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CSF > Amniotic Fluid > Flashcards

Amniotic Fluid Flashcards

1
Q

sac that surrounds amniotic fluid

A

amnion sac??

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2
Q

2 layers of amnion sac

A

amniotic membrane and chorion membrane

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3
Q

function of amniotic sac

A

-cushion to help prevent injury to fetus
-matrix for moving nutrients and waste products in and out
-sac grows with baby – serves as cushion
-maintain even temp

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4
Q

where does fluid come from

A

derived through different sources of pregnancy

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5
Q

where does fluid come from Beginning of preg

A

comes from placenta and amnion
-Made of same matrix as maternal serum

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6
Q

where does fluid come from as pregnancy continues?

A

Fluid from lung fluid (develops as baby develops)

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7
Q

where does fluid come form last part of pregnancy?

A

Baby’s urine contributes to amount of fluid

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8
Q

during 3rd tri fluid is maintained by

A

through fetal urination and fetal swallowing amniotic fluid – SWALLOWING is important part in determining baby is healthy

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9
Q

fluid volume

A

increases throughout pregnancy

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10
Q

how much fluid in 1st tri

A

60 mL

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11
Q

how much fluid last tri until birth

A

800 mL-1200 mL

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12
Q

> 1200 mL

A

polyhydramnios : wrong with fetal swallowing (can be determined by ultrasound)– seen in neural tube defects

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13
Q

<800 mL

A

oligohydramnios : indicates congenital malformation/ premature rupture of amniotic membrane

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14
Q

composition of amniotic fluid

A

similar to maternal fluid
-electrolytes, glucose, etc
-cells unique to fetus

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15
Q

specimen collection

A

amniocentesis- only trained physician should preform

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16
Q

what is recommended for aminocentesis?

A

do not do prior to 14 weeks gestation (not enough fluid to be safe)

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17
Q

how is amniocentesis guided?

A

ultrasound

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18
Q

what is max amount to withdraw for amniocentesis?

A

30 mL

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19
Q

2 different ways to do amniocentesis?

A

intraabdominal and transvaginal

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20
Q

intraabdominal

A

most common way to do -can sterilize

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21
Q

transvaginal

A

easier method, but higher risk because risk of bacteria

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22
Q

reasons to perform amniocentesis

A

-mother is older/ history of miscarriage or birth defects
-find out lung maturity

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23
Q

what age should get an amniocentesis

A

> 35

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24
Q

1 concern of premature babies

A

lung immaturity

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25
Q

amniotic fluid is a what procedure

A

stat
-should be brought to lab ASAP

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26
Q

if fetal lung immaturity needs to be done how should sample be kept

A

on wet ice as soon as collected and refrigerated if can’t be done immediately

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27
Q

why does fetal lung maturity be placed on wet ice immediately

A

lecithin decrease quickly after drawn

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28
Q

if possible HDN what are you looking for

A

increase levels in bilirubin
(keep specimen away from light)

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29
Q

for cytogenetic studies how should specimen be kept

A

RT or 37 degrees and treated aseptically

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30
Q

what test does not get centrifuged

A

fetal lung maturity

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31
Q

normal appearance of amniotic fluid

A

clear or slightly yellow

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32
Q

when would amniotic fluid be slightly turbid

A

3rd tri

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33
Q

what does blood tinged amniotic fluid mean

A

intra abdominal hemorrhage or HDN

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34
Q

what does dark red amniotic fluid mean?

A

baby is in bad danger or has died already

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35
Q

if RBCs are present in amniotic fluid need to determine if mother origin or fetal; how is this done

A

Kleihauer Betke Stain

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36
Q

Kleihauer Betke Stain principle

A

fetal Hgb is resistant to acid elution and adult Hgb is not

fetal cells= darker
mother= ghost cells

(we now do flow cytometry)

37
Q

what does green amniotic fluid mean?

A

presence of meconium - baby poop

large amounts dangerous to baby– they can choke on it

38
Q

1st reason for amniocentesis??

A

HDN

39
Q

1 cause of HDN

A

Rh incompatibility and sometimes ABO

40
Q

what kind of bili in HDN

A

unconjugated

41
Q

how is amount of bili measured

A

spectrophotometer

-most can’t be measured due to turbidity of sample

42
Q

amount of bili directly proportional to

A

severity of hemolysis

-serial measurements taken at different intervals

43
Q

what is measured on semi log paper

A

absorbance versus wavelength

normal fluid= straight line decrease

44
Q

what does semi log paper show when bili present

A

450 nm peak

45
Q

liley graph bilirubin plots

A

absorbance versus gestational age

best done as 20-40 weeks

46
Q

liley graph: zone 1

A

midly affected fetus

47
Q

zone 2

A

moderately affected fetus– decide if intervention is needed (depends on weeks preg)

48
Q

zone 3

A

severely affected fetus, intervention is needed

49
Q

quean chart??

A

starts at 14 weeks

50
Q

draw backs in amniotic fluid

A

-keep out of light
-no meconium- will interfere
-if has blood– peaks at 410 nm and misinterpreted as bili peak

51
Q

if doing amniotic fluid should not be done before

A

13 weeks

52
Q

most common neural defect

A

spina bifida

53
Q

other kind of neural defect

A

anisufily??
-not compatible with life: born with no brain

54
Q

if neural defect suspected what us first drawn

A

alpha fetoprotein on mother’s serum

produced by fetal liver and crossed to maternal serum

55
Q

alpha fetal protein depends on

A

gestational age of fetus, mother’s weight, diabetic, smoker

changes each week

56
Q

if doesn’t match gestational age

A

will do by amniotic fluid

57
Q

increases in alpha fetoprotein

A

neural tube defect

58
Q

decrease in alpha feto protein

A

down syndrome

59
Q

how to prevent neural tube defect

A

folic acid, vitamin B12

60
Q

what is also drawn with alpha feto protein levels

A

acetyl colin esterase

-should not be present in normal pregnancy
-can’t be run if bloody
-present in neural tube defects

61
Q

1 complication of early term delivery

A

fetal lung maturity/ respiratory distress

62
Q

fetal lung immaturity is due to

A

insufficient surfactant which helps the lungs mature

63
Q

why is surfactant important

A

so lungs do not collapse in exposure to oxygen during delivery

64
Q

tests for surfactant should not be done before

A

30 weeks

-they will negative because not a normal amount of surfactant

65
Q

3 tests for maturity

A
  1. Lecithin levels
    1. Spengolmylein levels
    2. Phosphatidyl glycerol
66
Q

first thing you look for fetal lung maturity

A

lecithin: splengomylein ratio

67
Q

what is primary surfactant that indicates lung maturity

A

lecithin

68
Q

what week is lecithin produced at a stable rate

A

35th

69
Q

what is produced at a fairly constant ratio during gestation

A

spenglomylein

70
Q

what is normal fetal lung maturity at 35th week

A

2:1

71
Q

what is fetal lung maturity ratio for diabetic mothers

A

2.5 :1

72
Q

term given to immature lungs

A

RDS- respiratory distress syndrome

(use to be reason for crib death)

73
Q

beside L/S ratio what else is needed to be seen for lung maturity

A

Phosphatidyl glycerol

74
Q

L/S ratios performed by

A

old: thin layer chromatography

now: immunoassays

75
Q

need to be followed when testing for fetal lung maturity

A
  1. amnio fluid can’t have meconium or blood
  2. amniotic fluid needs to be placed on wet ice or refrigerated asap
  3. phosphatidyl glycerol done on immunoassays
76
Q

what test does blood and meconium not interfere with testing and is done after 35 weeks

A

Phosphatidyl glycerol- immunoassays

77
Q

screening test for fetal lung

A

shake test/ foam stability test

78
Q

test for foam stability

A

○ Amniotic fluid mixed with 95% ethanol
○ SHAKE for 15-20 sec
○ Sit for 15 min untouched
○ If enough surfactant= layer of bubbles at the top that remain for 15 min
○ Blood and meconium will interfere with this test

79
Q

TEST for fetal lung

A

lamellar bodies count

80
Q

when surfactant is made it is stored in

A

lamellar bodies
-when become filled enter amniotic fluid
-more surfactant= more found

81
Q

what can lamellar bodies not be contaminated with

A

blood- contains platelets

82
Q

amniocentesis can be used to determine

A

gestational age

83
Q

how does amniocentesis work with determining gestational age

A

look for measurement of creatinine values for muscle mass

> 3mg/dL indicate mature infant

84
Q

what test determines preterm risk / trauma to baby delivery

A

fetal fibronectin

85
Q

when are fetal fibronectin values high

A

beginning of preg because fibrin formed to hold baby in place

86
Q

when do fetal fibronectin levels decrease

A

once formed- levels decrease until baby is ready to be born and breaks down

87
Q

when should fetal fibronectin be done

A

22-35 weeks

88
Q

what indicates women at higher risk for preterm delivery

A

> 50 ng/mL

CSF (8 decks)

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