Amniotic fluid Flashcards
hCG production
Syncytiotrophoblast cells of placenta
hCG peak
1st trimester (blood, urine, amniotic fluid)
hCG subunit shared
Alpha (hCG, LH, FSH, TSH)
hCG specificity
Beta subunit
Pregnancy test principle
Enzyme immunoassay
Pregnancy test specimen
1st morning urine
Pregnancy kit cutoff
25 mIU/mL
Anti-hCG source
Rabbit
False-positive pregnancy test causes
Molar pregnancy, LH surge, hematuria, proteinuria, malignancies, postpartum, herbal meds, perimenopause, ovarian failure
False-negative pregnancy test causes
Early/late testing, dilute/adulterated urine, ectopic pregnancy, missed abortion
Hogben test
Female frog; positive: oogenesis
Galli-Mahini test
Male frog; positive: spermatogenesis
Friedmann test
Virgin rabbit; positive: corpora lutea/hemorrhagica
Ascheim-Zondek test
Immature mice; positive: ovarian hyperemia
Hyperemia in Preg test is also seen in
Kupperman/Kelso (virgin rat)
ELISA sensitivity
Positive at 10 days conception
Pregnancy urine SG
≥1.015
Amniotic fluid source
Placenta
Amniotic fluid functions
Cushion fetus, stabilize temp, movement, lung development
Amniotic fluid normal volume
800–1200 mL (3rd trimester)
1st trimester fluid source
Maternal circulation (35 mL)
Polyhydramnios causes
Decreased swallowing, NTDs, anomalies, infections
Oligohydramnios causes
Increased swallowing, membrane leakage, urinary deformities, malformations, premature membrane rupture, cord compression
Amniocentesis collection
30 mL in sterile syringe
Genetic defect assessment
2nd trimester amniocentesis (trisomy 21/Down syndrome)
Fetal lung maturity/HDN assessment
3rd trimester
Quadruple screen tests
Alpha-fetoprotein, HCG, unconjugated estriol (E3), inhibin A
FLM specimen handling
Ice delivery, refrigerated/frozen, filtration to prevent phospholipid loss
Cytogenetic study handling
Room temp or 37°C
HDN test specimen handling
Protect from light
Reliable fluid ID
Urea <30 mg/dL, creatinine <3.5 mg/dL
Fern test
Detect PROM/early pregnancy (fern crystals in dried vaginal fluid)
Yellow amniotic fluid
HDN
Dark green amniotic fluid
Meconium (first bowel movement)
Dark red-brown amniotic fluid
Fetal death
RDS test
Fetal lung maturity
RDS cause
Surfactant insufficiency (phospholipid production)
Surfactant function
Decrease surface tension, allow easier alveoli inflation
RDS reference method
L/S ratio
Alveolar stability
Lecithin
L/S ratio control
Sphingomyelin
L/S measurement
TLC
Mature lungs L/S ratio
≥2.0
False positive L/S ratio
Blood or meconium presence
Phosphatidyl glycerol test
Amniostat-FLM
Amniostat advantage
Not affected by blood/meconium
Phosphatidyl glycerol in diabetics
Delayed production
Foam stability test
Positive: foam/bubbles (mature lungs)
Microviscosity measurement
Fluorescence polarization
Type II pneumocytes produce surfactants stored as
Lamellar bodies
Lamellar body count can be measured using
Optical scatter (diameter similar to platelet)
Adequate FLM in LBC
> 32,000/ uL
Lamellar bodies O.D absorbance at
650 nm
O.D equivalent to L/S ratio >/= 2.0 in presence of PG
> 0.150
Prior to 36 weeks gestation, fetal amniotic fluid creatinine
1.5 to 2.0 mg/dL
At 36 weeks gestation, amniotic fluid creatinine
> 2.0 mg/dL
Test for HDN optical density
450 nm
Normal absorbance of amniotic fluid
Increased at 365 nm, decreased at 550 nm
Increased O.D at 450 nm indicates
HDN
Liley graph Zone I result
Non-affected or mildly affected fetus
Liley graph Zone II result
Moderately affected fetus (requires monitoring)
Liley graph Zone III result
Severely affected fetus (requires intervention)
Queenan curve shows absorbance values from
14-40 weeks of gestation
Lowest zone in Queenan curve
Rh negative (unaffected) fetus
Indeterminate and Rh positive zones in Queenan curve
Increasing hemolytic severity
Intrauterine death risk zone
High risk of mortality
Interferences for absorbance in amniotic fluid
Cells, meconium, debris, hemoglobin (peaks at 410nm)
To remove hemoglobin interference in absorbance
Add chloroform
Spina bifida characteristic
Incomplete closing of backbone and spinal cord membranes
Anencephaly characteristic
Absence of major brain, skull, and scalp portions
Screening test for NTDs
Alpha fetoprotein
AFP in NTDs
Increased
AFP in Down syndrome (T21)
Decreased
Confirmatory test for NTDs
Acetylcholinesterase
Tests for chromosomal abnormalities
Karyotyping, FISH, SKY
Major protein produced by fetal liver before 18 weeks
AFP