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Purpose of examination
Cytogenetic analysis A product of fetal metabolism Provide information about the metabolic processes taking place during fetal maturation *the danger to the fetus must be measured against the ability of the fetus to survive an early delivery
Physiology
function
Amnion-contains the amniotic fluid; a membranous sac that surrounds the fetus A protective cushion for the fetus Allow fetal movement Stabilize the temperature to protect the fetus from extreme temperature changes
function
Permit proper lung development Medium for exchange of water and chemicals between fetus and maternal circulation
volume
It is regulated by a balance between the production of fetal urine and lung fluid and the absorption from fetal lung swallowing and intramembranous flow
Intramembranous flow
Is the absorption of amniotic fluid water and solutes into the fetal vascular system
volume
Amount of amniotic fluid increases during pregnancy Peak of about 1L during the 3rd trimester Gradually decreases prior to delivery First trimester: 35 mL is derived from the maternal circulation
volume
Half to latter third of pregnancy, the fetus secretes a volume of lung liquid necessary to expand the lungs with growth Each fetal breathing movement secretes lung surfactants that serve as an index of fetal lung maturity
volume
After the first trimester, fetal urine is the major contributor to the amniotic fluid volume During fetal urine production, fetal swallowing of the amniotic fluid begins
Polyhydramnios
Failure of the fetus to begin swallowing results in excessive accumulation of amniotic fluid An indication of fetal distress Often associated with neural disorders
polyhydramnios
Secondarily associated with: Fetal structural anomalies Cardiac arrhythmias Congenital infections Chromosomal abnormalities
oligohydramnios
Decreased amniotic fluid Causes: Increased fetal swallowing Urinary tract deformities Membrane leakage Umbilical cord compression resulting in decelerated heart rate and fetal death
Chemical composition
Placenta-the ultimate source of amniotic fluid Amniotic fluid has a composition similar to maternal plasma and a small amount of sloughed cells from the skin,digestive system,and urinary tract (provides the basis for cytogenetic analysis
Chemical composition
Biochemical substances produced by the fetus: Bilirubin Lipids Enzymes Electrolytes Nitrogenous compounds Proteins
Chemical composition
Fetal respiratory tract Fetal urine Amniotic membrane Umbilical cord
Amniotic fluid Creatinine is </= 3.5 mg/dL Urea is </= 30 mg/dL Urine Creatinine is >/= 10 mg/dL Urea is >/= 300 mg/dL *fern test
Specimen Collection
Biochemical substances
Fluorescence polarization Thin-layer chromatography
Parent is a carrier of a metabolic disorder History of genetic diseases ex. CF Elevated maternal serum alpha fetoprotein Abnormal triple marker screening test Previous child with a neural tube disorder such as spina bifida,or ventral wall defects (gastroschisis) Three or more miscarriages
Amniocentesis indicated at 20 to 42 weeks to evaluate: Fetal lung maturity Fetal distress Hemolytic disease of the newborn caused by Rh blood type incompatibility infection
collection
Amniocentesis-collection of amniotic fluid by needle aspiration into the amniotic sac Transabdominal amniocentesis Safer when performed after the 14th week of gestation 16th week-chromosomal analysis 3rd trimester-tests for fetal distress and maturity
collection
Maximum of 30 mL is collected in sterile syringes First 2 to 3mL are discarded due to contamination *for bilirubin analysis due to HDNprotect from light; use amber-colored tubes or black colored covers
AChE
Amniotic acetylcholinesterase More specific for neural tube disorders
Lung surfactant
Keeps the alveoli from collapsing by decreasing surface tension and allows them to inflate with air more easily
Lecithin-Sphingomyelin Ratio
L/S ratio Lecithin-primary component of the surfactants (phospholipids,neutral lipids, and proteins) that make up the alveolar lining and account for alveolar stability
lecithin
sphingomyelin
Is a lipid produced at a constant rate after 26 weeks AOG Serves as a control on which to base the rise in lecithin
L/S ratio
Less than 1.6 prior to 35 weeks AOG Rises to 2.0 after 35 weeks AOG Ratio of 2.0 means safe to do a preterm delivery Falsely increased with blood or meconium contamination TLC-quantitative measurement
Amniostat-FLM
Phosphatidyl glycerol-lung surface lipid essential for adequate lung maturity Delayed production in maternal diabetes Respiratory distress=L/S ratio of 2.0 TLC Agglutination test
Foam Stability
foam or shake test mechanical screening test used to determine lung surfactants Amniotic fluid is mixed with 95% ethanol, shaken for 15 seconds,and stand for 15 minutes,then observed for presence of bubbles around the outside edge
principle
Dye bound to surfactant has a longer fluorescence lifetime and exhibits low polarization whereas dye bound to albumin has a decreased fluorescence lifetime and has a high polarization
FLM=/<55 mg surfactant per gram albumin Immature results=/< 39 mg/g Test requires at least 1.0 mL of amniotic fluid
Tests
Lamellar body counts (LBCs) with use of hematology analyzers(similar to platelets) Resistance-pulse counting(Beckman Coulter) 1.7 to 7.3 fL FLM=/> 32,000/uL ADVIA 120 hema system(Siemens) FLM=/> 35,400 particles/uL Sysmex XE-2100-impedance Cell-dyn 3500 (Abbott Lab)-optical scatter
Sysmex XE-2100