OB AF, TERA AND FETO

Question 1

Amnionic fluid volume increases from approximately :

10 weeks:
16 weeks:
midterm:
Third term:
Full term:

Answer 1

10 weeks: 30 mL
16 weeks: 200 mL
midterm: 800 mL
Third term: reaches 4 liters
Full term: 2,800 mL

Question 2

Placenta contains how much water?

Answer 2

400 mL

Question 3

abnormally decreased fluid volume

Answer 3

Oligohydramnios

Question 4

abnormally increased fluid volume i

Answer 4

Hydramnios or Polyhydramnios

Question 5

transfer of water and other small molecules takes place across the amnion

Answer 5

Transmembranous flow

Question 6

across the fetal vessels on placental surface

Answer 6

Intramembranous flow

Question 7

Flow across fetal skin

Answer 7

Transcutaneous flow

Question 8

Fetal urine production:
begins between what weeks of gestation, but it does not become a major component of amnionic fluid until the second trimester

Answer 8

8 and 11 weeks

Question 9

Water transport across the fetal skin continues until keratinization occurs at what week

Answer 9

22 to 25 weeks

Question 10

TRUE OR FALSE

extremely preterm neonates can experience significant fluid loss across their skin

Answer 10

True

Question 11

What is the primary source of amnionic fluid in the second half of pregnancy

Answer 11

Fetal urination

Question 12

True or falsehood I

fetal urine production may exceed 1 liter per day

Answer 12

True

Question 13

TRUE OR FALSE

entire amnionic fluid volume is recirculated on a weekly basis

Answer 13

False

On a daily basis

Question 14

TRUE OR FALSE

Fetal urine osmolality is similar to that of amnionic
• hypertonic to that of maternal and fetal plasma

Answer 14

FALSE

HYPOTONIC

Question 15

Approximate osmolality of maternal and fetal plasma

Answer 15

280 mOsm/mL

Question 16

Amniotic fluid in fetal urination is approx. how much?

Answer 16

260 mOsm/mL

Question 17

WHAT ARE THE FOUR PATHWAYS THAT PLAY A MAJOR ROLE IN AMNIONIC FLUID VOLUME REGULATION?

Answer 17

A.) Fetal urination
B.) Fetal swallowing
C.) Respiratory tract
D.) Transmembranous and transcutaneous flow

Question 18

primary mechanism for amnionic fluid resorption which averages 500 to 1000mL per day

Answer 18

Fetal swallowing

Question 19

TRUE OR FALSE

Impaired swallowing, secondary to either a central nervous system abnormality or GI tract obstruction, can result in an impressive degree of hydramnios

Answer 19

True

Question 20

third source of amnionic fluid regulation
• Approxi 350 mL of lung fluid is produced daily late in gestation
• half of this is immediately swallowed

Answer 20

Respiratory tract

Question 21

account for a far smaller proportion of fluid transport in the second half of pregnancy

Answer 21

Transmembranous and Transcutaneous flow

Question 22

What dye is injected to the amnionic cavity in measuring amniotic fluid

Answer 22

Aminohippurate

Question 23

average fluid volume was between 22 and 30 weeks

Answer 23

approximately 400 mL

Question 24

When is Sonographic assessment is done?

Answer 24

Second or third trimester

Question 25

a fluid pocket must be at least how many cm in width to be considered adequate?

Answer 25

1cm

Question 26

used to verify that umbilical cord is not within the measurement

Answer 26

Color doppler

Question 27

also called the largest or maximal vertical pocket of amnionic fluid.

Answer 27

Single Deepest Pocket

Question 28

TRUE OR FALS the ultrasound transducer is held perpendicular to the floor and parallel to the long axis of the woman.

Answer 28

TRUE

Question 29

Normal range for single deepest pocket measurement

Answer 29

Above 2cm and less than 8cm

Question 30

It is the sum of the single deepest pocket from each quadrant

Answer 30

Amnionic Fluid Index (AFI)

Question 31

normal AFI

Answer 31

greater than 5 cm and below 24 or 25

Question 32

TRUE OR FALSE mean AFI was found to be between 12 and 15 cm from 16 weeks until 40 weeks’ gestation

Answer 32

TRUE

Question 33

the uterus may feel tense, and palpating fetal small parts or auscultating fetal heart tones may be difficult

Answer 33

Hydramnios

Question 34

Category of Hydramnios 25 to 29.9 cm

Answer 34

Mild AFI

Question 35

Category of Hydramnios 30 to 34.9 cm

Answer 35

Moderate AFI

Question 36

Category of Hydramnios 35 cm or more

Answer 36

Severe AFI

Question 37

Single deepest pocket of amnionic fluid defines mild hydramnios as how many cm?

Answer 37

8 to 9.9cm

Question 38

Single deepest pocket of amnionic fluid defines moderate hydramnios as how many cm?

Answer 38

10 to 11.9 cm

Question 39

Single deepest pocket of amnionic fluid defines severe hydramnios as how many cm?

Answer 39

12 cm or more

Question 40

Impaired swallowing (CNS) can lead to?

Answer 40

Anencephaly Hydranencephaly Holoprosencephaly

Question 41

Impaired swallowing (craniofacial) can lead to

Answer 41

Cleft lip/palate Micrognathia

Question 42

Tracheal compression or obstruction can lead to?

Answer 42

Neck venolymphatic abnormality CHAOSa

Question 43

Thoracic etiology (mediastinal shift) can lead to?

Answer 43

Diaphragmatic hernia Cystic adenomatoid malformationa Pulmonary sequestrationa

Question 44

High-output cardiac state can lead to?

Answer 44

Ebstein anomalya Tetralogy of Fallot with absent pulmonary valvea Thyrotoxicosis

Question 45

Functional cardiac etiology

Answer 45

Cardiomyopathy, myocarditisa

Question 46

Cardiac arrhythmia

Answer 46

Tachyarrhythmiaa: atrial flutter, atrial fibrillation, supraventricular tachycardia Bradyarrhythmiaa: heart block

Question 47

GI obstruction

Answer 47

Esophageal atresia Duodenal atresia

Question 48

Renal-Urinary

Answer 48

Ureteropelvic junction obstruction (“paradoxical hydramnios”) Baarter syndrome

Question 49

Neurological or muscular etiology

Answer 49

Arthrogryposis, akinesia sequence Myotonic dystrophy

Question 50

Neoplastic etiology

Answer 50

Sacrococcygeal teratomaa Mesoblastic nephromaa Placental chorioangiomaa

Question 51

TRUE or FALSE The amniotic fluid glucose concentration is higher in diabetic women

Answer 51

TRUE

Question 52

MULTIFETAL GESTATION: What is the severity if a single deepest pocket measures 8 cm or more

Answer 52

MILD

Question 53

if the single deepest pocket is atleast 10cm

Answer 53

Severe

Question 54

MULTIFETAL GESTATION: What is the severity if the pocket is at least 12 cm

Answer 54

Severe

Question 55

hydramnios of one sac and oligohydramnios of the other are diagnostic criteria for twin-twin transfusion syndrome

Answer 55

Monochorionic gestations

Question 56

up to 70 percent of cases of hydramnios * 1 % of pregnancies * rarely identified during midtrimester sonography but as incidental finding later in gestation

Answer 56

IDIOPATHIC HYDRAMNIOS

Question 57

sonographic detection of idiopathic hydramnios is usually at what weeks?

Answer 57

32 and 35 weeks

Question 58

COMPLICATIONS: fluid accumulates gradually and a woman may tolerate excessive abdominal distention with relatively little discomfort

Answer 58

CHRONIC HYDRAMNIOS

Question 59

tends to develop earlier in pregnancy * May result in preterm labor before 28 weeks * symptoms may become so debilitating as to necessitate intervention

Answer 59

Acute hydramnios

Question 60

it is a consequence of major venous system compression by the enlarged uterus - most pronounced in the lower extremities, vulva, and abdominal wall

Answer 60

EDEMA

Question 61

results from ureteral obstruction by the enlarged uterus

Answer 61

oliguria

Question 62

-result from the rapid decompression of an overdistended uterus that follows fetal-membrane rupture or therapeutic amnioreduction * With prematurely ruptured membranes, a placental abruption occasionally occurs days or weeks after amniorrhexis.

Answer 62

Placental abruption

Question 63

symptoms of hydramnios

Answer 63

Dyspnea and orthopnea Edema Oliguria placental abruption uterine dysfunction postpartum hemorrhage

Question 64

largest contributor to amniotic fluid volume

Answer 64

fetal urine

Question 65

Pregnancy outcomes of hydramnios

Answer 65

*growth-restricted fetus * associated with trisomy 18 * preterm delivery (not for idiopathic hydramnios) * Small for-gestational age newborn * perinatal mortality

Question 66

* done with a larger needle, 18- or 20-gauge * uses either an evacuated container bottle or a larger syringe.

Answer 66

Amnioreduction

Question 67

Goal of amnioreduction

Answer 67

to restore amnionic fluid volume to the upper normal range

Question 68

initial amnioreduction is performed at what week of gestation?

Answer 68

31 weeks

Question 69

Complications of amnioreduction within 48 hours:

Answer 69

* delivery in 4 % * ruptured membranes in 1 %

Question 70

it is the abnormally decreased amount of amnionic fluid * 1 to 2 percent of pregnancies

Answer 70

OLIGOHYDRAMNIOS

Question 71

when no measurable pocket of amnionic fluid is identified

Answer 71

ANHYDRAMNIOS

Question 72

The sonographic diagnosis of oligohydramnios is usually based on an AFI of? or a single deepest pocket of amnionic fluid of?

Answer 72

AFI less than 5 cm or a single deepest pocket of amnionic fluid below 2 cm

Question 73

Management for oligohydramnios

Answer 73

vesicoamnionic shunt placement * especially for fetuses with bladder outlet obstruction

Question 74

Intake of NSAID may result to?

Answer 74

Fetal skull bone hypoplasia and limb contractures * fetal ductus arteriosus constriction and with lower fetal urine production

Question 75

* refers to an AFI between 5 and 8 cm * between 24 and 34 weeks with AFI between 5 and 8 cm

Answer 75

"Borderline" oligohydramnios

Question 76

Borderline oligohydramnios is complicated by? /

Answer 76

Hypertension, stillbirth, neonatal death

Question 77

defined as any agent that acts during embryonic or fetal development to produce a permanent alteration of form or function

Answer 77

Teratogen

Question 78

it is an agent that interferes with organ maturation and function

Answer 78

Hadegen

Question 79

Substances typically affect development in the fetal period or after birth - more difficult to document.

Answer 79

Trophogen

Question 80

2 weeks between fertilization and implantation * known as the “all or none” period

Answer 80

preimplantation period

Question 81

extends from the second through the eighth week postconception. It encompasses organogenesis * the most crucial period with regard to structural malformations

Answer 81

embryonic period

Question 82

beyond 8 weeks postconception characterized by continued maturation and functional development

Answer 82

Fetal period

Question 83

it is an antiemetic which have a combination of doxylamine and pyridoxine, with or without dicyclomine Safe and effective for nausea and vomiting in early pregnancy target of numerous lawsait leading to it's withdrawal from the market

Answer 83

Bendectin

Question 84

the combination of doxylamine and pyridoxine was subsequently remarketed under what brand name and was approved by the FDA in 2013.

Answer 84

Diclegis

Question 85

Which category where Studies in pregnant women have not shown an increased risk for fetal abnormalities if administered during the first (second, third, or all) trimester(s) of pregnancy, and the possibility of fetal harm appears remote

Answer 85

Category A

Question 86

Which category where Animal reproduction studies have been performed and have revealed no evidence of impaired fertility or harm to the fetus OR Animal studies have shown an adverse effect, but adequate and well-controlled studies in pregnant women have failed to demonstrate a risk to the fetus during the first trimester of pregnancy, and there is no evidence of a risk in later trimesters

Answer 86

Category B

Question 87

What category where Animal reproduction studies have shown that this medication is teratogenic (or embryocidal or has other adverse effect), and there are no adequate and well-controlled studies in pregnant women. There are no animal reproduction studies and no adequate and well-controlled studies in humans

Answer 87

Category C

Question 88

Category This medication can cause fetal harm when administered to a pregnant woman. If this drug is used during pregnancy or if a woman becomes pregnant while taking this medication, she should be apprised of the potential hazard to the fetus.

Answer 88

Category D

Question 89

Category This medication is contraindicated in women who are or may become pregnant. It may cause fetal harm

Answer 89

Category X

Question 90

considered the leading cause of preventable developmental disabilities worldwide

Answer 90

Alcohol