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OB/GYN Section 3 > Chapter 57 power point Amniotic Fluid > Flashcards

Chapter 57 power point Amniotic Fluid Flashcards

1
Q

Allows fetus to move freely within amniotic cavity

Maintains intrauterine temperature

Protects developing fetus from injury

A

Role of Amniotic Fluid

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2
Q 
Interfere with normal fetal development 
Cause structural abnormalities 
Be an indirect sign of an underlying anomaly 
Neural tube defect 
Gastrointestinal disorder
A

Abnormalities of the fluid

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3
Q

Amniotic cavity forms early in fetal life and is filled with amniotic fluid (AF)
Fluid completely surrounds and protects embryo and fetus
AF is produced by umbilical cord, membranes, lungs, skin, and kidneys
Amount of AF reflects balance between AF production and removal

A

Amniotic Fluid production

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4
Q

As fetus and placenta mature, AF production and consumption change

includes:
Movement of fluid across chorion frondosum and fetal skin
Fetal urine output and fetal swallowing
Gastrointestinal (GI) absorption

A

Changes in Amniotic Fluid

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5
Q

Portion of chorion that develops into fetal portion of placenta
Site where water exchanged freely between fetal blood and AF across amnion

A

Chorion frondosum

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6
Q

Fetal production of urine and ability to swallow begins between 8 and 11 weeks of gestation

Amount of urine produced is most significant at approximately 18 to 20 weeks’ gestation
Fetal urination into sac accounts for nearly total volume of AF by second half of pregnancy

Quantity of fluid directly related to kidney function

Fetus with malformed kidneys or renal agenesis results in little or no AF

A

Fetal Amniotic Fluid exchange

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7
Q 
Amount of AF regulated by:
Production of fluid 
Removal of fluid by swallowing
Fluid exchange within lungs
Membranes and cord
A

Quantity of Fluid

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8
Q

Normal lung development depends on exchange of AF within lungs

Inadequate lung development may occur when amount of AF severely low
This places the fetus at high risk for developing small, or hypoplastic, lungs

A

Amniotic fluid influence on lung developement

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9
Q

By 20 weeks’ gestation, AF volume increases by 10 ml/day

Fluid produced by fetal urination slightly exceeds amount removed by fetal swallowing

A

Highest level of Amniotic fluid

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10
Q

Uterine cavity divided into four equal quadrants by two imaginary lines running perpendicular to each other

Largest vertical pocket of AF, excluding fetal limbs or umbilical cord loops, is measured

A

Amniotic Fluid Index (AFI)

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11
Q

AFI of 10 to 20 cm

A

Normal AF

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12
Q

AFI Values of 5 to 10 cm

A

indicate low fluid

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13
Q

AFI values of 20 to 24 cm

A

indicate high fluid

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14
Q

(fluid should measure >1 cm “rule”) assessment of AF done by identifying largest pocket of AF

Pocket of fluid should be clear of fetal components and umbilical cord

A

Maximum vertical pocket

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15
Q

Defined as AF volume of >2000 ml

Associated with increased perinatal mortality and morbidity and maternal complications

Patient will present with clinical finding of uterus greater than dates

Sonography ordered to rule out multiple gestation, molar pregnancy, or fetal size greater than dates

A

Polyhydramnios

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16
Q

associated with central nervous system (CNS) disorders and/or gastrointestinal (GI) problems

CNS disorders cause depressed swallowing.

GI abnormalities result in ineffective swallowing that are often caused by a blockage (atresia) of the esophagus, stomach, duodenum, or small bowel.

A

Polyhydramnios complications

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17
Q 
Diabetes mellitus
Obesity
Rh incompatibility
Anemia
Congestive cardiac failure
A

Maternal conditions associated with polyhydramnios

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18
Q

Overall reduction in amount of AF resulting in fetal crowding and decreased fetal movement

Estimated incidence between 0.5% and 5.5% of all pregnancies

Estimates depend on:
Population tested
Criteria used for diagnosis

A

Oligoyhydramnios

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19
Q 
Congenital anomalies 
IUGR
Postterm pregnancies
Rupture of membranes (ROM)
Iatrogenesis
A

1st trimester oligohydramnios

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20
Q

often has poor prognosis, especially if maternal serum alpha-fetoprotein level also elevated

A

Second trimester oligohydramnios

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21
Q 
Hypertension 
Preeclampsia 
Chronic cardiac or renal disease
Connective tissue disorders 
Patients receiving indomethacin
A

Maternal conditions associated with oligiohydramnios

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22
Q

Fetal hypoxemia may produce growth restriction and oligohydramnios.

Four-fold increased risk of growth delay when oligohydramnios present

Doppler evaluation of growth-restricted fetus shows abnormal umbilical flow in patients with oligohydramnios

A

Clinical Findings oligohydramnios

23
Q

_____________ insufficiency may cause IUGR associated with ___________

A

placental

oligohydramnios

24
Q

Medications
Insensible fluid loss
Maternal intravascular fluid depletion
Prior procedures such as CVS

A

Iatrogenic causes of oligohydramnios

25
Q

Nonsteroidal antiinflammatory drugs
Angiotensin-converting enzyme inhibitors
Calcium channel blockers
Nitrous oxide

A

Medications associated with oligohydramnios

26
Q

IUGR
Premature rupture of membranes
Postdate pregnancy (42 weeks)
Chorionic villus sampling

A

Causes of Oligohydramnios

Nonanomalous Conditions

27
Q 
Infantile polycystic kidney disease
Renal agenesis
Posterior urethral valve syndrome
Dysplastic kidneys
Chromosomal abnormalities
A

Causes of Oligohydramnios

Fetal Anomalous Conditions

28
Q

Tissue makeup of chorioamniotic membrane composed of several types of cells

Integrity and makeup of cells aid in determination of strength of membrane

Under normal conditions, chorioamniotic membranes rupture due to normal cell death activation of enzymes and mechanical forces

A

Ruptured Fetal Membranes

29
Q

Premature rupture of membranes

A

PROM

30
Q

spontaneous rupture of membranes

A

SPROM

31
Q

Patients suspected to have ROM present clinically with sudden gush or leaking of fluid.

test used as screening test to determine presence of AF in vaginal secretions

Patient is checked for cervical dilatation and for leaking of fluid with coughing or fundal pressure

A

Nitrazine test

32
Q 
Preterm delivery
Fetal and neonatal death 
Neonatal respiratory distress
Prolapsed umbilical cord
Chorioamnionitis 
Placental abruption
A

Abnormal ROM associated

33
Q

depends on fetal GA, fetal status, and ability to control uterine contractions

A

Prognosis with ROM

34
Q

Is associated with abnormality in fetal membranes

Is a common, non-recurrent cause of various fetal malformations involving limbs, craniofacial region, trunk

A

Amniotic Band Syndrome

35
Q

amniotic deformities, adhesion, mutilation

A

ADAM complex

36
Q

ADAM complex
Amniotic band sequence
Aberrant tissue bands
Congenital constricting bands

A

Synonyms used to describe disruption of fetal tissue due to the presence of amniotic bands

37
Q

Most widely accepted is rupture of amnion during early pregnancy development leads to subsequent entanglement of various embryonic or fetal parts by fibrous mesodermic bands, which emanate from chorionic side of amnion

Entrapment of fetal parts by bands may cause lymphedema, amputations, slash defects in nonembryologic distributions

A

Amniotic Band Theory

38
Q

Facial clefts, asymmetric encephaloceles, constriction or amputation defects of extremities, clubfoot deformities

A

Amniotic band Common findings

39
Q

identified as echogenic, nonfloating bands crossing through amniotic cavity
Are thicker than bands associated with amniotic band syndrome
Do not cause fetal malformations
Most likely signify uterine synechiae

A

Amniotic Sheets, shelves or folds

40
Q

Uterine scars from previous instrumentation used in uterus
Cesarean section
Episodes of endometritis

A

amniotic sheets caused by:

41
Q

Patients with history of endometrial D&C, intrauterine infections, endometritis, removal of fibroids or endometrial polyps, or prior cesarean section are at risk for developing uterine scars.

Synechiae associated with infertility and miscarriages

Patients who present with uterine synechiae and infertility often diagnosed with

A

Asherman’s syndrome

42
Q

Disparity between amounts of serous fluid being produced and absorbed

A

Hydrops

43
Q 
Pleural effusions 
Ascites 
Cardiac effusion 
Skin edema 
Anasarca
A

Hydrops indications

44
Q 
Enlarged umbilical cord
Polyhydramnios 
Placental edema 
Enlarged liver and spleen 
In many cases,  highly associated with mortality
A

Hydrops fetal findings

45
Q

Hydrops is identified on ultrasound by presence of abnormal collections of fluid

Ascites can be seen as anechoic fluid surrounding abdomina, pelvic organs, and umbilical cord

Do not to mistake normal hypoechoic abdominal musculature for ascites (pseudoascites).

A

Hydrops sonographically

46
Q

can be seen as increased skin thickening around the skull, neck, extremities, or abdomen.

Measurement of >5 - 6 mm for soft tissue thickness is used for diagnosis in some reports

A

Hydrops skin edema

47
Q

When skin edema is massive, encasing the majority of the body,

A

anasarca

48
Q

can be identified as a thickened placenta measuring >4 - 4.5 cm in true anterior-posterior diameter

A

placental edema w/hydrops

49
Q

Is associated with alloimmune hemolytic disease (erythroblastosis fetalis) or rhesus (Rh) isoimmunization

Maternal blood sampling and history of previously affected fetus extremely important for pregnancy management

A

Immune Hydrops

50
Q

Nonimmune hydrops fetalis (NIHF): Presence of abnormal accumulations of fluid in fetal body and/or skin

Is associated with numerous conditions and causes

A

Nonimmune Hydrops

51
Q

May be sporadic condition or associated with numerous other causes

Cardiac insufficiency one of the most common causes

Cardiac insufficiency can result from cardiac anomalies (tumors) or arrhythmias (tachycardia)

A

Nonimmune Hydrops causes

52
Q

All abnormal fluid collections should be documented and measured.

Fetus should be thoroughly evaluated for anomalies that may be associated with NIHF.

A

Nonimmune Hydrops sonographically

53
Q

Fetal tumors (heart or liver)
Cardiac anomalies
Cystic adenomatoid malformation of lung
Chorioangioma of placenta

A

Nonimmune Hydrops anomalies

54
Q

Trisomy 21
45X
Fetal infections (TORCH)

A

NIHF, sonographic findings associations documentation

OB/GYN Section 3 (11 decks)

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