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Amniotic Fluid

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From the amniotic fluid lecture
Samantha Hale
Quiz by Samantha Hale, updated more than 1 year ago
Samantha Hale
Created by Samantha Hale over 3 years ago
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Resource summary

Question 1

Question
What is the normal gestation period?
Answer
  • 38-42 weeks
  • 30-35 weeks
  • 45-50 weeks
  • 20-35 weeks

Question 2

Question
Which of the following is a function of amniotic fluid?
Answer
  • 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

Question 3

Question
Initially, amniotic fluid is produced by the [blank_start]amnion and the placenta[blank_end].
Answer
  • amnion and the placenta

Question 4

Question
Production of amniotic fluid in the first trimester is supplied by [blank_start]maternal circulation[blank_end], approximately [blank_start]35mL[blank_end].
Answer
  • maternal circulation
  • 35mL

Question 5

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

Question 6

Question
In the 2nd trimester, [blank_start]fetal urine[blank_end] is the main contributor.
Answer
  • fetal urine

Question 7

Question
In the last half (to 1/3) of the pregnancy, regulation of the volume of amniotic fluid is further influenced by the production of [blank_start]fetal lung fluid[blank_end].
Answer
  • fetal lung fluid

Question 8

Question
Surfactants secreted by the fetus include
Answer
  • Alpha fetoprotein and AChE
  • AChE and Lecithin
  • Sphingomyelin and AChE
  • Lecithin and sphingomyelin

Question 9

Question
The volume of amniotic fluid increases throughout the pregnancy and peaks during the [blank_start]3rdtrimester[blank_end] (around 36 weeks gestation) before gradually [blank_start]decreasing[blank_end] prior to delivery.
Answer
  • 3rd trimester
  • decreasing

Question 10

Question
_______ is an excess accumulation of amniotic fluid due to failure of the fetus to start swallowing the fluid.
Answer
  • Oligohydramnios
  • Polyhydramnios

Question 11

Question
Polyhydramnios is associated with _____ while oligohydramnios is associated with ______.
Answer
  • Congenital fetal deformations; Congenital deformations or amniotic membrane rupture
  • Congenital deformations or amniotic membrane rupture; Congenital fetal deformations

Question 12

Question
Check the answers that are associated with polyhydramnios.
Answer
  • 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

Question 13

Question
Check the answers associated with Oligohydramnios.
Answer
  • 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

Question 14

Question
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.
Answer
  • 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

Question 15

Question
Amniotic fluid creatinine levels may be used to assess fetal age. At less than 36 weeks old, that should be [blank_start]1.5-2.0[blank_end] mg/dL. At greater than 36 weeks old, that should be [blank_start]> 2.0 mg/dL[blank_end].
Answer
  • 1.5-2.0
  • > 2.0 mg/dL

Question 16

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

Question 17

Question
Amniocentesis when used to screen for birth defects is performed between [blank_start]15-18[blank_end] weeks.
Answer
  • 15-18

Question 18

Question
Amniocentesis, when performed to monitor fetal distress is performed between [blank_start]20-42[blank_end] weeks.
Answer
  • 20-42

Question 19

Question
Check the appropriate boxes associated with amniotic fluid collection.
Answer
  • Keep at room temperature.
  • Keep on ice.
  • Separate from cells asap.

Question 20

Question
[blank_start]Filtration[blank_end] is recommended for FLM (fetal lung maturity studies) to prevent loss of phospholipids (lung surfactants)
Answer
  • Filtration

Question 21

Question
Surfactants are unstable at room temperature but stable if refrigerated for up to 72 hours
Answer
  • True
  • False

Question 22

Question
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).
Answer
  • True
  • False

Question 23

Question
The mother's triple screen serum test includes [blank_start]AFP[blank_end], [blank_start]hCG[blank_end], and [blank_start]UE3[blank_end].
Answer
  • AFP
  • hCG
  • UE3

Question 24

Question
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.
Answer
  • Estriol
  • Bilirubin
  • AFP
  • hCG

Question 25

Question
Low levels are a concern for maintaining the pregnancy. High levels are associated with down syndrome.
Answer
  • hCG
  • Estriol
  • Bilirubin
  • AFP

Question 26

Question
High "unconjugated estriol" indicates a problem with the fetus development.
Answer
  • True
  • False

Question 27

Question
Erroneous results can be obtained for ____ due to preeclampsia, anemia, and kidney disease.
Answer
  • Estriol
  • AFP
  • Bilirubin
  • hCG

Question 28

Question
DHEA, a precursor hormone, is produced by the fetal adrenal glands and converted to estriol in the placenta.
Answer
  • True
  • False

Question 29

Question
What is included in a Quad Screen?
Answer
  • Cholesterol
  • DHEA
  • Inhibin-A
  • Glucose

Question 30

Question
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.
Answer
  • True
  • False

Question 31

Question
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.
Answer
  • True
  • False

Question 32

Question
All amniotic fluid is turbid to some degree
Answer
  • True
  • False

Question 33

Question
A protein produced by the fetal liver during the 1st trimester and present in both fetal serum and fetal CSF
Answer
  • AFP
  • AChE
  • Bilirubin
  • Albumin

Question 34

Question
These are tests that measure the various lung surfactants - lecithin, sphingomyelin, and [blank_start]phosphatidyl glycerol[blank_end].
Answer
  • phosphatidyl glycerol

Question 35

Question
The Foam Stability Index (FSI) is a test that measures the relative amounts of [blank_start]phospholipids[blank_end]; it correlates well with results of the L/S ratio and phosphatidyl glycerol assays.
Answer
  • phospholipids

Question 36

Question
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.
Answer
  • True
  • False

Question 37

Question
Check the tests associated with assessing AFP levels.
Answer
  • Cytogenetics
  • Flow Cytometry
  • EIA
  • RIA

Question 38

Question
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.
Answer
  • True
  • False

Question 39

Question
Amniotic fluid - Bilirubin and the Liley Graph - Zone 1
Answer
  • 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.

Question 40

Question
Amniotic fluid - Bilirubin and the Liley Graph - Zone 3
Answer
  • 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

Question 41

Question
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 [blank_start]32[blank_end] weeks
Answer
  • 32

Question 42

Question
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 [blank_start]lung surfactants[blank_end] present in the amniotic fluid.
Answer
  • lung surfactants

Question 43

Question
The most common complication of early delivery and is the leading cause of death in premature infants.
Answer
  • Down Syndrome
  • Anencephaly
  • RDS
  • AIDS

Question 44

Question
The function of the surfactant is to keep the [blank_start]alveoli open[blank_end].
Answer
  • alveoli open

Question 45

Question
The primary lung surfactant is
Answer
  • Lecithin
  • Sphingomyelin
  • Phosphatidyl Glycerol

Question 46

Question
[blank_start]Lecithin[blank_end] production increases toward the end of the pregnancy; by 34-36 weeks the amount of [blank_start]lecithin[blank_end] is present in sufficient amounts to prevent alveolar collapse.
Answer
  • Lecithin
  • lecithin

Question 47

Question
[blank_start]Sphingomyelin[blank_end] is a lipid that is produced at a constant steady rate after 26 weeks. The exact role of [blank_start]sphingomyelin[blank_end] has not yet been determined but is used as a reference for lecithin.
Answer
  • Sphingomyelin
  • sphingomyelin

Question 48

Question
Prior to 35 weeks L/S is usually <[blank_start]1.6[blank_end], but as lecithin increases (and sphingomyelin remains constant) the ratio increases. When it reaches [blank_start]2.0[blank_end] it is considered safe to deliver the baby.
Answer
  • 1.6
  • 2.0

Question 49

Question
Lecithin and sphingomyelin are measured by
Answer
  • TLC
  • RIA
  • EIA

Question 50

Question
[blank_start]Phosphatidyl Glycerol[blank_end] 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.
Answer
  • Phosphatidyl Glycerol

Question 51

Question
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.
Answer
  • True
  • False

Question 52

Question
[blank_start]Amniostat FLM[blank_end] 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
Answer
  • Amniostat FLM

Question 53

Question
Phosphatidyl glycerol (PGL) is measured by (check all associated with it).
Answer
  • TLC
  • Amniostat FLM
  • EIA
  • RIA

Question 54

Question
Rapid tests for determining FLM (Check all that apply).
Answer
  • EIA
  • RIA
  • FSI
  • Lamellar body counts
  • TLC

Question 55

Question
The FSI is based on the fact that [blank_start]ethanol[blank_end] destroys [blank_start]phospholipids[blank_end]; it is an antifoaming agent.
Answer
  • ethanol
  • phospholipids

Question 56

Question
Amniotic Fluid - FSI
Answer
  • 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.

Question 57

Question
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.
Answer
  • True
  • False

Question 58

Question
FSI: The ones with less ethanol should have less bubbles because ethanol is an antifoaming agent.
Answer
  • True
  • False

Question 59

Question
The first tube that shows foaming gives us the FSI.
Answer
  • True
  • False

Question 60

Question
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.
Answer
  • True
  • False

Question 61

Question
The storage form of lung surfactants
Answer
  • Lamellar bodies
  • Sphingomyelin
  • Lecithin
  • Phosphatidyl glycerol

Question 62

Question
As the lungs mature the increased lamellar body production reflects a decrease in phospholipids and L/S ratio.
Answer
  • True
  • False

Question 63

Question
[blank_start]Lamellar bodies[blank_end] will increase the optical density of amniotic fluid.
Answer
  • Lamellar bodies

Question 64

Question
When measured at 650 nm, [blank_start]meconium[blank_end] falsely increases the optical density, but [blank_start]hemoglobin[blank_end] does not.
Answer
  • meconium
  • hemoglobin

Question 65

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

Question 66

Question
In a lamellar body count, contamination from [blank_start]blood[blank_end] will falsely increase the counts since [blank_start]platelets[blank_end] will be present.
Answer
  • blood
  • platelets

Question 67

Question
[blank_start]Fetal Fibronectin[blank_end] 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.
Answer
  • Fetal Fibronectin

Question 68

Question
During weeks 22 to 35, the presence of [blank_start]fetal fibronectin[blank_end] 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
Answer
  • fetal fibronectin

Question 69

Question
Fetal fibronectin Test is performed on
Answer
  • A cervical/vaginal swab
  • Amniotic fluid
  • Urine
  • Serum

Question 70

Question
Fetal Fibronectin tests include
Answer
  • ELISA
  • Rapid Lateral flow immunosorbent assay
  • RIA
  • Flow cytometry

Question 71

Question
At 22-35 weeks gestation, fFN levels are normally below [blank_start]50[blank_end] ng/dL.
Answer
  • 50
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