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OBSTETRIC PATHOLOGY > ABNORAMALITY OF AMNIOTIC FLOW > Flashcards

ABNORAMALITY OF AMNIOTIC FLOW Flashcards

1
Q

Normal AFI

A

10 to 20cm

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2
Q

Low fluid
Increased fluid
AFI

A

5 to 10 Cm
20 to 24 Cm

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3
Q

Oligohydramnios

A

AFI < 5cm
With largest vertical pocket 2 Cm aless

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4
Q

Poly hydramnios

A

AFI > 24 cm
Largest vertical pocket 8cm
Or more
AF volume of > 2000 ml

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5
Q

Polyhydramnios sono orders to rule out

A

Multiple gestation
Molar pregnancy
Fetal size greater Than dates

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6
Q

Polyhydramnios clinical finding

A

Uterus greater than dates

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7
Q

Polyhydramnios associated with

A

Perinatal mortality
Morbidity
Maternal complications

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8
Q

Acute one set of hydramnius may

A

Be painful
Compress other organs and vascular structures
Hydronephrosis

Produce sob

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9
Q

Polyhydramnious associated with

A

CNS disorders
GI problems

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10
Q

Clinical finding fetal in Polyhydramnios

A

Hydrops
Skeletal anomalies
Renal disorders

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11
Q

Maternal condition with Polyhydramnios

A

Diabetes mellitus
Obesity
Rh

Anemia
Congestive cardiac faiure

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12
Q

Polyhydramnios in US

A

Freely floating fetus within swollen amniotic cavity
AFI =20cm or more
Accentuated feral anatomy
Single vertical pocket more than 8cm

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13
Q

When Oligohydramnios has poor prognosis

A

-Second trimester
It maternal AFT level is elevated

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14
Q

Maternal condition associated with

Oligohydramnios

A

Hypertension
pre eclampsia
Renal disease
Connective tissue disorders
Indomethacin
Cardiac disease

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15
Q

Reasons for Oligohydramnios

A

Fetal hypoxemia
→IUGR and oligohydramnios
Placental insufficiency→IUGR

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16
Q

Commoncomplication of posidate pregnancies

A

Oligohydramnios associated with diminished placental function
Redistribution of blood with brain-sparing effect

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17
Q

Cause of Oligohydramnios

A

Nonanamalous conditions
Fetal anomalous conditions

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18
Q

Nananomalous condition of Oligohydramnios

A

IUGR
PROM
Post date pregnancy
42 weeks
Sampling villus

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19
Q

Fetal anomalous

Oligohydramnios

A

Infantile polyclystic kidney disease
Renal agenesis
Pysplastic kidney
Chromosomal abnormality
Posterior urethral valve syndrome

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20
Q

Reason for rupture of chorinomniotic membrane under normal conditions

A

Normal cell death activation of enzymes and mechanical forces

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21
Q

Condition when membrane rupture abnormally resulting gir loss of AF and oLigohydramnious

A

PROM premature
PPROM_ preterm
SPROM _spontaneous

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22
Q

Clinical finding in ROM

A

With sudden gush or leaving of fluid
Nitrazine paper and Fern test
Checked for cervical dilation and leaking of fluid with coughingor or fundal pressure

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23
Q

Prognosis of fetus affected by PROM depends on

A

FeTal GA
Fetal status
Ability to control uterine contractions

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24
Q

PROM associated with

A

Preterm delivery
Fetal death
Neaonatal respiratory distress
Prolapsed umbilical cord
Chorioamnionitis
Placental abruption

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25
Q

PROM is associated with

A

Placenta abruption

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26
Q

Amniotic band syndrome

A

Associated with fetal membranes abnormality

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27
Q

Common nonrecurrent cause fetal of various malformations involving limbs cranial facial region trunk

A

Amniotic band syndrome

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28
Q

Other names for disruption of feral tissue due amniotic bands

A

ADAM COMPLEX_ amniotic deformities,
Adhesion mutilation
Ammotic band sequence
Aberrant tissue bands
Congenital constricting bands

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29
Q

Entrapment of feral parts by bands may cause

A

Lymphedema
Amputations
Slash defects in none embryologic distributions

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30
Q

Protect fetus from contact with the chorion

A

Amnion

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31
Q

Clinical finding of amniotic band syndrome

A

Represent milder form of limb-body wall complex
May predicted by amniotic bands that entangle or amputate fetal parts

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32
Q

Common US finding in amniotic band syndrome

A

Facial cleft
Asymmetric encephalóceles
Amputation defects of extremities
Clubfootdeformities

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33
Q

Ammoniotic bands

A

-siring like bands
Fibrous strands

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34
Q

Sonographic finding amniotic band

A

Echogenic band floating in The AF
The echogenic band may attach to The wan of uterus or gestational sac
Following the band closely with real-time scan can be observed the band is attached to Tue uterin wall and constriction is placed on the fetus

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35
Q

Amniotic sheets

A

Shelves or folds identified as echogenic bands crossing through amniotic cavity
Thicker than Bands syndrome

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36
Q

Most likely signify uterine synechiae

A

Amniotic sheets

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37
Q

Cause of amniotic sheets

A

Uterine scars from previous instrumentation used in uterus
Cesarean section
Episodes of endemetritis

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38
Q

Risk factors for uterine scars and sheets

A

-history of
Endometrial DC
Intrauterine infection
Endometritis
Removal fibroids or polyps
C section

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39
Q

Synechia associated with

A

Infertility
Miscarriage

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40
Q

Ashermans’ syndrome

A

Formation of scar tissue in the uterine cavity

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41
Q

US in amniotic sheets

A

Fine echo-dense line in uterine cavity separated from uterine wall by echo-lucent space
Membrane may completely surround fetus or be freely mobile in amniotic cavity

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42
Q

Amniotic sheets on US

A

Extending from me side of uterus to other side oblique across uterus
Or multiple echogenic lines

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43
Q

Hydrops fetalis

A

A life threatening condition abnormal amount of fluid accumulation in two armore body areas of fetus

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44
Q

Most often sides of fluid accumulation in hydros

A

Abdomen
Around the heart
Lungs
Under skin

45
Q

Other symptoms of hydropes condition include

A

Polyhydramnioes
Thickening of the placenta
Placenta edema
Enlarged umbilical cord
Enlarged liver and spleen

46
Q

Accumulation of fluid aredema can represented by

A

Pleural effusion
Cardiac effusion
Ascities
Skinedtima
Anarsarca

47
Q

Types sofhydrops

A

Immune
Nonimmune

48
Q

More common type of hydrops

A

Non-immune
An diseases arcomplicarians that interferes with now the fetal body manages fluid balance.

49
Q

Fetal hydropshighly associated with

A

mortality

50
Q

US hydros

A

Presence of abnormal collection of fluid

51
Q

Ascities and psedoascites

A

Are choir fluid surrounding abdominl, pelvic organs and umbilical cord
Mistaken normal hypoechoic abdominal musculature for ascities

52
Q

Skin edema in hydros

A

Î skin tnickness around the skull, neck, extremities or abdomen

53
Q

Soft tissue thickening for diagnosis hydros

A

> 5-6mm

54
Q

Anasarca

A

‘skin edema is massive encasing most of the body

55
Q

Pericardial effusion in hydrops

A

Excessive anechoic fluid in pericardial cavity
More than 2 mm

56
Q

Placental edema in hydrops

A

Thickening of placenta more than 4 -4.5cm in anterior posterior diameter

57
Q

Non immune hydrops reason

A

Cardiac insufficiency one of the most common causes
From cardiac anomalies
Tumors or arrhythmias like tachycardia

58
Q

One of the Most common causes of , nonimmune hydros

A

Cardiac insufficiency
Or hyperoteinuria
Structural lymphatic obstruction
Decreased venous réturn to heart

59
Q

Anomalies may present in non immune hydrops

A

Feral tuners heart or liver
Cardiac anomalies
Cynic adenomatoid malformation of lung
Charinargiama of placenta

60
Q

Which abnormalities should be documented in hydros

A

Due to relationship with NIHF
Trisomy 21
45x
Feral infections TORCH

61
Q

Clinical Findings
• Fetal hydrops, skeletal anomalies, some renal disorders may be associated with hydramnios.
• Maternal conditions associated with polyhydramnios
• Diabetes mellitus
• Obesity

A

• Fetal hydrops, skeletal anomalies, some renal disorders may be associated with hydramnios.
• Maternal conditions associated with polyhydramnios
• Diabetes mellitus
• Obesity
• Rh incompatibility
• Anemia

62
Q

Sonographic Findings

A

• Freely floating fetus within swollen amniotic cavity
• Accentuated fetal anatomy (increased AF improves image resolution)
• AFI = 20 cm or greater

63
Q

Sonographic Findings

A

Fetus presenting at 29 weeks gestation with duodenal atresia. The single vertical pocket measurement of 13.71 cm suggests polyhydramnios. An AFI of 32.36 cm supports the findings. The + indicates fetal head.

64
Q

Etiology

A

• Development of oligohydramnios may be attributed to:
• Congenital anomalies
• IUGR
• Post term pregnancies
• Rupture of membranes (ROM)
* latrogenesis

65
Q

Second trimester oligohydramnios often has poor prognosis,

A

• Second trimester oligohydramnios often has poor prognosis, especially if maternal serum alpha-fetoprotein level also elevated
• Maternal conditions associated with oligohydramnios
• Hypertension
• Preeclampsia
• Chronic cardiac or renal disease
• Connective tissue disorders
• Patients receiving indomethacin

66
Q

Clinical Findings

A

• Fetal hypoxemia may produce growth restriction and oligohydramnios.
• Four-fold increased risk of growth delay when oligohydramnios present
• Doppler evaluation of growth-restricted fetus shows abnormal umbilical flow in patients with oligohydramnios.

67
Q

Clinical Findings

A

• Placental insufficiency may cause IUGR associated with oligohydramnios.
• Produces redistribution of fetal blood flow away from kidneys and toward brain to counteract hypoxia
• Results in decreased urine output, which decreases fluid volume

68
Q

Clinical Findings

A

• Post term pregnancy defined as gestational age of 42 weeks or more
• Oligohydramnios is common complication of postdate pregnancies.
• Is associated with diminished placental function and arterial redistribution of fetal blood flow with brain-sparing effect

69
Q

Post term pregnancy defined

A

as gestational age of 42 weeks or more

70
Q

• Medications associated with oligohydramnios

A

• Medications associated with oligohydramnios
• Nonsteroidal antiinflammatory drugs
• Angiotensin-converting enzyme inhibitors
• Calcium channel blockers
• Nitrous oxide

71
Q

Causes of Oligohydramnios
Causes of Oligohydramnios
Nonanomalous Conditions

A

• IUGR
• Premature rupture of membranes
• Postdate pregnancy (42 weeks)
• Chorionic villus sampling

72
Q

Causes of Oligohydramnios
Fetal Anomalous Conditions

A

Fetal Anomalous Conditions
• Infantile polycystic kidney disease
• Renal agenesis
• Posterior urethral valve syndrome
• Dysplastic kidneys
• Chromosomal abnormalities

73
Q

Fetal Membranes

A

The amnion divides the amniotic and chorionic cavities and at 10 weeks gestation.

74
Q

Ruptured Fetal Membranes

A

• Membranes normally rupture after onset of labor.
* Premature rupture of membranes (PROM), preterm
premature rupture of membranes (PROM), and spontaneous rupture of membranes (SPROM) describe conditions in which membranes rupture (“water breaks” abnormally, resulting in loss of AF and/or oligohydramnios.
• Multiple underlying pathologic processes associated with abnormal ruptured membranes

75
Q

Ruptured Fetal Membranes

A

• Clinical findings
• Patients suspected to have ROM present clinically with sudden gush or leaking of fluid.
Nitrazine paper and fern test used as screening test to determine presence of AF in vaginal secretions
• Patient is checked for cervical dilation and for leaking of fluid with coughing or fundal pressure.

76
Q

Patient is checked for cervical dilation and for leaking

A

Patient is checked for cervical dilation and for leaking of fluid with coughing or fundal pressure.

77
Q

• Abnormal ROM associated with:

A

• Prognosis of fetus affected by abnormal ruptured membranes depends on fetal GA, fetal status, and ability to control uterine contractions
• Abnormal ROM associated with:
Preterm delivery
Fetal and neonatal death
Neonatal respiratory distress
Prolapsed umbilical cord
Chorioamnionitis*
Placental abruption

78
Q

•SONOGRAPHIC FINDING

A

Role of sonography is to document integrity of placenta, fetal size, AF volume, fetal well-being, to perform fetal Doppler studies.
• Common for patients to be evaluated every day assess fetal well-being and fluid volumes

79
Q

• Evaluate the integrity of the placenta, fetal growth, and biophysical profile.
•…….. is associated with ROM.

A

• Evaluate the integrity of the placenta, fetal growt! and biophysical profile.
• Placenta abruption is associated with ROM.

80
Q

Coanechoic fetal cord was not misrepresented as fluid.

A

Patient presents at 30 weeks gestation with ROM.AFI reveals severe oligohydramnios. Color Doppler was used to ensure that the anechoic fetal cord was not misrepresented as fluid.

81
Q

지/
Amniotic Band Syndrome

A

• Is associated with abnormality in fetal membranes
• Is a common, nonrecurrent cause of various fetal malformations involving limbs, craniofacial region, trunk
• Synonyms used to describe disruption of fetal tissu due to the presence of amniotic bands:
ADAM complex (amniotic deformities, adhesion, mutilation)
• Amniotic band sequence
• Aberrant tissue bands
Congenital constricting bands

82
Q

• ADAM complex)
•

A

(amniotic deformities, adhesion, mutilation

83
Q

• Synonyms used to describe disruption of fetal tissue due to the presence of amniotic bands:

A

• ADAM complex (amniotic deformities, adhesion, mutilation)
• Amniotic band sequence
• Aberrant tissue bands
• Congenital constricting bands

84
Q

Amniotic Band Syndrome
• May represent milder form of limb-body wall
complex
• May be predicted by amniotic bands that entangle or amputate fetal parts
• Common findings:

A

facial clefts, asymmetric encephaloceles, constriction or amputation defects of extremities, clubfoot deformities

85
Q

Sonographic Findings

A

Echogenic band floating in the AF. The echogenic band was attached to the wall of the gestational sac.
Copyright

86
Q

Sonographic Findings

A

Soft tissue edema is seen in the forearm, where the band is constricting the soft tissue.

87
Q

Amniotic Band Syndrome

A

• May represent milder form of limb-body wall complex

88
Q

Amniotic Sheets

A

•Amniotic sheets, shelves, or folds identified as echogenic, nonfloating bands crossing through
amniotic cavity
• Are thicker than bands associated with amniotic band syndrome
• Do not cause fetal malformations
• Most likely signify uterine synechiae

89
Q

Amniotic Sheets

A

Etiology
• Visualization of amniotic sheets believed to be caused by:
• Uterine scars from previous instrumentation used in uterus
• Cesarean section
• Episodes of endometritis

90
Q

Amniotic Sheets
Clinical findings

A

Clinical findings
• Patients with history of endometrial D&C, intrauterine infections, endometritis, removal of fibroids or endometrial polyps, or prior cesarean section are at risk for developing uterine scars.
• Synechiae associated with infertility and miscarriages
* Patients who present with uterine synechiae and infertility often diagnosed with Asherman’s syndrome (Asherman syndrome is the formation of scar tissue in the uterine cavity).

91
Q

Synechiae

A

Synechiae associated with infertility and miscarriages

92
Q

Amniotic Sheets

A

Sonographic findings
• May show fine echo-dense line in uterine cavity separated from uterine wall by echo-lucent space
• Membrane may either completely surround fetus or be freely mobile in amniotic cavity
• Can appear anywhere in uterine or cervical cavity
• Are seen extending from one side of uterus to other, oblique across uterus or as multiple echogenic lines

93
Q

Hydrops

A

•Other fetal findings identified with hydrops
• Enlarged umbilical cord
• Polyhydramnios
• Placental edema
• Enlarged liver and spleen
• In many cases, fetal hydrops highly associated with mortality

94
Q

• Do not to mistake normal hypochoic abdominal musculature).

A

for ascites (pseudoascites

95
Q

Hydrops

A

Skin edema can be seen as increased skin thickening around the skull, neck, extremities, or abdomen.
• Measurement of >5 to 6 mm for soft tissue thickness is used for didgnosis in some reports.
• When skin edema is massive, encasing most of the body, the term anasarca is used.

96
Q

Normally, a small amount of fluid is noted in this cavity, particularly in the apex.
• pericardial effusion considered

A

If fluid collection measures >2 mm,

97
Q

• Placental edema

A

can be identified as a thickened placenta measuring >4 to 4.5 cm in true anterior-posterior diameter.

98
Q

Oligohydramnios in the third trimester is most likely a result of:
a. duodenal atresia
b. diaphragmatic hernia
c. infantile polycystic renal disease
d. cystic adenomatoid malformation

A

infantile polycystic renal disease

99
Q

Which portion of the biophysical profile study is a chronic marker of fetal hypoxia?
a. fetal tone
b. fetal movement
c. amniotic fluid volume d. maturity of the placenta
maturity of the placenta

A

c. amniotic fluid volume

Amniotic fluid volume is a chronic marker of fetal hypoxia. Acute markers of fetal hypoxia in- clude fetal breathing movement, fetal tone, nonstress test, and fetal movement.

100
Q

When measuring amniotic fluid volume,

A

When measuring amniotic fluid volume, the transducer must re- main perpendicular to the maternal coronal plane and parallel to the ma- ternal sagittal plane.

101
Q

Doppler of the umbilical artery evaluates fetal well-being using the:
a. resistive index
b. pulsatility index
c. peak systolic velocity d.
systolic–diastolic ratio

A

The systolic-to-diastolic ratio of the umbilical artery can evaluate fetal well-being after 30 weeks’ gestation. A ratio greater than 3.0 is abnormal. Absence or reversal of the diastolic component is also abnormal.

102
Q

The single most sensitive indicator of intrauterine growth restriction is:
a. femur length
b. head circumference
c. abdominal circumference
d. head circumference-to-abdominal circumference
ratio

A

The abdominal circumference is the single most sensitive indicator

103
Q

Which technique is both valid and reproducible when assessing amniotic fluid volume?
a. uterine volume
b. amniotic fluid index
c. single vertical pocket d. subjective assessment

A

Of all the techniques to assess amniotic fluid volume, the amniotic fluid index (AFI) is both valid and reproducible.
31. d. Maternal diabetes can resul

104
Q

Intrauterine growth restriction is defined as a fetal weight:
a. below the 5th percentile for gestational age
b. below the 10th percentile for gestational age
c. at or below the 5th percentile for gestational age d. at or below the 10th percentile for gestational age

A

c. at or below the 5th percentile for gestational age d. at or below the 10th percentile for gestational age

105
Q

A transverse fetal position in the late third trimes- ter of pregnancy is most likely associated with:
a. macrosomia
b. placenta previa
c. polyhydramnios
d. intrauterine growth restriction

A

b. placenta previa

106
Q

Which of the following fetal positions is at most risk for cord prolapse?
a. oblique
b. transverse
c. frank breech
d. incomplete breech

A

Incomplete or footling breech places the fetal foot as the present- ing part and places the greatest risk for cord prolapse.

107
Q

A fetus presents with multicystic dysplastic renal disease. The amniotic fluid volume is expected to appear:
a. below normal
b. slightly lower than normal c. slightly higher than normal
*d. normal

A

Multicystic dysplastic kidney disease is a unilateral disease. The normal contralateral kidney will continue urinary function, allow

108
Q

To demonstrate the umbilical cord insertion into the fetal abdomen, one would
look:
A. Superior to the fetal kidneys
B. Superior to the fetal bladder
C. Posterior to the fetal stomach
D. Posterior to the umbilical vein
E. At the level of the adrenal glands

A

B

109
Q
  1. Which long bone is LEAST likely to be affected by intrauterine growth restriction?
    A. Femur
    B. Humerus
    C. Clavicle
    D. Tibia
    E. Radius
    E 139. You are measuring abdominal circumference. You choose to do so at the level
A

C

OBSTETRIC PATHOLOGY (7 decks)

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