ABNORAMALITY OF AMNIOTIC FLOW Flashcards

Question

PROM is associated with

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Placenta abruption

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Associated with fetal membranes abnormality

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Amniotic band syndrome

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ADAM COMPLEX_ amniotic deformities, Adhesion mutilation Ammotic band sequence Aberrant tissue bands Congenital constricting bands

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Lymphedema Amputations Slash defects in none embryologic distributions

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Represent milder form of limb-body wall complex May predicted by amniotic bands that entangle or amputate fetal parts

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Facial cleft Asymmetric encephalóceles Amputation defects of extremities Clubfootdeformities

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-siring like bands Fibrous strands

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Echogenic band floating in The AF The echogenic band may attach to The wan of uterus or gestational sac Following the band closely with real-time scan can be observed the band is attached to Tue uterin wall and constriction is placed on the fetus

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Shelves or folds identified as echogenic bands crossing through amniotic cavity Thicker than Bands syndrome

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Amniotic sheets

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Uterine scars from previous instrumentation used in uterus Cesarean section Episodes of endemetritis

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-history of Endometrial DC Intrauterine infection Endometritis Removal fibroids or polyps C section

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Infertility Miscarriage

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Formation of scar tissue in the uterine cavity

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Fine echo-dense line in uterine cavity separated from uterine wall by echo-lucent space Membrane may completely surround fetus or be freely mobile in amniotic cavity

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Extending from me side of uterus to other side oblique across uterus Or multiple echogenic lines

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A life threatening condition abnormal amount of fluid accumulation in two armore body areas of fetus

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Abdomen Around the heart Lungs Under skin

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Polyhydramnioes Thickening of the placenta Placenta edema Enlarged umbilical cord Enlarged liver and spleen

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Pleural effusion Cardiac effusion Ascities Skinedtima Anarsarca

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Immune Nonimmune

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Non-immune An diseases arcomplicarians that interferes with now the fetal body manages fluid balance.

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Presence of abnormal collection of fluid

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Are choir fluid surrounding abdominl, pelvic organs and umbilical cord Mistaken normal hypoechoic abdominal musculature for ascities

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Î skin tnickness around the skull, neck, extremities or abdomen

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'skin edema is massive encasing most of the body

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Excessive anechoic fluid in pericardial cavity More than 2 mm

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Thickening of placenta more than 4 -4.5cm in anterior posterior diameter

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Cardiac insufficiency one of the most common causes From cardiac anomalies Tumors or arrhythmias like tachycardia

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Cardiac insufficiency Or hyperoteinuria Structural lymphatic obstruction Decreased venous réturn to heart

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Feral tuners heart or liver Cardiac anomalies Cynic adenomatoid malformation of lung Charinargiama of placenta

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Due to relationship with NIHF Trisomy 21 45x Feral infections TORCH

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• Fetal hydrops, skeletal anomalies, some renal disorders may be associated with hydramnios. • Maternal conditions associated with polyhydramnios • Diabetes mellitus • Obesity • Rh incompatibility • Anemia

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• Freely floating fetus within swollen amniotic cavity • Accentuated fetal anatomy (increased AF improves image resolution) • AFI = 20 cm or greater

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Fetus presenting at 29 weeks gestation with duodenal atresia. The single vertical pocket measurement of 13.71 cm suggests polyhydramnios. An AFI of 32.36 cm supports the findings. The + indicates fetal head.

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• Development of oligohydramnios may be attributed to: • Congenital anomalies • IUGR • Post term pregnancies • Rupture of membranes (ROM) * latrogenesis

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• Second trimester oligohydramnios often has poor prognosis, especially if maternal serum alpha-fetoprotein level also elevated • Maternal conditions associated with oligohydramnios • Hypertension • Preeclampsia • Chronic cardiac or renal disease • Connective tissue disorders • Patients receiving indomethacin

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• Fetal hypoxemia may produce growth restriction and oligohydramnios. • Four-fold increased risk of growth delay when oligohydramnios present • Doppler evaluation of growth-restricted fetus shows abnormal umbilical flow in patients with oligohydramnios.

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• Placental insufficiency may cause IUGR associated with oligohydramnios. • Produces redistribution of fetal blood flow away from kidneys and toward brain to counteract hypoxia • Results in decreased urine output, which decreases fluid volume

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• Post term pregnancy defined as gestational age of 42 weeks or more • Oligohydramnios is common complication of postdate pregnancies. • Is associated with diminished placental function and arterial redistribution of fetal blood flow with brain-sparing effect

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as gestational age of 42 weeks or more

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• Medications associated with oligohydramnios • Nonsteroidal antiinflammatory drugs • Angiotensin-converting enzyme inhibitors • Calcium channel blockers • Nitrous oxide

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• IUGR • Premature rupture of membranes • Postdate pregnancy (42 weeks) • Chorionic villus sampling

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Fetal Anomalous Conditions • Infantile polycystic kidney disease • Renal agenesis • Posterior urethral valve syndrome • Dysplastic kidneys • Chromosomal abnormalities

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The amnion divides the amniotic and chorionic cavities and at 10 weeks gestation.

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• Membranes normally rupture after onset of labor. * Premature rupture of membranes (PROM), preterm premature rupture of membranes (PROM), and spontaneous rupture of membranes (SPROM) describe conditions in which membranes rupture ("water breaks" abnormally, resulting in loss of AF and/or oligohydramnios. • Multiple underlying pathologic processes associated with abnormal ruptured membranes

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• Clinical findings • Patients suspected to have ROM present clinically with sudden gush or leaking of fluid. Nitrazine paper and fern test used as screening test to determine presence of AF in vaginal secretions • Patient is checked for cervical dilation and for leaking of fluid with coughing or fundal pressure.

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Patient is checked for cervical dilation and for leaking of fluid with coughing or fundal pressure.

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• Prognosis of fetus affected by abnormal ruptured membranes depends on fetal GA, fetal status, and ability to control uterine contractions • Abnormal ROM associated with: Preterm delivery Fetal and neonatal death Neonatal respiratory distress Prolapsed umbilical cord Chorioamnionitis* Placental abruption

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Role of sonography is to document integrity of placenta, fetal size, AF volume, fetal well-being, to perform fetal Doppler studies. • Common for patients to be evaluated every day assess fetal well-being and fluid volumes

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• Evaluate the integrity of the placenta, fetal growt! and biophysical profile. • Placenta abruption is associated with ROM.

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Patient presents at 30 weeks gestation with ROM.AFI reveals severe oligohydramnios. Color Doppler was used to ensure that the anechoic fetal cord was not misrepresented as fluid.

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• Is associated with abnormality in fetal membranes • Is a common, nonrecurrent cause of various fetal malformations involving limbs, craniofacial region, trunk • Synonyms used to describe disruption of fetal tissu due to the presence of amniotic bands: ADAM complex (amniotic deformities, adhesion, mutilation) • Amniotic band sequence • Aberrant tissue bands Congenital constricting bands

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(amniotic deformities, adhesion, mutilation

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• ADAM complex (amniotic deformities, adhesion, mutilation) • Amniotic band sequence • Aberrant tissue bands • Congenital constricting bands

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facial clefts, asymmetric encephaloceles, constriction or amputation defects of extremities, clubfoot deformities

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Echogenic band floating in the AF. The echogenic band was attached to the wall of the gestational sac. Copyright

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Soft tissue edema is seen in the forearm, where the band is constricting the soft tissue.

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• May represent milder form of limb-body wall complex

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•Amniotic sheets, shelves, or folds identified as echogenic, nonfloating bands crossing through amniotic cavity • Are thicker than bands associated with amniotic band syndrome • Do not cause fetal malformations • Most likely signify uterine synechiae

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Etiology • Visualization of amniotic sheets believed to be caused by: • Uterine scars from previous instrumentation used in uterus • Cesarean section • Episodes of endometritis

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Clinical findings • Patients with history of endometrial D&C, intrauterine infections, endometritis, removal of fibroids or endometrial polyps, or prior cesarean section are at risk for developing uterine scars. • Synechiae associated with infertility and miscarriages * Patients who present with uterine synechiae and infertility often diagnosed with Asherman's syndrome (Asherman syndrome is the formation of scar tissue in the uterine cavity).

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Synechiae associated with infertility and miscarriages

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Sonographic findings • May show fine echo-dense line in uterine cavity separated from uterine wall by echo-lucent space • Membrane may either completely surround fetus or be freely mobile in amniotic cavity • Can appear anywhere in uterine or cervical cavity • Are seen extending from one side of uterus to other, oblique across uterus or as multiple echogenic lines

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•Other fetal findings identified with hydrops • Enlarged umbilical cord • Polyhydramnios • Placental edema • Enlarged liver and spleen • In many cases, fetal hydrops highly associated with mortality

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for ascites (pseudoascites

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Skin edema can be seen as increased skin thickening around the skull, neck, extremities, or abdomen. • Measurement of >5 to 6 mm for soft tissue thickness is used for didgnosis in some reports. • When skin edema is massive, encasing most of the body, the term anasarca is used.

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If fluid collection measures >2 mm,

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can be identified as a thickened placenta measuring >4 to 4.5 cm in true anterior-posterior diameter.

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infantile polycystic renal disease

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c. amniotic fluid volume Amniotic fluid volume is a chronic marker of fetal hypoxia. Acute markers of fetal hypoxia in- clude fetal breathing movement, fetal tone, nonstress test, and fetal movement.

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When measuring amniotic fluid volume, the transducer must re- main perpendicular to the maternal coronal plane and parallel to the ma- ternal sagittal plane.

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The systolic-to-diastolic ratio of the umbilical artery can evaluate fetal well-being after 30 weeks’ gestation. A ratio greater than 3.0 is abnormal. Absence or reversal of the diastolic component is also abnormal.

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The abdominal circumference is the single most sensitive indicator

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Of all the techniques to assess amniotic fluid volume, the amniotic fluid index (AFI) is both valid and reproducible. 31. d. Maternal diabetes can resul

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c. at or below the 5th percentile for gestational age d. at or below the 10th percentile for gestational age

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b. placenta previa

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Incomplete or footling breech places the fetal foot as the present- ing part and places the greatest risk for cord prolapse.

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Multicystic dysplastic kidney disease is a unilateral disease. The normal contralateral kidney will continue urinary function, allow

ABNORAMALITY OF AMNIOTIC FLOW Flashcards

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