ultrasound diagnosis of fatal anomalies

PLACENTA, CORD, AND AMNIOTIC FLUID
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Hydramnios
Definition: Increased amount of amniotic fluid:
amniotic fluid index (AFI) above 25cm, or largest
depot above 8 cm. At the due date, the amniotic
fluid volume is more than 2 L.
Incidence: About 1% of all pregnancies.
Clinical history/genetics: Diabetes mellitus.
Etiology: Fetal anomalies are responsible in up
to 20% of cases: atresia of the esophagus,
duodenal stenosis, jejunal stenosis, disturbance
of swallowing reflex due to muscular or neural
causes, displacement of the mediastinum as in
CCAM or diaphragmatic hernia, some fetal syndromes
(Pena–Shokeir syndrome, and rarely
Neu–Laxova syndrome). It may also occur in association
with fetal hydrops and congenital infections.
Ultrasound findings: Amniotic fluid index of
above 25cm, or the largest depot measuring
above 8 cm. Development of hydramnios is rare
prior to 24–25weeks, even if fetal anomalies are
present.
Clinical management: Detailed scan is mandatory.
Maternal diabetes mellitus should be excluded.
Search for infections (TORCH), possibly
karyotyping. Therapeutic amniocentesis for
aspiration of amniotic fluid is recommended to
relieve maternal abdominal pressure and prevent
premature delivery, if there is dyspnea or
premature contractions, which affect cervical
competence.
Prognosis: This depends on the causative factor.
The perinatal mortality rate is increased due to
premature birth and complications arising
during labor (dystocia, umbilical cord prolapse).
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