OB- hydrops

Question 1

Fetal ascites is diagnosed when fluid is seen where? (4)

Answer 1

1. between bowel loops
2. along the abdominal flanks
3. around the liver
4. outlining potential spaces

Question 2

what is isolated ascites caused by?

Answer 2

obstructive urinary or gastrointestinal obstruction

Question 3

what does early or small amounts of ascites appear as?

Answer 3

• difficult to visualize and appears as an anachouc rim of fluid at the edge of abdominal viscera

Question 4

in male fetuses, ascites may be seen in what?

Answer 4

in the scrotum (hydrocele)

Question 5

advanced stages of ascities and easier to diagnose and appear as what? outlining what (5)?

Answer 5

• anachoic fluid

outlining:

• liver
• spleen
• small bowel
• umbilical vein
• falciform ligament

Question 6

Hypoechoic band In normal fetuses?

Answer 6

In normal fetuses, there is a small hypoechoic band (< 2 cm in thickness) extending along the anterior and lateral fetal abdomen

Question 7

What is psedoascites?

Answer 7

Pseudoascites does NOT surround the liver, and is always a subcutaneous finding, whereas the true ascites will extend around bowel loops

Question 8

what is hydrops fetalis?

Answer 8

• Rhesus (Rh) blood group isoimmunization of the fetus

Question 9

what is nonimmune hydrops caused by?

Answer 9

caused by factors other than isoimmunization

Question 10

hydrops fetalis symptoms? (4)

Answer 10

• placental thickening
• abnormal fluid in abdominal cavity, heart, or lungs
• excess amniotic fluid
• general edema

Question 11

what does fetal hydrops refer to?

Answer 11

• a fetus with pathological accumulation of fluid in 2 or more body cavities of tissue

Question 12

what are the potential body cavities that may conatin fetal hydrops? (5)

Answer 12

• Subcutaneous edema (thick skin)
• Peritoneal cavity (ascites)
• Pericardial effusion (heart)
• Pleural effusion (lungs)
• Associated with Polyhydramnios and Placental Edema

Question 13

What is immune hydrops?

Answer 13

• decreased since the advent Rh(D) immunoglobuin (prophylaxis given to mother’s at risk for Rh isoimmunization)

Question 14

What does immune hydrops occur?

Answer 14

when a mother develops (Rh-) antibodies (IgG) to antigen-positive fetal

Question 15

what kind of disease is immune hydrops?

Answer 15

fetal hemolytic disease

Question 16

imune hydrops: fetal hemolytic disease includes? (5)

Answer 16

1. anemia
2. extramedullary erythropoisesis
3. hepatosplenomegaly
4. hypoalbuminemia
5. congestive heart failure

Question 17

prevention of immune hydrops?

Answer 17

300mg of RhoGam is given at 28 weeks gestation in sensitized individuals, or within 48 h after invasive fetal procedure (amniocentesis, chronic villus sampling)

Question 18

Maternal non-immune hydrops causes and associations? (9)

Answer 18

1. uncontrolled diabetes
2. severe anemia
3. severe hypoproteinemia
4. Indomethacin
   (premature closure of ductus arteriosus)
5. Maternal syphilis
6. Maternal hyperthyroidism
7. Cytomegalovirus
8. Parvovirus B19 (Fifth Disease)

Question 19

Placenta/ cord non-immune hydrops causes and associations?

Answer 19

• large chorioangioma
• umbilical artery aneurysm
• cord torsion, knot or tumor

Question 20

What is indomethacin (indocin)?

Answer 20

• prescription drug used to treat moderate to severe pain, swelling, and stiffness from arthritis

Question 21

why is Indomethacin (Indocin) not safe to take during pregnancy?

Answer 21

because it may cause heart defects and other problems to a developing fetus

Question 22

What can Syphilis cause?

Answer 22

• can cause miscarriage, still birth, or fetal death after birth

Question 23

Babies born with congenital syphilis can have what S/S? (7)

Answer 23

• bone damage
• severe anemia
• enlarged liver and spleen
• jaundice
• nerve problems causing blindness or deafness
• meningitis
• skin rashes

Question 24

what does CMV stand for?

Answer 24

cyto- megalo- virus

Question 25

what is the leading non-genetic cause of childhood hearing loss?

Answer 25

- CMV

Question 26

What does CMV cause?

Answer 26

- vision loss - microcephally - behaviour issues - mental disability - cerebral palsy - seizures

Question 27

Non- immune fetal hydrops causes and associations? (13)

Answer 27

``` Congenital Infection Monochorionic twins (TTTS) Skeletal dysplasia Fetal hypokinesis Tumours and other syndromes Chest: Congenital diaphragmatic hernia Lymphatic neck (cystic hygroma) Gastrointestinal Urinary tract cardiovascular chromosomal hematologic ```

Question 28

cardiovascular non- immune fetal hydrops causes and associations? (2)

Answer 28

- supraventricular tachycardia | - vein of galen malformation

Question 29

chromosomal non- immune fetal hydrops causes and associations? (5)

Answer 29

- turners syndromes - trisomy 21, 18, 13 - triplody

Question 30

What is fetal akinesia deformation sequence characterized by (6)?

Answer 30

- decreased fetal movement (fetal akinesia) - IUGR - multiple joint contractures (arthrogryposis) - facial anomalies - pulmonary hypoplasia - developmental abnormalities

Question 31

Fetal akinesia deformation sequence prognosis?

Answer 31

- 30% of affected individuals are stillborn | - many liveborn infants survive only a short time due to complications of pulmonary hypoplasia

Question 32

FADS (Fetal akinesia deformation sequence) inheritence?

Answer 32

- may be inherited in an autosomal recessive manner | - may be caused by matations in the RAPSN or DOK7 genes