pregnancy stuff Flashcards

Question

**complications of multiple pregnancy**

Answer 1

**1st trimester** o Maternal * Anaemia * Miscarriage * HG o Foetal * risk of congenital anomalies **2nd trimester-3rd trimester** o Foetal * Polyhydramnios * IUGR * Placental abruption * **_Twin-twin transfusion syndrome_** (most common with monochorionic, diamniotic) o Maternal * Pre-eclampsia 3-4x * Gestational diabetes **Delivery complicx** * Instrumental delivery * Prematurity **Postpartum complicx** * PPH * Post-natal depression

Answer 2

when the fetuses **share a placenta** the 2 fetuses *share the blood supply*, one will end up getting more than the other!\>\> **diamniotic Monochorionic** * the Recipient who gets majority of blood is overloaded with fluid —\> polyhydramnios * the Donor who is starved of blood —\> anaemia, GR *refer to **_TERTIARY SPECIALIST FETAL MEDICINE CENTRE_*** Severe cases – ***laser treatment*** required to destroy connection between two blood supplies

Answer 3

Monoamniotic twins – requires elective C-section at around 32-34 weeks · Diamniotic twins —\> induction/C-section between 37 weeks and 38 weeks Delivery \>38 weeks – assoc. w/ increased risk of fetal death o Vaginal delivery is possible when presenting twin is cephalic presentation § 2nd baby may require C-section after delivery of the first baby o Elective C-section advised when presenting twin not cephalic presentation **· Antenatal steroids prior if delivery at \<36 week**

Answer 4

**_A specialist multiple pregnancy obstetric team_** ***At booking:*** * 5mg folic acid *(as opposed to 400micrograms in single pregnancy)* * Iron supplements to prevent anaemia * Vitamin D * it is 1 RFx for pre-eclampsia so if they have one more e.g. nulliparous then they require ASpirin 75mg prophylaxis **FBC Check at:** 1. Booking clinic 2. 5 mnths 3. 7 mnths **Down Syndrome screening** – only suitable for 1st trimester nuchal translucency scan, combined testing and quadruple testing is not accurate since hormones are higher in multiple pregnancy **USS** **scans** -**viability, chorionicity, nuchal translucency, malformation:** *close monitoring look for growth restrict /TTTS/Unequal growth* o Monochorionic – 2 weekly scans from 16 weeks (membrane folding sug- gests TTTS ) o Dichorionic – 4 weekly scans from 20 weeks

Answer 5

(**+ urine pregnancy test + vaginal bleeding +/- pain)**--\> Early Pregnancy Assessment Unit (EPAU) **TRANSVAGINAL USS**--\> *most important finding to exclude miscarriage is fetal cardiac activity.* things the sonographer will look for: * **fetal heartbeat** * **fetal crown rump length (CRL)--\>**estimate gestation * **Measure mean sac diameter (MSD)--\>**measure gestational sac in 3 dimensions:

Answer 6

**3 or more** consecutive miscarriages. ## Footnote Epidemiological factors (age) **\*\*ANTIPHOSPHOLIPID SYNDROME\*\*** Genetic factors (parental /embryonic) Structural factors (Congenital uterine malformations, cervical weakness) Endocrine factors (diabetes, thyroid, PCOS) Infective agents (bacterial vaginosis) Inherited thrombophilic defects (factor V Leiden, factor II (prothrombin) gene mutation and protein S)

Answer 7

Menstrual cycle history **Medical Hx:** clotting (DVT, PE\>--\> APS), Lupus? endocrinopathy (diabetes mellitus, thyroid dysfunction) Surgical Hx --\> uterine Sx (cervical incompetence, Asherman’s syndrome) **Hx of congenital abnormalities** that may be heritable **FHx of bleeding disorders** **Exposure to environmental toxins** (e.g. occupational exposures)

Answer 8

Blood tests and genetic testing * ALLL women should be screened b4 pregnancy for \*\***antiphospholipid antibodies\*\*** ***To diagnose APS it is mandatory that she has 2 positive tests at least 12 weeks apart for either _lupus anticoagulant_ or _anticardiolipin_ antibod*** * **Karyotyping** **⇒ Cytogenetic analysis** of the products of conception from the _3rd_ or future miscarriages *if unbalanced structural chromosomal abnormality seen...* **⇒ Parental peripheral blood karyotyping of both partners** * **Pelvic USS--\> uterine abnormalities** * **Testing for hereditary thrombophilias** * **Blood tests: HbA1c, antiphospholipid/thrombophilia screen, TFT's**

Answer 9

*Subject to the provisions of this section, a person **shall not be guilty of an offence under the law relating to abortion** when a pregnancy is terminated by a _registered medical practitioner_ if two registered medical practitioners are of the opinion, formed in good faith* ► that the pregnancy ***has not exceeded its 24th week*** and that the continuance of the pregnancy is riskier than termination, of injury to the physical or mental health of the pregnant woman or any existing children of her family; or ► that the termination is necessary to **prevent permanent injury to the physical or mental health of the pregnant woman**; or ► that the continuance of the pregnancy would involve **risk** **to** **the LIFE of the pregnant woman,** greater than if the pregnancy were terminated; or ► that there is a substantial risk that if the **child were born it would suffer from such physical or mental abnormalities** as to be seriously **handicapped**.

Answer 10

*behaves like a normal pregnancy. a few things that can indicate a molar pregnancy vs a normal pregnancy:* * More **_severe_** ***_morning_*** **_sickness_** * Vaginal bleeding * Increased enlargement of the uterus * Abnormally high hCG * Thyrotoxicosis (hCG can mimic TSH and stimulate the thyroid to produce excess T3 and T4) REFER TO **_gestational trophoblastic disease centre_** *chemotherapy bc mole may Metastasize*

Answer 11

A ***hydatidiform mole*** is a type of tumour that grows like a pregnancy inside the uterus. This is called a molar pregnancy. ## Footnote A **complete mole** occurs when 2 sperm cells fertilise an ovum that contains NO genetic material (an “empty ovum”). These sperm then combine genetic material, and the cells start to divide and grow into a tumour called a complete mole. NO FETAL MATERIAl will form.\>\>Dads genetics codes for development of an abnormal placenta A **partial mole** occurs when 2 sperm cells fertilise a normal ovum (containing genetic material) at the same time. The new cell now has three sets of chromosomes (it is a haploid cell). The cell divides and multiplies into a tumour called a partial mole. In a partial mole, SOME FETAL MATERIAL MAY form.

Answer 12

* 1st pregnancy * Previous Hx of HG * Obesity * Multiple pregnancy * Hyperthyroidism * **Hydatidiform mole** ## Footnote **_Pregnancy-Unique Quantification of Emesis (PUQE)_**

Answer 13

refers to **_persistent & severe vomiting_** during pregnancy, which leads to * ***5%** pre-pregnancy weight loss* * *DEHYDRATION* * *electrolyte imbalance* **rapidly increasing levels of B- hCG → CTZ → Vommit** most common between **_8 and 12 weeks_** but may persist up to **20 weeks\*.**

Answer 14

**bedside tests, labs and imaging.** **_ELECTROLYTE LEVELS r SOO important to monitor as deranged levels are a hallmark of HG_** **Bedside Tests** * BMI * Urine dipstick: quantify ketonuria (1+ ketones) * Mid-stream urine **Labs** * FBC: anaemia, infection, haematocrit (can be raised) * U&E: hypokalaemia, hyponatraemia, dehydration, renal d. * BM: exclude DKA if diabetic * LFT's: exclude liver d. ex hepatitis or GS, monitor malnutrition * Amylase: exclude pancreatitis * TFT's: hypo-/hyper-thyroid **Imaging** * USS: confirm viability, confirm gestation, exclude multiple pregnancy and trophoblastic disease.

Answer 15

* Continued N & V and is **_unable to keep down liquids or oral antiemetics_** * Continued N & V + **_ketonuria and/or weight loss_** (greater than 5% of body weight), despite treatment with oral antiemetics * A confirmed or **suspected** **comorbidity** (for example she is unable to tolerate oral antibiotics for a urinary tract infection)

Answer 16

**Mild cases** 1. Oral anti-emetics at home 2. complementary therapies: * Ginger & Peppermint * dry bicuits in morning * eat less and more frequent * Acupressure on wrist at P6 point (inner wrist) * Acupuncture **Severe cases** factors requiring Admission! * Unable to tolerate oral anti-emetics/keep down fluids * Ketones present on urine dip (2+) * Electrolyte imbalances Admission: 1. Thromboprophylaxis ex: TED stockings, LMWH 2. IV anti-emetics 3. IV fluids to rehydrate 4. Thiamine ⇒ to prevent ***_Wernicke-Korsakoff’s_*** **_1st line:_ Antihistamines (****Promethazine****) or** **Cyclizine** **_2nd line_: Ondansetron** *(contraindicated in 1st trimester)* and **metoclopramide** *(may cause extrapyramidal side effects)* **_3rd line_** : **Corticosteroids** **IV hydration--\>**may need to admit **Thiamine:** for prolonged vomiting to prevent *Wernicke’s encephalopathy* **Thromboprophylaxis:** for all requiring admission

Answer 17

Complications * **Wernicke's encephalopathy** * **Mallory-Weiss tear** * **central pontine myelinolysis** * **ATN** * **fetal: SGA, pre-term birth**

Answer 18

Pain infection bleeding uterine rupture haemorrhage After abortion Discuss how long bleeding will last after abortion It is normal to feel emotions after abortion How to get help out of hours if complications arise Discuss contraception after abortion Can try again after her period comes back Went to do sexual intercourse again Advice woman to seek support if they need it Peer support or support groups with other woman who have had abortion

Answer 19

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pregnancy stuff Flashcards

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