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DMST 285 OBGYN 2 > Hydrops > Flashcards

Hydrops Flashcards

1
Q

What is a hydrops? 2

A

One or the other of:

  1. An abnormal accumulation of serous fluid in at least 2 body cavities
  2. Serous fluid in only 1 body cavity with tissue edema
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2
Q

What are some examples of hydrops? 4

A
  1. Pleural effusion
  2. Abdominal ascites
  3. Pericardial effusion
  4. Edema
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3
Q

What does this image demonstrate?

A

Fetal hydrops two body

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4
Q

What does this image demonstrate?

A

One body cavity with edema

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5
Q

Hydrops are based on two groups of ethologies, what are they?

A
  1. Immune hydrops
  2. Non-immune hydrops (NIH)
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6
Q

Hydrops is common but each specific etiology that causes them is how common?

A

Rare

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7
Q

Hydrops is usually involved in what stage for many conditions signifying what? 2

A
  1. Terminal stage
  2. Fetal decompensation
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8
Q

Once decompensation occurs, progression of hydrops is what?

A

Rapid and demise can occur within 24-48 hours

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9
Q

Investigation of hydrops is very important for what?

A

Management of the pregnancy

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10
Q

Sonographic documentation of the fetus aids in what?

A

Counseling for future pregnancies

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11
Q

What modalities and techniques are important aspects for hydrops investigation? 2

A
  1. Ultrasound
  2. Fetal blood
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12
Q

What are some sonographic features of hydrops? 7

A
  1. Ascites
  2. Pleural effusions
  3. Subcutaneous edema
  4. Placenta edema
  5. Pericardial effusions
  6. Arterial or venous Doppler abnormalities
  7. Low BPP scores
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13
Q

What are ascites?

A

Fluid collecting in the fetal abdomen

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14
Q

Where might we see ascites first?

A

Pelvis first

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15
Q

Ascites can have fluid that can track down in males, this leads to what?

A

The fluid can track down into the scrotum causing hydrocele s

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16
Q

What is a pseudo ascites?

A

<2mm hypoechoic ring might be the hypoechoic muscular layer of the abdominal wall

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17
Q

If we see pseudo ascites what do we do?

A

Change probe angle to assess if this is in fact fluid

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18
Q

Ascites should always sit in what type of location?

A

Dependent location

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19
Q

What does this image demonstrate?

A

First location for hydrops to appear

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20
Q

What does this image demonstrate?

A

Hydroceles

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21
Q

What are pleural effusions?

A

Fluid in pleural space around the lung

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22
Q

The greater the pleural effusion, the greater the pressure on what? 3

A
  1. The mediastinum
  2. Thoracic vasculature
  3. Heart
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23
Q

What does pleural effusions cause? 3

A
  1. Upper body edema
  2. Polyhydramnios
  3. Pulmonary hypoplasia
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24
Q

What does this image demonstrate?

A

Pericardial effusion

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25
Q

Subcutaneous edema can be affected where? 2

A
  1. General
  2. Local or limited to upper or lower body depending on etiology
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26
Q

What does anasarca stand for?

A

General edema

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27
Q

General edema is first seen where?

A

In the fetal scalp and face, then the abdomen and limbs

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28
Q

Placental edema is a late sign of what ?

A

Hydrops

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29
Q

What does Placental edema look like?

A

“Ground glass” appearance on ultrasound

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30
Q

How thick is placental edema?

A

> 4cm

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31
Q

If hydrops is from fetal etiology the whole placenta should be what?

A

Thick

Fetal long mass (CPAm), diaphragmatic hernia

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32
Q

If hydrops is due to placenta vascular malformation than what happens?

A

The placenta looks hydropic

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33
Q

What does this image demonstrate?

A

Ground glass appearance

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34
Q

What is a pattern of hydrops with immune hydrops? 3

A

Within immune hydrops
1. 1st Ascites
2. 2nd edema
3. 3rd pleural and pericardial effusion will occur

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35
Q

What patterns of hydrops will occur with thoracic abnormalities? 3

A
  1. Chylothorax
  2. Heart Abnormalities
  3. Pleural and pericardial effusions usually occurring first
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36
Q

What is a chyle?

A

A milky fluid from food that is taken up during digestion.

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37
Q

What does chyle consist of?

A

Lymph and triglyceride fat

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38
Q

How is chyle passed?

A

Passed into the veins by thoracic duct and mixes with blood

39
Q

Chylothorax is the presence of what?

A

Effused chyle in the pleural space

40
Q

Immune hydrops occur when what happens?

A

A rhesus sensitized mother has antibodies to the + fetal red blood cells (maternal is rH-)

41
Q

In terms of immune hydrops, Maternal immunoglobin antibodies cross the placenta and do what?

A

Attach antigen positive (Rh+), fetal red cells, hemolysis occurs

42
Q

Hemolysis is what?

A

The separation of the hemoglobin from the red cells and is then found in the plasma (destruction of red blood cells)

43
Q

What does this image demonstrate?

A

How the Rh in mother and baby occur

44
Q

What is erythroblastosis?

A

Abnormal presence of erythroblasts in the blood

45
Q

In terms of Rhesus factor how many are RH+ and RH-?

A

85% or + and 15 are -

46
Q

The 85% that have Rh+ have what?

A

Red cell protein called rhesus factor

47
Q

Of the 15% that are RH-, what does it lack?

A

Red cell protein called rhesus factor

48
Q

80% of Immune hydrops is due to what? What about the other 20%?

A
  1. Anti D antibodies
  2. Other 20% is due to other antibodies
49
Q

What are some causes for fetal red blood cell destruction? 3

A
  1. Anemia in the fetus
  2. Fetal Hepatosplenomegaly
  3. Erythroblastosis fetalis
50
Q

What is erythroblastosis fetalis? 2

A
  1. Outpouring of many new immature blood cells to compensate for the RBC destruction
  2. These immature RBCs do not support or carry oxygen well
51
Q

What does fetal red blood destruction result in? (In order) 4

A

In order

  1. Tissue hypoxia
  2. Hydrops
  3. Cardiac failure
  4. Demise

Basically, fluid does not get back to heart&raquo_space;» Heart works harder to compensate&raquo_space;»> cardiac failure&raquo_space;»»» demise

52
Q

Why do we have tissue hypoxia with fetal red blood cell destruction?

A

Immature red blood cells can’t carry oxygen to tissues

53
Q

Why do we have hydrops with fetal red blood cell destruction?

A

Fluid leaks out of cells causing hydrops

54
Q

What does an assessment of immune hydrops include? 4

A
  1. Assess maternal antibody concentration (blood test)
  2. Detailed fetal sonographic assessment for signs of hydrops
  3. MCA doppler
  4. Optical density determination (ODD) amniocentesis
55
Q

In terms of assessment of immune hydrops, With severe anemia the velocity increase in the arteries due to what?

A

Decreased viscosity of the blood.

56
Q

In terms of assessment of immune hydrops, MCA doppler is asset why?

A

MCA doppler is reproducible and accurate

57
Q

What is the treatment of immune hydrops? 2

A
  1. Fetal blood sampling and blood transfusion in utero
  2. Win intravascular transfusion
58
Q

In terms of treatment of immune hydrops, how many fetuses with intravascular transfusion survive? 2

A
  1. 70-75% of fetuses with hydrops will survive,
  2. 85-05% of the fetuses without hydrops will survive
59
Q

When is NIH (non immune hydrops) commonly seen?

A

1st and 2nd trimester with spontaneous aborted fetuses

60
Q

Etiology of NIH varies with what?

A

Geography

61
Q

What does NIH look like in North America and Europe? 3

A
  1. Cardiovascular
  2. Infection
  3. Chromosomal
62
Q

What does the etiology of NIH look like in Southeast Asia/

A

Homozygous thalassemia

63
Q

What is homozygous thalassemia?

A

Blood disorder not compatible with life

64
Q

If both parents pass the homozygous thalassemia gene what happens?

A

If both parents pass the gene to the fetus, the fetus as profound anemia resulting in death in utero

65
Q

If one parent pass the homozygous thalassemia gene what happens?

A

Then the fetus would have relatively mild red blood cell anomalies

66
Q

What are some causes of NIH? 3

A
  1. Maternal
  2. Placental
  3. Fetal
67
Q

What are some causes of maternal NIH? 3

A
  1. Severe diabetes mellitus
  2. Severe anemia
  3. TORCH infections
68
Q

What are some causes of Placental NIH? 3

A
  1. Chorioangioma (shunting)
  2. Venous thrombosis
  3. Cord torsion
69
Q

What are some fetal causes of NIH? 8

A
  1. Cardiac
  2. Thorax and neck
  3. Urinary
  4. Chromosomal
  5. Infection
  6. Skeletal dysplasia
  7. Fetal hypokinesis
  8. Idiopathic
70
Q

In terms of fetal causes of NIH, cardiac issues are what? 3

A
  1. Malformations of the heart
  2. Arrhythmia
  3. High output failure (from fetal shunts) TTS
71
Q

In terms of fetal causes of NIH, Thorax and neck are usually what?

A

Any anomaly of the chest that causes compression

72
Q

In terms of fetal causes of NIH, Urinary issues are due to what?

A

Prune belly syndrome

73
Q

In terms of fetal causes of NIH, chromosomal causes are what? 3

A
  1. Turner syndrome
  2. T21, 18 and 13
  3. Triploidy
74
Q

In terms of fetal causes of NIH, infection causes are what? 3

A
  1. Cytomegalovirus
  2. Parvovirus
  3. Toxoplasmosis
75
Q

In terms of fetal causes of NIH, skeletal dysplasia causes are what? 3

A
  1. Achondroplasia
  2. Achondrogenesis
  3. Thanatophoric dysplasia
76
Q

In terms of fetal causes of NIH, Fetal hypokinesis causes are what? 2

A
  1. Decreases mobility
  2. Arhtrogryoposis
77
Q

As a sonographer, what do we do to investigate for NIH? 9

A
  1. History
  2. Detailed scan for markers and anomalies
  3. Fetal echocardiography
  4. Karyotype for chromosomal abnormalities and for management
  5. Fetal blood sampling
  6. A fetal blood transfusion will be performed at the same time
  7. Cavity aspiration
  8. Pathology
  9. Autopsy
78
Q

In terms of investigations for NIH, what exam do we do too identify karyotypes for chromosomal abnormalities and for management?

A

FISH - Fluorescent in Situ hybridization

79
Q

In terms of fetal blood sampling how long will it take to get results?

A

48 hours

80
Q

Why do we take a fetal blood transfusion at the same time of fetal blood sampling?

A

Avoids second procedure or poke

81
Q

If we see NIH what do we do? 4

A
  1. Assess change in degree of hydrops
  2. Cardiothoracic ratios for cardiomegaly
  3. Doppler for cardiac failure
  4. Colour doppler over the right atria to assess tricuspid regurgitation
82
Q

What are some etiologies that relate to NIH? 5

A
  1. Arrhythmias
  2. Aneuploidy
  3. Non immune anemia
  4. Chylothorax and CCAM type 1
  5. Infections
83
Q

What it’s the therapy for NIH If the baby has arrhythmias?

A

Digoxin can be administered via maternal administration

84
Q

What is the therapy if the baby has aneuploidy?

A

No therapy

85
Q

What is the therapy for NIH if the baby has non immune anemia?

A

Due to parvovirus or fetal hemorrhage a fetal blood transfusion is performed

86
Q

In terms of therapy for NIH, what do we do with Chylothorax and CCAM type 1? What might we do as a result? Why is it performed?

A

Pleural drainage
1. Done in utero
2. May even leave shunts in
3. Performed to prevent pulmonary hypoplasia

87
Q

What do we do in terms of therapy for NIH, if there is a fetal infection?

A

Maternal or fetal antibiotics administered

88
Q

What are some adverse affects of administering antibiotics as therapy for NIH? What are some examples?

A

Some fetuses may still have long term adverse effects if not caught soon enough

Examples
1. Toxoplasmosis
2. Cytomegalovirus

89
Q

What is the prognosis for NIH?

A

Mortality is high

90
Q

What is the process of counselling for NIH?

A

Counselling is a challenge as it is impossible to be specific

91
Q

What happens if NIH is identified in the 1st or early 2nd semester?

A

Termination is offered

92
Q

What are two types of antenatal therapies? 2

A
  1. Thoracentesis
  2. Paracentesis
93
Q

What is thoracentesis? Why is it performed?

A
  1. Removing of fluid form the fetal chest
  2. May be performed to aid in fetal respiration
94
Q

What is Paracentesis? Why is it done?

A
  1. Removing fluid from the fetal abdomen
  2. May be done to drain ascites to prevent dystocia

DMST 285 OBGYN 2 (15 decks)

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