Multifetal Pregnancy MCQs

Some conditions associated with abnormal maternal serum alpha fetoprotein concentration. Elevated levels Error in dates Multifetal pregnancy Severe oligohydramnios Neural tube defects Pilonidal cysts Esophageal or intestinal obstruction (and atresia) Liver necrosis Cystic hygroma Sacrococcygeal teratoma Fetal death Abdominal wall defects: omphalocele gastroschisis Urinary obstruction Renal anomalies: polycystic kidney absent kidneys Congenital nephrosis Osteogenesis imperfecta Congenital skin defects Cloacal exstrophy Chorioangioma of placenta Low birth weight Placental abruption Placenta accreta Preeclampsia Improper adjustment for low maternal weight Maternal hepatoma or teratoma Low level G: G estational trophoblastic diseases O 2 : O verestimated gestational age, overweight mother A: Spontaneous a bortion T: T risomy (21 or 18) Reference: Williams Obs. 24/e, p 287

Shock index (SI) refers to heart rate (HR) divided by systolic blood pressure (SBP). The normal value is 0.5–0.7. For obstetric shock index (OSI) normal value in pregnancy is 0.7–0.8. Increase in the pulse rate and a fall in systolic blood pressure that is seen with significant haemorrhage, results in an increase in the shock index. If it increases above 0.9–1.1, intensive resuscitation may be required. If OSI > 1 indicates massive blood obstetric haemorrhage that required blood transfusion. Reference:Arias practical guide to high risk pregnancy and delivery 4 th edition, chapter 23

Some factors that influence a successful trial of labor in a woman with prior cesarean delivery Low risk Transverse incision prior vaginal delivery appropriate counseling sufficient personnel and equipment Favors success Teaching hospital white race spontaneous labor prior fetal malpresentation 1 or 2 prior transverse incision Nonrecurrent indication current preterm pregnancy Increase failure rate Single mother Increased maternal age Macrosomic fetus Obesity Breech Multifetal pregnancy Preeclampsia EGA > 40 weeks Low-vertical incision Unknown incision Labor induction Medical disease Multiple prior cesarean deliveries Education Short interdelivery interval Liability concerns High risk Classical or T incision Prior rupture Patient refusal Transfundal surgery Obstetrical contraindication, e.g. previa Inadequate facilities Reference : Williams 24/e, p 611

Some unique complications can rarely follow compression sutures Variations of uterine ischemic necrosis with peritonitis Rarely uterine wall defects or uterine cavity synechiae. Reference:Williams obstetrics 26 th edition, chapter 44

Parity & Gravida Parity Is number of past pregnancies that have gone beyond period of viability i.e. 28 weeks gestation. Gravida Is the total number of pregnancies(past and present), a woman has had regardless of outcome. Living issue Number of living children In both cases, twins are counted as a single pregnancy As this pregnant woman delivered twins 4 years ago, her parity(P) is 1, gravida(G) is 2 and living issue(L) is 2 i.e G2P1L2