AUBF-Lec-Amniotic fluid Flashcards by vnlla babe

Primary Function of Amniotic Fluid

• Cushion for the fetus
• Allows fetal movement
• Stabilizes temperature
• Proper lung development

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AMNIOTIC FLUID VOLUME is from

From fetal urine and lung fluid

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NORMAL AMNIOTIC FLUID VOLUME

800-1,200 mL (3rd trimester)

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major contributor to the AF volume after the 1st trimester of pregnancy

FETAL URINE

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INCREASE AMNIOTIC FLUID VOLUME (>1,200 mL)

POLYHYDRAMNIOS

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Causes of POLYHYDRAMNIOS

Decreased fetal swallowing of urine
Neural tube defects
Others: fetal structural anomalies, cardiac arrhythmias, congenital infections, chromosomal abnormalities

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DECREASE AMNIOTIC FLUID VOLUME (<800 mL)

OLIGOHYDRAMNIOS

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Causes of OLIGOHYDRAMNIOS

Increased fetal swallowing of urine Membrane leakage
Urinary tract deformities
Others: congenital malformations, premature amniotic membrane rupture, umbilical cord compression

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Method of Collection for AF

Amniocentesis (up
tom 30 mL collected in sterile syringe)

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Assess genetic defects (Ex. Trisomy 21/Down syndrome)

2nd trimester amniocentesis

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fetal lung maturity (FLM), Fetal hemolytic disease (HDN)

3rd trimester amniocentesis

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QUADRUPLE SCREENING TESTS PRIOR TO PERFORMING AMNIOCENTESIS

• Alpha-fetoprotein (AFP)
• Human chorionic gonadotropin (hCG) • Unconjugated estriol (UE3)
• Inhibin A

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Specimen Handling Test for Fetal Lung Maturity (FLM):

• Place on ice on delivery
• Kept refrigerated or frozen
• Filtration=prevents loss of phospholipids

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Specimen Handling Test for Cytogenetic studies:

Kept at room temperature or at 37°C

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Specimen Handling Test for Hemolytic Disease of the Newborn (HDN):

Protected from light

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Detects ruptured amniotic membranes
Also used to diagnose early pregnancy (Increase estrogen)

Fern Test

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Fern Test Procedure

Specimen (Vaginal Fluid)

Slide (air dry)

(+) Fern-like crystals –Amniotic Fluid

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AMNIOTIC FLUID

LESS RELIABLE
• Protein
• Glucose
MORE RELIABLE
• Urea (mg/dL)
• Creatinine (mg/dL)

+
+

<30
<3.5

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MATERNAL URINE

LESS RELIABLE
• Protein
• Glucose
MORE RELIABLE
• Urea (mg/dL)
• Creatinine (mg/dL)

> 300
10

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Amniotic fluid color: colorless

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Amniotic fluid color: blood streaked

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Amniotic fluid color: yellow

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Amniotic fluid color: dark green

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Amniotic fluid color: dark red brown

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Test for HDN A.K.A

OPTICAL DENSITY 450 (OD 450)

Absorbance of amniotic fluid: Normal: HDN:

Normal: Increase at 365nm, Increase at 550nm HDN: Increase at 450 nm (bilirubin)

A.K.A OPTICAL DENSITY 450 (OD 450) Results are plotted on a

Liley graph:

Liley graph: zone I

Nonaffected/mildly affected fetus

Zone II:

Moderately affected fetus (requires close monitoring)

Zone III

Severely affected fetus (requires intervention)

Use to Assess Spina bifida

Test for Neural Tube Defects (NTD)

-incomplete closing of the backbone and membranes around the spinal cord

Spina bifida

absence of the major portion of the brain, skull, and scalp that occurs during embryonic development

Anencephaly

Screening Test:

AFP (Alpha-fetoprotein)

AFP (Alpha-fetoprotein) increased in

Neural tube defect

AFP (Alpha-fetoprotein) decreased in

Down syndrome

Confirmatory:

Acetylcholinesterase

-most frequent complication of early delivery

Respiratory Distress Syndrome (RDS)

7th most common cause of morbidity and mortality in the premature infant

Respiratory Distress Syndrome (RDS)

caused by insufficiency of lung surfactant (phospholipids) production & fetal lung immaturity

Respiratory Distress Syndrome (RDS)

Lecithin/Sphingomyelin (L/S) Ratio Lecithin- Sphingomyelin-

Lecithin- for alveolar stability Sphingomyelin- serves as a control (due to constant production)

*L/S ratio is measured using

thin layer chromatography (TLC)

Ratio of _____= MATURE FETAL LUNGS

>2.0

Ratio of >2.0= MATURE FETAL LUNGS * cannot be done on a specimen contaminated by?

blood or meconium

Immunologic test for phosphatidylglycerol (PG) Not affected by blood or meconium Production of PG is delayed among diabetic mothers

Amniostat-FLM

(+) Foam/Bubbles (presence of ______)= Mature Fetal Lungs

phospholipids

Foam stability (Foam/Shake Test) procedure

Amniotic fluid + Ethanol 􏰀 shake for 15 seconds 􏰀 stand for 15 minutes

is a friction experienced by a single particle undergoing diffusion because of its interaction with its environment at the micrometer length scale

Microviscosity

Microviscosity Measured by: ____ to ______ ratio is measured Dye bound to surfactant had ______ fluorescence & ______ polarization Dye bound to albumin had _______ fluorescence & ______ polarization

Measured by: fluorescence polarization Surfactant to albumin (S/A) ratio is measured Dye bound to surfactant had longer fluorescence & low polarization Dye bound to albumin had decreased fluorescence & high polarization

produce alveolar surfactants stored in the form of lamellar bodies

Type II pneumocytes:

______ lamellar body count=ADEQUATE FLM

>32,000/uL

OD 650nm Increase lamellar bodies=

Increase O.D. (absorbance)

O.D of >/= 0.150 is equivalent to:

L/S ratio of >/= 2.0 and the presence of PG

Bilirubin Scan value

A450 >0.025

Alpha-fetoprotein value

<2 multiples of median (MoM)

L/S ratio value

>/= 2.0

Amniostat-FLM value

positive

Foam Stability Index value

>/=47

Microviscosity (FLM-TDx) value

>/=55 mg/g

Optical Density 650nm value

>/= 0.150

Lamellar body count value

>/= 32,000/mL