Multiple pregnancy and Puerperium Flashcards Preview

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Flashcards in Multiple pregnancy and Puerperium Deck (21):
1

What is the difference between dizygotic and monozygotic twins? (2)

DZ: fertilisation of two different eggs (2/3)
MZ: mitotic division of single zygote

2

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)

3

Name 3 risk factors for DZ twins? (2)

Genetic factors
Increasing maternal age
Assisted conception
-IVF (no more than 2 embryos in UK if under 40)
-Clomifene

4

Name 2 antepartum complications of multiple pregnancy? (2)

Maternal:
Gestational diabetes
Pre-eclampsia
Anaemia

Fetal:
increased mortality
Increased long term handicap
Preterm delivery, IUGR, Twin to twin transfusion syndrome
Miscarriage
Preterm labour

5

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.

6

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

7

What is the lambda sign on ultrasound? (1)

represents dichorionicity.
(T sign in monochorionic twins)

8

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.

9

What is the puerperium? (2)

From delivery until 6 weeks after as the body returns to pre-pregnancy state.

10

What is lochia? (1)

Discharge from the uterus after birth. It is bloody for approximately 4 weeks after birth.

11

Why is the risk of VTE most in the puerperium? (1)

Increased platelets and clotting factors

12

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.

13

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.

14

What is primary post-partum haemorrhage? (2)

Loss of >500ml of blood in less than 24 hours after delivery.
If c/s then 1000ml

15

name 3 risk factors for PPH. (3)

Previous history
Previous c/s
Coagulation defect
Instrumental delivery or c/s
Retained placenta
APH
Polyhydramnios/multiple pregnancy
Grand multiparity
Uterine malformation or fibroids
Prolonged/induced labour

16

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

17

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.

18

name 3 complications of the puerperium. (3)

VTE
Postpartum pyrexia
post partum haemorrhage
post natal depression
baby blues
postpartum thyroiditis

19

What scale can be used to assess post natal depression? (1)

Edinburgh PND scale

20

name 2 risk factors for post natal depression. (2)

Socially/emotionally isolated
previous history
pregnancy complications
(consider postpartum thyroiditis)

21

What is puerperial psychosis? (1)

Abrupt onset of psychotic symptoms usually aroudn the fourth day post partum, requires admission to psychiatric services and sedation.
most likely in primigravids with family history