Obstetrics Flashcards
1
Q
Non-immune Hydrops
A
- Single live intra-uterine pregancy with heartbeat…
- Polyhdramnios ( MVP of >8 and 4 quad >24)
- 2 Pleural cavities (ascites, pericardial effusion, pleural effusion)
- Mediastinal shift
- Umbilical artery
- MCA doppler normal ( if raised =fetal anaemia)
- Growth normal
- Placenta not hydropic
DD-
- Structural abnormality
- cardiac
- infection i.e. parvovirus
- chylothorax
Management:
- Urgent specialist obstetric
- MFM referral
- Infection screen
2
Q
Autosomal recessive poylcystic kidney disease
A
- Single live intrauterine pregnancy with heartbeat___
- Anhydramnios ( severe oligohydramnios AFI<5, MVP <2 ).
- Cervix is long and closed.
- Placenta is ____.
- Both kidneys are present.
- Bilateral enlarged and hyperechoic kidneys.
- Absent bladder.
- Dolicocephaly
- Normal growth.
- No other feotal anomaly.
- Normal SD ratio of the umbilical artery.
Differentials
- Spontaneous rupture of the membranes
- Chromosomal abnormality.
Referral
- Tertiary centre/ MFM
3
Q
Ileal atresia
A
Findings
- Single live intrauterine pregnancy.
- Cephalic presentation.
- Placenta is anterior and clear of the os.
- Normal umbilical artery SD ratio and umbilical artery doppler.
- There is evidence of poyhydramnios ( AFI > 24, MVP >8)
- There is a dilated stomach.
- Prominent loops of small bowel.
Other
- Normal lips.
- No thoracic mass seen.
- Cereberum seen, no intranial abnormality identified.
- No anterior abdominal wall mass
- Abdominal wall is seen
Diagnosis
- Small bowel atresia.
- Obstruction.
- Polyhydramnios.
Differential
- -Aneuploidy T21
- -Cystic fibrosis
- -Jejunal/ileal atresia
- -VACTERL
Management
- UrgentTertiary referral/ MFM
- Consider karyotyping.
4
Q
Retained products of conception
A
- Transabdominal/transvaginal exam
- The uterus is anteverted.
- There is a high echogenic mass within the endometrium of the uterus.
- It is well defined and is separable from the myometrium.
- The myometrium- endometrium interface is well preserved.
- It does not demonstrate any flow on colour doppler.
- No other uterine lesions seen
Findings
- Cystic mass in the left ovary that contains septations and particulate material.
- It is a complex cystic mass.
- Does not demonstrate any increased flow on colour doppler.
- There is no increased flow o-n colour doppler in the left ovary.
- The right ovary is normal.
Diagnosis-
Retained products of conception
Differential
- Uterine
- Endometrial polyp
- Malignancy
- Ovarian appearances
- Haemorrhagic corpus luteum
Referral
- Gynaecology- dilatation and curettage
5
Q
Chiari 2
A
- Lemon shaped head with frontal bone depression
- Banana cerebellum c/w Chiari II malformation
- Ventricles not dilated, but choroid dangling
- Level of defect L2/3 to low sacrum
- Defect open
- No other abnormality
Diagnosis
- Lumbosacral neural tube defect
Differential No differential
- Further Investigation or Management Urgent Specialist/MDM referral
- Recurrence risk in subsequent pregnancies approx. 5%
- Recommend high dose folate in subsequent pregnancies
- No association with chromosome abnormalities, would not recommend amniocentesis
6
Q
Trisomy 18
DD
Aneupoloidy
A
IUGR 60%
Polyhydramnios
Single umbilical artery- 80%
CHD, 90%
Choroid plexus cysts, 30% (1%-2% of normal population) All CP cysts resolve, but resolution does not alter association Normal if no other abnormality
- Characteristic face:
- Dolichocephaly
- strawberry skull
- Micrognathia
- Low-set ears
Heart
- CHD
Skeletal abnormalities
- Clenched hand with overlap of 2nd and 3rd digits
- 80% Rockerbottom feet
GI abnormalitis
- Hernia
- omphalocele( If omphalocele contains liver, it is less likely to be associated with trisomy 18)
- atresias
Managment
- Urgent phone contact with obstetrician
- Risk of premature labour from polyhydramnios
- Consideration of late amniocentesis for delivery and neonatal planning
- Consideration of amnioreduction
7
Q
Endometriosis
A
- Indistinct endometrial myometrial border
- Heterogenous myometrial echotexture
- Small anechoic lakes
- Ill defined hypoechoic areas
- Echogenic linear striations from the uterus
- Asymmetric uterus enlargement
- Globular appernace of the uterus.
- Posterior acoustic enhancing
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