Amniotic fluid pathology

Question 1

How the amniotic fluid appear on US?

Answer 1

Hypoechogenic

Question 2

main role of amniotic fluid

Answer 2

protection agaisnt infection and uterine compression ….

Question 3

2 period of AF in pregnancy?
Why there is 2 periods?
why do they differ?

Answer 3

-up to 20th week
then from 20th week till end
-because source AF is different between the 2 stages
-because in second stage the skin become impermeable (keratinization) while fetogenesis continue mainly in GI kidney and lungs

Question 4

During the first period:
-AF is —osmolar
-the composition of AF is same as—-
-as early as —–weeks of amenorrhea the fetal kidney is the main source

Answer 4

-isoosmolar
-fetal serum (skin of fetus is permeable to water sodium and chlorine)
-12th-13th (no keratinization before it)

Question 5

During second part:
-the AF comes mainly from—
-Its—osmolar

Answer 5

fetus urine
hypoosmolar

Question 6

T or F
-the osmolarity changes in case of hydramnios
-Diuresis (1ml/h) reaches 600 to 1200ml per 24hr at end of pregnancy
-The AF decreases during first 20 weeks
-Slow decrease from peak at 32-33 weeks then fast decrease 39-40 weeks
-In amniocentesis it will be reestablished within 24hr
In post term preg starting from 37 weeks fluid starts to decrease rapidly which affects the decision to deliver the baby

Answer 6

F(constant)
F(0.7ml/hr)
F(increase)
T
T
F (from 39-40w)

Question 7

t or F
-Antiprostaglandins causes anuria
-Lungs begin to secrete as early as 15 weeks
-The lung secretion reaches 300 ml at end of preg which allows larynx opening and passage of surfactant

Answer 7

T
F (18th but still the kidney is the main source)
T

Question 8

Regarding L/S ratio
if >—-then its a good indicator for fetal maturity
Used in case of (f/u or without F/U)

Answer 8

2
not followed up

Question 9

US is most precise in —-trimester +—-days
——trimester+-2-3weeks
—–trimester+-1-2weeks

Answer 9

1st 3days
3rd
2nd

Question 10

synthesis of Af is by —–and….

Answer 10

amnion and chorion

Question 11

the amnion has large vascularization

Answer 11

false the chorion

Question 12

the chorion is a …. membrane with numerous….but with evidence of ……
……has receptors in chorion and passes into….
AF at beginning has the same weight as….. it decreases over time to reach….. but must nor exceed….

Answer 12

semi-permeable
pores
protein synthesis
prolactin-amniotic cavity
as the fetus-1000ml-2000ml

Question 13

Oligoamnios:
-defined as <…..ml (volume or as US finding)
_discovered thru….
we must search for—-
-clinically the fetus is difficult to —–by—–
-is this sign enough for diagnosis?

Answer 13

200ml , Real volume
US
malformations
-palpate by leopolds maneuver
suspection not Dx

Question 14

in oligoamnios:
AFI:….
DVP:…
Factor of prognosis:…..especially <…..
Fetus will be….with signs of ….
if in doubt of fetal morpho ……

Answer 14

<5cm
<3cm or even <1cm
compression of lungs , <26wks
compressed and in hyperflexion
instillation of saline

Question 15

by definition
DVP is…..
AFI….

Answer 15

-Largest vertical fluid without fetal parts or UC
-sum of 4 pockets (4 measurments)

Question 16

DD of oligoamnios:

Answer 16

PROM (but usually we have other sx like contractions or fever)

Question 17

Etiologies of Oligoamnios:
1-
2-
3-

Answer 17

1-organic: severe bilateral renal agenesis (potter)
2-Organic: Polymalformative syndrome (prune belly)
3-Functional: insufficiency of placental perfusion

Question 18

T or F
The early oligoamnios of 2nd trimester ….dominates with …..prognosis
the oligo of 2nd or 3rd where…..is the main cause with …..prognosis

Answer 18

malfomation/poorer prognosis
Growth retardation by insuff of perfusion/better

Question 19

List some diseases that happen in 2nd or 3rd trimester that causes oligoamnios

Answer 19

vasculo-renal syndromes
Biamniotic monochorionic twin preg (TTTTS)
Single UA
Smoking
Indomethacin
Hypothyroidism
Post-term

Question 20

Biophysical score is done by:…..and….
the 5 parameters are:
the most important:

Answer 20

NST and US
AFI,fetal tone,motricity,respiratory mvts + NST
AFI

Question 21

Hydramnios or polyhydramnios:
-DEfinition:
-Sx:
-AFI:……DVP:……mild:…moderate….severe….

Answer 21

-Amniotic volume exceeding 2L
-Nausea-vomitting and abdominal pain
->25cm >8cm
-8-11 12-15 >16

Question 22

Etiologies of hydramnios:
1-
2-
3-
4-
5-
6-
7-

Answer 22

1-twin pregnancy (monozygotic)
2-Fetal malformations :anenceohaly,spina,atresia of eso,duodenal stenosis,abdominal muscle atresia (prune belly),omphalocele,gastroschisis anasarca and poly malformations
3-anomalies of cord: nodes, angioma, agenesis of UA
4-Infection: Torch
5-hemolytic disease results in anasarca
6-Diabetes (osmotic diuresis)
7-Toxemia and preeclampsia

Question 23

T or F
Fetal causes are the most common etiology of Hydramnios

Answer 23

T

Question 24

2 presentations of hydramnios:

Answer 24

-very fast (acute) early poor prognosis 4th-6th ,always pathological egg (monoamnion monozygotic or serious fetal abnor) , pain,vomitting,insomnia,cyanosis,tachy, it terminates spon or we terminate it

-2nd is more common and evolution is slow we feel like we are touching an ice cube when we palpate the baby delivery occurs premature with: long labor,UC prolapse and increased risk of PP hemorrhage due to overdistended uterus

Question 25

Fetal survival is affected by:
1-
2
3-

Answer 25

PRM
Prematurity
IUFD

Question 26

Increased bilirubin occurs in:
increased of alpha fetoprotein and AChE:

Answer 26

CNS,GI,abdominal wall or in polyformations
CNS and GI

Question 27

DD of hydramnios:
1-
2-
3-

Answer 27

Error of GA
Fat child
Twins

Question 28

Tx

Answer 28

symptomatic
rest with indomethacin

Question 29

Mode of action of Indomethacin:
Side effects of indomethacin:
Indications: must be stopped before …..

Answer 29

Antiprostaglandins , decrease diuresis and pulmonary fluid productions

SE:premature closure of ductus arteriosus and coagulation disorders
34 weeks (8days before delivery)

Question 30

Candidates for tX:
1-
2-
3.
4.
if not a candidate what to do?

Answer 30

twins without fetal malformation
operable fetal malformations with no ass malfo
normal karyotype
if away of fetal lung maturity
if no cause of poly has been found
can also be etiological
Waaaledaaaaa wleyyy