Chpt 58 Amniotic Fluid...membranes

Question 1

Amniotic fluid is produced by:

Answer 1

Umbilical cord
Kidneys
Lungs
Skin
Amniotic membranes

Question 2

In early gestation, the main source of amniotic fluid is the

Answer 2

Amniotic membrane

Question 3

In second half of pregnancy, what accounts for nearly all of amniotic fluid

Answer 3

Fetal kidneys and urination

Question 4

Fetal lung development depends critically on….

Answer 4

The exchange of amniotic fluid within the lungs

Question 5

Severely low amniotic fluid(lungs) =

Answer 5

Pulmonary hypoplasia

Question 6

1st trimester fluid can be seen surrounding the fetus…what weeks contain more amounts of fluid?

Answer 6

20-30

Question 7

Fluid particles within amnion may represent:

Answer 7

Normal variant 
Particulate matter
Vernix(fatty material on fetal skin)
Intraamniotic blood
Intrauterine meconium(snowstorm)

Question 8

Intrauterine meconium produces what appearance

Answer 8

Snowstorm

Question 9

Amniotic sludge Is a dense collection of echogenic particles within the fluid at the level of the

Answer 9

Cervix

Question 10

Amniotic sludge is associated with

Answer 10

Premature rupture of membranes, chorioamnionitis, preterm delivery

Question 11

Most common ways to determine level of amniotic fluid

Answer 11

Subjective assessment
Amniotic fluid index—AFI
Single pocket assessment

Question 12

Performed as the sonographer initially scans through the entire uterus to visually assess the fluid present, fetal position, placental position. Most successful with experienced sonographers(eyeball)

Answer 12

Subjective assessment

Question 13

Uterine cavity is divided into four quadrants

Largest vertical pocket of amniotic fluid in each quadrant is measured

Answer 13

Amniotic fluid index

Question 14

For amniotic fluid index the image must be in the ___ plane

Answer 14

Longitudinal

Question 15

Concerning amniotic fluid index the probe should be in what position when determining fluid pockets

Answer 15

Perpendicular to the table

Question 16

T/f It is important to apply a lot of pressure when measuring the amniotic fluid index

Answer 16

False it is important to not apply to much pressure causing fluid pockets to appear smaller

Question 17

Criteria for amniotic fluid index

Answer 17

Image should be in longitudinal plane, probe should be perpendicular to table, measure each pocket in a vertical fashion, do not include thickness of maternal uterine wall, do not apply to much pressure, use color Doppler

Question 18

A.k.a. maximum vertical pocket

Answer 18

Single pocket assessment

Question 19

Concerning single pocket assessment fluid should measure greater than

Answer 19

1 cm

Question 20

Normal values correlate with a total AFI of

Answer 20

10 to 20 cm

Question 21

AFI less than 5 cm with largest vertical pocket measuring less than 2 cm

Answer 21

Oligohydramnios

Question 22

AFI measures greater than 24 cm and largest vertical pocket measures more than 8 cm

Answer 22

Polyhydramnios

Question 23

Horizontal and vertical dimensions of the maximum vertical pocket are multiplied together to obtain a single area

Rarely used, sometimes used with multiple gestation

Answer 23

2 diameter pocket assessment

Question 24

Twin pregnancies have a ____ median AFI value than singleton pregnancies

Answer 24

Slightly Lower

Question 25

Polyhydramnios is defined as amniotic fluid volume of

Answer 25

> 2000 ml

Question 26

Polyhydramnios may be painful, compress other organs, cause __________ or produce shortness of breath from compression on the diaphragm

Answer 26

Hydro nephrosis

Question 27

Fetal conditions associated with polyhydramnios

Answer 27

Central nervous system disorders (caused depressed swallowing), G.I. problems(ineffective swallowing)

Question 28

Maternal conditions associated with polyhydramnios

Answer 28

Congestive heart failure, obesity, anemia, Blood incompatibility, diabetes, syphilis

Question 29

The most common maternal cause of elevated AFI

Answer 29

Diabetes

Question 30

Fetal causes of polyhydramnios

Answer 30

Meningomyelocele, omphalocele(abdominal wall defect), twin transfusion, hydrocephaly, blood incompatible, skeletal anomalies/sacrococxygeal teratoma, urethra stenosis, spina bifida, esophageal atresia

Question 31

With polyhydramnios the mother has an increased risk of

Answer 31

Developing pregnancy induced hypertension, preterm labor, postpartum hemorrhage

Question 32

Oligohydramnios results in fetal crowding and

Answer 32

Decreased fetal movement

Question 33

Causes of oligohydramnios

Answer 33

Demise, renal anomalies, IUGR, PROM, post dates(42 weeks), pre eclampsia

Question 34

Most common cause of oligohydramnios

Answer 34

Premature rupture of membranes

Question 35

Growth delay is increased by how much when oligohydramnios is present

Answer 35

x4

Question 36

Persistent oligo hydramnios in the ____ has a poor prognosis

Answer 36

Second trimester

Question 37

Single pocket measurement less than _____ lasting ______ after a spontaneous premature rupture of membranes at ____ gestation is associated with an extremely high mortality rate

Answer 37

<1cm 14 days <25 weeks

Question 38

If membranes are not ruptured and oligo is present before 28 weeks gestation careful evaluation of what should be made

Answer 38

Kidneys

Question 39

When will the fetal membranes normally rupture

Answer 39

After onset of labor

Question 40

PROM

Answer 40

Premature rupture of membranes

Question 41

PPROM

Answer 41

Preterm premature rupture of membranes

Question 42

SPROM

Answer 42

Spontaneous rupture of membranes

Question 43

Risk factors for rupture of fetal membranes

Answer 43

Smoking, vaginal bleeding, history of STD, PID, pregnancy related invasive procedures, African-American descent

Question 44

PROM is associated with

Answer 44

Preterm delivery (common)

Question 45

If PROM occurs at 24 to 33 weeks gestation, follow up procedures include

Answer 45

Administration of corticosteroids, antibiotics, delivery at approximately 34 weeks

Question 46

An _____ may be performed to verify fetal lung maturity in cases where the fetus needs to be delivered before 34 weeks

Answer 46

Amniocentesis

Question 47

Term patients who experience rupture of membranes commonly move into active labor within

Answer 47

24 hours

Question 48

Associated with abnormality in fetal membranes | Common, non-recurrent cause of various fetal malformations involving the limbs, craniofacial region, and trunk

Answer 48

Amniotic band syndrome

Question 49

Caused by rupture of amnion during early pregnancy development, leading to subsequent entanglement of various fetal parts by fibrous bands, entrapment of fetal parts by the bands may cause lymphedema, amputations, or/defects. with this amnion disruption the fetus may also adhere to and fuse with chorion, causing maldevelopment of fetal tissues

Answer 49

Amniotic band syndrome

Question 50

Common findings with amniotic band syndrome are

Answer 50

Facial cloths, asymmetric encephaloceles, amputations, club foot deformities

Question 51

Identified as non-floating bands crossing through the amniotic cavity

Answer 51

Amniotic sheets

Question 52

Thicker than amniotic bands, Do not cause fetal malformations

Answer 52

Amniotic sheets

Question 53

Patients with uterine synechia and infertility are diagnosed with

Answer 53

Asherman syndrome

Question 54

Amniotic sheets are believed to be caused by

Answer 54

Uterine scars(from previous d&c)C-sections, episodes of endometritis