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OBYGN > [FETAL DIS] POLYHYDROAMNIOS > Flashcards

[FETAL DIS] POLYHYDROAMNIOS Flashcards

1
Q

Incidence of polyhydroamnios

A

1-2%

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2
Q

MC cause of polyhdroamnios

A

idiopathic

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3
Q

MC cause of SEVERE polyhdroamnios

A

fetal anomalies

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4
Q

fetal causes of polyhydramnios (5)

A

1-anomalies=
duodenal/esophageal/intestinal
atresia, open NTD, omphalocele, anencephaly
2-Trisomy 18, 21
3-Bartter syndrome
4-Fetal anemia & hydrops (↑COP=↑urine prod.)
5-fetal infection

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5
Q

maternal causes of polyhydramnios (2)

A

1-DM
2-severe generalized edema

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6
Q

placental causes of polyhydramnios (3)

A

1-Twin-Twin transfusion syndrome
2-chorioangioma
3-large placenta

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7
Q

complications of polyhydramnios (7)

A

1-pressure complications
2-PPROM
3-PTL
4-Prolonged labor
5-PPH
6-Puerperal sepsis
7- perinatal mortality (2-5 folds increase)

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8
Q

pressure complications of polyhydramnios

A

1-maternal respiratory compromise
2-dyspepsia, vomiting, abdominal discomfort
3-Pyelonephritis & renal insult
4-Pregnancy induced HTN
5-LL edema & varicose veins

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9
Q

PROM complications (5)

A

1-PTL
2-chorioamnionitis
3-umbilical cord prolapse
4-placental abruption
5-splanchnic shock

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10
Q

US Evaluation of amniotic fluid

A

single deepest pocket 2-8cm
amniotic fluid index 5-25cm

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11
Q

presentation of polyhydramnios (4)

A

1-progressive abdominal enlargement
2-abdominal pain & discomfort
3-dyspnea
4-LL edema

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12
Q

GE of polyhydramnios

A

DM & its complications; excessive weight gain, LL edema

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13
Q

AE of polyhydramnios

A

1- fundal level > date of amenorrhea
2-Fundal & umbilical grip
a) difficulty palpating fetal parts
b) malpresentation
c) skin is glistening, stretched
w/ dilated veins
d) +Ve thrill
3-pelvic grips: malpresentations & non-engagement
4-asculation: difficult/not heard

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14
Q

PV

A

-cervix is partially opened
-bag of forewater is bulging & tense

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15
Q

mild polyhydramnios US signs

A

SDP: 8-11.9
AFI: 25-30

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16
Q

moderate polyhydramnios US signs

A

SDP: 12-15.9
AFI: 30.1-35

17
Q

severe polyhydramnios US signs

A

SDP ≥16
AFI > 35

18
Q

management of polyhydramnios

A

1-history
2-management of cause (DM)

19
Q

investigations of polyhydramnios (5)

A

1-US–> fetal anomalies, fetal hydrops, chorioangioma, TTT syndrome
2-DM screening
3-Screening for immune/nonimmune hydrops fetalis
4-screening for chromosomal & genetic disorders
5-screening for infections

20
Q

tests for fetal wellbeing

A

1-NST
2-BPP
3-Dopples US

21
Q

management of mild-moderate polyhydramnios cases

A

1-conservative follow up
2-TOP at 39-40 weeks

22
Q

lung maturity of fetus is induced by

A

steroids

23
Q

____should be offered in all cases of severe polyhydramnios

A

screening for chromosomal & genetic disorders

24
Q

management of severe polyhydramnios before 32 weeks

A

amnioreduction + indomethacin (for 3d)

25
Q

amnioreduction mechanism

A

-removal of fluid shouldn’t be faster than 1000mL over 20 minutes
-shouldn’t remove more than 50L at one time

26
Q

management of severe polyhydramnios before 32-34 weeks

A

amnioreduction without administering indomethacin to avoid premature closure of DA

27
Q

TOP of severe polyhydramnios

A

34-37 weeks

28
Q

delivery indications (4)

A

1-gestational age:
>39 weeks in mild-moderate
cases
>37 weeks in severe cases
2-maternal conditions indicating delivery
3-Fetal conditions= IUFD, CFM, FDS
4-patient is in labor

29
Q

Modes of TOP

A

1-vaginal= spontaneous or IOL
2- C-section

30
Q

intrapartum management

A

1-PGs for cervical ripening
2-oxytocin for induction
3-controlled ROM to avoid cord prolapse & sudden decrease in IUP
4-continuous fetal monitoring

31
Q

PGs & oxytocin should be used with caution to avoid___

A

PPH & amniotic fluid embolism

32
Q

oligohydroamnios definition

A

AF volume< expected gestational age

33
Q

MC cause of oligohydramnios

A

idiopathic

34
Q

fetal causes of oligohydramnios (5)

A

1-ruptured fetal membranes
2-IUGR & IUFD
3-Post term pregnancy
4-Fetal anomalies= bilateral renal agenesis/hypoplasia, ureter/urethral atresia, post urethral valve, PCKD, MCKD, Potter $
5-Trisomy 13

35
Q

maternal causes of oligohydramnios (3)

A

1-suboptimal maternal hydration
2-vascular diseases causing ↓ uteroplacental BF
3-drugs= ACEI, PG synthetase inhibitors, trastuzumab

36
Q

placental causes of oligohydramnios (3)

A

1-chronic abruptio placenta
2-premature aging of placenta
3-Twin-Twin $

37
Q
A

OBYGN (2 decks)

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