amniotic fluid Flashcards by Sharmaine Madjid

frequently associated w/ cytogenetic analysis.

Amniotic fluid exam

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it is a product of fetal metabolism

amniotic fluid

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amniotic fluid is present in a membranous sac that surrounds the fetus called ____

amnion

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FUNCTIONS OF AMNIOTIC FLUID

1) To provide a protective cushion for the fetus
2) Allow fetal movement
3) Stabilize temperature to protect the fetus from extreme temperature changes
4) To permit proper lung development.

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Amniotic fluid volume is regulated by a balance between the production of ________ & the absorption from _________-.

fetal urine & lung fluid ; fetal swallowing & intramembranous flow

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absorption of amniotic fluid water and solutes into the fetal vascular system.

Intramembranous flow

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The amount of amniotic fluid increases throughout ________, reaching a peak approximately ______ during the 3rd trimester, & then gradually decreases prior to ______.

pregnancy ; 1 liter ; delivery

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During the 1st trimester, the approximately _____ of A.F derived primarily from the _______.

35ml/g ; maternal circulation

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After the 1st trimester, _______ is the major contributor to the A.F. volume.

Fetal urine

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When fetal urine production occurs, fetal swallowing of A.F. ______ & _____ the increase in fluid from the fetal urine.

begins ; regulates

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excessive accumulation of A.F. resulting from the failure of the fetus to begin swallowing.

Polyhydramnios

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Polyhydramnios indicates ________, often associated w/ _________.

fetal distress ; neural tube disorders

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decreased A.F. due to increase fetal swallowing, urinary tract deformities, & membrane leakage.

Oligohydramnios

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Oligohydramnios is associated with ______, resulting in __________-.

umbilical cord compression ; decelerated heart rate & fetal death.

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Ultimate Source of AF & solutes.

PLACENTA

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Amniotic fluid has a composition similar to that of the maternal plasma and contains a small amount of sloughed fetal cells from the ____

DUS (Digestive system, Urinary tract, Skin)

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Amniotic fluid also contains Biochemical substances produced by the fetus, such as _____

BELPEN (Bilirubin, Enzymes, Lipids, Proteins, Electrolytes, Nitrogenous compounds)

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BELPEN can be tested to ______

determine the health or maturity of the fetus.

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used to determine fetal age.

creatinine measurement

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Prior to 36 weeks gestation , the amniotic fluid creatinine level ranges bet _______

1.5 and 2.0 mg/dl.

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the amniotic fluid creatinine level rises above _____ providing a means of determining fetal age as greater than _____.

2.0 mg/dl ; 36 weeks

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Levels of creatinine and urea are much lower in _____ than in _____.

amniotic fluid ; urine

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AMNIOTIC FLUID: creatinine does not exceed _____; urea does not exceed _____.

3.5 mg/dl ; 30 mg/dl

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URINE: as high as ______ for creatinine; and ______ for urea.

10 mg/dl ; 300 mg/dl

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differentiate amniotic fluid from urine

Fern test

in Fern test, _____ specimen or smear is examined microscopically

Vaginal fluid

Fetal epithelial cells in AF can be examined for chromosome abnormalities by:

1) Karyotyping 2) Fluorescence in situ hybridization (FISH) 3) Fluorescent mapping spectral karyotyping (SKY) 4) DNA testing

Biochemical substances produced by the fetus can be analysed by ________ and _________ to evaluate the health of the fetus.

Fluorescence polarization ; Thin-layer chromatography

Amniocentesis may be indicated at 15-18 weeks of gestation to determine early treatment or intervention:

1) Mother’s age of 35 or more at delivery 2) Family history of chromosome abnormalities such as down syndrome (trisomy 21) 3) Parents carry an abnormal chromosome rearrangement 4) Earlier pregnancy or child w/ birth defect 5) Parent is a carrier of metabolic disorder 6) History of genetic diseases such as: - sickle cell disease - sickle cell anemia - tay sach disease - hemophilia - muscular dystrophy - huntington chorea - cystic fibrosis 7) Elevated maternal serum alpha fetoprotein 8) Abnormal triple marker screening test 9) Previous child w/ neural tube disorder such as spina bifida or ventral wall defects 10) 3 or more miscarriages

Evaluation of amniocentesis is indicated later in pregnancy (______) to evaluate:

20-42 weeks 1) Fetal lung maturity 2) Fetal distress  HDN cause by Rh incompatibility  Infection

Amniocentesis (procedure) – is obtained by ______ into the ______ (transabdominal amniocentesis). Safe procedure.

needle aspiration ; abdominal sac

Using continuous _______ for guidance, the physician locates the _______ to safely perform the procedure.

ultrasound ; fetus and placenta

______ maybe performed but carries a greater risk of infection

vaaginal amniocentesis

amniocentesis volume collected in sterile syringes

30 ml

Fluid for bilirubin analysis in cases of _________ must be protected from light at all times.

Hemoytic disease of the newborn (HDN)

specimen should be placed in ice for delivery to the lab

Fetal Lung Maturity (FLM) Tests

Fetal Lung Maturity (FLM) Tests specimen should be placed in ice for delivery to the lab & refrigerated up to _____ prior to testing or kept frozen & tested w/in _____

72 hrs ; 72 hrs.

maintained at room temp or body temp (37°c incubation) prior to analysis to prolong the life of the cells.

cytogenetic studies

cytogenetic studies temperature

room temp or body temp (37°c incubation)

All fluid for chemical testing should be separated from ______ as soon as possible to prevent distortion of chemical constituents by cellular metabolism or disintegration. This can be performed using ___________.

cellular elements & debris ; Centrifugation/filtration

recommended for FLM to prevent loss of phospholipids.

Filtration

normal color of AF

colorless

yellow colored AF =

Presence of bilirubin

dark green colored AF =

Presence of meconium

newborn’s first bowel movement. Results for fetal intestinal secretions.

meconium

dark red-brown colored AF =

fetal death

blood streaked colored AF =

Result of a traumatic cap, abnormal trauma, & intra-amniotic hemorrhage.

in HEMOLYTIC DISEASE OF THE NEWBORN (HDN), Measurement of bilirubin in the AF determines the extent the hemolysis. Performed by __________

Spectrophotometric Analysis.

determines the severity of the hemolytic disease

Liley Graph

Liley Graph interpretation

Zone I – mildly affected fetus Zone II – require careful monitoring Zone III – severely affected fetus

high levels of alpha-fetoprotein (AFP) in both the maternal circulation & the AF indicates fetal neural tube defects, such as ________

anencephaly & spina bifida.

major CHON produced by the fetal liver during early gestation (prior to 18 weeks)

Alpha-fetoprotein (AFP)

more specific for neural tube disorders than AFP, provided it is not performed on a bloody specimen because blood contains AChE.

Amniotic acetylcholinesterase (AChE) test

Most frequent complication of early delivery & cause of morbidity & mortality in the premature infant.

Respiratory Distress Syndrome (RDS)

Caused by a lack of lung surfactant, a substance that normally appears in mature lungs & allows the alveoli to remain open throughout the normal cycle of inhalation & exhalation.

Respiratory Distress Syndrome (RDS)

keeps the alveoli from collapsing by decreasing surface tension & allows them to inflate w/ air more easily.

Surfactant

The reference method to which tests of FLM are compared is the __________ ratio

Lecithin-spingomyelin

primary component of the surfactants

Lecithin

Quantitative measurement of lecithin and sphingomyelin is performed using _____________.

thin-layer chromatography

uses anti-sera specific for phosphatidyl glycerol and is not affected by specimen contamination with blood and meconium.

Amniostat-FLM

The presence of _________ decreases the micro viscosity of amniotic fluid.

Phospholipids

measure the polarization of a fluorescent dye that combines w/ both surfactants & albumin.

Fluorescence Polarization Assay

Low polarization, longer fluorescence lifetime =

dye bound to surfactant

(↑) High polarization, (↓) fluorescence lifetime =

dye bound to albumin

used as an internal standard in the same manner as sphingomyelin because it remains at a constant level throughout gestation.

Albumin

lamellated phospholipids that represent a storage form of surfactants.

Lamellar bodies

The surfactants responsible for FLM are produced & secreted by the _________ of the fetal lung & stored in the form of structures termed lamellas bodies of about ________.

type II pneumocytes ; 20 weeks of gestation

The lamellar bodies enter the _____ spaces to provide ______ & also enter the _________ at about __________.

alveolar ; surfactant ; amniotic fluid ; 26 weeks of gestation

As the fetal lung matures, ↑ lamellar body production is reflected by an ↑ in ______ & the ______.

AF phospholipids ; L/S ratio

The # of lamellar bodies present in the AF correlates w/ the amount of _______ present in the _______.

phospholipid ; fetal lungs

The presence of lamellar bodies increases the ______ of the AF

OD = optical density

A confirmatory procedure in testing for urinary CHON.

Sulfosalicylic Acid Test (SSA)

Sulfosalicylic Acid Test (SSA) is able to detect not only albumin but also _______, __________ & ___________.

globulin, mucoprotein & Bence Jones protein

A rapid screening method w/c is more sensitive to the presence of albumin than globin, mucoprotein & Bence Jones protein.

Reagent Strip Test