Exam 3 - Amniotic Fluid Complications

Question 1

What is the function of amniotic fluid?

Answer 1

Functions:

• Protective cushion surrounding fetus in amniotic sac
• Provides space for fetal moveemnt and growth
• Helps maintain a consistent temperature and pressure

Question 2

How is amniotic fluid produced?

Answer 2

Amniotic fluid produced in last half of pregnancy by fetus in form of urine and lung fluid –> fluid swallowed and removed through placenta

Question 3

What is the amniotic fluid index (AFI)?

Answer 3

Estimate of total volume of fluid based on ultrasound measurements in four quadrants

Question 4

What is polyhydramnios (hydramnios)?

Answer 4

Excessive amniotic fluid production surrounding fetus or removal of too little amniotic fluid

Question 5

What is the AFI of polyhydramnios?

Answer 5

AFI >24 cm or a vertical pocket >8 cm in length

Question 6

When should polyhydramnios be suspected based on exam findings?

Answer 6

• Enlargement of uterine size > gestational date
• Increased abdominal girth
• Fundal height larger than expected for gestational age

Question 7

How can polyhdramnios make it difficult for the provider to assess the progression of pregnancy?

Answer 7

Difficult to auscultate fetal heart tones, palpate fetal outline and fetal parts, use Leopold maneuvers to determine unstable fetal lay

Question 8

What symptoms would the patient endorse if they have polyhydramnios?

Answer 8

• Dyspnea
• Vulvar edema
• GI upset (N/V, dyspepsia)

Question 9

What are complications associated with polyhydramnios?

Answer 9

• Preterm labor
• Uterine distention
• PPROM
• Fetal malpresentation
• Cord prolapse
• Placental abruption
• Dysfunctional labor
• Postpartum hemorrhage

Question 10

What should the provider order to confirm the diagnosis of polyhydramnios?

Answer 10

Ultrasound

Question 11

Management for polyhydramnios

Answer 11

• Consider rescreen for gestational diabetes
• Antibody titer for isoimmunization

Question 12

What is oligohydramnios?

Answer 12

Abnormally low volume of amniotic fluid

Question 13

What is the AFI of oligohydramnios?

Answer 13

AFI <5 cm

Question 14

What risks does oligohydramnios have on the fetus?

Answer 14

Hypoplastic lung development since amniotic fluid is required for normal chest expansion and fetal breathing

Question 15

What fetal and maternal complications are associated with oligohydramnios?

Answer 15

• Absent kidneys
• Uterine placement perfusion problems
• Post-term pregnancy
• Fluid leaking from premature ROM

Question 16

What should the provider suspect when oligohydramnios is present at 24-34 weeks?

Answer 16

• Fetal anomalies
• Renal agenesis
• Fetal growth restriction

Question 17

What are the clinical signs of oligohydramnios?

Answer 17

• Lagging fundal height
• Molding of uterus around fetus
  
  • Easily outlined and not ballotable
• Variable fetal heart decelerations in labor d/t cord compression with contractions

Question 18

Management of oligohydramnios

Answer 18

• Ultrasound to confirm
• R/o spontaneous ROM
• Consult with physician
• Hydration

Question 19

What is considered premature rupture of membranes (PROM)?

Answer 19

Rupture of membranes prior to onset of labor

• Uterine contractions begin within 24 hours of PROM in term pregnancy

Question 20

What is considered prolonged premature rupture of membranes (PPROM)?

Answer 20

Rupture of membranes prior to onset of labor and before 37 weeks gestation

• 50% will deliver within one week

Question 21

What is thought to be the cause of PROM?

Answer 21

D/t underlying infectious or inflammatory process that weakened the membranes

• Common cause of preterm births

Question 22

PROM is associated with what inflammatory process?

Answer 22

Increases risk of chorioamnionitis

Question 23

What is spontaneous rupture of membranes (SROM)?

Answer 23

Sudden spontaneous rupture of membranes

Question 24

If PROM is suspected, what should the provider avoid during the physical exam?

Answer 24

Avoid inserting anything non-sterile into vagina to prevent chorioamnionitis

Question 25

How would the provider confirm SROM?

Answer 25

• Analysis of small sample of fluid collected by sterile technique on microscope slide –> ferning
• Nitrazine, blood, semen, urine can create false positives

Question 26

What is artificial rupture of membranes (AROM)?

Answer 26

Amniotomy used to induce labor –> committed to giving birth

• Can shorten active labor