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OBGYN 2 > M15: Hydrops > Flashcards

M15: Hydrops Flashcards

1
Q

define hydrops

A

abnormal accumulation of serous fluid in at least 2 body cavities or 1 cavity w/ edema

it is the terminal stage for many conditions and signifies fetal decomposition

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2
Q

2 etiologies of hydrops

A

immune
non-immune

… hydrops is common, but specific etiology that causes hydrops is rare

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3
Q

on hydrops occurs, what is its rate of progression

A

rapid…. demise can occur w/in 24-48 hours

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4
Q

US appearance of hydrops

A 
ascites
pleural effusion
pericardial effusion
subcutaneous edema
placental edema
A-V doppler abnormalities
low BPP score
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5
Q

why can ascites often be seen in the pelvis first

ascites can cause what pathology in the scrotum

A

most dependant part of the abdo cavity

hydrocele

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6
Q

describe pseudoascites

what can help us determine if its fluid

A

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

change probe angle and assess if its sitting in the most dependant location

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7
Q

what can pleural effusion cause

why

A

upper body edema
polyhydramnios
pulmonary hypoplasia

due to increased pressure on the mediastinum, thoracic vasculature and heart

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8
Q

where is subcutaneous edema usually first seen

what is anasarca

A

fetal scalp and face….. then abdo and limbs

general edema

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9
Q

what type of edema is a late sign of hydrops

A

placental edema

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10
Q

US appearance of placental edema

A

ground glass appearance and > 4 cm thick

whole placenta is thick: if hydrops is of fetal etiology
focal placental thickening: due to placental vascular malformation

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11
Q

pattern of immune hydrops

A

1st acites
2nd edema
3rd pleural and pericardial effusions

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12
Q

w/ thoracic abnormalities, where is hydrops seen first

what other abnormalities will this cause

A

seen as pleural and pericardial effusions

chylothorax and heart abnormalities

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13
Q

other names for immune hydrops

A

alloimmune hydrops

erythroblastosis fetalis

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14
Q

when does immune hydrops occur

A

when a rhesus mother has antibodies to fetal RBCs

maternal Rh - e.g. A- , or, O-

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15
Q

what is hemolysis

when would it occur

A

destruction of RBCs… (separation of hemoglobin from the RBCs, the hemoglobin would then be found in the plasma)

with a rhesus mother…. when maternal immunoglobulin antibodies cross the placenta and attack the antigen positive fetal RBCs

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16
Q

People who lack the Rh- lack what on their RBCs

A

They lack the RBC protein called rhesus factor

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17
Q

What % of immune hydrops is due to D antibodies

A

80%

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18
Q

What does the destruction of fetal RBCs cause

A

Anemia in the fetus - due to below normal level of erythrocytes

Fetal hepatosplenomagaly

Erythroblastosis fetalis

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19
Q

What is Erythroblastosis fetalis

A

Outpouring of many immature RBCs…. the immature RBCs don’t support of carry 02 well to tissue

20
Q

What does Erythroblastosis fetalis cause

A

Tissue hypoxia
Hydrops
Cardiac failure
Demise

…. when the immature RBCs cant carry 02 to the tissue, fluid leaks out of cells causing hydrops… this leaking fluid doesn’t return to the heart so it has to work harder to compensate which causes the cardiac failure and demise

21
Q

Steps to assessing immune hydrops

A
  • Maternal antibody titers by blood test
  • detailed fetal Us looking for hydrops
  • MCA doppler… w/ severe anemia the velocity increases in the arteries due to decreased velocity of blood
  • optical density determination (ODD) amnio is performed to assess bilirubin levels in amniotic fluid
22
Q

Is MCA doppler reproducible and accurate

A

Yes

23
Q

Treatment of immune hydrops

A

Fetal blood sampling and blood transfusions in utero (PUBS)

24
Q

What % of hydropic fetuses will survive W/ intraventricular transfusions

Non-hydropic

A

70-85% of hydropic

85-95% of non-hydrops

25
Q

When is non immune hydrops commonly seen in 1st and 2nd trimester

A

W/ spontaneously aborted fetuses

26
Q

Common etiologies of non-immune hydrops in North American and Europe

A

Cardiovascular, infection, chromo

27
Q

Common etiologies of non-immune hydrops in Southeast Asia

A

Homozygous thalassemia

28
Q

What is Homozygous thalassemia

heterozygous thalassaemia

A

-Blood disorder not compatible w/ life…
if both parents pass the genes for this disorder to the fetus then the fetus has profound anemia resulting in death in utero.

-If only one parent passes the gene to the fetus, fetus would have mild RBC anomalies

29
Q

Maternal causes of non-immune hydrops

A

Severe diabetes mellitus
Severe anemia
TORCH

30
Q

Placental causes of non-immune hydrops

A

Chorioangioma (shunting)
Venous thrombosis
Cord tension

31
Q

Fetal causes of non-immune hydrops

A

Many

32
Q

Cardiac causes of NIH

A

Malformations
arrhythmia
High output failure from fetal shunts (TTTS)

33
Q

Thorax and neck causes of NIH

A

Any anomaly of the chest that causes compression

34
Q

Urinary causes of NIH

A

Prune belly

35
Q

Chromosomal causes of NIH

A

45X0 - turners
T21, 18, 13
Triploidy

36
Q

Other causes of non immune hydrops

A

Infection
Skeletal dysplasia
Fetal hypokinesis
Idiopathic

37
Q

How do we investigate NIH

A

History - provide clues to ethology
Detailed scan for markers and anomalies
Fetal echo
Karyotype for chorom abnormalities and management
Fetal blood sampling and blood transfusion at the same time

38
Q

What is FISH

What does it detect

A

Fluorescent in situation hybridization

Technique used to COUNT chromo for common aneuploidies
Only take 24-48 hrs

T21, 18, 13

39
Q

What is cavity aspiration

A

Sample of fluid for a diagnosis of chylothorax

40
Q

What is assessed after birth at NIH

A

Placenta

41
Q

Once baby is diagnosed w/ hydrops, whats next

A

Assess changes to hydrops
Cardiothoracic ratios for cardiomegaly
Doppler for heart failure and to assess vessels for arterial pulsations w/ TR (IVC, PV and umbilical vein)… or you can do a colour assessment for TR

42
Q

Therapy for NIH

A

Depends on etiology:
Arrhythmias - digoxin
Aneuploidy - no therapy
Non immune anemia -fetal blood transfusion is performed

43
Q

Therapy for chylothorax and CCAM type 1 causing NIH

A

Pleural drainage to prevent pulmnary hypoplasia

44
Q

Therapy for infections causing NIH

A

Antibiotics

45
Q

Prognosis for NIH

A

Poor… termination is offered if NIH identifies in the 1st or early 2nd trimester

46
Q

Antenatal therapy for NIH

A

Thoracentesis

Paracentessis

47
Q

Therapy for TTTS

A

Serial therapeutic amniocentesis for recipient twin

Fetoscopic ablation of communicating vessels in the placenta

Cord occlusion w/ TRAP syndrome to prevent cardiac failure

OBGYN 2 (15 decks)

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