fetal conditions

Question 1

Imaging of Choroid plexus cysts

What do they look like

How to image?

Answer 1

Sonographic well circumscribed echolucent discrete small cysts found within the choroid plexus within the lateral ventricle
Imaging should be in the transverse plane of the fetal head at the same level for evaluation of lateral ventricles
Inspect bilaterally for CPC
CPC should not be reported unless > 5mm in maximum dimension
Cystic spaces within the choroid less than this size should be considered “mottled” choroids, and unlikely to be significant

Question 2

What is the significance of a choroid plexus cyst?

What is the management

Answer 2

1-3% of the population will have this at midtrimester USS

Associated with T18 - LR 9
NOT associated with T21
30-50 % of T18 have a CPC
80% have other structural abnormalities
Number or size of cysts does not effect risk
Finding this is an indication for close scanning
If no other anomalies, no follow up

Look for signs of T18 
Clenched hands/ crossed over fingers
Ventriculomegaly 
Cardiac abnormalities
diaphragmatic hernia
Cystic hygroma
NTD
Omphalocoele 
IUGR
Single umbilical artery

Question 3

What is the dx criteria of non immune hydrops fetalis

Answer 3

NIHF is established by the ultrasound findings of at least two of the following:
• Ascites
• Pleural effusion: ANY fluid abnormal;
• Pericardial effusion: > than 2mm
• Skin edema: > than 5mm on chest and scalp
• Polyhydramnios: Max pocket > 8cm, or AFI > 24cm
• Placentomegaly: Thickness >4cm

Question 4

What are the most common causes of NIHF

under 24 weeks and over 24 weeks

Answer 4

Aneuploidy 
• Most common cause of NIHF under 24/40 
• Cardiovascular abnormalities 
• Structural 
Most common cause of NIH over 24/40

Question 5

Tetracyclines in pregnancy

Risks?

Answer 5

crosses the placenta
deposits in the embryos bones and teeth in sites of active calcifications

T3 - yellow staining of deciduous teeth
tooth defects - enamel hypoplasia
diminished growth of long bones

also associated with hearing deficit and impaired VIII Cranial nerve

Question 6

What do ACE i do in pregnancy

Answer 6

Impair renal development

Oligohydramnios
Fetal death
long lasting hypoplasia of the bones of the calvaria (skull)
IUGR

Question 7

Warfarin
When is it worst
What are the risks

Answer 7

Embryopathy 30-40% of woman who stay pn it throughout

Greatest sensitivity 6-12 weeks (8-14 post LMP)

The most common developmental abnormalities affect bone and cartilage; these simulate chondromalacia punctata, with stippled epiphyses and nasal and limb hypoplasia

T2/3 also associated with mental deficiency, optic nerve atrophy, microcephaly

Question 8

Retinoic acid in pregnancy / isoretinoin

Answer 8

Critical week 3-5 (5-7 post LMP )

Risk
miscarriage
Birth defects - ear anomalies (microtia with or without atresia of the ear canal), CNS malformations, hydrocephalus, neuronal brain migration defects, cerebellum abnormalities, severe intellectual disability, seizures, optic nerve/retinal abnormalities, conotruncal heart defects, thymic defects, and dysmorphic features
Neuropsychological impairment