Amniotic Fluid Flashcards by Salonee Malviya

Source of amniotic fluid during pregnancy

1 to 12 weeks source is ultrafiltrate of maternal plasma
12 to 20 weeks transudate across fetal skin
>20 weeks fetal urine(main)

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Osmolality of amniotic fluid

Approx 260mosm/L

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Which substance is replaced in amniotic fluid

And replaced after how many hours

Water in amniotic fluid is replaced once in every three hours that is eight times a day

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PH of amniotic fluid

7-7.5

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First structure to be stained with meconium is

Umblical cord

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Last structure to be stained with meconium is

Placenta

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Colour of amniotic fluid

Straw coloured

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What does the following colour of the amniotic fluid tell you
Green
Golden
Dark
dark brown
Greenish yellow

Green – meconium stained
Golden – Rh incompatibility
Dark – abruption (blood stained)
Dark brown (tobacco juice) – intra uterine death
Greenish yellow – post term baby (40 weeks - EDD)

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Turn over rate of amniotic fluid at term

Fetal urine production rate at term

500-800ml/24hrs

27ml/hr (650ml/day)

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Range of weeks on the following
Early term
Term
Late term
Post term

Early Term- 37wk-38wk + 6
Term- 39wk-40wk + 6
Late term- 41wk-41+6
Post term- >42wk

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At How many weeks does a non-medically indicated Csection done

39 weeks

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Amount of amniotic fluid at the following time
12wks
16wks
20wks
28wks
36wks
40wks
42wks

12wks-50ml
16wks-250ml
20wks-400ml
28wks-1L
36wks-900ml
40wks-800ml (EDD)(Term)
42wks-200ml

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When is the Amniotic fluid maximum during pregnancy

32weeks

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What are the methods to measure poly/oligohydroamnios
Which is MC used
Which is more sensitive

A F I (amniotic fluid index)
DVP (Deep vertical pocket)
-A F I
-DVP

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AFI and DVP for the following 
Normal 
Oligo
Poly 
volume

Condition AFI DVP
Normal 5-24 2-8cm
Oligo =5 =2
Poly >/=24 >8
Volume >/=2L =200ml

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The following problems will need to what poly or oligo hydroamnio
Any problems swallowing
Any problem in urinating

Polyhydroamnios

Oligohydroamnios

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M.c.c of mild polyhydroamnios
M.c.c of mild oligohydroamnios
M.c.c of severe polyhydroamnios
M.c.c of severe oligohydroamnios

Idiopathic
Idiopathic
Gross congenital anomalies (GCA)
Gross congenital anomalies (GCA)

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Which GCA Is associated with Severe polyhydramnios

GIT>NTD

Most common in GIT:Cleft Palate

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Which d/s is ass. With severe oligohydroamnios

Other causes

Renal agenesis

PUV (Post. Urethral valve)- shows KEY HOLE SIGN on USG

Conditions caused by polyhydroamnios

Severe respiratory distress
Abruption
PTL
Cord prolapse
PROM(when membrane rupture before onset of labour)
Malpresentation
PPH
Amniotic fluid embolisation

Conditions caused by oligohydroamnios

Pulmonary hypoplasia (early onset oligo)
Limb deformities (limb amputatation)
Fetal distress(compression of umbilical cord)
Malpresentation
Long standing oligo-abruption
IUGR (uteroplacental insufficiency causes oligo - they exist together)

1st definitive sign of pregnancy

USG showing
gestational sac-yolk sac-cardiac activity
Can be seen in TVS/TAS

Probes used in doing TVS / TAS

One with higher frequency is used to do TVS (usually >/=5)

TAS - 3

Which of the following is done empty bladder
TAS
TVS

TVS is done empty bladder

TAS is done with full bladder

Gestational sac is seen earliest on

TVS 4wk 1D-3D to 4.5wks TVS here is operator dependent

Earliest time g.sac can be identified on TVS from LMP 1. 20D 2. 25D 3. 30D 4. 35D

30D | Earliest time g.sac can be identified on TVS is 4wks 1D-3Dto 4.5 wks from LMP

Earliest time g.sac can be identified on TVS from fertilisation 1. 20D 2. 25D 3. 30D 4. 35D

This would be LMP-15days So earliest time g.sac can be identified on TVS from LMP would be 4wks 1D-3D to 4.5wks i.e 30D Now earliest time g.sac can be identified on TVS from fertilisation will be 30D-15D=15D Therefore in options earliest time would be 20D

Earliest time g.sac can be identified on TAS will be

5 wks

When is G.sac seen on USG 1. 4wks 2. 5wks 3. 6wks 4. 7wks

2. 5wks

Is the statement true or false | Whatever seen on TVS can be seen on TAS

False | Whatever seen on TAS can be seen on TVS but the vice versa is not true

True g.sac is lateral in uterus true or false

True

Name the intrauterine Px sign of g.sac

double ring sign Aka double decidual sac sign (1 g.sac + 1 decidua)

What does pseudo sac during Px means

During normal Px the g.sac shows double decidual sac sign or double ring sign (1 g.sac + 1 decidua) In ectopic Px single ring in uterus is seen it is present at the centre This is known as pseudo sac

When is yolk sac detected on TVS

5wks ; earliest

Name the sign together formed by yolk sac and amniotic sac | Name the sign together formed by decidua and g.sac

Double bleb sign | Double decidual sac sign / double ring sign

When can cardiac activity detected on USG | At what time it can be detected earliest

TVS- 5-6 wks TAS- 6-7 wks Earliest -5 wks If TVS/TAS not mentioned then 6 wks

Best marker for gestational age assessment | And what is ideal time to measure

Crown rump length | 7-10 weeks

Can CRL be used to calculate g.sac age

Yes until 14 wks i.e 1st trimester CRL can be used to calculate g.sac age

What do you use in 2nd trimester to calculate the CRL

In 2nd trimester we use USG to see the BPD (biparietal diameter) At 14-20 weeks

How do you calculate the CRL in 3rd trimester

Femur length

Which of the following is best marker for gestation age 1. CRL 2. BPD 3. Femur length ‘ 4. Abdominal circumference

CRL

Which of the following is best marker for gestational age 1. CRL@ 16wks 2. BPD@ 16wks 3. Femur length@ 32wks 4. Abdominal length@ 20wks

BPD @16wks

The earliest we do Gestational Age assessment the more better results True or false

True

USG markers of macrosomia/ IUGR

Abdominal circumference

IUGR Criteria

Expected birth wt. <10th percentile

On USG what is the significance of abdominal circumference with reference to macrosomia

If AC is > 35cm is suggestive of macrosomia