OB AF, TERA AND FETO Flashcards
Amnionic fluid volume increases from approximately :
10 weeks:
16 weeks:
midterm:
Third term:
Full term:
10 weeks: 30 mL
16 weeks: 200 mL
midterm: 800 mL
Third term: reaches 4 liters
Full term: 2,800 mL
Placenta contains how much water?
400 mL
abnormally decreased fluid volume
Oligohydramnios
abnormally increased fluid volume i
Hydramnios or Polyhydramnios
transfer of water and other small molecules takes place across the amnion
Transmembranous flow
across the fetal vessels on placental surface
Intramembranous flow
Flow across fetal skin
Transcutaneous flow
Fetal urine production:
begins between what weeks of gestation, but it does not become a major component of amnionic fluid until the second trimester
8 and 11 weeks
Water transport across the fetal skin continues until keratinization occurs at what week
22 to 25 weeks
TRUE OR FALSE
extremely preterm neonates can experience significant fluid loss across their skin
True
What is the primary source of amnionic fluid in the second half of pregnancy
Fetal urination
True or falsehood I
fetal urine production may exceed 1 liter per day
True
TRUE OR FALSE
entire amnionic fluid volume is recirculated on a weekly basis
False
On a daily basis
TRUE OR FALSE
Fetal urine osmolality is similar to that of amnionic
• hypertonic to that of maternal and fetal plasma
FALSE
HYPOTONIC
Approximate osmolality of maternal and fetal plasma
280 mOsm/mL
Amniotic fluid in fetal urination is approx. how much?
260 mOsm/mL
WHAT ARE THE FOUR PATHWAYS THAT PLAY A MAJOR ROLE IN AMNIONIC FLUID VOLUME REGULATION?
A.) Fetal urination
B.) Fetal swallowing
C.) Respiratory tract
D.) Transmembranous and transcutaneous flow
primary mechanism for amnionic fluid resorption which averages 500 to 1000mL per day
Fetal swallowing
TRUE OR FALSE
Impaired swallowing, secondary to either a central nervous system abnormality or GI tract obstruction, can result in an impressive degree of hydramnios
True
third source of amnionic fluid regulation
• Approxi 350 mL of lung fluid is produced daily late in gestation
• half of this is immediately swallowed
Respiratory tract
account for a far smaller proportion of fluid transport in the second half of pregnancy
Transmembranous and Transcutaneous flow
What dye is injected to the amnionic cavity in measuring amniotic fluid
Aminohippurate
average fluid volume was between 22 and 30 weeks
approximately 400 mL
When is Sonographic assessment is done?
Second or third trimester
a fluid pocket must be at least how many cm in width to be considered adequate?
1cm
used to verify that umbilical cord is not within the measurement
Color doppler
also called the largest or maximal vertical pocket of amnionic fluid.
Single Deepest Pocket
TRUE OR FALS
the ultrasound transducer is held perpendicular to the floor and parallel to the long axis of the woman.
TRUE
Normal range for single deepest pocket measurement
Above 2cm and less than 8cm
It is the sum of the single deepest pocket from each quadrant
Amnionic Fluid Index (AFI)
normal AFI
greater than 5 cm and below 24 or 25
TRUE OR FALSE
mean AFI was found to be between 12 and 15 cm from 16 weeks until 40 weeks’ gestation
TRUE
the uterus may feel tense, and palpating fetal small parts or auscultating fetal heart tones may be difficult
Hydramnios
Category of Hydramnios
25 to 29.9 cm
Mild AFI
Category of Hydramnios
30 to 34.9 cm
Moderate AFI
Category of Hydramnios
35 cm or more
Severe AFI
Single deepest pocket of amnionic fluid defines mild hydramnios as how many cm?
8 to 9.9cm
Single deepest pocket of amnionic fluid defines moderate hydramnios as how many cm?
10 to 11.9 cm
Single deepest pocket of amnionic fluid defines severe hydramnios as how many cm?
12 cm or more
Impaired swallowing (CNS) can lead to?
Anencephaly
Hydranencephaly
Holoprosencephaly
Impaired swallowing (craniofacial) can lead to
Cleft lip/palate
Micrognathia
Tracheal compression or obstruction can lead to?
Neck venolymphatic abnormality
CHAOSa
Thoracic etiology (mediastinal shift) can lead to?
Diaphragmatic hernia
Cystic adenomatoid malformationa
Pulmonary sequestrationa
High-output cardiac state can lead to?
Ebstein anomalya
Tetralogy of Fallot with absent
pulmonary valvea
Thyrotoxicosis
Functional cardiac etiology
Cardiomyopathy,
myocarditisa
Cardiac arrhythmia
Tachyarrhythmiaa: atrial
flutter, atrial fibrillation,
supraventricular tachycardia
Bradyarrhythmiaa: heart block
GI obstruction
Esophageal atresia
Duodenal atresia
Renal-Urinary
Ureteropelvic junction
obstruction (“paradoxical
hydramnios”)
Baarter syndrome
Neurological or muscular etiology
Arthrogryposis, akinesia
sequence
Myotonic dystrophy
Neoplastic etiology
Sacrococcygeal teratomaa
Mesoblastic nephromaa
Placental chorioangiomaa
TRUE or FALSE
The amniotic fluid glucose concentration is higher in diabetic women
TRUE
MULTIFETAL GESTATION:
What is the severity if a single deepest pocket measures 8 cm or more
MILD
if the single deepest pocket is atleast 10cm
Severe
MULTIFETAL GESTATION:
What is the severity if the pocket is at least 12 cm
Severe
hydramnios of one sac and
oligohydramnios of the other are diagnostic criteria for twin-twin transfusion syndrome
Monochorionic gestations
up to 70 percent of cases of hydramnios
* 1 % of pregnancies
* rarely identified during midtrimester sonography but as incidental finding later in gestation
IDIOPATHIC HYDRAMNIOS
sonographic detection of idiopathic hydramnios is usually at what weeks?
32 and 35 weeks
COMPLICATIONS:
fluid accumulates gradually and
a woman may tolerate excessive abdominal distention
with relatively little discomfort
CHRONIC HYDRAMNIOS
tends to develop earlier in
pregnancy
* May result in preterm labor before 28 weeks
* symptoms may become so debilitating as to
necessitate intervention
Acute hydramnios
it is a consequence of major venous system compression by the enlarged uterus - most
pronounced in the lower extremities, vulva, and
abdominal wall
EDEMA
results from ureteral obstruction by the
enlarged uterus
oliguria
-result from the rapid
decompression of an overdistended uterus that follows
fetal-membrane rupture or therapeutic amnioreduction
* With prematurely ruptured membranes, a placental
abruption occasionally occurs days or weeks after
amniorrhexis.
Placental abruption
symptoms of hydramnios
Dyspnea and orthopnea
Edema
Oliguria
placental abruption
uterine dysfunction
postpartum hemorrhage
largest contributor to amniotic fluid volume
fetal urine
Pregnancy outcomes of hydramnios
*growth-restricted fetus
* associated with trisomy 18
* preterm delivery (not for idiopathic hydramnios)
* Small for-gestational age newborn
* perinatal mortality
- done with a larger needle, 18- or 20-gauge
- uses either an evacuated container bottle or a larger
syringe.
Amnioreduction
Goal of amnioreduction
to restore amnionic fluid volume to the upper
normal range
initial amnioreduction is performed at what week of gestation?
31 weeks
Complications of amnioreduction within 48 hours:
- delivery in 4 %
- ruptured membranes in 1 %
it is the abnormally decreased amount of amnionic fluid
* 1 to 2 percent of pregnancies
OLIGOHYDRAMNIOS
when no measurable pocket of
amnionic fluid is identified
ANHYDRAMNIOS
The sonographic diagnosis of oligohydramnios is
usually based on an AFI of? or a single
deepest pocket of amnionic fluid of?
AFI less than 5 cm or a single
deepest pocket of amnionic fluid below 2 cm
Management for oligohydramnios
vesicoamnionic shunt placement
- especially for fetuses with bladder outlet
obstruction
Intake of NSAID may result to?
Fetal skull bone hypoplasia and limb
contractures
* fetal ductus arteriosus constriction and with
lower fetal urine production
- refers to an AFI between 5 and 8 cm
- between 24 and 34 weeks with AFI between 5 and 8
cm
“Borderline” oligohydramnios
Borderline oligohydramnios is complicated by?
/
Hypertension, stillbirth, neonatal death
defined as any agent that acts
during embryonic or fetal development to
produce a permanent alteration of form or
function
Teratogen
it is an agent that interferes with organ maturation
and function
Hadegen
Substances typically affect
development in the fetal period or after
birth - more difficult to document.
Trophogen
2 weeks between fertilization and implantation
* known as the “all or none” period
preimplantation period
extends from the second through the eighth
week postconception. It encompasses
organogenesis
* the most crucial period with regard to structural
malformations
embryonic period
beyond 8 weeks postconception characterized by continued maturation and functional
development
Fetal period
it is an antiemetic which have a combination of doxylamine and
pyridoxine, with or without dicyclomine
Safe and effective for nausea and vomiting in early pregnancy
target of numerous lawsait leading to it’s withdrawal from the market
Bendectin
the combination of doxylamine and pyridoxine was
subsequently remarketed under what brand name
and was approved by the FDA in 2013.
Diclegis
Which category where Studies in pregnant women have not shown an increased
risk for fetal abnormalities if administered during the first (second, third, or all) trimester(s) of
pregnancy, and the possibility of fetal harm appears remote
Category A
Which category where Animal reproduction studies have been performed and have revealed no evidence of impaired fertility or harm to the fetus OR Animal studies have shown an adverse effect, but adequate and well-controlled studies in pregnant women have failed to demonstrate a risk to the fetus during the first trimester of pregnancy, and there is no evidence of a risk in later trimesters
Category B
What category where Animal reproduction studies have shown that this medication is teratogenic (or embryocidal or has other adverse effect), and there are no adequate and well-controlled studies in pregnant women.
There are no animal reproduction studies and no
adequate and well-controlled studies in humans
Category C
Category
This medication can cause fetal harm when administered
to a pregnant woman. If this drug is used during pregnancy
or if a woman becomes pregnant
while taking this medication, she should be apprised of the
potential hazard to the fetus.
Category D
Category
This medication is contraindicated in women who are or
may become pregnant. It may cause fetal harm
Category X
considered the leading cause of preventable
developmental disabilities worldwide
Alcohol