1. Quiz Fetal Medicine

3. Biometry 1. Landmarks for AC
Standard checklist for routine fetal growth scan

6. What is the diagnosis?   
What is the recurrence rate?
What advice would you give for future pregnancies?

7. 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

8. A B

9. 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?

11. Differential diagnosis
physiologic bowel herniation
umbilical hernia
gastroschisis
amniotic band syndrome
exstrophy of urinary bladder and cloaca
pentalogy of Cantrell
body stalk anomaly

12. 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
Plan delivery at a surgical centre
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.

14. Identify the abnormality
What are the commonly associated anomalies?
What are the factors affecting prognosis?
What is the antenatal management?

15. Ventriculomegaly Associated anomalies Chiari malformations
Neural tube defects
Dandy Walker malformations
Agenesis of the corpus callosum
Genetic syndromes
Factors affecting prognosis
Unilateral/Bilateral
Severity

16. 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

18. What is the abnormality?
What are the associated abnormalities?
What are the prognostic factors?
What is the antenatal management plan?

19. Congenital Diaphragmatic Hernia
Herniation 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

20. Prognostic factors
Abnormal karyotype
Associated anomalies
Right-sided defect
Liver herniation
Lower fetal lung volume
Management
Fetal karyotype,
Fetal MRI to look for liver herniation
Echocardiography
Serial ultrasound examinations for fetal well being

21. Indentify the abnormaility
What are the associated anomalies
2. Outline the management

22. Fetal kidney

23. Head circumference
Comment on the appearance

24. 20 week anomaly scan

25. A B

26. 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?

27. Risks with MCDA twins Twin–twin transfusion syndrome (TTTS) – 10-15%
Discordant malformations
Discordant growth in the absence of TTTS (10%)
Single fetal demise
Neurological abnormality in the surviving twin (18%)

28. 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.

29. Treatment of TTTS laser ablation (61% survival rate) Amnioreduction
Septostomy
Selective feticide
fewer 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

30. Complications of TTTS premature rupture of the membranes
infection (chorioamnionitis)
pregnancy loss
iatrogenic donor intrauterine death
recipient intrauterine death
persistent disease
reverse transfusion