Foetal medicine

Question 1

Define oligohydramnios

Answer 1

Reduced amniotic fluid - deepest pool of <2cm or amniotic fluid index of <8cm

Question 2

What is the prognosis of oligohydramnios?

Answer 2

Before 22 weeks the prognosis is very poor

Question 3

What is the amniotic fluid mostly composed of after 20 weeks and how might this influence oligohydrmanios?

Answer 3

Most composed of fetal urine. <br></br>

Vol of urine depends on fetal urine production, fetal swallowing and absorption

Question 4

At what stage in the pregnancy is the amniotic fluid highest?

Answer 4

24-36 weeks

Question 5

List 3 causes of olgiohydramnios

Answer 5

Leakage of amniotic fluid
  SROM <br>
 <br>
Reduced fetal urine production
  IUGR
  Fetal renal failure or abnormalities
  Post-dates pregnancy <br>
 <br>
Obstruction to fetal urine output:
  Fetal abnormalities such as posterior urethral valves

Question 6

How is the amniotic fluid index measured?

Answer 6

Measure the deepest pools in the 4 quadrants of the uterus

Question 7

What examination should you carry out on the mother if you diagnose oligohydramnios?

Answer 7

Speculum exam to determine SPROM

Question 8

State 2 complications of oligohydramnios

Answer 8

Lung hypoplasia if occurs <22 weeks <br>
Limb abnormalities (eG) talipes, if prolongued

Question 9

Define polyhydramnios

Answer 9

Increased amniotic fluid

Deepest pool >8cm or an AFI >22 cm is abnormal

Question 10

What is the aetiology of polyhydramnios?

Answer 10

Increased fetal urine production:
  MAternal diabetes
  Twin-twin transfusion syndrome
  Fetal hyrdops
 <br>
Fetal inability to swallow or absorb amniotic fluid
  Fetal GI tract obstruction
    Duodenal atreasia
    Tracheo-oesophageal fistula
  Fetal neurological or muscular abnormalities
    Myotonic dystrophy
    Anencephaly
  Other rare abnormalities or syndromes
    Facial obstuction <br>
 <br>
Idiopathic
  Usually mild

Question 11

At what degree of polyhydramnios would you consider amnioreduction?

Answer 11

AFI >40

Question 12

State two ways to reduce amniotic fluid in severe polyhydramnios

Answer 12

Amnioreduction <br></br>

NSAIDs (CAUTION - ductus arteriosus)

Question 13

What is the treatment for twin-twin transfusion syndrome?

Answer 13

Laser ablation of the anastamoses

Question 14

What condition is duodenal atresia associated with?

Answer 14

Trisomy 21

Question 15

List 4 complications of polyhydramnios

Answer 15

PReterm delivery - probably due to uterine stretch <br></br>
Complication of the cause of the polyhydramnios <br></br>
Malpresentation at delivery because of increased room <br></br>
Maternal discomfort

Question 16

What is adnexal torsion?

Answer 16

When the enlarged ovary twists on its pedicle

Question 17

What are the signs and symptoms of adnexal torsion?

Answer 17

May have fever <br></br>
Sudden onset of unilateral colicky lower abdominal pain <br></br>
Nausea and vomiting

Question 18

How do you diagnose adnexal torsion?

Answer 18

US of pelvis to show the mass with Doppler to show impaired blood flow

Question 19

What is the treatment for adnexal torsion?

Answer 19

Urgent laparotomy to remove or untwist ovary depending on how viable it is deemed to be