amniotic fluid Flashcards
A pregnant woman at 32 weeks gestation presents with complaints of significant abdominal discomfort and shortness of breath. Ultrasound reveals a single deepest pocket of amniotic fluid measuring 9 cm. Which of the following is the MOST likely diagnosis?
A) Normal amniotic fluid volume
B) Oligohydramnios
C) Polyhydramnios
D) Premature rupture of membranes
C) Polyhydramnios
Explanation: The presentation stated a single deepest pocket (SDP) greater than or equal to 8 cm is a diagnostic criterion for polyhydramnios. The woman’s symptoms (abdominal discomfort, shortness of breath) are also consistent with this condition
Which of the following is NOT a typical fetal cause of polyhydramnios?
A) Fetal swallowing disorder
B) Fetal renal agenesis (absence of kidneys)
C) Fetal neuromuscular disorder
D) Fetal cardiac anomaly
B) Fetal renal agenesis (absence of kidneys)
Explanation: Fetal renal agenesis would cause oligohydramnios due to decreased fetal urine production. Swallowing disorders, neuromuscular disorders (impairing swallowing), and cardiac anomalies (affecting circulation and fluid balance) can all lead to polyhydramnios.
A pregnant woman is diagnosed with polyhydramnios at 28 weeks gestation. What initial test is MOST important to consider?
A) Fetal echocardiogram
B) Amniocentesis with chromosomal microarray
C) Maternal glucose tolerance test (GTT)
D) Fetal biophysical profile (BPP)
C) Maternal glucose tolerance test (GTT)
Explanation: The presentation emphasizes maternal diabetes as a major cause of polyhydramnios. While a fetal echo, amniocentesis, and BPP may eventually be indicated, ruling out maternal diabetes with a GTT is usually the highest-priority first step
A patient with polyhydramnios is being considered for treatment with indomethacin. Which of the following statements regarding indomethacin use is MOST accurate?
A) Indomethacin is safe to use at any gestational age to reduce amniotic fluid volume.
B) Indomethacin acts by increasing fetal urine production.
C) Indomethacin should be discontinued no later than 32 weeks gestation due to the risk of premature ductal constriction.
D) Indomethacin’s primary mechanism for reducing fluid volume is increasing amniotic fluid swallowing.
C) Indomethacin should be discontinued no later than 32 weeks gestation due to the risk of premature ductal constriction.
Explanation: Indomethacin is used to reduce amniotic fluid volume by decreasing fetal urine production, ultimately reducing the fluid. However, prolonged use, especially beyond 32 weeks, increases the risk of premature closure of the ductus arteriosus in the fetus, a serious complication.
A 36-week gestation patient presents with polyhydramnios and significant abdominal pain. Which of the following is the MOST immediate concern with this patient?
A) Fetal distress
B) Preterm labor
C) Placental abruption
D) Vasa previa
C) Placental abruption
Explanation: Polyhydramnios, especially when accompanied by abdominal pain, can significantly increase the risk of placental abruption. Decompression of the uterus can disrupt the placental attachment, leading to hemorrhage. While fetal distress, preterm labor, and vasa previa are important considerations, the abdominal pain makes placental abruption the most pressing immediate concern.
A single deepest pocket (SDP) measurement of ≥ ____ cm defines polyhydramnios
8
What maternal condition is the MOST common cause to assess in a patient with polyhydramnios?
Gestational diabetes (GTT to rule out)
After what gestational age should indomethacin use generally be discontinued due to the risk of ductal constriction?
32 weeks
Oligohydramnios: Is there a treatment for oligohydramnios that has been proven to be effective long-term?
No
Oligohydramnios in the first trimester is an ominous finding.
True
In pregnancies with mild to moderate polyhydramnios, what should the patient’s AFI be?
AFI >25 cm
What fetal anomaly is the MOST common cause to asses in a patient with polyhydramnios?
Swallowing anomaly
Amniotic fluid is mainly composed of what fluid from the fetus by mid-gestation.
Fetal urine
Front: Name 2 fetal conditions associated with polyhydramnios.
Swallowing disorder, neuromuscular disorders, cardiac anomalies
Name 2 complications associated with polyhydramnios.
Preterm birth, placental abruption, cord prolapse
What diagnostic tool is usually used to confirm polyhydramnios?
Ultrasound
Define oligohydramnios?
Amniotic fluid volume that is less than expected for gestational age. typically diagnosed by ultrasound when the amniotic fluid index (AFI) ≤5 cm or single deepest pocket ≤2 cm.
Define polyhydramnios?
An excessive volume of amniotic fluid. typically diagnosed in the second or third trimester when amniotic fluid volume exceeds 2000 ml.
How does indomethacin work to lower amniotic fluid volume?
Decreases fetal urine production.
At what gestational age is early delivery considered for oligohydramnios?
36 to 37+6
What are the diagnostic criteria for polyhydramnios?
Polyhydramnios is diagnosed by ultrasound when the single deepest pocket ≥8 cm or the amniotic fluid index (AFI) ≥25 cm
What are the common etiologies of polyhydramnios?
Common etiologies include fetal malformations/genetic disorders, maternal diabetes, multiple gestation, and rare causes like congenital viral infection or Bartter syndrome.
What maternal complications can arise from polyhydramnios?
Maternal complications include preterm birth, premature rupture of membranes, maternal respiratory compromise, and placental abruption.
What fetal complications are associated with polyhydramnios?
Fetal complications include fetal anomalies, fetal hydrops, umbilical cord prolapse, and fetal malposition
