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MIDS 187 - OB2 + OB3 > The Fetal Genitourinary System (lesson 19b) > Flashcards

The Fetal Genitourinary System (lesson 19b) Flashcards

1
Q

By how many weeks gestation can the kidneys be identified and thoroughly evaluated?

A

22 weeks

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2
Q

Does fetal voiding decrease or increase bladder size?

A

Decrease

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3
Q

How often does the fetal bladder void?

A

Once per hour

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4
Q

What can help rule out bilateral renal dysfuction or agenesis, bilateral renal or ureteral obstruction?

A

Bladder filling, as it shows at least one kidney is doing its thing

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5
Q

By which weeks does fetal urine make up 90% of amniotic fluid?

A

20 wks

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6
Q

If oligiohydramnios is present after 16 weeks gestation, what is this suspicious for?

A

Malfunctioning GU system, because if baby’s not peeing, then something is up with the GU (geniturinary) system

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7
Q

What is the recurrence rate of renal agenesis in families?

A

50%

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8
Q

Unilateral agenesis is often correlated with which urinary tract anomalies of the contralateral kidney?

A

UPJ, VUR

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9
Q

In the case of unilateral agenesis, what happens to the single kidney?

A

Compensatory hypertrophy

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10
Q

Does unilateral agenesis result in a change in amniotic fluid or bladder filling?

A

No, it does not affect the amniotic fluid

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11
Q

What are some of the differential diagnoses for an empty renal fossa?

A

renal aplasia, renal dysplasia, multicystic dysplastic kidney, renal ectopia

(a.d.m.e.)

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12
Q

What anomalies have an increased incidence in association with renal ectopia?

A

Hydronephrosis and VUR, UTIs, and renal stones

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13
Q

What’s the most common location for an ectopic kidney?

A

Pelvis

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14
Q

What are the most common crossed renal ectopia?

A

Left to right crossover; upper pole of crossed ectopic kidney latches onto the lower pole of the normal kidney

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15
Q

What are some ultrasound findings that occur with crossed renal ectopia?

A

Calyceal dilation and hydronephrosis

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16
Q

What is a renal isthmus?

A

The connection between the two renal masses during a horseshoe kidney

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17
Q

What is the most common renal fusion anomaly?

A

Horseshoe kidney

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18
Q

What makes a MILD degree of hydronephrosis in SECOND trimester?

A

4 to < 7 mm

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19
Q

What makes a MODERATE degree of hydronephrosis in SECOND trimester?

A

7 to ≤ 10 mm

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20
Q

What makes a SEVERE degree of hydronephrosis in SECOND trimester?

A

> 10 mm

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21
Q

What makes a MILD degree of hydronephrosis in THIRD trimester?

A

7 to < 9 mm

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22
Q

What makes a MODERATE degree of hydronephrosis in THIRD trimester?

A

9 to ≤ 15 mm

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23
Q

What makes a SEVERE degree of hydronephrosis in THIRD trimester?

A

> 15 mm

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24
Q

What is one of the most common fetal uropathy anomalies detected on prenatal sonography?

A

Obstruction

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25
Q

What type of dilation is more common in fetuses with trisomy 21?

A

Pelvic dilation

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26
Q

What measurement are most kidneys with antenatal hydronephrosis normal at birth with? (answer in mm)

A

10 mm

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27
Q

When is a follow up ultrasound done when hydro is detected in the second trimester?

A

32 weeks

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28
Q

What is one of the key factors in determining postnatal pathology? (fluid related)

A

Oligio

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29
Q

What is APRPD?

A

Anterior posterior renal pelvic diameter; the renal pelvis measured

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30
Q

What is the most common cause of congenital obstructive hydronephrosis?

A

UPJ, ureteropelvic junction obstruction

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31
Q

What is the typical sonographic appearance of UPJ?

A

Severe unilateral hydronephorsis without ureteral dilation, and normal bladder

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32
Q

What is UVJ Obstruction?

A

Ureterovesical junction obstruction; hydro and dilatation of he ureter to the level of the bladder, without dilated bladder

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33
Q

What is the measurement for megaureter?

A

Greater than 7mm from 30wks onwards

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34
Q

What type of obstruction is most common in females?

A

Ureterocele

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35
Q

What is a ureterocele most commonly associated with?

A

Duplicated renal collecting systems

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36
Q

Ureteroceles found outside the bladder may simulate what?

A

Any pelvic cystic mass, ovarian cyst, anterior meningocele, or hydrocolpos

37
Q

An enlarged bladder (megacystis) and bilateral hydronephrosis characterizes what type of obstruction?

A

Lower urinary tract obstruction (LUTO)

38
Q

What are the two most common causes of LUTO?

A

PUV and urethral atresia

39
Q

Urethral atresia is characterized by what?

A

Anhydramnioas and a largely distended bladder that fills the entire abdo and pelvis

40
Q

What is the ‘keyhole sign’ associated with?

A

PUV (posterior urethral valves)

41
Q

What is the least common type of PUV?

A

Type II: vertical of longitudinal folds between the verumontanum and prox prostatic urethra bladder neck

42
Q

What is the most common type of PUV?

A

Type I: anterior fusing of the plicae colliculi, mucosal extending from the bottom of the verumontanum distally along the prostatic and membranous urethra

43
Q

Prune belly syndrome is four times more common in what types of twins?

A

Monozygotic and dizygotic

44
Q

What is the triad for Prune Belly Syndrome?

A

Distension of the anterior abdominal wall, obstruction of urinary tract, and bilateral cryptorchidism

45
Q

What are the hereditary polycystic kidney diseases?

A

ARPKD (autosomal recessive) & ADPKD (autosomal dominant)

46
Q

What are the nonhereditary polycystic kidney diseases?

A

MCDK (multicystic dysplastic kidneys)

47
Q

What are the four types of ARPKD?

A

Perinatal, neonatal, infantile, and juvenile

PNIJ - J most popular

48
Q

What is the leading cause of perinatal death?

A

Pulmonary hypoplasia related to oligiohydramnios

49
Q

What is the most common inherited kidney disease?

A

ADPKD

50
Q

Is MCDK typically unilateral or bilateral?

A

Unilateral

51
Q

With MCDK, contralateral renal anomalies are a common finding - what is the most common renal anomaly found?

A

VUR

52
Q

With MCKD, will the lungs develop normally?

A

Yes, as amniotic fluid level is not affected

53
Q

In cases of PUV, urethral atresia, or UPJ obstruction, what type of kidney disease is most common?

A

Obstructive Cystic Dysplasia

54
Q

Are simple renal cysts something to worry about, when on their own?

A

No

55
Q

Renal tumours occur in which trimester?

A

Exclusively third trimester

56
Q

Renal tumours are associated with what?

A

Polyhydramnios and subsequent premature labor

57
Q

Adrenal glands are best visualized in which trimester?

A

Third trimester (but can be seen in the second trimester)

58
Q

Is the prognosis of fetal neuroblastoma a good one if detected?

A

Yes, as these blastomas can spontaneously regress and do not require aggressive intervention

59
Q

What does the bony pelvis consist of?

A

Iliac crests (echogenic) separated from the sacrum (echogenic) by the sacroiliac joint (hypoechoic)

60
Q

What are the two major abnormalities in the pelvis?

A

Internal pelvic masses and sacrococcygeal teratomas

61
Q

What are the most common urachal anomalies?

A

Urachal sinus and urachal cyst

62
Q

If the bladder appears as a solid anterior abdominal wall mass, what can it be?

A

Bladder exstrophy

63
Q

Bladder exstrophy can also look like what other two abnormalies?

A

Omphalocele or gastroschisis

64
Q

What are some other diagnostic criteria for bladder exstrophy? (3)

A

Splayed iliac bones, epispadias, and small genitals

65
Q

What are the sonographic findings of cloacal exstrophy?

A

Absent bladder, large midline infraumbilical anterior wall defect, omphalocele, and lumbosacral anomalies (myelomeningocele)

66
Q

What is the OEIS complex?

A

Omphalocele, exstrophy of the bladder, imperforate anus, spinal anomalies (also known as cloacal exstrophy)

67
Q

Which weeks are the genital tubercle in males and females indistinguishable?

A

Weeks 12-14

68
Q

Downward angle of the tubercle indicates which sex?

A

Female

69
Q

Upward angle of the tubercle indicates which sex?

A

Male

70
Q

Are the normal ovaries, uterus, and vagina are typically seen within the fetus?

A

Yes, true.

71
Q

What is hypospadias?

A

The abnormal development of the corpus spongiosum and cavernosa urthera due to incomplete fusion of urogenital folds.

72
Q

What can be seen with hypospadias? (think balls)

A

Bifid scrotum

73
Q

When does testicular descent occur abdominally?

A

10-15 wks gestation

74
Q

When does testicular descent inguinally?

A

26-25 wks gestation

75
Q

From what week can bilateral testicular descent be observed?

A

32 wks

76
Q

Is it normal for a variable amount of fluid remaining from testicular descent into the scrotum to surround the testes?

A

Yes, normal

77
Q

What can crypotorchidism be associated with?

A

Noonan syndrome, Klinefelter syndrome, multiple congenital anomalies, and masculinization of female genitalia

78
Q

What might it mean if a hydrocele keeps enlarging?

A

A continued patency of the processus vaginalis

79
Q

What could increasing scrotal volume indicate?

A

Inguinoscrotal hernia

80
Q

What side do inguinoscrotal hernias most commonly occur on?

A

The right side

81
Q

What are the most common intraabdominal tumours in female fetuses and neonates?

A

Fetal ovarian cysts

82
Q

What may cause a fetal ovarian cyst to develop? (3)

A

Maternal hormonal stimulation, hypothyroidism, or diabetes

83
Q

When are fetal ovarian cysts typically seen?

A

Third trimester

84
Q

At what size do fetal ovarian cysts start to become worrisome for torison?

A

5cm

85
Q

What is hydrocolpos/hydrometrocolpos?

A

Hydrocolpos - cystic dilatation of vagina
Hydrometrocolpos - cystic dilatation of vagina and uterus

86
Q

How will you see hydrocolpos/hydrometrocolpos on ultrasound?

A

Midline anechoic or hypoechoic mass posterior to the bladder, can compress lower ureters

87
Q

What are poor prognostic signs with hydrocolpos?

A

Associated renal dysplasia, oligohydramnios, fetal ascites, and resultant pulmonary hypoplasia

88
Q

What does ‘disorders of sex development’ mean?

A

A congenital condition in which development of chromosomal, gonadal, or anatomical sex is atypical.

89
Q

What is AIS?

A

(Androgen insensitivity syndrome)
Results in a normal female phenotype but amenorrhea presents at puberty and testes may be found

MIDS 187 - OB2 + OB3 (8 decks)

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