OB Ch 60

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Author:
rbeacr
ID:
148734
Filename:
OB Ch 60
Updated:
2012-04-19 21:30:58
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Fetal Thorax
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Fetal Thorax
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  1. fetus considered not viable under how many weeks?
    24
  2. what weeks are there a drastic increase in number and complexity of air spaces and vascular structires
    16-24 wks
  3. fluid in lungs at birth leaves though what 3 ways
    • mouth and nose
    • pulmonary capillaries
    • lymphatics in pulm vessles
  4. chest circum made at level of
    4 ch heart
  5. fetus with narrow chest
    • asphyxiating thoracic dystrophy
    • associated with thanatophoric dwarfism (hypoplastic lungs)
  6. formular for pulm hypoplasia
    CA-HA x 100/ CA
  7. fetal lung texture
    • homogenous
    • early - less echogenic than liver
    • later- more echogenic than liver
  8. fetal breathing prominent when
    • 2nd -3rd tri
    • seasaw movement of chest 20sec during 20 min
  9. which lung has greater volume
    right
  10. fetuses with lung masses may present with
    abnormal cardiac rythm and fetal hydrops fro compression on venous return.

    Pleural eff found with lung masses
  11. lungs do not develop with
    oligo
  12. pulmonary hypoplasia
    • decreaesed number of lung cells, airways, alveoli, decresaed organ weight
    • PROM

    • prolonged oligo- kidney function
    • IUGR
    • placenta
    • dwarfism
  13. renal obstruction
    potters
  14. unilateral pulm agenesis
    • rare
    • usually with other malformations
  15. prognosis for infants with pulm hypoplasia
    80% dye after birth
  16. cystic lung masses
    • replace normal lung tissue
    • shift in structures
    • can be excised after birth
  17. bronchogenic cysts
    • most common lung cyst prenatal
    • abnormal budding of foregut
    • lack of commun with the trachea or bronch tree
    • usually in mediastinum or lung- rarely below diaphragm
  18. plueral eff or hydrothorax
    accumulation of fluid in the pleural cavity

    cardiac problems

    most common reason is chylothorax- right side collection of fluid second to malformed thoracic duct
  19. chylothorax
    • white milky fluid from lymphatics
    • hydraminos
    • right sided ple eff from malformed thoracic duct
  20. pleural eff can result from
    • immune and non immune or nonimmune or cong heart failure
    • chrom anomolies
  21. lymphangiectasia
    dilated lymph node
  22. pleural eff rarely before what week
    • 15
    • except in turners or downs
  23. mortality of pleuarl eff
    • 50%
    • higher with hydrops
  24. pulmonary sequestration
    • supernumerary lobe of lung seperated from normal bronch tree
    • may be in lung sac or in its own (extralobar associated anomolies and hydrops)
    • non funtional - blood from system
    • can be in abd cavity with vascular connection
    • echodense solid mass
    • usually on left side lung rarely below diaphragm
  25. vongrnital cystic adenomatoid malformation CCAM
    multicystic mass in lungs consisting of primitve lung tissue and abd brochial and bronch like structures

    • happens in dev of lung 8-9 weeks
    • one or more lobes rarely bilateral
    • 3 forms
  26. CCAM 3 forms
    • I macrocystic- one or more large cysts replace tisse (2-10cm)
    • II macro with micro- multiple small cysts (<1cm)
    • III micro- bulky large noncystic lesions, echodense mass, entire lung.

    3 has worst outcome

    poorer outcome with hydrops, poly, cardiac diviation
  27. congential bronchial atresia
    • rare pulm anomonly focal obliteration of a segment of bronch lumen
    • upper left lobe
    • echogenic pulm mass lesion
  28. congenital lobar emphysema
    • lobar over inflation of lung without destruction of alveolar septa
    • upper left or middle lobe
    • looks like micro CCAM
  29. congenital diaph hernia
    • herniation of abd organs into chest from defect in diaph
    • 1in 2000 to 1 in 5000
  30. most common diaph hernia 90%
    • posterior and lateral
    • foramen of bockdalek
    • left side with left organs
    • shifts heart to right
  31. anterior and medial hernia
    • formen of morgagni
    • communicate with pericardial sac
  32. hydrops not present with what side hernia
    left side hernia unless associated fetal malformation
  33. ECMO
    • extracorporeal membrane oxegenation
    • block carotid to bypass pulm circulation to give the lung a chance to develop/mature before cicrc demands in place

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