Review Practice Exercise 2

Fertilization and Implantation, Fetal Environment > Maternal Newborn

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Practice Exercise 2

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Total Questions : 5

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Question 1:

Which of the following statements indicates understanding of the amnion?

A. “The amnion is derived from the syncytiotrophoblast and surrounds the yolk sac.” B. “The amnion is responsible for hormone production like human chorionic gonadotropin.” C. “The amnion develops from the epiblast and helps form the amniotic cavity.” D. “The amnion and chorion remain separated throughout gestation.”

Answer and Explanation

Choice A:

The amnion is not derived from the syncytiotrophoblast. Syncytiotrophoblasts are involved in maternal tissue invasion and hCG secretion but not in amniotic membrane formation. The amnion originates from the inner cell mass specifically from the epiblast.

Choice B:

The amnion does not produce hormones like human chorionic gonadotropin. hCG is secreted by the syncytiotrophoblast starting around day 8 post-fertilization and peaks at approximately 100,000 IU/L by week 10. The amnion primarily serves a mechanical and protective function.

Choice C:

The amnion originates from the epiblast during the second week of development. A cavity forms within the epiblast, bordered by amnioblasts, leading to the formation of the amniotic cavity. This structure eventually encloses the entire embryo and contributes to fluid regulation.

Choice D:

The amnion and chorion eventually fuse by week 14, obliterating the chorionic cavity. Persistence of their separation would indicate abnormal development. This fusion is necessary to complete formation of the amniotic sac surrounding the fetus.

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Question 2:

Which of the following fetal conditions is a possible cause of polyhydramnios?

A. Posterior urethral valves. B. Anencephaly. C. Renal agenesis. D. Intrauterine growth restriction.

Answer and Explanation

Choice A:

Posterior urethral valves cause bladder outlet obstruction, leading to decreased fetal urination. This reduces amniotic fluid production, often causing oligohydramnios, not polyhydramnios. Ultrasound findings typically show a distended bladder with reduced fluid.

Choice B:

Anencephaly causes impaired fetal swallowing due to the absence of major portions of the brain and skull. This results in an inability to recycle amniotic fluid through the gastrointestinal system, leading to progressive accumulation. Anencephaly is a common cause of severe polyhydramnios, especially in the second trimester.

Choice C:

Renal agenesis results in absent fetal kidneys and thus complete lack of urine production, which is the major source of amniotic fluid in the second half of pregnancy. This condition leads to severe oligohydramnios, not polyhydramnios, and is associated with Potter sequence.

Choice D:

Intrauterine growth restriction (IUGR) is often associated with placental insufficiency and reduced fetal urine output, leading to oligohydramnios. It is rarely associated with increased amniotic fluid and more commonly presents with AFI <5 cm.

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Question 3:

Which of the following best describes a function of the chorionic villi?

A. They release luteinizing hormone to maintain the pregnancy. B. They initiate the fetal heartbeat at 5 weeks gestation. C. They form the outer layer of the yolk sac. D. They facilitate nutrient and gas exchange between maternal and fetal blood.

Answer and Explanation

Choice A:

Luteinizing hormone is not secreted by chorionic villi. Instead, human chorionic gonadotropin (hCG) is produced by syncytiotrophoblasts to maintain the corpus luteum. LH is a pituitary hormone and has no role in early placental function.

Choice B:

The fetal heartbeat is initiated by the sinoatrial node in the primitive heart tube, not by chorionic villi. Cardiac activity begins at approximately 5.5–6 weeks of gestation and is driven by intrinsic pacemaker activity within the developing myocardium.

Choice C:

The yolk sac is an endoderm-derived structure, and its outer layer is formed by extraembryonic mesoderm and endoderm, not chorionic villi. Chorionic villi are entirely separate from the yolk sac and serve different physiological roles.

Choice D:

Chorionic villi contain fetal capillaries surrounded by trophoblasts, facilitating the bidirectional transfer of gases and nutrients between maternal blood in the intervillous space and fetal circulation. This exchange supports fetal growth and development and begins by the end of the third week of gestation.

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Question 4:

A nurse is reviewing normal contents of amniotic fluid. Which of the following are expected components? Select all that apply

A. Vernix caseosa. B. Hemoglobin A1C. C. Fetal skin cells. D. Urea. E. Amylase.

Answer and Explanation

Choice A:

Vernix caseosa, a white, cheesy substance produced by fetal sebaceous glands, is found in amniotic fluid starting from the third trimester. It consists of lipids, proteins, and desquamated skin, and floats in the amniotic fluid as the fetus sheds it.

Choice B:

Hemoglobin A1C is a glycated hemoglobin used to assess maternal blood glucose control. It is not a component of amniotic fluid. Maternal blood is separate from the amniotic compartment, and A1C reflects long-term maternal glycemia, not fetal or fluid content.

Choice C:

Fetal skin cells, also called squamous cells, are routinely present in amniotic fluid, especially as gestation progresses. These desquamated cells are important for diagnostic procedures such as amniocentesis and fetal karyotyping.

Choice D:

Urea is a nitrogenous waste product derived from fetal metabolism and is excreted in fetal urine, which significantly contributes to amniotic fluid composition after 16 weeks. Normal concentrations rise with gestational age and help indicate fetal renal function.

Choice E:

Amylase, a digestive enzyme, is not normally found in significant amounts in amniotic fluid. It is produced by the fetal pancreas and salivary glands later in gestation but does not accumulate in measurable concentrations in the fluid under normal physiological conditions.

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Question 5:

A nurse is assessing a client with confirmed polyhydramnios. Which of the following risks should the nurse anticipate? Select all that apply

A. Preterm labor. B. Umbilical cord prolapse. C. Shoulder dystocia. D. Post-term delivery. E. Maternal shortness of breath.

Answer and Explanation

Choice A:

Uterine overdistention from excessive amniotic fluid stretches the myometrium, which increases irritability and sensitivity to oxytocin, promoting early and uncoordinated uterine contractions. This significantly raises the risk of preterm labor, particularly when AFI exceeds 30 cm.

Choice B:

Excess fluid increases intrauterine pressure and may allow umbilical cord descent through the cervical os when membranes rupture, especially in cases of high fetal station or malpresentation. This sudden gush of fluid may carry the cord ahead of the presenting part.

Choice C:

Shoulder dystocia is commonly associated with macrosomia, gestational diabetes, or post-term pregnancy, not polyhydramnios. Polyhydramnios more commonly leads to malpresentations such as breech or transverse lie due to excessive fetal mobility, rather than shoulder entrapment.

Choice D:

Post-term delivery is not associated with polyhydramnios. In fact, polyhydramnios often precipitates earlier delivery due to preterm labor, premature rupture of membranes, or the need for induction because of maternal or fetal compromise.

Choice E:

Polyhydramnios causes rapid uterine enlargement, elevating the diaphragm and compressing maternal lungs. This can result in restrictive pulmonary mechanics and maternal dyspnea, particularly in the third trimester. Pulmonary function tests often show reduced forced vital capacity.

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Practice Exercise 2

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