Samantha Hale
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From the amniotic fluid lecture

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Samantha Hale
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Amniotic Fluid

Question 1 of 71

1

What is the normal gestation period?

Select one of the following:

  • 38-42 weeks

  • 30-35 weeks

  • 45-50 weeks

  • 20-35 weeks

Explanation

Question 2 of 71

1

Which of the following is a function of amniotic fluid?

Select one of the following:

  • Cushions the fetus while in utero and allows for movement

  • Stabilizes fetal temperature

  • Plays a role in fetal lung development

  • Allows exchange of water and substances between the fluid, the fetus and the maternal
    circulation.

  • All of the above

Explanation

Question 3 of 71

1

Fill the blank space to complete the text.

Initially, amniotic fluid is produced by the .

Explanation

Question 4 of 71

1

Fill the blank spaces to complete the text.

Production of amniotic fluid in the first trimester is supplied by , approximately .

Explanation

Question 5 of 71

1

Amniotic fluid in the first trimester is similar to the composition of the mother's plasma (plus some sloughed off cells from the fetus).

Select one of the following:

  • True
  • False

Explanation

Question 6 of 71

1

Fill the blank space to complete the text.

In the 2nd trimester, is the main contributor.

Explanation

Question 7 of 71

1

Fill the blank space to complete the text.

In the last half (to 1/3) of the pregnancy, regulation of the volume of amniotic fluid is
further influenced by the production of .

Explanation

Question 8 of 71

1

Surfactants secreted by the fetus include

Select one of the following:

  • Alpha fetoprotein and AChE

  • AChE and Lecithin

  • Sphingomyelin and AChE

  • Lecithin and sphingomyelin

Explanation

Question 9 of 71

1

Fill the blank spaces to complete the text.

The volume of amniotic fluid increases throughout the pregnancy and peaks during the (around 36 weeks gestation) before gradually prior to delivery.

Explanation

Question 10 of 71

1

_______ is an excess accumulation of amniotic fluid due to failure of the fetus to
start swallowing the fluid.

Select one of the following:

  • Oligohydramnios

  • Polyhydramnios

Explanation

Question 11 of 71

1

Polyhydramnios is associated with _____ while oligohydramnios is associated with ______.

Select one of the following:

  • Congenital fetal deformations; Congenital deformations or amniotic membrane rupture

  • Congenital deformations or amniotic membrane rupture; Congenital fetal deformations

Explanation

Question 12 of 71

1

Check the answers that are associated with polyhydramnios.

Select one or more of the following:

  • Fetal distress

  • Failure of the fetus to start swallowing amniotic fluid

  • Increased fetal swallowing

  • Urinary tract deformities

  • Fetal structure anomalies

  • Neural tube disorders

  • Amniotic membrane leakage

  • Congenital infections

  • Cardiac arrhythmias

  • Chromosomal abnormalities

Explanation

Question 13 of 71

1

Check the answers associated with Oligohydramnios.

Select one or more of the following:

  • Accumulation of amniotic fluid

  • Decreased amniotic fluid

  • Cardiac arrhythmias

  • Failure of the fetus to start swallowing the fluid.

  • Urinary tract deformities

  • Increased fetal swallowing

  • Amniotic membrane leakage

  • Umbilical cord compression

Explanation

Question 14 of 71

1

As the pregnancy continues, the composition of amniotic fluid changes to reflect contributions from the fetus. Check the answers to the changes that we would see in this case.

Select one or more of the following:

  • Decrease in creatinine

  • Increase in creatinine

  • Increase in urea

  • Increase in uric acid

  • Increase in protein

  • Decrease in protein

  • Increase in glucose

  • Decrease in glucose

  • Decrease in urea

  • Decrease in uric acid

Explanation

Question 15 of 71

1

Fill the blank spaces to complete the text.

Amniotic fluid creatinine levels may be used to assess fetal age. At less than 36 weeks old, that should be mg/dL. At greater than 36 weeks old, that should be .

Explanation

Question 16 of 71

1

Generally, amniocentesis can be performed anytime after 8 weeks gestation, but the purpose for
the procedure dictates when it is actually performed.

Select one of the following:

  • True
  • False

Explanation

Question 17 of 71

1

Fill the blank space to complete the text.

Amniocentesis when used to screen for birth defects is performed between weeks.

Explanation

Question 18 of 71

1

Fill the blank space to complete the text.

Amniocentesis, when performed to monitor fetal distress is performed between weeks.

Explanation

Question 19 of 71

1

Check the appropriate boxes associated with amniotic fluid collection.

Select one or more of the following:

  • Keep at room temperature.

  • Keep on ice.

  • Separate from cells asap.

Explanation

Question 20 of 71

1

Fill the blank space to complete the text.

is recommended for FLM (fetal lung maturity studies) to prevent loss of phospholipids (lung surfactants)

Explanation

Question 21 of 71

1

Surfactants are unstable at room temperature but stable if refrigerated for up to 72 hours

Select one of the following:

  • True
  • False

Explanation

Question 22 of 71

1

Centrifugation must be done much slower than for other specimen types. 140g are used to recover
fetal cells, 500g is used to separate supernatant containing phospholipids for FLM analysis. Higher
centrifugation forces will result in loss of phospholipids into the pellet with erroneous L/S ratio
(later). Other assays can be done in clear supernatant after centrifugation at 1500g (5 to 15
minutes).

Select one of the following:

  • True
  • False

Explanation

Question 23 of 71

1

Fill the blank spaces to complete the text.

The mother's triple screen serum test includes , , and .

Explanation

Question 24 of 71

1

Produced by the fetal liver during 1st trimester; elevated with open neural tube defects (such as spina bifida – neural tissue is exposed, not covered with skin) – elevated in amniotic fluid and also in the mother’s circulation. Low levels are associated with Down Syndrome.

Select one of the following:

  • Estriol

  • Bilirubin

  • AFP

  • hCG

Explanation

Question 25 of 71

1

Low levels are a concern for maintaining the pregnancy. High levels are associated with down syndrome.

Select one of the following:

  • hCG

  • Estriol

  • Bilirubin

  • AFP

Explanation

Question 26 of 71

1

High "unconjugated estriol" indicates a problem with the fetus development.

Select one of the following:

  • True
  • False

Explanation

Question 27 of 71

1

Erroneous results can be obtained for ____ due to preeclampsia, anemia, and kidney disease.

Select one of the following:

  • Estriol

  • AFP

  • Bilirubin

  • hCG

Explanation

Question 28 of 71

1

DHEA, a precursor hormone, is produced by the fetal adrenal glands and converted to estriol in the placenta.

Select one of the following:

  • True
  • False

Explanation

Question 29 of 71

1

What is included in a Quad Screen?

Select one of the following:

  • Cholesterol

  • DHEA

  • Inhibin-A

  • Glucose

Explanation

Question 30 of 71

1

Inhibin-A is a protein produced by the fetus and ovaries. Elevated values, together with increased hCG, decreased AFP and estriol, are a better indication of Down syndrome.

Select one of the following:

  • True
  • False

Explanation

Question 31 of 71

1

The fern test helps determined if there is premature rupture of the amniotic sac. Vaginal fluid is smeared on a glass slide and allowed to dry. If amniotic fluid is present, it will crystalize in a characteristic fern-like formation.

Select one of the following:

  • True
  • False

Explanation

Question 32 of 71

1

All amniotic fluid is turbid to some degree

Select one of the following:

  • True
  • False

Explanation

Question 33 of 71

1

A protein produced by the fetal liver during the 1st trimester and present in both fetal serum and fetal CSF

Select one of the following:

  • AFP

  • AChE

  • Bilirubin

  • Albumin

Explanation

Question 34 of 71

1

Fill the blank space to complete the text.

These are tests that measure the various lung surfactants - lecithin, sphingomyelin, and .

Explanation

Question 35 of 71

1

Fill the blank space to complete the text.

The Foam Stability Index (FSI) is a test that measures the relative amounts of ; it
correlates well with results of the L/S ratio and phosphatidyl glycerol assays.

Explanation

Question 36 of 71

1

AFP Levels peak at 16 weeks (500µg/L) then slowly decrease. Only a small (<1%) amount is filtered by the kidney and excreted in fetal urine. As a result, small amounts of AFP are normally present (< 10 µg/L) in amniotic fluid.

Select one of the following:

  • True
  • False

Explanation

Question 37 of 71

1

Check the tests associated with assessing AFP levels.

Select one or more of the following:

  • Cytogenetics

  • Flow Cytometry

  • EIA

  • RIA

Explanation

Question 38 of 71

1

AChE acetylcholinesterase is normally present in amniotic fluid (called pseudoacetylcholinesterase) and it will
migrate slow in electrophoresis. With open NTDs, another form specific to neural tissue will be present that
migrates much faster.

Select one of the following:

  • True
  • False

Explanation

Question 39 of 71

1

Amniotic fluid - Bilirubin and the Liley Graph - Zone 1

Select one of the following:

  • indicates a normal to mildly affected fetus

  • quires careful monitoring of the pregnancy as it suggests HDFN may be
    occurring

  • indicates a severely affected fetus and a need for intervention.

Explanation

Question 40 of 71

1

Amniotic fluid - Bilirubin and the Liley Graph - Zone 3

Select one of the following:

  • indicates a normal to mildly affected fetus

  • requires careful monitoring of the pregnancy as it suggests HDFN may be
    occurring

  • indicates a severely affected fetus and a need for intervention

Explanation

Question 41 of 71

1

Fill the blank space to complete the text.

FML maturity - baby is mature enough to avoid respiratory distress syndrome and
delivery will be induced. After how many weeks is this usually? Answer: After weeks

Explanation

Question 42 of 71

1

Fill the blank space to complete the text.

When results of the Liley graph point to very early induction, fetal lung maturity must first
be assessed. This is done by testing the level of present in the amniotic
fluid.

Explanation

Question 43 of 71

1

The most common complication of early delivery and is the leading cause of death in premature infants.

Select one of the following:

  • Down Syndrome

  • Anencephaly

  • RDS

  • AIDS

Explanation

Question 44 of 71

1

Fill the blank space to complete the text.

The function of the surfactant is to keep the .

Explanation

Question 45 of 71

1

The primary lung surfactant is

Select one of the following:

  • Lecithin

  • Sphingomyelin

  • Phosphatidyl Glycerol

Explanation

Question 46 of 71

1

Fill the blank spaces to complete the text.

production increases toward the end of the pregnancy; by 34-36 weeks the
amount of is present in sufficient amounts to prevent alveolar collapse.

Explanation

Question 47 of 71

1

Fill the blank spaces to complete the text.

is a lipid that is produced at a constant steady rate after 26 weeks. The
exact role of has not yet been determined but is used as a reference for
lecithin.

Explanation

Question 48 of 71

1

Fill the blank spaces to complete the text.

Prior to 35 weeks L/S is usually <, but as lecithin increases (and sphingomyelin
remains constant) the ratio increases. When it reaches it is considered safe to
deliver the baby.

Explanation

Question 49 of 71

1

Lecithin and sphingomyelin are measured by

Select one of the following:

  • TLC

  • RIA

  • EIA

Explanation

Question 50 of 71

1

Fill the blank space to complete the text.

parallels the production of lecithin except in cases of maternal diabetes where production is delayed. In this case RDS can occur with an L/S of 2.0.

Explanation

Question 51 of 71

1

It is best to have an L/S ratio > 2.0 and detectable PGL to ensure FLM, however it’s only necessary
in women with gestational diabetes to measure all three.

Select one of the following:

  • True
  • False

Explanation

Question 52 of 71

1

Fill the blank space to complete the text.

uses antisera specific for phosphatidyl glycerol; this is a semi-quantitative
agglutination slide test that is faster to perform than TLC. There is no interference by blood
or meconium but it has higher incidence of false negatives

Explanation

Question 53 of 71

1

Phosphatidyl glycerol (PGL) is measured by (check all associated with it).

Select one or more of the following:

  • TLC

  • Amniostat FLM

  • EIA

  • RIA

Explanation

Question 54 of 71

1

Rapid tests for determining FLM (Check all that apply).

Select one or more of the following:

  • EIA

  • RIA

  • FSI

  • Lamellar body counts

  • TLC

Explanation

Question 55 of 71

1

Fill the blank spaces to complete the text.

The FSI is based on the fact that destroys ; it is an antifoaming agent.

Explanation

Question 56 of 71

1

Amniotic Fluid - FSI

Select one of the following:

  • When mixed with amniotic fluid and shaken, the amount of foam is proportional to the
    amount of surfactant present.

  • When mixed with amniotic fluid and shaken, the amount of foam is inversely proportional to the amount of surfactant present.

Explanation

Question 57 of 71

1

Foam Stability Test - The presence of bubbles around the outside edge of the
liquid surface is a sign that a sufficient amount of these phospholipids are present to
support lung function. This test may be performed at the bedside by the physician.

Select one of the following:

  • True
  • False

Explanation

Question 58 of 71

1

FSI: The ones with less ethanol should have less bubbles because ethanol is an antifoaming agent.

Select one of the following:

  • True
  • False

Explanation

Question 59 of 71

1

The first tube that shows foaming gives us the FSI.

Select one of the following:

  • True
  • False

Explanation

Question 60 of 71

1

FSI: If it corresponds to 47 or higher (0.47 mL ethanol or greater) that means there are enough phospholipids to over come the antifoaming action of the ethanol even at that higher amount and thus the lungs are mature enough.

Select one of the following:

  • True
  • False

Explanation

Question 61 of 71

1

The storage form of lung surfactants

Select one of the following:

  • Lamellar bodies

  • Sphingomyelin

  • Lecithin

  • Phosphatidyl glycerol

Explanation

Question 62 of 71

1

As the lungs mature the increased lamellar body production reflects a decrease in phospholipids and L/S ratio.

Select one of the following:

  • True
  • False

Explanation

Question 63 of 71

1

Fill the blank space to complete the text.

will increase the optical density of amniotic fluid.

Explanation

Question 64 of 71

1

Fill the blank spaces to complete the text.

When measured at 650 nm, falsely increases the optical density, but does not.

Explanation

Question 65 of 71

1

An OD reading of 0.150 correlates well with an L/S ratio ≥ 2.0 and the presence of phosphatidyl glycerol.

Select one of the following:

  • True
  • False

Explanation

Question 66 of 71

1

Fill the blank spaces to complete the text.

In a lamellar body count, contamination from will falsely increase the counts since will be present.

Explanation

Question 67 of 71

1

Fill the blank space to complete the text.

is a glycoprotein secreted during pregnancy by cells of the fetal membranes (amnion and chorion) that make the amniotic sac and the fetal side of the placenta. It acts as a glue that binds the placenta to the uterus.

Explanation

Question 68 of 71

1

Fill the blank space to complete the text.

During weeks 22 to 35, the presence of may be used as a predictor for preterm delivery.
If detected, it might be necessary for the mother to be on bed rest for the remainder of the pregnancy. A negative test is a predictor that delivery over the next two weeks is unlikely

Explanation

Question 69 of 71

1

Fetal fibronectin Test is performed on

Select one or more of the following:

  • A cervical/vaginal swab

  • Amniotic fluid

  • Urine

  • Serum

Explanation

Question 70 of 71

1

Fetal Fibronectin tests include

Select one or more of the following:

  • ELISA

  • Rapid Lateral flow immunosorbent assay

  • RIA

  • Flow cytometry

Explanation

Question 71 of 71

1

Fill the blank space to complete the text.

At 22-35 weeks gestation, fFN levels are normally below ng/dL.

Explanation

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