Amniotic Fluid

Front 1

amniotic fluid is produced by

Back 1

fetal kidney, skin, lungs, umbilical cord, membranes

Front 2

in 2nd and 3rd trimesters what accounts for 2/3 of AFI

Back 2

fetal urination

after 16 wks most of the fluid is produced by the fetal urinary system

amniotic fluid is absorbed by fetal swallowing and gastrointestinal absorption

Front 3

functions of the amniotic fluid

Back 3

cushion fetus

allows for fetal movement or activity

prevents adherence of amnion to embryo

promotes lung growth

regulates temp

Front 4

amount of fluid is directly related to

less than 15 wks

Back 4

AFI is from amnion: diffusion of maternal plasma through chorionic plate; exchange of fluids through fetal maternal circulation

Front 5

amount of fluid is directly related to

15-30 wks

Back 5

fetal kidneys and skin diffusion

if abnormality/absence of fetal kidneys, AFI is directly impacted

Front 6

amount of fluid is directly related to

greater that 30 wks

Back 6

skin diffusion decreases; renal function and urine output increases

Front 7

1st trimester: fluid is regulated through

Back 7

membranes, fetal lungs, and skin

Front 8

2nd/3rd trimester fluid is regulated through

Back 8

urine and fetal swallowing

Front 9

normal levels based on GA

10wks

Back 9

30mL

Front 10

normal levels based on GA

20 wks

Back 10

300mL

Front 11

normal levels based on GA

30 wks

Back 11

600mL

Front 12

normal levels based on GA

36wks

Back 12

1000mL

Front 13

normal levels based on GA

38-42 wks

Back 13

600mL

Front 14

subjective observation

Back 14

sonographer eye-balls amount

Front 15

subjective observation

20-30 wks

Back 15

AFI appears generous but normal amount

Front 16

subjective observation

end of prgnancy

Back 16

AFI appears minimal with a single larger pocket of fluid within uterus

Front 17

assessment of amniotic fluid volume

maximum vertical pocket

Back 17

measure largest pocket found

measure anterior to posterior

MVP of 8cm or greater is considered polyhydramnnios

Front 18

don't measure fluid where

Back 18

loops of cord are present

can use color/power to obtain a more accurate fluid volume assessment

Front 19

amniotic fluid can be assessed subjectively or

Back 19

quantified with the four-quadrant method or single largest vertical pocket method

Front 20

amount of fluid correlates with fetal and placental weight

Back 20

small for age fetus - low AFI

large for dates fetus - high AFI

Front 21

amniotic fluid u/s

Back 21

appears anechoic but some particulate matter may appear further along in the pregnancy

Front 22

vernix

Back 22

fatty material of fetal skin

may be visualized in amniotic fluid later in pregnancy

Front 23

subjective assessment; sonographer should

Back 23

visually assess fetal lie and placental position

Front 24

decreased AFI

Back 24

sonographer feels there is an overall crowding of fetal parts and unable to visualize any significant pockets of fluid within entire uterus

Front 25

increased AFI

Back 25

overall appearance of an excess of fluid

(more accurate with experienced sonographers)

Front 26

Four-Quadrant Method (amniotic fluid index)

Back 26

divide iterus into 4 quadrants and measure largest vertical pocket (absent of fetal parts) in each quadrant - then total them up

Front 27

normal AFI measurement (4 quad)

Back 27

8-22 cm

Front 28

decreased AFI measurement ( 4 quad)

Back 28

less than 5 cm

Front 29

increased AFI measurement (4 quad)

Back 29

greater than 22cm

Front 30

4 quadrant method

Back 30

correct transducer placement

Front 31

AFI pitfalls

Back 31

be sure NOT to include uterine wall

transducer is perpendicular in relation to table

gain to low: could miss fetal part, could include uterine wall

gain to high: make fluid appear to echogenic

use of color Doppler will assist in identifying portion of umbilical cord present

Front 32

single pocket assessment

Back 32

identify largest pocket (must be more than 1 cm) without fetal parts and measuring depth

Front 33

single pocket

less than 2cm

Back 33

oligohydraminos

Front 34

single pocket

2-8 cm

Back 34

normal

Front 35

single pocket

greater that 8 cm

Back 35

polyhydraminos

Front 36

polyhydraminos

Back 36

amniotic fluid volume greater than 2000mL at term

largest pocket greater than 8cm

Front 37

polyhydramnios - etiology

Back 37

increased secretion of amniotic fluid by large placenta or fetal malformation which prevents swallowing or absorption

60% idiopathic

20% due to maternal disease

20% due to fetal structure anomaly

Front 38

polyhydramnios

Back 38

can put too much pressure on baby ; can cause congestive heart failure, puts stress on lungs

Front 39

polyhydramnios - S/S

Back 39

sudden maternal weight gain

patient large for dates

maternal lower limb adema

"distant fetal parts and heart tones" clinical quotes

Front 40

polyhydrmnios - u/s

Back 40

large amount of amniotic fluid

exceptional visualization of fetal parts/details

placenta may appear thin (compressed from excessive fluid)

Front 41

seven fetal assessments to be made when examining a fetus with polyhydramnios

Back 41

1.assess the head - is there a brain malformation

2. assess the neck and mouth - is there obstuction

3. assess the heart - is there heart failure

4. assess the chest - is there compression

5. assess the esophagus - is the stomach seen

6. assess the upper gastrointestinal tract - obstruction

7. assess the fetus neurologically - is there poor tone

Front 42

oligohydramnios

Back 42

abnormally small amount of fluid

less than 400-500mL at birth

mild - pocket <2 cm but >1cm

Oligo - pocket is < 1 cm

Front 43

oligohydramnios - etiology

Back 43

fetal demise

IUGR (cause or result)

placental vascular insufficency

PROM

fetal renal anomilies

Front 44

Oligohydramnios AFI

Back 44

AFI <5-8 cm

16-34 wks AFI less than 8 cm is termed oligo or decreased amniotic fluid volume

beyond 34 wks fluid is decreasing and one should see at least a 2 x 2 pocket

Front 45

organs to assess if oligohydramnios is not the result of PROM

Back 45

demise D

renals R

IUGR I

PROM P

Trisomies T

twin to twin transfusion

Front 46

Oligohydramnios S/S

Back 46

lack of normal materna weight gain

small for dates

Front 47

Oligohydramnios U/S

Back 47

reduced amount of amniotic fluid

poor image detail due to lack of tissue-fluid interface

crowding of fetal parts

decreased in number of pockets of fluid

Front 48

oligohydramnios - prognosis

Back 48

fetal risks are dependent of severity and time of onset of oligo

skeletal and facial deformities

pulmonary hypoplasis

under developed lungs, no fluid to develop them

Front 49

polyhydraminos - prognosis

Back 49

increased risk of preterm labor (more pressure)

pregnancy induced hupertension

postpardium hemorrage

Front 50

echogenic fluid

Back 50

amniotic fluid with sludge, patients with preterm labor have an increased risk of infection and preterm delivery

Front 51

3rd trimester echogenic particle most likely represent

Back 51

vernix