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DIUdcho
MarinaMERVEILLE
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Ra el h siolo i ue
1000ml34SA
Diminutionenfindegrossesse: 800ml40SA
500m 42
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P ysio ogiedu
LA
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ys o og e
u
Diurseftaleds14SA:++
8001200ml/24henfindegrossesse
Scrtionpulmonaireds18SA:300400ml/24h(=2030%duLA)
Elimination:
terme:500ml/h
lesmembranesftales semipermables>20SApermabilitpassiveactivitmtabolique
lecordonombilical fluxminimes
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RAPPELSPHYSIOLOGIELIQUIDEAMNIOTIQUE
RleduLA:
Mcanique: dveloppementftalharmonieuxdveloppementpulmonairematurationdelamotricitgastro
Antibactrien: bactriostatique 28sa
bactricide 31sa
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H dramnios:dfinition
quantitdeLA 2litres
difficileenpratiquecarapprciationindirecte
frquence:0,23,5%selonlescritresutiliss
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Hydramnios:valuation
chographique
Mthodesubjective
am t o e e am er a n:pro on eur e ac terne apluslarge: >8cm => hydramnios
8
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+gran e
c terne
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H dramnios:valuationcho ra hi ue
ec n que e e ane o .=>4qua ran s
ILA>25cm=>Hydramnios
ILAentre18et25 => Excsdeliquide
ILA>2535 => Hydramniosmodr
ILA> cm => H dramniossvre
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Hydramnios:tableau
clinique
Hydramniosaigu: Installationprcoce:2trimestre Principalescauses:STT,chorioangiome
Mauvaisetolrancematernelle(MAP)=>ponctionvacuatrice
y ramn osc ron que Installationprogressive, +tardif
Causesouventinconnue(30%) Meilleurpronostic
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Etiopat og nie
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Hydramnios:
tiopat og nieMcanisme: dsquilibreentreproductionetlimination
ro uc onexcess ve: polyurieftale
facteurmaternel=diabte
facteurftal=cardiopathie,infection dfautderevtementcutan
Dfautd limination:
anomaliedeladglutition obstacledigestif
membranesamniochoriales ?
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H dramnios:tiolo ies
Maternelles:25%
Chromosomiques:3%
opat que:30
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scrtion scrtion
STT Causesdanasarque: Choriangiome Diabte,macrosomie
Anomalieslymphatiques MonosomieXO
Anoma ieFTN Immunisationfoeto
Anmies Compressions(chylothorax,
Insuffisancecardiaque
Shunt(veinedeGalien,
tratomesacrococcygien) Sd Bartter (polyurie),sd
nphrotiquefinlandais
Hypoprotidmie Maladiesmtaboliques
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rabsorptionrabsorption
Com ression: Troublesdglutition Tumeur Epanchement
Sd PierreRobin 22q11 Neuro :Steinert
Chylothorax MAKP
Myogne Myasthnie
Atrsiesophage(typeIetII
surtout)
Ostochondrodysplasies
Hypomobilit : tr s e uo na eChromosomes(T21)
Sd Prader Willi Pathologieneuromusculaire
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scrtion :shunts
Syndrometransfuseur
transfus
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scrtion :shunts
Chorioangiome
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scrtion :shunts
Anvrismeveine
de
Galien
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scrtion :shunts
Tratomesacrococc ien
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scrtion :anasarque
Anasarque
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ParvovirusB19scrtion :anmie
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scrtion :anmie
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scrtion :anomalieFTN
Spinabifida
l
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scrtion :polyurie
Sd deBartter
b i l i
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rabsorption :causespulmonaires
MAKP
b i l i
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rabsorption :causespulmonaires
Hydrothorax
b ti di ti
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rabsorption :causesdigestives
Stnoseduodnale
b ti di ti
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rabsorption :causesdigestives
rabsorption : causes digestives
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rabsorption :causesdigestives
Atrsiedu rle
rabsorption : causes digestives
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rabsorption :causesdigestives
Herniedia hra mati ue
rabsorption : trouble dglutition
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rabsorption :troubledglutition
Sd dePierre
Robin
rabsorption : immobilisme foetal
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rabsorption :immobilismefoetal
r rogryppose
rabsorption: anomalie K
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rabsorption:anomalieK
Trisomie18
Consquence : MAP
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Consquence:MAP
Echo ra hieducol
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me me Hydramniossvre
Anomaliemorpho
Hydramniosminime
Pasdanomaliemorpho RCIU Pasdediabtenimacrosomie
Macrosomie Et/oudiabte er
Caryotype
>80%danomalies Pasdecar ot e
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Conclusion:
!
mfiance
Seulement65%danomalies
dia nostiquesenantnatal
persisterjusquenpostnatal
Informationprnatalepru en ee r serv e
OLIGOAMNIOS fi i i
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OLIGOAMNIOS Dfinition
LaplusfrquentedesanomaliesduLA
0,44%
uantitdeLApronosticmdiocre
Anamnios:absencetotaledeLA
OLIGOAMNIOS Cli i
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OLIGOAMNIOS Clinique
Hauteurutrine
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OLIGOAMNIOS Echographie
OLIGOAMNIOS Di ti ECHO
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OLIGOAMNIOS DiagnosticECHO
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OLIGOAMNIOS Etiologies (1)
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OLIGOAMNIOS Etiologies(1)
Avant28sa => ++malformationsAprs28sa =>autrestiologies
Eliminerruptureprmaturedesmembranes
SiRPMvidente => pronosticfonctionprcocitAvant2224sa : risquedhypoplasiepulmonaire++
OLIGOAMNIOS Etiologies (2)
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OLIGOAMNIOS Etiologies(2)
etrnales
Agnsiernalebilatrale1/3000++chezles ar ons x2 Risquercurrence
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g n s er na e
a ra e
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namn os
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Dysplasiernale
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OLIGOAMNIOS Etiologies(4)
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g (4)
Causesfoetales
Rnales(suite):
,Oligoamnios morphologiernaleconserve
(dysplasietubulairernale)
RCIU=>diminutiondiurseftalecorrlationentresvritoli oamniosetfrquencedesmalformationsetdesRCIU
oligoamnios associdans0,610%++triplodieT18T13monosomie
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Dysplasietubulaire
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Valvesde
lurtre
postrieur
OLIGOAMNIOS Etiologies(5)
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g 5
CausesMaternelles
Insuffisanceutroplacentaire
Hypovolmie
HypertensionartriellePrclampsie
IatrogneAINS,IEC
Collagnose
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OLIGOAMNIOS Pronostic
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Hypoplasiepulmonaire:
Par: compressionextrinsquepasdemvts respiratoires
surfacepithlialealvolaire
acteurs=> ate esurvenue++
dured exposition
19sa 5025sa 10%
Risquessi:Survenueprcoce1726SA(phasecanaliculaire)Oligoamnios svreILA1sem 1mois
OLIGOAMNIOS Bilaninitial
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c ograp emorp o og que++ c eDopplerombilicaletdopplersutrins
Croissancesousestime
++aidedelamnioinfusion
Pourcomplterl tudemorphologique
Srolo iesinfectieuses CMV++
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ANASARQUE
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ANASARQUEFOETOPLACENTAIRE
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Physiopathologie4situations:
delapressionhydrostatiqueintravasculaire par
,auretourveineux)
delapressiononcotiqueplasmatique=hypoalbuminmie
delapermabilitcapillaire
s ruc onau uxymp a que=syndromedeTurner/syndromedeNoonan
ANASARQUEFOETOPLACENTAIRE
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AspectchographiqueDiagnosticpositif
2Prciselaquantitdeliquideamniotique
++Hydramnios
2535%descas:oligoamnios
3Permetunetudemorphologique
URGENCEdiagnostiqueetthrapeutique+++
ANASARQUEFOETOPLACENTAIRE
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AspectchographiqueDiagnosticpositif
1 PrciselaspectdelAFP:
mesouscutan 5mm ++pr ronta
.panchementpricardique(pointeducur)(=1des remierssi nes
.panchementpleural
.ascite(prihpatiqueansesintestinalestrop
env s es.placentapais 6cm
ANASARQUEFOETOPLACENTAIRE
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CAUSESIAFPI: immun
EchecdeprventiondelalloImmunisation antiD
Alloimmunisation autrequedanslesystme
rhsusstandard
Atteinteftaleproportionnellel anmie
Thrapeutiquepossible: transfusionsinutero
ANASARQUEFOETOPLACENTAIRE
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CAUSESIIAFPNI (environ100causes)
6tiologies 75%desAFPNI
ygromaco 30anomaliescardiaques 20%
tratomesacrococcygien 3%s ndrometransfuseurtransfus 3%chorioangiome placentaire 1,5%
25%AFPNI idiopathiques20%AFPNI anom.Chromosomi ues
(T18/T21/T13/Turner/.)
Insuffisancecardiaqueftale Anasarque
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ur n m e ompress on
.Tbles RCF Hmolyse MKAP,squestrTbles mtaboliques Foetopathie (PVB19,CMV) Epanchements
noma e umeurs t ratome asses yst ques
Tbles maternels(lupus) SquestrationGR MaladiesosseusesFoetopathie infectieuse sclroseBournevilleTumeurcardiaque pricardite,chyloMalform.multiples
Shunts Hypoprotidmie
Tumeurs(tratome) TumeursSd TT Fuiteprotidique
v.Gallien Maladiehpatique
acardiaque Porphyrie
ANASARQUEFOETOPLACENTAIRE
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BILAN1Exclurecauses immunologiques:RAI
2AFPNI:
. an n ec eux ,ru o e, , oxo, 19, erp s.TestdeKleihauer.
=>Sibilanngatif`=>bilanpluspouss
3Prlvementsovulaires:
.LApourcaryotype
.Sangftalpourcaryotype,numrationglobulaire
ANASARQUEFOETOPLACENTAIRE
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Traitementinutro
Troublesdurythmesupraventriculaires :
Chylothorax :panchementpleural+anasarque
drainageinutero => mortalitde50%
Anmieftale:
transfusioninutero recherchePVB1hmorragiefoetomatern.)
S ndromeTransfuseurTransfus :laser
Ftusacardiaque :coagulationslectivecordon
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Anasarque:CAT
Urgencediagnostiqueetthrapeutique(sipossible):risquedeSFA
Csarienneenurgencepoursauvetageftalparfois
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nasarque
ygroma
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Anasarque:parvovirus
B19
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Anasarque:ascite
CMV
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Anasarque:hydrothorax
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FIN