Multifetal Gestation
Multifetal gestation is considered a high risk factor for pre-eclampsia, therefore low dose aspirin prophylaxis is recommended. When should it be initiated?
Between 12-28 weeks of gestation (ideally before 16 weeks) and continued daily until delivery
A post-void residual volume of ___ indicates adequate bladder emptying in women with stress urinary incontinence.
Less than 150 mL
True or False (if false, explain why):
The best injection technique involves angling the entire device in order to get the correct injection angle.
False.
You should move the entire system in a parallel fashion against the urethral wall. Angling can lead to an injection being too superficial or too deep.
What is the preferred measurement for diagnosing oligohydramnios?
Most vertical pocket preferred over AFI
MVP of 2 cm or less indicates oligohydramnios
(Using MVP instead of AFI is associated with a reduction in unnecessary interventions without an increase in adverse perinatal outcomes)
If only one placenta is visualized, what is the best ultrasonographic characteristic to distinguish chorionicity?
Twin peak sign (also called the lambda or delta sign)
What is considered a positive cough stress test?
When fluid loss from the urethra occurs simultaneously with a cough
(is diagnostic of stress urinary incontinence)
What type of urinary incontinence is Bulkamid approved to treat?
Stress urinary incontinence (and/or stress predominant mixed incontinence)
What is the definition of fetal movement on BPP?
three or more discrete body or limb movements within 30 minutes
When should serial ultrasonographic evaluation in monochorionic gestations begin and how often should it be performed in order to monitor for twin-to-twin transfusion syndrome?
Every 2 weeks beginning at 16 weeks of gestation
List four non-surgical treatment options for urinary incontinence.
1. Pelvic floor exercises (with or without physical therapy)
2. Behavioral/lifestyle modifications (weight loss, bladder training, fluid management, avoid caffeine, scheduled voiding, bladder diary)
3. Pessaries
4. Pharmacotherapy - antimuscarinics, beta-agonists, botox, estrogen
Bulkamid should not be used in patients suffering from what acute condition?
An active urinary tract infection
What is the minimum frequency at which fetal growth assessments should be performed in growth-restricted fetuses?
Growth assessment should not be performed more frequently than every 2 weeks.
When should women with the following uncomplicated twin pregnancies undergo delivery:
1. Monochorionic-monoamniotic?
2. Monochorionic-diamniotic?
1. Mono-mono: 32 0/7 - 34 0/7 weeks of gestation
2. Mono-di: 34 0/7-37 6/7
All women with significant pelvic organ prolapse should undergo preoperative evaluation for what other condition?
Occult stress urinary incontinence
(40% of women will develop SUI after surgical correction of POP)
Approximately how distal should you be from the bladder neck prior to injecting Bulkamid?
Should be approximately 2 cm away from bladder neck before injecting
In the setting of otherwise uncomplicated isolated and persistent oligohydramnios, when is delivery indicated?
36 0/7 - 37 6/7 weeks of gestation
(or at diagnosis if diagnosed later than 37 6/7)
Describe the criterion for diagnosis of twin-twin transfusion syndrome with ultrasonography.
Monochorionic - diamniotic twin gestation with:
1. Oligohydramnios (MVP <2 cm) in one sac and
2. Polyhydramnios (MVP >8 cm) in the other sac
What is the most common postoperative complication/patient complaint following transobturator sling placement?
Groin pain
Where should the bevel of the Bulkamid needle be facing during the procedure?
Towards the urethral lumen at all times
Describe the components of an adequate uterine contraction pattern on contraction stress testing.
Adequate contraction pattern present when:
At least 3 contractions persisting for at least 40 seconds each in a 10-minute period