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Obstetrics > Increased SF Height > Flashcards

Increased SF Height Flashcards

1
Q

What is the most accurate time to measure SF?

A

Between 20-34 weeks

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2
Q

What is excessive fundal growth?

A

It’s is the measurement of SF-height that is above the 90th percentile for a specific gestational period

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3
Q

What are the factors that lead to uterus growth?

A
  1. Myometrial cells and dilation occurs in response to estrogen, progesterone and growth factors
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4
Q

When is the SF height measured?

A

Between 20-34 weeks after the woman has emptied her bladder

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5
Q

When should we suspect excessive fundal growth?

A
  • when there are two or more consecutive SF heights that are above the 90th percentile
  • when there is a 2 week difference between the SF height and the date of amenorrhea
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6
Q

What are the causes of excessive fundal growth?

A
  1. Wrong dates
  2. Maternal obesity
  3. Multiple pregnancies
  4. Polyhydroamnios
  5. Excessive foetal size
  6. Uterine leimyomas
  7. molar pregnancy
  8. Ovarian tumor
  9. Abruptio placentae with covelaire uterus
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7
Q

Why does the patient get the dates wrong?

A
  1. She either does not remember when her first day of her last menstrual period was
  2. Is on oral contraceptives
  3. Has irregular cycles
  4. Had implantation bleeding
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8
Q

What causes an increased size of the fetus?

A
  1. diabetes mellitus
  2. Hydrops fetalis
  3. Fetal ascites
  4. Fetal tumours
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9
Q

In which ethnic groups is fibroids/leimyomas most common in?

A

Black people and women in their thirties

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10
Q

What size myomata is dangerous and can have clinical significance?

A

> 3cm

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11
Q

What is the most common presentation of the myomata?

A

Acute severe pain that can warrant analgesia

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12
Q

What is the biggest complication post-partum associated with myomata?

A

Post-partum haemorrhage due to uterine atony

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13
Q

What is the common type of ovarian tumor?

A

A cystic mature teratoma

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14
Q

What is polyhydroamnios?

A

It is a pathological condition characterised by excessive accumulation of amniotic fluid index of more than the 95th percentile or an amniotic pool of >8cm

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15
Q

What is the function of the amniotic fluid?

A
  1. Shock absorber
  2. Antibacterial function from infections
  3. Provides fetus with nutrients
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16
Q

What is the typical amount in liters that the amniotic fluid will be at 36 weeks?

A

About 1 Litre

17
Q

What produces the amniotic fluid in early pregnancy?

A

The fetal skin and amnioblasts

18
Q

What produces the greatest amount of amniotic fluid in later stages of pregnancy?

A

Fetal micturition

19
Q

What conditions are associated with the inability to swallow in the fetus?

A
  1. Anencephaly
  2. Duodenal/oesophageal atresia
  3. Tracheo-oesophageal fistula
  4. Open neural tube defects (the CSF disposes straight into the amniotic cavity)
20
Q

What are the causes of polyhydroamnios?

A
  1. Diabetes mellitus-especially 3rd trimester
  2. Multiple pregnancies
  3. Congenital malformations-anencepahly, oesophageal atresia, spina bifida, cardiac anomalies, urinary tract defects
  4. Hydrops fetalis
  5. Trisomy 18,21
  6. Idiopathic(60%) no known cause
21
Q

What are the two types of hydrops fetalis?

A
  1. Iso-immune: rhesus or ABO incompatibility

2. Non-immune caused by syphillis, rubella, toxoplasmosis

22
Q

What is the clinical presentation of polyhydroamnios?

A
  1. There is a gross abdominal distension and discomfort
  2. Peripheral oedema of the legs, abdomen and vulva (compression of the major venous systems)
  3. Rare: bilateral ureteric obstruction

“:

23
Q

What is acute polyhydroamnios?

A

<2% of cases

  • rapid accumulation of amniotic fluid at 24-26 weeks
  • presents with oedema, nausea and vomiting, severe dyspnea, abdominal discomfort and pain
24
Q

What is chronic polyhydroamnios?

A

Usually develops after 28 weeks

25
Q

How do we diagnose a patient with polyhydroamnios con examination?

A
  1. Positive fluid thrills in the uterus
  2. Peripheral oedema and dyspnea
  3. Decreased fetal heart sounds
  4. Abnormal lie or breech position
26
Q

What special investigations can we do to help determine they cause of the polyhydroamnios?

A
  1. Ultrasound
  2. bloods: Rh, ABO, oral glucose tolerance test, maternal infections(syphillis, rubella, cytomegalovirus, parvovirus B19
  3. Amniotic fluid analysis top look for trisomy 18,21
27
Q

How do we manage a patient with acute polyhydroamnios?

A
  1. Admit the patient
  2. Determine if there are any malformations first
    - if malformations present-termination of pregnancy
    - if no malformations continue
  3. Slow amniocentesis every 2-3 days of about 250-1000ml has been shown to help
  4. Administer indomethacin or sulindac rectally 12 hourly
28
Q

What are the risks associated with amniocentesis?

A
  1. Placenta abruptio
  2. Preterm rupture of membranes
  3. Chorioamnionitis
29
Q

How do we manage a patient with chronic polyhydroamnios?

A
  1. Admit the patient
  2. Determine the cause and treat-if the patient has DM(treat), if congenital anomaly (TOP)
  3. Give indomethacin 100mg 12 hourly and observing the amniotic fluid index
  4. If severe polyhydramnios then use diuretics (furosemide-40mg orally)
  5. Deliver baby at term
30
Q

What are the complications of polyhydroamnios?

A
  1. Abruptio placentae
  2. Cord prolapse
  3. Malpresentations (breech)
  4. Abnormal lie(oblique, transverse,unstable)
  5. Post-partum haemorrhage
  6. Preterm rupture of membranes with chorioamnionitis
  7. Prematurity
31
Q

How does indomethacin work in treating in polyhydroamnios?

A
  1. It decreases fetal urine production
  2. It increases resorption of fluid by fetal lung and decreases the pulmonary fluid
  3. It causes movement of fluid from the fetal compartment across the fetal movements
32
Q

How does indomethacin prevent pre-term labour?

A

Indomethacin has tocolytic effects that causes decrease in pre-term labour

33
Q

What are the neonatal/fetal side effects that indomethacin causes?

A
  1. Renal insufficiency-possible oligohydroamnios
  2. Closure of the ductus arteriosus which is dangerous during foetal development
  3. Necrotising enterocolitis
34
Q

Which route is the indomethacin given?

A

Rectally

35
Q

What is the dose of Indomethacin and sulindac that we give to treat polyhydroamnios?

A
  1. 100mg 12 hourly rectally

2. 200mg sulindac 12 hourly

Obstetrics (18 decks)

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