Amnionic Fluid - William Obstetric 24th Study Guide

CHAPTER 11 11–1.

Which o the ollowing conditions is not related to an absence or diminution o amnionic luid volume during etal development?

a.

Contractures

b.

Pulmonary hypoplasia

c.

Abdominal wall de ects

d.

Gastrointestinal tract development

11–2.

What is the normal amnionic luid volume at term?

a.

300 mL

b.

800 mL

c.

1200 mL

d.

1500 mL

11–3.

Which o the ollowing is NOT a signi icant source or luid in the amnionic cavity in the irst trimester?

a.

Fetal skin

b.

Fetal urine

c.

Flow across amnion

d.

Flow across etal vessels

11–4.

In a normal etus at term, what is the daily volume o etal urine that contributes to the amount o amnionic luid present?

a.

250 mL

b.

500 mL

c.

750 mL

d.

1000 mL

11–5.

A 28-year-old primigravida presents with a 3-day history o ever, vomiting, and diarrhea at 28 weeks’ gestation. Several amily members are also sick at home with similar complaints. During sonographic evaluation, her etus is appropriately grown, but her amnionic luid index is below the 10th percentile or the gestational age. What is the most likely explanation or this inding?

a.

Increased etal swallowing

b.

Decreased etal serum osmolality

c.

Increased maternal serum osmolality

d.

Probable premature rupture o membranes

11–6.

Amnionic luid volume is a balance between production and resorption. What is the primary mechanism o luid resorption?

a.

Fetal breathing

b.

Fetal swallowing

c.

Absorption across etal skin

d.

Absorption and iltration by etal kidneys

11–7.

All EXCEPT which o the ollowing are acceptable methods o sonographic amnionic luid volume evaluation?

a.

Subjective estimate

b.

Amnionic luid index

c.

Dye-dilution measurement

d.

Two-dimension single-pocket measurement

11–8.

Which o the ollowing is associated with the single deepest pocket measurement seen below?

a.

Increased perinatal mortality rate

b.

Increased rate o bronchopulmonary dysplasia

c.

Increased rate o operative vaginal delivery

d.

Decreased rate o nonreassuring etal heart rate tracings

Amnionic Fluid CH A P T E R 1 1

69 11–9.

Oligohydramnios is de ined as which o the ollowing?

a.

Amnionic luid index < 5 cm

b.

Single deepest pocket < 2 cm

c.

Amnionic luid index < 90th percentile

d.

All o the above

11–10.

What technique or amnionic luid evaluation in multi etal gestations is used in the image below?

a.

Amnionic luid index

b.

Single deepest pocket

c.

Subjective evaluation

d.

Two-dimension single pocket measurement

11–11.

Concurrent use o this imaging technique with amnionic luid index measurements leads to which o the ollowing?

a.

Improved etal outcomes

b.

Overdiagnosis o hydramnios

c.

Overdiagnosis o oligohydramnios

d.

More accurate estimation o amnionic luid volume

11–12.

Which o the ollowing is a clinical sign o polyhydramnios?

a.

Tense uterus

b.

Increase in undal height measurement

c.

Inability to palpate etal small parts

d.

All o the above

11–13.

Using the technique demonstrated in this igure, what is the lower threshold or diagnosing

hydramnios? A B

a.

18 cm

b.

20 cm

c.

24 cm

d.

28 cm

The Feta l Pa tient SE C T I O N 5

70 11–14.

How would the amnionic luid be categorized based on the ollowing image o a single deepest pocket?

a.

Normal

b.

Mild polyhydramnios

c.

Severe polyhydramnios

d.

Moderate polyhydramnios

11–15.

A new patient presents or her irst prenatal visit at 26 weeks’ gestation. She has no complaints other than rapid abdominal growth. Sonographic indings include a 26-week etus with these indings and

a pleural e usion. Potential associated maternal complications may include all EXCEPT which o the ollowing?

11–16.

Which o the ollowing laboratory studies is NOT currently indicated in evaluation o the patient in Question 11–15?

a.

Creatinine

b.

Indirect Coombs

c.

Cytomegalovirus IgM and IgG titers

d.

Venereal Disease Research Laboratory (VDRL)

A B

a.

Dyspnea

b.

Oliguria

c.

Seizures

d.

Vulvar edema MCGH319-CH11_068-074.indd 70 6/13/14 2:32 PM

Amnionic Fluid CH A P T E R 1 1

71 11–17.

What is the etiology o hydramnios in the condition depicted in the ollowing image? Arrows point to the etal eye and nose.

Reproduced with permission rom Cunningham FG, Leveno KJ, Bloom SL, et al (eds): Fetal imaging. In Williams Obstetrics, 23rd ed. New York, McGraw-Hill, 2010, Figure 16-8.

a.

Reduced etal swallowing

b.

Increased maternal glucose levels

c.

Increased production o etal urine

d.

High requency o associated tracheal-esophageal istula

11–18.

Which o the ollowing congenital anomalies is

NOT associated with polyhydramnios?

a.

Pierre Robin sequence

b.

In antile polycystic kidney

c.

Congenital diaphragmatic hernia

d.

Ureteropelvic junction obstruction

11–19.

What placental abnormality, seen in the ollowing image, is associated with polyhydramnios?

Reproduced with permission rom Hof man BL, Dashe JS: Placental chorioangioma (update) in Cunningham FG, Leveno KL, Bloom SL, et al (eds): Williams Obstetrics, 22nd ed. Online. New York, McGraw-Hill, 2009. http://www.accessmedicine.com. Figure 10.

a.

Chorioangioma

b.

Choriocarcinoma

c.

Placenta previa

d.

Placenta accreta

11–20.

A 30-year-old patient had an sonographic

evaluation or a uterine size-date discrepancy. The amnionic luid index was 36 cm. Without any other in ormation, what is the risk o congenital mal ormation in this patient’s etus?

a.

b.

c.

10%

The Feta l Pa tient SE C T I O N 5

72 11–21.

The ollowing image depicts the etal abdomen seen during sonographic evaluation o the patient in Question 11–20. Which o the ollowing is appropriate in the evaluation o this etus?

a.

Glucose tolerance test

b.

Fetal magnetic resonance imaging

c.

Amniocentesis with etal karyotype

d.

None o the above

11–22.

A patient with a known monozygotic twin gestation presents at 26 weeks’ gestation or sonographic

evaluation o etal growth. Twin A has an estimated etal weight o 804 g, whereas twin B’s estimated etal weight is 643 g. The largest pocket o amnionic luid around twin A is 9.6 cm and 2.2 cm or twin B. Which o the ollowing conditions most likely explains these indings?

a.

Gestational diabetes

b.

Congenital anomaly in twin A

c.

Twin-twin trans usion syndrome

d.

Twin B with premature membrane rupture

11–23.

Idiopathic hydramnios is associated with which o the ollowing conditions?

a.

Congenital in ection

b.

Birthweight > 4000 g

c.

Neonatal diabetes mellitus

d.

Increased perinatal mortality rate

11–24.

Which o the ollowing is NOT a recognized

maternal complication associated with hydramnios?

a.

Postpartum atony

b.

Placental abruption

c.

Ureteral obstruction

d.

Gestational hypertension

11–25.

Fetal-growth restriction and polyhydramnios are associated with which o the ollowing chromosomal abnormalities?

a.

Triploidy

b.

Trisomy 18

c.

Trisomy 21

d.

Turner syndrome (Monosomy X)

11–26.

Use o the amnionic luid index rather than single deepest pocket or de ining oligohydramnios is associated with which o the ollowing?

a.

Improved pregnancy outcomes

b.

Increased diagnosis o oligohydramnios

c.

Improved detection o congenital anomalies

d.

Increased detection o etal-growth restriction

11–27.

Second-trimester oligohydramnios may be attributed to which o the ollowing conditions?

a.

Poor placental per usion

b.

Rupture o etal membranes

c.

Fetal bladder outlet obstruction

d.

All o the above

Amnionic Fluid CH A P T E R 1 1

73 11–28.

An obstetric patient presents at 35 weeks’ gestation with a complaint o decreased etal movement.

Variable decelerations are present on a nonstress test, so an amnionic luid index (AFI) is per ormed. The result is seen below. What subsequent evaluation is recommended?

B A

a.

Sterile speculum examination

b.

Umbilical artery Doppler studies

c.

Sonographic measurement o etal growth

d.

All o the above

11–29.

The evaluation o the patient in Question 11–28 is normal. What is the most appropriate step in the management o her pregnancy?

a.

Immediate cesarean delivery

b.

Induction o labor in 1 week

c.

Administration o antenatal corticosteroids

d.

Expectant management with etal surveillance

11–30.

Which o the ollowing medications is associated with oligohydramnios when taken in the latter hal o pregnancy?

a.

Hydralazine

b.

Beta blockers

c.

Calcium-channel blockers

d.

Angiotensin-receptor blockers

11–31.

Oligohydramnios is NOT associated with which o the ollowing pregnancy complications?

a.

Stillbirth

b.

Neonatal sepsis

c.

Congenital mal ormations

d.

Meconium aspiration syndrome

11–32.

A borderline amnionic luid index (AFI), de ined as an AFI between 5 and 8 cm, is associated