Amniotic Fluid PDF

Amniotic Fluid
By: Cabadin, Cayetano, Chumacera,

and Detras
Amniotic Fluid
❏ Product of fetal metabolism

❏ Fetal distress and fetal maturity
❏ Present in the amnion
❏ Membranous sac
❏ Metabolically active
❏ Produce peptides, growth factors, and cytokines
Primary Functions
❏ Provide protective cushion for the fetus

❏ Allow fetal movement
❏ Stabilize temperature
❏ Permit proper lung development
Volume
❏ is regulated by a balance between

❏ production of fetal urine and lung fluid
❏ absorption from fetal swallowing and intramembranous flow
❏ 800 to 1200 mL
❏ Polyhydramnios
❏ Oligohydramnios
Volume
❏ First trimester: maternal circulation

❏ Latter third to half: lung liquid
❏ Lung surfactants
❏ Fetal urine and fetal swallowing
❏ Polyhydramnios
❏ Oligohydramnios
Chemical Composition
❏ Placenta
❏ Similar to maternal plasma
❏ Small amount of sloughed fetal cells
❏ Biochemical substances
❏ Alpha-fetoprotein
❏ acetylcholinesterase
Chemical Composition
❏ Fetal urine production

❏ inc: creatinine, urea, UA
❏ dec: glucose, proteins
❏ Amniotic fluid creatinine
❏ 1.5-2.0 mg/dL
❏ above 2.0 mg/dL
Differentiating Maternal Urine from
Amniotic Fluid
❏ Determine possible premature membrane rupture or accidental

puncture or maternal bladder during specimen collection
❏ Chemical analysis of
❏ Creatinine and urea
❏ Glucose and protein
❏ Fern test
Specimen Collection
❏ Indications for Amniocentesis

❏ Recommended for neural tube defects
❏ To detect genetic disorders or evaluate the
health of the fetus
❏ Fetal body measurements (aided by ultrasonography)
❏ Fetal epithelial cells
❏ Indicate genetic material and biochemical
substances
Amniocentesis
❏ Safe procedure
❏ Performed after 14th week of gestation
❏ Fluid for chromosome analysis (16 weeks of
gestation)
❏ Tests for intrauterine growth retardation (end of 2nd
trimester)
❏ Tests for fetal distress and maturity (3rd trimester)
❏ Transabdominal amniocentesis (most common)
Collection
❏ Vaginal amniocentesis (greater risk of infection)

❏ Maximum of 30 ml
❏ First 2 or 3 ml (can be contaminated)
❏ Fluid for bilirubin analysis (diagnosis of HDN)
❏ Protected from light at all times
Specimen Handling and Processing
❏ Vary with the test requested and with the

methodology used by the lab
❏ Fluid for fetal lung maturity
❏ Bilirubin testing
❏ Cytogenetic/Microbial studies
❏ Fluid for chemical testing
Color and Appearance
❏ Normal amniotic fluid = colorless, slight to

moderate turbidity
❏ Blood streaked - traumatic tap
❏ Kleihauer-Betke Test
❏ Yellow colored - presence of bilirubin (HDN)
❏ Very Dark red-brown fluid - fetal death
❏ Meconium - first bowel movement
❏ May result due to fetal distress
❏ Dark green, mucus-like material
Tests for Fetal Distress
HDN (Hemolytic Disease of the Newborn)
❏ Evaluates the severity of fetal anemia produced by

HDN
❏ Incidence is decreasing rapidly
❏ Amniotic fluid bilirubin - measured by
spectrophotometer
❏ Optical density - measured between 365 - 550 nm
❏ Absorbance difference at 450 nm
Cont. of HDN
❏ Liley graph plots the absorbance difference at

450 nm
❏ Zone 1 - mildly affected fetus
❏ Zone 2 - moderate hemolysis and
require careful monitoring anticipating
an early delivery
❏ Zone 3 - severe hemolysis and severely
affected fetus
Cont. HDN
❏ Specimens contaminated with meconium

❏ Falsely low A450 values and not acceptable
❏ Specimens contaminated with blood
❏ Not acceptable because of the maximum absorbance of oxyhemoglobin
❏ Interference can be removed by extraction with chloroform
Neural Tube Defects
❏ Detected by the presence of

❏ Maternal serum alpha-fetoprotein (AFP)
❏ Ultrasound
❏ Amniocentesis
❏ Indicated by increased levels of AFP
❏ Examples
❏ Spina bifida
❏ Anencephaly
Neural Tube Defects
❏ AFP
❏ Produced by the fetal liver
❏ Increased levels in NTD
❏ Normal values are based on the week of gestational age
❏ Reported in multiples of median (MoM)
❏ A value 2x greater than the median value is abnormal
❏ High levels of AFP → measure amniotic acetylcholinesterase
Fetal Lung Maturity
❏ Respiratory distress syndrome

❏ Caused by an insufficiency of lung surfactant production
or an anatomical defect
❏ Atelectasis
❏ Hypoxemia
❏ Surfactant
❏ Prevents the collapse of the alveoli
❏ Decrease surface tension
❏ Amount of surfactant in fetal lungs
❏ Measured by amount of surfactant in amniotic fluid
Lecithin-Sphingomyelin Ratio
Lecithin
❏ Primary component of surfactant
❏ Produced at a relatively low and constant rate until 35th week of gestation
Sphingomyelin
❏ Produced at a constant rate at about 26 weeks’ gestation
L:S ratio -> <1.6 prior to 35th week of gestation
-> >2.0 to prevent alveolar collapse
❏ Falsely elevated: with blood or meconium
Phosphatidyl glycerol
❏ Lung surface lipid

❏ Essential for adequate lung maturity
❏ Detected after 35th week gestation
Aminostat-FLM
❏ Polyclonal anti-PG bodies specific for PG-containing lamellar bodies

❏ Negative= Pulmonary immaturity
❏ Positive=Pulmonary maturity
Foam stability index
❏ Foam or Shake test
❏ For individual lung-surface lipid concentration
❏ Amniotic fluid+95% etOH
(+)continuous line of bubbles
❏ Semiquantitative measurement
Gradient of ethanol/fluid (0.42 ml to 0.55ml in 0.01ml increment)
value= >47 means (+) for FLM

Lamellar bodies
❏ 90% phospholipid
❏ 10% protein
❏ Type II pneumocytes of the fetal
lung @ 24th week
❏ 26th week
❏ No. of lamellar bodies=amt of phospholipid in the fetal lungs
Lamellar body count
❏ Platelet channels of automated hematology counters
❏ Impedance or optical methods
Advantage of LBC:
1. Rapid turnaround time
2. Low reagent cost
3. Wide availability
4. Low degree of technical difficulty
5. Low volume of amniotic fluid required
6. Excellent clinical performance

Amniotic Fluid PDF

Uploaded by

Copyright:

Available Formats

Amniotic Fluid PDF

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Amniotic Fluid PDF

Uploaded by

Copyright:

Available Formats

Amniotic Fluid

By: Cabadin, Cayetano, Chumacera,

❏ Product of fetal metabolism

❏ Provide protective cushion for the fetus

❏ is regulated by a balance between

❏ First trimester: maternal circulation

❏ Fetal urine production

❏ Determine possible premature membrane rupture or accidental

❏ Indications for Amniocentesis

❏ Vaginal amniocentesis (greater risk of infection)

❏ Vary with the test requested and with the

❏ Normal amniotic fluid = colorless, slight to

HDN (Hemolytic Disease of the Newborn)

❏ Evaluates the severity of fetal anemia produced by

❏ Liley graph plots the absorbance difference at

❏ Specimens contaminated with meconium

❏ Detected by the presence of

❏ Respiratory distress syndrome

❏ Lung surface lipid

❏ Polyclonal anti-PG bodies specific for PG-containing lamellar bodies

(+)continuous line of bubbles

Gradient of ethanol/fluid (0.42 ml to 0.55ml in 0.01ml increment)

value= >47 means (+) for FLM

You might also like