Amniotic Fluid Analysis

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1

amniotic fluid

protects fetus while enabling movement; produced by amnion and placenta initially then by fetus (swallowing, respiration, and urination)

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amniocentesis

transabdominally or vaginally with simultaneous ultrasound examination to collect amniotic fluid

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diagnosis of genetic and congenital disorders

amniotic fluid collected early in gestation (15-18 weeks)

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fetal lung maturity assessment

amniotic fluid collected at 32-42 weeks

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estimate and monitor fetal distress

reason to collect amniotic fluid

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aseptic technique

use of long sterile needle to collect 1-20mL of fluid into syringes and transferred into sterile plastic containers; should be protected from light and transported to lab immediately

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glucose and protein present, creatinine similar to plasma, no urea

how to differentiate amniotic fluid from urine

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urea or creatinine

best indicators to differentiate amniotic fluid from urine

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colorless or pale yellow, somewhat turbid

normal appearance of amniotic fluid

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bilirubin

gives amniotic fluid yellow or amber color

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meconium

gives amniotic fluid green color

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blood or hgb

gives amniotic fluid pale pink to red color

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early pregnancy

little particulate matter present

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late pregnancy

more tubidity due to increased fetal cells, hair, and vernix in fluid

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pulmonary system

one of the last organ systems to mature

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32 weeks

produces no testing value for chemical exam of fetal lung maturity indicating complete immaturity at that stage

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respiratory distress syndrome

most common cause of death in newborn; results from insufficient production of surfactant in newborn's lungs

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results of FLM and gestational age

how probability of respiratory distress syndrome is determined

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lecithin/sphingomyelin (L/S) ratio

used to determine maturity of fetal lungs

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phospholipids

required in fetal lungs to decrease surface tension (surfactants)

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lectithin

major pulmonary surfactant

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sphingomyelin

phospholipid in cell membranes; role yet to be established

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34-36 weeks

lecithin increases and sphingomyelin stays constant or decreases

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greater than or equal to 2.0

L/S ratio that indicates maturity of fetal lungs

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phosphatidyl glycerol (PG)

not detectable until 35 weeks gestation; positive is very specific, but many false negatives

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lemellar body counts

pulmonary surfactants sotred in lamellar bodies; use platelet automation to measure

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greater than 50,000 per microliter

lamellar body count indicated FLM

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amniotic fluid bilirubin

normally undetectable in amniotic fluid; correlates with severity of hemolysis; causes absorbance peak at 450 nm; bloody or meconium contaminated specimens unacceptable; must be protected from light

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queenan chart

used to evaluate severity of hemolytic disease between 14 and 40 weeks gestation; divided into four zones indicating the severity of hemolysis