obs - drvictoria

[ArchivalUser]

32yo G3P2 @ 37wks GA with polyhydramnious. USS done @ 16wks was normal.
Wat is d most likely cause of her polyhydramnious?
a] Anencephaly
b] Tracheo-esophageal fistula
c] Renal Agenesis
d]Meconium ileus

[ArchivalUser]

A: anencephaly

[ArchivalUser]

B TOF

[ArchivalUser]

bb

[ArchivalUser]

# Polyhydramnios is usually defined as an amniotic fluid index (AFI) of more than 24 cm or a single pocket of fluid at least 8 cm in depth that results in an amniotic fluid volume of more than 2000 mL.
# Oligohydramnios is sonographically defined as an AFI less than 7 cm or the absence of a fluid pocket 2-3 cm in depth.


# Polyhydramnios
#

* Visual inspection may reveal a rapidly enlarging uterus in the pregnant mother.
* Multiple gestations are associated with polyhydramnios.
* Fetal abnormalities associated with polyhydramnios include neonatal macrosomia, fetal or neonatal hydrops with anasarca, ascites, pleural or pericardial effusions, and GI tract obstruction (eg, duodenal atresia, tracheoesophageal fistula).
* Skeletal malformations can also occur; these include congenital hip dislocation, clubfoot, and limb reduction defect.
* Abnormalities in fetal movement are suggestive of primary neurologic abnormalities or are in association with a genetic syndrome, such as polyploidy.

# Oligohydramnios
#

* When the oligohydramnios is associated with renal agenesis or dysgenesis, symptoms include a marked deformation of the fetus due to of intrauterine constraint (Potter syndrome).
* Obstructive uropathies cause similar deformations, including external compression with a flattened facies and epicanthal folds, hypertelorism, low-set ears, a mongoloid slant of the palpebral fissure, a crease below the lower lip, and micrognathia. Thoracic compression may also occur.
* Oligohydramnios adversely affects fetal lung development, resulting in pulmonary hypoplasia that typically leads to death from severe respiratory insufficiency. Other fetal deformations include bowed legs, clubbed feet, a single umbilical artery, GI atresias, and a narrow chest secondary to external compression. Infants are typically small for their stated gestational age (SGA). When an abdominal mass is found on examination of the infant in this clinical setting, it often represents multicystic-dysplastic kidney, enlarged urinary bladder, or prune-belly syndrome.


Causes

* Polyhydramnios: The underlying cause of the excessive amniotic fluid volume is obvious in some clinical conditions and is not completely understood in others. Causes include the following:
*
o Twin gestation with twin-to-twin transfusion syndrome (increased amniotic fluid in the recipient twin and decreased amniotic fluid in the donor) or multiple gestations
o Fetal anomalies, including esophageal atresia (usually associated with a tracheoesophageal fistula), tracheal agenesis, duodenal atresia, and other intestinal atresias
o CNS abnormalities and neuromuscular diseases that cause swallowing dysfunction
o Congenital cardiac-rhythm anomalies associated with hydrops, fetal-to-maternal hemorrhage, and parvovirus infection
o Poorly controlled maternal diabetes mellitus (Oligohydramnios may also be seen if severe vascular disease is present.)
o Chromosomal abnormalities, most commonly trisomy 21, followed by trisomy 18 and trisomy 13.
o Fetal akinesia syndrome with absence of swallowing
* Oligohydramnios
*
o Fetal urinary tract anomalies, such as renal agenesis, polycystic kidneys, or any urinary obstructive lesion (eg, posterior urethral valves)
o PROM and chronic leakage of the amniotic fluid
o
+ Chorioamnionitis is an additional important maternal complication from oligohydramnios due to rupture of the membranes, which has an incidence of 21-74%.
+ The earlier chorioamnionitis occurs in pregnancy, the greater the fetal risk of bronchopulmonary dysplasia (BPD), neurologic complications, pulmonary hypoplasia, and, in severe cases, respiratory failure in the neonate.
o Placental insufficiency, as seen in pregnancy-induced hypertension (PIH), maternal diabetes, or postmaturity syndrome when the pregnancy extends beyond 42 weeks' gestation
o Maternal use of prostaglandin synthase inhibitors or ACE inhibitors

so ans is te fistula