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MRCOG - Part 2 > Polyhydramnios > Flashcards

Polyhydramnios Flashcards

1
Q

Define Polyhydramnios

A
  • AFV of 2,000 mL or greater at term
  • DVP is greater than or equal to 8 cm
  • AFI is above the 95th percentile for the particular gestational age
  • AFI is more than or equal 25 cm
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2
Q

Degrees of polyhydramnios are based on

A

he measurement of the largest vertical pocket of liquor.

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3
Q

What is mild polyhydramnios

A

Largest vertical pocket of liquor measures 8–11 cm

AFI: 25.0–29.9 cm

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4
Q

What is moderate polyhydramnios

A

Largest vertical pocket of liquor measures 12–15 cm

AFI: 30–34.9 cm

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5
Q

What is severe polyhydramnios

A

Largest vertical pocket of liquor measures >16 cm

AFI: >35

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6
Q

What is the incidence of polyhydramnios

A

0.2-3.9%

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7
Q

Define the course of amniotic fluid when it starts increasing, reaching plateau and declining

A
  • ** Increases up to: 33 Weeks
  • Plateau: 33-38 Weeks
  • Declining: 38-42 Weeks**
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8
Q

Factors affect Amniotic fluid balance

A

amniotic fluid production
* fetal urine production
* secretions from the respiratory tract
* oral secretions

amniotic fluid removal
* fetal swallowing

fluid dynamics across the membranes
* transfer across the placenta, umbilical cord, and fetal skin (intramembranous flow)
* across the fetal membranes (transmembranous flow)

Abnormality of these mechanisms leads to excessive accumulation of AF.

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9
Q

Methods for assessment of amniotic fluid

A

Ultrasound evaluation of the amount of amniotic fluid:
* deepest vertical pocket (DVP)
or
* amniotic fluid index (AFI)

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10
Q

The AFI is calculated by

A

obtaining a sum of the vertical dimensions of four quadrants of the uterus without any cord ot limb meausred
Normal: 5-25

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11
Q

DVP is calculated by

A

(Single deepest pocket) the largest visible pocket of amniotic fluid without any limb or cord measured
Normal: 2-8 cm

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12
Q

Most common cause of polyhydramnios in sigleton pregnancy

A

Idiopathic 60%

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13
Q

Most common fetal complication of mother uses lithium

A

Fetal nephrogenic diabetes insipidus

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14
Q

Most common Known cause of polyhydramnios in sigleton pregnancy

A

Maternal Diabetes

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15
Q

How Maternal DM causes polyhydramnios

A

Pederson’s Hypothesis:
Maternal Hyperglycemia leads to fetal hyperglycemia and hyper-insulinemia leading to polyuria by osmotic action

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16
Q

Fetal causes of Polyhydramnios

A
  1. Congenital malformations
  2. Chromosomal and genetic abnormalities, e.g. trisomies, Beckwith–Wiedemann syndrome, fetal akinesia–dyskinesia syndrome
  3. Congenital infections, e.g. toxoplasma, rubella, cytomegalovirus, and parvovirus
  4. Macrosomia
  5. Fetal tumours, e.g. teratomas, nephromas, neuroblastoma, and haemangiomas
17
Q

Maternal Causes of polyhydramnios

A
  1. Uncontrolled diabetes mellitus 2. (pregestational and gestational)
  2. Rhesus and other blood group isoimmunisation leading to immune hydrops
  3. Drug exposure, e.g. lithium leading to fetal diabetes
18
Q

Fetal CNS disorders that cause polyhydramnios

A
  • Anencephaly
  • Spina bifida
  • Encephalocele
  • Hydrocephalus
  • Microcephaly
  • Dandy–Walker malformation
19
Q

Fetal Respiratory disorders that cause polyhydramnios

A
  • Tracheal agenesis
  • Congenital diaphragmatic hernia
  • Congenital cystic adenomatoid malformation
  • Bronchopulmonary sequestration
20
Q

Fetal GIT disorders that cause polyhydramnios

A
  • Esophageal atresia
  • Tracheo-oesophageal fistula
  • Duodenal and intestinal atresia
  • Exomphalos
  • Gastroschisis
21
Q

Fetal Genitourinary disorders that cause polyhydramnios

A
  • Pelvi-uretric junction obstruction
  • Bartter syndrome
22
Q

Fetal Head & neck disorders that cause polyhydramnios

A

Goitre, cystic hygroma, cleft palate

23
Q

Perinatal mortality & morbidity increase due to polyhydramnios

A

2-5 folds

24
Q

Maternal Complications of polyhydramnios

A

4U 6P 1G

Presentation (abnormal)
PROM
Placental abruption
Premature delivery
PPH
Perinatal mortality

Unstable lie
Uterine inversion
Uterine dysfunction
Umbilical cord prolapse

GDM

25
Q

Fetal Complications of polyhydramnios

A
  1. Congenital malformations
  2. Increased perinatal morbidity
  3. Stillbirths
  4. Preterm births
26
Q

Polyhydramnios

Inspite of normal sonographic monitoring, risk of major anomaly is

A

with mild: 1%
with moderate: 2%
with severe: 11%

27
Q

polyhydramnios

Indication of referral to fetal medicine specialist

A
  • suspected fetal anomaly
  • small for gestational age fetus
  • concerns with fetal movements
  • persistent or worsening polyhydramnios.
28
Q

Therapuetic ttt we can use to relief symptoms of polyhydramnios

A

Therapeutic amniocentesis or amniodrainage has been used to treat symptomatic polyhydramnios in order to minimise respiratory embarrassment.

also used in pts w/ significant cx shortening to avoid preterm birth.

29
Q

In case of mild to moderate unexplaind polyhydramnios, how we monitor this pt. in the rest of her antenatal period

A

Mild to moderate: Serial growth scan + TVS = for cx lengh
Severe: presistent causing maternal complications refere to FMU
Only discomfort: Therpuetic amniosentesis

30
Q

Management n case of suspected fetal anomaly (IUGR- SGA- fetal aneuploidy or infections)

A

refer to FMU directly

31
Q

Management n case of suspected maternal infections, DM or red cell antibodies in a case of polyhydramnios

A

refer to FMU directly

32
Q

What will we do if we find cx shortening due to polyhydramnios

A
  • Considered High risk
  • Antnatal corticosteroids for lung maturation
  • Hospital with intensive car unit for delivery within 24 hours
33
Q

What is the risks of preterm labour due to polyhydramnios

A

* unstable lie requiring delivery by caesarean section
* umbilical cord prolapse
* abruptio placentae
* postpartum haemorrhage.

34
Q

In which cases of polyhydramnios we need IOL

A

when polyhydramnios is a part of the clinical picture such as uncontrolled maternal diabetes or associated with other obstetric conditions such as prolonged pregnancy, maternal hypertension, etc.

35
Q

How we manage polyhydramnios patients in labour

A

Controlled amniotomy in theatre
Continous fetal monitoring
Anticipation of complications like shoulder dystocia & PPH

36
Q

What is fetal loss rates related to polyhydramnios

A

4% increases to 60% with coexistent structural anomaly

37
Q

Sum up of management after diagnosis of poly hydramnios

A
  1. Investigate
  2. maternal RBS/GTT/ HbA1c/ Toxoplasma/ CMV/ PArvovirus/ Red cell antibodies
  3. Detailed U/S for fetal anomalies, weight, stomach & movements
  4. TVS for Cx. lenght
38
Q

How much of AF do we draw for amnio reduction

A

It has 2 parameters:
1. AFI become normal less than 25. OR
2. mother gets symptomatic relief

MRCOG - Part 2 (43 decks)

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