[FETAL DIS] POLYHYDROAMNIOS

Question 1

Incidence of polyhydroamnios

Answer 1

1-2%

Question 2

MC cause of polyhdroamnios

Answer 2

idiopathic

Question 3

MC cause of SEVERE polyhdroamnios

Answer 3

fetal anomalies

Question 4

fetal causes of polyhydramnios (5)

Answer 4

1-anomalies=
duodenal/esophageal/intestinal
atresia, open NTD, omphalocele, anencephaly
2-Trisomy 18, 21
3-Bartter syndrome
4-Fetal anemia & hydrops (↑COP=↑urine prod.)
5-fetal infection

Question 5

maternal causes of polyhydramnios (2)

Answer 5

1-DM
2-severe generalized edema

Question 6

placental causes of polyhydramnios (3)

Answer 6

1-Twin-Twin transfusion syndrome
2-chorioangioma
3-large placenta

Question 7

complications of polyhydramnios (7)

Answer 7

1-pressure complications
2-PPROM
3-PTL
4-Prolonged labor
5-PPH
6-Puerperal sepsis
7- perinatal mortality (2-5 folds increase)

Question 8

pressure complications of polyhydramnios

Answer 8

1-maternal respiratory compromise
2-dyspepsia, vomiting, abdominal discomfort
3-Pyelonephritis & renal insult
4-Pregnancy induced HTN
5-LL edema & varicose veins

Question 9

PROM complications (5)

Answer 9

1-PTL
2-chorioamnionitis
3-umbilical cord prolapse
4-placental abruption
5-splanchnic shock

Question 10

US Evaluation of amniotic fluid

Answer 10

single deepest pocket 2-8cm
amniotic fluid index 5-25cm

Question 11

presentation of polyhydramnios (4)

Answer 11

1-progressive abdominal enlargement
2-abdominal pain & discomfort
3-dyspnea
4-LL edema

Question 12

GE of polyhydramnios

Answer 12

DM & its complications; excessive weight gain, LL edema

Question 13

AE of polyhydramnios

Answer 13

1- fundal level > date of amenorrhea
2-Fundal & umbilical grip
a) difficulty palpating fetal parts
b) malpresentation
c) skin is glistening, stretched
w/ dilated veins
d) +Ve thrill
3-pelvic grips: malpresentations & non-engagement
4-asculation: difficult/not heard

Question 14

PV

Answer 14

-cervix is partially opened
-bag of forewater is bulging & tense

Question 15

mild polyhydramnios US signs

Answer 15

SDP: 8-11.9
AFI: 25-30

Question 16

moderate polyhydramnios US signs

Answer 16

SDP: 12-15.9
AFI: 30.1-35

Question 17

severe polyhydramnios US signs

Answer 17

SDP ≥16
AFI > 35

Question 18

management of polyhydramnios

Answer 18

1-history
2-management of cause (DM)

Question 19

investigations of polyhydramnios (5)

Answer 19

1-US–> fetal anomalies, fetal hydrops, chorioangioma, TTT syndrome
2-DM screening
3-Screening for immune/nonimmune hydrops fetalis
4-screening for chromosomal & genetic disorders
5-screening for infections

Question 20

tests for fetal wellbeing

Answer 20

1-NST
2-BPP
3-Dopples US

Question 21

management of mild-moderate polyhydramnios cases

Answer 21

1-conservative follow up
2-TOP at 39-40 weeks

Question 22

lung maturity of fetus is induced by

Answer 22

steroids

Question 23

____should be offered in all cases of severe polyhydramnios

Answer 23

screening for chromosomal & genetic disorders

Question 24

management of severe polyhydramnios before 32 weeks

Answer 24

amnioreduction + indomethacin (for 3d)

Question 25

amnioreduction mechanism

Answer 25

-removal of fluid shouldn't be faster than 1000mL over 20 minutes -shouldn't remove more than 50L at one time

Question 26

management of severe polyhydramnios before 32-34 weeks

Answer 26

amnioreduction without administering indomethacin to avoid premature closure of DA

Question 27

TOP of severe polyhydramnios

Answer 27

34-37 weeks

Question 28

delivery indications (4)

Answer 28

1-gestational age: >39 weeks in mild-moderate cases >37 weeks in severe cases 2-maternal conditions indicating delivery 3-Fetal conditions= IUFD, CFM, FDS 4-patient is in labor

Question 29

Modes of TOP

Answer 29

1-vaginal= spontaneous or IOL 2- C-section

Question 30

intrapartum management

Answer 30

1-PGs for cervical ripening 2-oxytocin for induction 3-controlled ROM to avoid cord prolapse & sudden decrease in IUP 4-continuous fetal monitoring

Question 31

PGs & oxytocin should be used with caution to avoid___

Answer 31

PPH & amniotic fluid embolism

Question 32

oligohydroamnios definition

Answer 32

AF volume< expected gestational age

Question 33

MC cause of oligohydramnios

Answer 33

idiopathic

Question 34

fetal causes of oligohydramnios (5)

Answer 34

1-ruptured fetal membranes 2-IUGR & IUFD 3-Post term pregnancy 4-Fetal anomalies= bilateral renal agenesis/hypoplasia, ureter/urethral atresia, post urethral valve, PCKD, MCKD, Potter $ 5-Trisomy 13

Question 35

maternal causes of oligohydramnios (3)

Answer 35

1-suboptimal maternal hydration 2-vascular diseases causing ↓ uteroplacental BF 3-drugs= ACEI, PG synthetase inhibitors, trastuzumab

Question 36

placental causes of oligohydramnios (3)

Answer 36

1-chronic abruptio placenta 2-premature aging of placenta 3-Twin-Twin $