QuizFetal Medicine

Biometry

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1. Landmarks for AC

2. Standard checklist for routine fetal growth scan

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What is the diagnosis?  What is the recurrence rate? What advice would you give for

future pregnancies?

Anencephaly Neural tube defects (NTDs) result from failure of the neural

tube closure between 25 and 27 days after conception.

Absence of brain and calvaria superior to the orbits on coronal views of the fetal head

Up to 75 percent of anencephalic infants are stillborn

Risk of recurrence for NTDs (spina bifida or anencephaly) - 2 to 4 percent with one affected sibling - 10 percent with two affected sibling

Higher doses of folic acid supplements are usually recommended for women who have had a previous pregnancy affected by a NTD

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Identify the above abnormalities

Outline 4 major differences between the 2 abnormalities.

 What are the other differential

diagnoses? What is the antenatal and

intrapartum management?

Differential diagnosisphysiologic bowel herniation umbilical hernia gastroschisis amniotic band syndromeexstrophy of urinary bladder and

cloacapentalogy of Cantrell body stalk anomaly

Gastroschisis Mx – If associated malformations, offer karyotyping Antepartum fetal surveillance Delivery at 39 weeks if no other indications Full thickness closure of abdo wall defect

Omphalocele Mx – Karyotyping Antepartum fetal surveillance Plan delivery at a surgical centre Delivery at 39 weeks if no other indications In the delivery room - cover the defect with gauze

dressings soaked in thermally neutral sterile saline, cover the dressing with Saran Wrap, insert an orogastric tube to decompress the stomach, stabilize the airway to ensure adequate ventilation, and establish peripheral intravenous access.

Identify the abnormality

What are the commonly associated anomalies?

What are the factors affecting prognosis?

 What is the antenatal management?

VentriculomegalyAssociated anomalies Chiari malformations Neural tube defectsDandy Walker malformationsAgenesis of the corpus callosum Genetic syndromes

Factors affecting prognosisUnilateral/BilateralSeverityAssociated anomalies

Management Structural Survey

Fetal karyotype

Testing for infectious etiologies (cytomegalovirus [CMV] and toxoplasmosis)

Fetal MRI for isolated ventriculomegaly in which the etiology is unexplained.

A follow-up ultrasound examination to assess progression or regression

What is the abnormality?

What are the associated abnormalities?

 What are the prognostic factors?

What is the antenatal management plan?

Congenital Diaphragmatic HerniaHerniation usually occurs on the left (80 to 85 percent); right-sided diaphragmatic hernias occur in only 10 to 15 percent of cases. Bilateral herniation is rare. Associated anomalies – Neural tube defects - anencephaly, myelomeningocele,

hydrocephalus, and encephaloceles Cardiac defects - VSD, vascular rings, and coarctation of

the aorta Midline developmental anomalies- esophageal atresia,

omphalocele, and cleft palate Chromosomal anomalies - trisomies 18, 13, and 21,

monosomy X, tetrasomy 12 p (isochromosome 12p), partial trisomy 5, partial trisomy 20

 

Prognostic factorsAbnormal karyotypeAssociated anomalies Right-sided defect Liver herniationLower fetal lung volume ManagementFetal karyotype, Fetal MRI to look for liver herniationEchocardiographySerial ultrasound examinations for fetal

well being

Indentify the abnormaility1. What are the

associated anomalies

2. Outline the management

Fetal kidney

Head circumferenceComment on the appearance

20 week anomaly scan

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Describe the above images

What are the risks associated with the pregnancy in 2nd image?

How is TTTS diagnosed?

What is the treatment for TTTS and the outcomes?

What are the complications of laser ablation?

Risks with MCDA twins Twin–twin transfusion syndrome

(TTTS) – 10-15%Discordant malformationsDiscordant growth in the absence

of TTTS (10%)Single fetal demiseNeurological abnormality in the

surviving twin (18%)

Diagnosis of TTTS

Oligohydramnios with maximum vertical pocket [MVP] less than 2 cm in one sac and polyhydramnios in other sac (MVP ≥ 8 cm)

Discordant bladder appearances – severe TTTS

Haemodynamic and cardiac compromise –

severe TTTS.

Treatment of TTTSlaser ablation (61% survival rate) Amnioreduction SeptostomySelective feticidefewer deaths of both babies, fewer

neonatal deaths and fewer perinatal deaths.

More babies were alive without neurological abnormality at 6 months of age after laser ablation

Complications of TTTSpremature rupture of the

membranesinfection (chorioamnionitis)pregnancy loss iatrogenic donor intrauterine

deathrecipient intrauterine deathpersistent diseasereverse transfusion