M5: Amniotic Fluid (Part 1: Physiology) Flashcards
T or F
Although the testing of amniotic fluid is frequently associated with microscopic analysis, the clinical laboratory also performs several significant tests on amniotic fluid
F (Although the testing of amniotic fluid is frequently associated with cytogenic analysis, the clinical laboratory also performs several significant tests on amniotic fluid
Amniotic fluid is a product of ?
fetal metabolism
Amniotic fluid is a product of fetal metabolism that provide information about metabolic processes taking place when?
(2)
- During
- Progress of fetal maturation
PHYSIOLOGY
Is present in the amnion which is a membranous sac that surrounds the fetus
Amniotic fluid
PHYSIOLOGY
- A membrane composed of cuboidal cells
- Metabolically active and is involved in the exchanges of water and chemicals between the fluid, the fetus, and the maternal circulation
- Produces peptides, growth factors, and cytokines
Amnion
PHYSIOLOGY
Amnion is a mebrane composed of what cells?
cuboidal cells
PHYSIOLOGY
T or F
Amnion is metabollically active and is involved in exchanges of plasma and chemicals between the fluid, fetus and maternal circulation
F (involved in exchanges of water and chemicals between the fluid)
PHYSIOLOGY
Amnion, involved in exchange of water and chemicals occurs between what (3) components?
- fluid
- fetus
- maternal circulation
PHYSIOLOGY
Amnion produces what (3) constituents?
- Peptides
- Growth factor (GF)
- Cytokines
PHYSIOLOGY
Familiarize the primary functions of amniotic fluid
- Provide a protective cushion for the fetus
- Allow fetal movement
- Stabilize the temperature to protect the fetus from extreme temperature changes
- Permit proper lung development
PHYSIOLOGY
Which does not belong to primary functions of amniotic fluid
i. Provide a protective cushion for the fetus
ii. Restricts fetal movement
iii. Stabilize the temperature to protect the fetus from extreme temperature changes
iv. Delays proper lung development
a. i, ii, iv
b. i and iii only
c. i, ii, iii, iv
d. ii, iv only
e. none
d. ii, iv only
ii. Restricts fetal movement - amniotic fluid allows fetal movement
iv. Delays proper lung development amniotic fluid permits flung development
VOLUME
regulated by a balance between
the production of fetal urine and lung fluid and the absorption from fetal swallowing and intramembranous flow.
Amniotic fluid volume
VOLUME
Amniotic fluid volume is regulated by a balance between:
(1) production of (blank) and (blank)
sorry nabubura pag underscore
production of fetal urine and lung fluid
VOLUME
Amniotic fluid volume is regulated by a balance between:
(2) (blank) from fetal swallong
sorry nabubura pag underscore
absorption from fetal swallowing
VOLUME
Amniotic fluid volume is regulated by a balance between:
(3) (blank) flow
sorry nabubura pag underscore
intramembranous flow
VOLUME
is the absorption of amniotic fluid
water and solutes into the fetal vascular system
Intramembranous flow
VOLUME
What happens to the volume of amniotic fluid as fetus grows
Volume increases
VOLUME
T or F
Amniotic fluid volume decrease = fetus further grows
F (amniotic fluid volume increase = fetus further grows
Volume of AF at 12 weeks of gestation?
60 mL
T or F
The amount of amniotic fluid increases in quantity throughout pregnancy
T
VOLUME
The amount of amniotic fluid increases in quantity throughout pregnancy, reaching a peak of what volume range during 3rd trimester
800-1,200 mL
this then gradually decreases prior to delivery
VOLUME
Amniotic fluid increases or decreases prior to delivery of baby?
decreases
palabas na
VOLUME
(Polyhydramnios or Oligohydramnios?)
Amniotic fluid volume
greater than 1200 ml
Failure of the fetus to begin
swallowing
Seen in:
* fetal distress/fetal structural anomalies
* cardiac arrythmias
* neutral tube disorders/defects
* congenital infections
* chromosome abnormalities
Polyhydramnios
VOLUME
(Polyhydramnios or Oligohydramnios?)
Amniotic fluid volume
less than 800 ml
Increased AF swallowing
Seen in:
* premature rupture of amniotic membrane
* urinary tract deformities
* membrane leakage
* congenital malformations
* umbilical cord compression
Oligohydramnios
VOLUME
(Polyhydramnios or Oligohydramnios?)
Amniotic fluid volume greater than 1200 ml
Polyhydramnios
VOLUME
(Polyhydramnios or Oligohydramnios?)
Failure of the fetus to begin
swallowing
Polyhydramnios
kasi masyadong marami na
VOLUME
(Polyhydramnios or Oligohydramnios?)
fetal distress/fetal structural anomalies
Polyhydramnios
VOLUME
(Polyhydramnios or Oligohydramnios?)
cardiac arrythmias
Polyhydramnios
VOLUME
(Polyhydramnios or Oligohydramnios?)
neutral tube disorders/defects
Polyhydramnios
VOLUME
(Polyhydramnios or Oligohydramnios?)
congenital infections
Polyhydramnios
VOLUME
(Polyhydramnios or Oligohydramnios?)
chromosome abnormalities
Polyhydramnios
VOLUME
(Polyhydramnios or Oligohydramnios?)
Amniotic fluid volume less
than 800 ml
Oligohydramnios
VOLUME
(Polyhydramnios or Oligohydramnios?)
Increased AF swallowing
Oligohydramnios
kasi onti lang af so need niya more, hence iincrease niya pagswallow
sana all
VOLUME
(Polyhydramnios or Oligohydramnios?)
premature rupture of amniotic membranes
Oligohydramnios
VOLUME
(Polyhydramnios or Oligohydramnios?)
premature rupture of amniotic membranesurinary tract deformities
Oligohydramnios
VOLUME
(Polyhydramnios or Oligohydramnios?)
membrane leakage
Oligohydramnios
VOLUME
(Polyhydramnios or Oligohydramnios?)
congenital
malformation
Oligohydramnios
VOLUME
(Polyhydramnios or Oligohydramnios?)
umbilical cord compression
Oligohydramnios
VOLUME
- approximately 35 mL of amniotic fluid is derived primarily from the maternal circulation
What stage of pregnancy
1st trimester
VOLUME
1st trimester
a. 35 ul of AF
b. derived from maternal circulation
c. both
d. NOTA
b. derived from maternal circulation
a should be 35 mL of AF to be correct
VOLUME
- fetus secretes a volume of lung liquid necessary to expand the lungs with growth
What stage of pregnancy
2nd trimester or latter third to half of pregnancy
VOLUME
During each episode of fetal respiratory movement what process occurs which then (1) bathes lungs (2) wash pumonary and alveolar content
lung movement of fetus secretes lung liquid and enters amniotic fluid
which then (1) bathes lungs (2) wash pumonary and alveolar content
VOLUME
Each episode of fetal respiratory movement secretes lung liquid enetrs amniotic fluid which
a. bathe lungs
b. wash pulmonary and alveolar contents (such as lecithin, sphingomyelin, phosphatidyl glycerol)
c. both
d. NOTA
c. both
VOLUME
What pulmonary and elveolar contents does lung liquid wash?
lecithin,
sphingomyelin, and phosphatidyl glycerol
into the amniotic fluid surrounding the fetus
VOLUME
These (3) lung surfactants serve as an index of fetal lung
maturity
lecithin,
sphingomyelin, and phosphatidyl glycerol
VOLUME
- fetal urine is the major contributor to the amniotic fluid volume
- Fetal swallowing of the amniotic fluid begins and regulates the increase in fluid from the fetal urine
What stage of pregnancy
After the first trimester
VOLUME
After the first trimester, this is the major contributor to the amniotic fluid volume
fetal urine
VOLUME
This act regulates the increase in fluid from the fetal urine
Fetal swallowing
of amniotic fluid
VOLUME
T or F
The fetus swallows amniotic fluid, which is absorbed through the gastrointestinal tract and reexcreted by the kidneys from the blood into fetal urine and back into
amniotic fluid
T
kadiri
CHEMICAL COMPOSITION
is the ultimate source of amniotic fluid water
and solutes
placenta
CHEMICAL COMPOSITION
Amniotic fluid has a composition similar to that of what, which contains a small amount of sloughed fetal cells from the skin, digestive system, and urinary tract.
composition similar to maternal plasma
CHEMICAL COMPOSITION
- has a composition similar to that of the maternal plasma
- contains a small amount of sloughed fetal cells from the skin, digestive system, and urinary tract
Amniotic fluid
CHEMICAL COMPOSITION
Part of composition of amniotic fluid which provide the basis for cytogenetic
analysis
clue: cyto
Sloughed cells
CHEMICAL COMPOSITION
Familiarize the biochemical substances produced by fetus that are in amniotic fluid
bilirubin, lipids, enzymes, electrolytes, urea, creatinine, uric acid, proteins, hormones
CHEMICAL COMPOSITION
Condition which allow fetal cerebrospinal fluid to enter the amniotic fluid directly
Neural tube defects
CHEMICAL COMPOSITION
(2) biochemical markers for neural tube defects
Alpha-fetoprotein, Acetylcholinesterase
CHEMICAL COMPOSITION
T or F
A portion of the fluid arises from the fetal respiratory tract, fetal urine, the amniotic membrane, and the umbilical cord
T
CHEMICAL COMPOSITION
The chemical composition of amniotic fluid changes when what begins?
when fetal urine production begins
CHEMICAL COMPOSITION
When fetal urine production begins, themical composition of amniotic fluid changes, what the the components that are increased?
- Creatinine
- Urea
- Uric acid
CUU
CHEMICAL COMPOSITION
When fetal urine production begins, themical composition of amniotic fluid changes, what the the components that are decreased?
- Glucose
- Protein
CHEMICAL COMPOSITION
These components are affected as fetal urine production begins
a. creatinine, urea, uric acid
b. glucose and protein
c. electrolytes, enzymes, hormes, metabolic end products
d. all
e. NOTA
d. all
electrolytes, enzymes, hormes, metabolic end products but are of little clinical significance ok?
CHEMICAL COMPOSITION
Measurement of amniotic fluid creatinine has been used to
determine?
fetal age
CHEMICAL COMPOSITION
- This is when amniotic fluid creatinine level ranges between 1.5 and 2.0 mg/dL
fetal age
before 36 weeks’ gestation
CHEMICAL COMPOSITION
- This is when amniotic fluid rises above 2.0 mg/dL
fetal age
greater than 36 weeks
DIFFERENTIATING MATERNAL URINE FROM AMNIOTIC FLUID
Differentiating maternal urine from amniotic fluid is important to dtermine what (2)
- possible premature membrane rupture
- accidental puncture of maternal bladder during specimen collection
DIFFERENTIATING MATERNAL URINE FROM AMNIOTIC FLUID
What are the (4) parameters in chemical analaysis which helps to differentiate maternal urine from amniotic fluid?
Creatinine, Urea, Glucose, Protein
DIFFERENTIATING MATERNAL URINE FROM AMNIOTIC FLUID
Maternal fluid or Amniotic fluid?
Creatinine: As high as 10 mg/dL
Urea: As high as 300 mg/dL
Glucose and Protein: Not present in normal circumstances
pH: Acidic
Maternal urine
DIFFERENTIATING MATERNAL URINE FROM AMNIOTIC FLUID
Maternal fluid or Amniotic fluid?
Creatinine: <3.5 mg/dL
Urea: <30 mg/dL
Glucose and Protein: More commonly seen under normal circumstances
pH: Alkaline
Amniotic fluid
DIFFERENTIATING MATERNAL URINE FROM AMNIOTIC FLUID
Maternal fluid or Amniotic fluid?
Levels of creatinine and urea are much lower in?
Amniotic fluid
DIFFERENTIATING MATERNAL URINE FROM AMNIOTIC FLUID
T or F
Measurement of glucose and protein by a reagent strip is a reliable indicator
F (Measurement of glucose and protein by a reagent strip is a less reliable indicator)
because glucose and protein are not uncommon urine constituents during pregnancy
DIFFERENTIATING MATERNAL URINE FROM AMNIOTIC FLUID
What are the 3 tests used to diagnose PROM ?
PREMATURE RUPTURE OF MEBRANES
- pH test
- Nitrazine test
- Biomarker testing
DIFFERENTIATING MATERNAL URINE FROM AMNIOTIC FLUID
- Can differentiate amniotic fluid from urine and other body fluids
- Used to evaluate premature rupture of the membranes
- a vaginal fluid specimen is spread on a glass slide and allowed to completely air dry at room temperature; then it is observed microscopically
- presence of “fern-like” crystals due to the protein and sodium chloride content is a positive screen for amniotic fluid
Test
Fern test
Specimen used in fern test?
Vaginal fluid specimen
spread on a glass slide and allowed to completely air dry at room temperature; observed microscopically
Fern-like crystals are seen in fern test due to presence of what (2) components?
Protein, Sodium chloride
fluid
a positive screen for amniotic fluid
- A test for pH
- If the pH of the fluid being tested turns blue, the pH is greater than 6 and it suggests that the membrane has ruptured
test
Nitrazine test
Positive result for nitrazine?
change to Blue color
suggests membrane has ruptured
Vaginal fluid or amniotic fluid?
pH test: 4.5 - 6.0
NItrazine: Negative
Fern test: Non-appearance of fern like crystal
Vaginal fluid
Vaginal fluid or amniotic fluid?
pH test: 7.1 - 7.3
NItrazine: Positive
Fern test: Appearance of fern like crystal
Amniotic fluid
WHat are the (3) biomarker testing in amniotic fluid
- AmniSure ROM
- Actim Prom
- ROM Plus
Priciple: Immunochromatogrpahic test
Biomarkers: Placental alpha macroglobulin (PAMG-1)
(3) biomarker testing in amniotic fluid
AmniSure
ROM
Priciple: Rapid immunoassay point-of-care test
Biomarkers:
Insulin-likegrowth factor binding protein-1 (IGFBP-1)
Placental protein 12 (pP12)
(3) biomarker testing in amniotic fluid
Actim PROM
Priciple: Immunoassay
Biomarkers:
Alpha-fetoprotein (AFP)
IGFBP-1
ROM Plus
Biomarker: IGFBP-1
A. Actim PROM
b. ROM Plus
c. both
d. NOTA
c. both