Meh+UW polyhyrd/oligohydramnios 02-17 (1)

Question 1

mehl. polyhydr. definition?

Answer 1

Excessive amniotic fluid.

Question 2

mehl. oligohydr. definition?

Answer 2

Insufficient amniotic fluid.

Question 3

mehl. polyhydr. 2 important maternal causes?

Answer 3

GDM and multiple gestation pregnancies.

Question 4

mehl. polyhydr. maternal cause. GDM. mechanism?

Answer 4

incr.­ glucose in the fetus pulls water with it through
the fetal kidneys, causing ­inr. urinary volume.

Question 5

mehl. polyhydr. maternal cause. multiple gestations. mechanism?

Answer 5

This is due to the combined incr.­ in urinary
output in the setting of multiple fetuses.

Question 6

mehl. polyhydr. important fetal cause? 2

Answer 6

fetal hydrops.

Question 7

mehl. polyhydr. fetal cause = fetal hydrops. definition?

Answer 7

severe edema in the fetus usually as a result of heart failure

Question 8

mehl. polyhydr. fetal cause = fetal hydrops. what cause it?

Answer 8

In the setting of Parvo B19 infection, fetal anemia, or HDN, cardiac output ­incr. to compensate,
leading to incr. renal perfusion and ­incr. urine production.
In the setting of fetal heart failure where cardiac output is decreased, increased venous pressure will
cause edema, where the kidneys attempt to rid the body of excess fluid by incr.­ urinary output.

Question 9

mehl. oligohydr. 1 important maternal cause?

Answer 9

Uteroplacental insufficiency.

Question 10

mehl. oligohydr. maternal = uteroplacental insuff. causes?

Answer 10

Reduced blood flow to the fetus as a result of
smoking, preeclampsia, and SLE (discussed in below tables) can result in compromised renal function and urinary output. This is likely related to impaired nutrient delivery in the setting of minimally sufficient oxygenation.

Question 11

mehl. oligohydr. fetal causes? 2

Answer 11

posterior urethral valves;
renal agenesis (potter sequence)

Question 12

mehl. oligohydr. fetal causes = Posterior urethral valves. frequency?

Answer 12

Most common genitourinary abnormality in
neonatal males.

Question 13

mehl. oligohydr. fetal causes = Posterior urethral valves. definition?

Answer 13

“Posterior” refers to the prostatic urethra developing thin membranes, or “valves,” that prevent urinary outflow.

Question 14

mehl. oligohydr. fetal causes = Posterior urethral valves. mechanism?

Answer 14

This can lead to obstructive uropathy with vesicoureteral reflux and hydronephrosis.

Question 15

mehl. oligohydr. fetal causes = Posterior urethral valves.

Severity can vary; some Qs give severe oligohydramnios; other Qs are male neonate hours old who hasn’t urinated, or male neonate weeks old with urinary retention.

Answer 15

.

Question 16

mehl. oligohydr. fetal causes = renal agenesis (potter sequence). mechanism?

Answer 16

Failure of kidney development –> decr. urinary output –> decr. amniotic fluid –> decr. swallowing of fluid by fetus –> impaired lung development –> pulmonary hypoplasia.

The decr. amniotic fluid also leads to flattened facies and rocker-bottom feet.

Question 17

UW. amniotic fluid index table. AFI in oligo?

Answer 17

AFI < 5cm

Question 18

UW. amniotic fluid index table. AFI in poly?

Answer 18

AFI >= 24 cm

Question 19

UW. amniotic fluid index table. oligo. causes? 5

Answer 19

preeclampsia
abruptio placentae
uretoplacental insuff.
renal anomalies
NSAIDs

Question 20

UW. amniotic fluid index table. polyhydr. causes? 5

Answer 20

eso/duodenal atresia
anencephaly
mulptiple gestation
congenital infections
DM

Question 21

UW. amniotic fluid index table. oligo. complications? 3

Answer 21

meconium aspiration
preterm delivery
umbilical cord compression

Question 22

UW. amniotic fluid index table. poly. complications? 4

Answer 22

fetal malpresentation
umbilical cord prolapse
preterm labor
preterm prelabor rupture or membranes

Question 23

UW. amniotic fluid index.
Case: 24 weeks + UG shows 24 weeks + uterus size 30 weeks. AFI 40 cm. visualized Tracheoeso fistula. Patient is incr. risk for what complications?

Answer 23

preterm prelabor rupture of membranes

Question 24

UW. how is produced amniotic fluid?

Answer 24

amniotic fluid production (ie, fetal urination)

Question 25

UW. how is removed amniotic fluid?

Answer 25

removal (ie, fetal swallowing)

Question 26

UW. what is required for normal fetal development?

Answer 26

a normal volume of amniofluid is required for fetal development (eg, lung maturity).

Question 27

UW. How tracheoeso fistula cause polyhydr?

Answer 27

polyhydramnios is due to an isolated fetal tracheoesophageal fistula that impairs fetal swallowing and removal of amniotic fluid.

Question 28

UW. Most patients with polyhydramnios are asymptomatic and have a uterine size-larger-than-dates discrepancy (eg, fundal height 32 cm at 24 weeks gestation); others may have dyspnea due to insufficient maternal lung expansion from an enlarged uterus.

Answer 28

.

Question 29

UW. Polyhydramnios, especially with increasing severity, can cause obstetric complications due to uterine overdistension and increased intraamniotic pressure. The increased tension of the fetal membranes makes them more susceptible to rupture, placing these patients at higher risk for preterm prelabor rupture of membranes

Answer 29

UW. Uterine overdistension may also cause inflammation, prostaglandin release, uterine irritability, and an increased risk of preterm labor.

Question 30

UW. polyhydr. Additional complications include fetal malpresentation (eg, breech), umbilical cord prolapse, and postpartum uterine atony.

Answer 30

.

Question 31

UW. patients with symptomatic polyhydr. may benefit with what procedure?

Answer 31

Patients with symptomatic polyhydramnios may benefit from amnioreduction (ie, amniotic fluid removal by amniocentesis).