MFM

Question 1

Timing of CVS

Answer 1

10-12 weeks (can do up to 15)

Question 2

Cleft lip/palate Ddx

Answer 2

Normal
amniontic band
facial mass
T13/T18
other syndrome

Question 3

cleft lip association with palate

Answer 3

80%

Question 4

cleft lip/palate management

Answer 4

Detailed anatomy scan to exclude associated abnormalities
Amniocentesis should be offered
Preparation for delivery
a. Plastic surgeon, ENT, Dentist, speech and language therapist, social work, psychiatrist, genetic counsellor
4. Surgery
a. Repair of cleft lip at 2-3 months
b. Repair of cleft palate at 9-18 months

Question 5

Diaphragmatic hernia management

Answer 5

Multidisciplinary counselling
MFM specialist, neonatologist, neonatal surgeon, geneticist, paediatric intensivist.
Fetal treatment-Currently in-utero therapy is not available in New Zealand
Follow-up
Fortnight scan for fetal growth and to exclude polyhydramnios
Timing and mode of delivery
• Timing: to consider delivery by 40 weeks gestation
• Mode of delivery: caesarean for standard obstetric indications only
Recurrence risk
• Isolated: 1-2%
• Multiple congenital anomalies of unknown aetiology: <5%
• Referral to genetic counsellor for genetic work-up for recurrence risk of specific
chromosomal abnormalities and syndromes

Question 6

Diaphragmatic hernia investigations

Answer 6

Referral to Fetal medicine unit
• Fetal genetic studies – amniocentesis:
• Karyotype if isolated
• Microarray if multiple abnormalities
• MRI: Does not improve assessment of lung hypoplasia
• Have a role in the quantitative assessment of liver herniation
• Screening fetal echocardiogram

Question 7

Kell antibodies management

Answer 7

fetus only affected if kell antigen positive
check husband phenotype as if antigen positive other pregnancies at risk
Refer MFM
serial USS for development of fetal hydrops with MCA PSV (every two-weekly from 18 weeks)
Titres not useful
Inhibits erythropoeisis
Can have IUT
If IUT aim delivery 34-35
if no complications with Kell deliver at term
Can test via nipts or cordocentesis

Question 8

TTTS management options

Answer 8

Expectant
amnioreduction
laser therapy
selective termination
TOP all pregnancy

Question 9

Trisomy 13

Answer 9

Patau syndrome
1:5000-1:12000 live births
Median survival 2.5 days
significant congenital abnormalities with cardiac defects, omphalocele, duodenal atresia

Question 10

NAIT

Answer 10

maternal antibodies raised against alloantigens on fetal platelets
Test parents for HPA specific antigens and mum for antibodies

Question 11

Echogenic bowel differential

Answer 11

IUGR
anueploidy
infection
CF
intrauterine bleeding

Question 12

antibodies that can do cffdna testing

Answer 12

D, C, c, E, e Kell

Question 13

for antibodies other than D, K, c, what titre to refer to MFM

Answer 13

32 and rising

Question 14

anti-D titre referral

Answer 14

> 4 - MOD risk HDN

>15=severe risk

Question 15

anti-c titre referral

Answer 15

> 7.5
7.5-15 - severe risk
refer earlier if anti-E antibodies

Question 16

Measurement of titres

Answer 16

anti-D and anti -c monthly until 28/40 then every two weeks

all other antibodies-retest at 28 weeks

Question 17

Management of rising titres

Answer 17

MFM referral

weekly MCA PSV

Question 18

PP management in fetal anaemia

Answer 18

cord DAT performed
early referral MFM future pregnancies
feed baby regularly- LC support

Question 19

Bloods for workup of hydrops

Answer 19

TORCH screen
Kleihauer
CBC
G&S
HbA1c

Question 20

cleft lip/palate consequences

Answer 20

speech
feeding difficulties
dental abnormalities

Question 21

echogenic bowel

Answer 21

non-specific finding in normal fetus
can be associated with chromosomal and non-chromosomal abnormalities
isolated finding - usually good prognosis
association with IUGR and SB and therefore need monthly growth scans

Question 22

potential causes of echogenic bowel

Answer 22

CF
T21, T13, T18
Congenital malformations of the bowel
Congenital infections
IUGR
intra-amniotic bleed (swallowed blood)

Question 23

Balanced translocation

Answer 23

Significance depends on if de novo or carried by a parent
10% risk abnormality not detected on uss if de novo
Genetic counselling
Test mum and dad (karyotype)
Tertiary uss fetal phenotype

Question 24

Quintero staging

Answer 24

1: Still see bladder of donor twin - afi >8 & <2cm
2: no bladder of donor twin
3. abnormal dopplers (absent/reversed EDF, abn DV)
4. hydrops
5. one or both twins demise

Question 25

risks of laser therapy

Answer 25

infection, pprom (6%), fetal death (2%), abruption

80% survival and of those surviving 80% neurologically intact