 3-8: monochorionic, diamniotic (70%)
Division day 9-13: monochorionic, monoamniotic (rare)
Name 3 risk factors for DZ twins? (2)
Increasing maternal age
-IVF (no more than 2 embryos in UK if under 40)
Name 2 antepartum complications of multiple pregnancy? (2)
Increased long term handicap
Preterm delivery, IUGR, Twin to twin transfusion syndrome
What is win-to-twin transfusion syndrome? (2)
Caused by unequal blood distribution through the vascular anastomoses of the shared placenta.
One twin (donor) becomes volume depleted and develops anaemia, IUGR and oligohydramnios. The recipient twin is volume overloaded and may develop polycythaemia, cardiac failure and polyhydramnios.
Name 2 intrapartum complications of multiple pregnancies. (2)
Malpresentation (c/s if in first twin)
Fetal distress in labour is more common
Post partum haemorrhage is more common
What is the lambda sign on ultrasound? (1)
(T sign in monochorionic twins)
What is the preferred treatment of twin-to twin transfusion syndrome? (1)
laser photo-coagualtion of placental anastomoses
50% chance of both twins surviving, 80% of one twin surviving.
What is the puerperium? (2)
From delivery until 6 weeks after as the body returns to pre-pregnancy state.
What is lochia? (1)
Discharge from the uterus after birth. It is bloody for approximately 4 weeks after birth.
Why is the risk of VTE most in the puerperium? (1)
Increased platelets and clotting factors
What is the biological mechanism of lactation? (2)
Prolactin is from the anterior pituitary, and causes the secretion of milk. There are high levels at birth but it is after birth when the oestrogen and progesterone levels have dropped that the milk is secreted. (O+P are antagonists of prolactin)
Oxytocin is required from the posterior pituitary for the ejection of milk in response to sucking on the nipple. however as oxytocin is produced in the hypothalamus, it is affected by emotional and physical stress.
Fiona has decided to breastfeed her baby, and now would like some advice on contraception now little Bonnie is 6 weeks old.
What would you advise her? (2)
COC is contraindicated (can suppress lactation)
Progesterone depots good for long term, or IUD.
What is primary post-partum haemorrhage? (2)
Loss of >500ml of blood in less than 24 hours after delivery.
If c/s then 1000ml
name 3 risk factors for PPH. (3)
Instrumental delivery or c/s
Uterine malformation or fibroids
name 1 drug that can help prevent PPH? (1)
Use of oxytocin or ergometrine in the the third stage of labour.
Note ergometrine is contraindicated in hypertension
What is a secondary PPH? (2)
Excessive blood loss occurring between 24 hours and 6 weeks after delivery.
Often due to endometritis with or without retained placental tissue.
name 3 complications of the puerperium. (3)
post partum haemorrhage
post natal depression
What scale can be used to assess post natal depression? (1)
Edinburgh PND scale
name 2 risk factors for post natal depression. (2)
(consider postpartum thyroiditis)