Review Practice Exercise 3

Fertilization and Implantation, Fetal Environment > Maternal Newborn

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Practice Exercise 3

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Total Questions : 5

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Question 1:

The passive immunity a newborn receives from the mother is primarily due to the placental transfer of which of the following immunoglobulins?

A. Immunoglobulin A (IgA). B. Immunoglobulin M (IgM). C. Immunoglobulin G (IgG). D. Immunoglobulin D (IgD).

Answer and Explanation

Choice A:

Immunoglobulin A (IgA) is the major antibody found in colostrum and breast milk, providing mucosal immunity postnatally but does not cross the placenta in significant amounts.

Choice B:

Immunoglobulin M (IgM) is a large pentameric molecule that does not cross the placental barrier due to its size; neonatal IgM synthesis begins after birth, indicating in utero infection if detected.

Choice C:

Immunoglobulin G (IgG) is the only immunoglobulin class that efficiently crosses the placenta by active transport via the neonatal Fc receptor. This transfer mainly occurs after 28 weeks of gestation, increasing significantly in the last trimester, conferring passive immunity against pathogens.

Choice D:

Immunoglobulin D (IgD) is present in very low concentrations in serum and is primarily involved in B-cell receptor function. It does not cross the placenta and plays no role in passive immunity.

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Question 2:

A nurse examines the umbilical cord and notes the presence of two umbilical arteries and one umbilical vein. The nurse correctly documents this finding as which of the following?

A. An abnormal finding that requires immediate notification of the primary health care provider. B. A finding associated with an increased risk for congenital anomalies. C. A normal finding consistent with a healthy umbilical cord. D. A rare finding that often indicates a velamentous cord insertion.

Answer and Explanation

Choice A:

An abnormal finding requiring immediate notification is typically a single umbilical artery (SUA), which occurs in about 1% of pregnancies. The presence of two arteries is normal and does not require urgent intervention.

Choice B:

A single umbilical artery is associated with increased risk of congenital anomalies such as cardiac, renal, or chromosomal abnormalities. However, two arteries do not signify this increased risk.

Choice C:

The presence of two umbilical arteries and one vein is the normal anatomical structure of the umbilical cord. This arrangement is essential for adequate fetal circulation. The two arteries carry deoxygenated blood from the fetus to the placenta, while the single vein returns oxygenated blood to the fetus. This finding indicates normal umbilical cord development.

Choice D:

Velamentous cord insertion refers to the umbilical vessels inserting into the fetal membranes rather than the placental mass and is often associated with single umbilical artery or other anomalies but not the typical two-artery one-vein configuration.

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Question 3:

The fetal surface of the placenta is called the "Shiny Schultze" is covered by which of the following membranes?

A. The chorion. B. The amnion. C. The decidua basalis. D. The trophoblast.

Answer and Explanation

Choice A:

The chorion is the outer fetal membrane that, together with the amnion, forms the fetal sac but it primarily covers the outer surface facing the maternal side or lies beneath the decidua. It does not form the shiny fetal surface of the placenta.

Choice B:

The amnion covers the fetal surface of the placenta, forming a smooth, shiny membrane known as the Schultze presentation. It originates from the epiblast and provides a protective barrier for the fetus and placenta against mechanical injury and infection. This membrane is avascular and adheres tightly to the chorion but is distinct from it.

Choice C:

The decidua basalis is the maternal component of the placenta, forming the maternal-fetal interface on the uterine side, not the fetal surface.

Choice D:

The trophoblast forms the outer layer of the blastocyst and contributes to placental formation but does not cover the fetal surface as a membrane; it is part of the placental villous structure.

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Question 4:

Which of the following are functions of the placenta? Select all that apply.

A. Synthesis of glycogen for fetal energy. B. Synthesis of fatty acids for fetal growth. C. Catabolism of maternal proteins for fetal amino acid supply. D. Storage of fat-soluble vitamins. E. Retention of fetal waste products.

Answer and Explanation

Choice A:

The placenta synthesizes glycogen, which acts as an energy reserve for the fetus, especially important during periods of increased metabolic demand. Glycogen synthesis in the placenta supports fetal glucose supply.

Choice B:

Fatty acids synthesized by the placenta are vital for fetal cellular growth, particularly in neural and organ development. These fatty acids supplement maternal supply and are essential for membrane formation.

Choice C:

The placenta does not catabolize maternal proteins to provide amino acids; instead, amino acids are transported intact from maternal circulation to the fetus. Protein catabolism occurs mainly in maternal tissues.

Choice D:

Fat-soluble vitamins (A, D, E, K) are stored in the placenta and regulated for fetal use. These vitamins are crucial for antioxidative protection, bone development, and coagulation in the fetus.

Choice E:

The placenta does not retain fetal waste products; it facilitates the removal of fetal wastes such as urea and carbon dioxide by transferring them to maternal circulation for excretion. Retention would be harmful to fetal health.

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Question 5:

A nurse reviews placental variants. Which of the following are expected eventualities? Select all that apply

A. succenturiate lobe may lead to retained placental tissue B. battledore placenta describes marginal cord insertion C. margin of placenta is smooth and uniform D. succenturiate lobe is connected by blood vessels to main placenta E. battledore placenta always causes fetal growth restriction

Answer and Explanation

Choice A:

A succenturiate lobe is an accessory placental lobe connected to the main placenta by blood vessels. This lobe may remain in the uterus post-delivery, increasing risk for retained placental tissue and postpartum hemorrhage.

Choice B:

Battledore placenta refers to a marginal umbilical cord insertion near the placental edge. This variant can affect blood flow distribution but is often benign. It is named for the paddle-like shape resembling a battledore.

Choice C:

The margin of a placenta with variants like succenturiate lobe or battledore insertion is often irregular, not smooth or uniform. A smooth, uniform margin describes a normal placenta, not variants.

Choice D:

The succenturiate lobe is anatomically connected to the main placenta via vascular structures, which may be prone to rupture or thrombosis, potentially compromising fetal circulation or causing hemorrhage.

Choice E:

Battledore placenta does not always cause fetal growth restriction; many cases are asymptomatic without impacting fetal growth. Growth restriction is more related to other placental insufficiencies.

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