AMNIOTIC FLUID

Yves Laure Pimentel · 70問 · 2年前

通報

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Present in Amnion

AMNIOTIC FLUID

(membranous sac that surrounds the fetus)

Amnion

Functions: o Provide a protective cushion for the fetus, allow fetal movement o Stabilize the temp & protect fetus from temperature changes o Permit lung development

AMNIOTIC FLUID

Needle aspiration of amniotic fluid into the amniotic sac (fransabdominal amniocentesis)

AMNIOCENTESIS

volume collected (1st-3 ml is discarded: blood, fissue fluid contamination)

30 ml

Safely done after amniocentesis safely done after?

14 weeks of gestation

weeks Chromosome analysis, genetic defects

16th weeks

intrauterine growth restriction

near the end of 2nd trimester

Fetal Are. fetal ng maturity, fetal haemolytic dse

3rd trimester

protected from light

fluid for HDN:

Fluid for Fetal Lung Maturity: storage

placed on ICE OR REFRIGERATE

CENTRIFUGATION to Prevent phospholipid loss

Low speed centrifuge (500-1000g for <5min):

Cytogenetic/ Microbiology: storage

room temperature or body temperature

Chemical Testing:

separate cellular elements and debris as soon as possible

Regulated by the balance bet. fetal urine, lung fluid, absorption from fetal swallowing and intramembranous flow (Absorption of amniotic fluid water & solutes into the fetal vascular system)

VOLUME

Peak: VOLUME & gradually decreases

800-1200 ML

> 1200 mL

POLYHYDRATION

<800 ml

OLIGOHYDRATION

1ST trimester: ML derived from maternal circulation

35 ml

after 1ST trimester: Is the major contributor to the amniotic fluig volume

FETAL URINE

If not swallowed: (fetal distress, neural tube disorders)

POLYHYDRAMNIOS

INCREASED Swallowing: [congenital malformations, rupture of amniotic membrane,decelerated heart rate - fetal death

OLIGOHYDRAMNIOS

Fetus secretes lung liquid in AF

3rd half of pregnancy

ultimate source of AF H20 & solutes

Placenta

Neural tube defects: CSF in AF (Markers:

ALPHA FETO PROTEIN, ACETYLCHOLINESTERASE

AF creatinine: Fetal Age

Bet. 1.5-2 mg/dl: 36 weeks gestation >2mg/dl: > 36 weeks

Amniotic Fluid CREATININE

<3.5 MG/DL

Maternal Urine CREATININE

10 MG/DL

Maternal Urine UREA

300 MG/DL

Amniotic Fluid UREA

30 MG/DL

Fern-like Crystals due to CHON, NaCl (+)

Amniotic Fluid

Cause: Premature Membrane Rupture

Amniotic Fluid

Puncture of the bladder in amniocentesis

Maternal Urine

APPEARANCE Normal COLOR AND CLARITY

COLORLESS AND SLIGHTLY TURBID

HDN (bilirubin)

yellow

HDN (bilirubin)

Meconium (Fetus' 1ST bowel movement)

DARK GREEN

Meconium (Fetus' 1ST bowel movement)

Fetal Death

DARK RED BROWN

FETAL DEATH

is measured by Spectrophotometer using serial dilutions

AF bilirubin

Normal fluid:

OPTICAL DENSITY AT 365 NM DECREASES TO 550 NM

(+) Bilirubin: (Maximum bilirubin absorption) OPTICAL DENSITY

OPTICAL DENSITY 450 NM

A 450 is then plotted to ? to measure the severity of the HDN

LILY GRAPH

Zone 1: No more than a mildly affected fetus =

observe fetus

Zone 2: Moderate hemolysis:

Close monitoring, treatment

Zone 3: Severe hemolysis=

Labor/ Intra-uterine Exchange transfusion

NEURAL TUBE DEFECTS Detected by Maternal serum ? (INCREASED Anencephaly, Spina bifida, multiple pregnancy)

ALPHA FETO PROTEIN

Major protein produced by the fetus liver at early gestation prior to 18" weeks

ALPHA FETO PROTEIN

Major protein produced by the fetus liver at early gestation prior to HOW MANY WEEKS?

18TH weeks

Normal: fetus produces maximal AFP bet ? weeks

12 & 15 weeks

NEURAL TUBE DEFECTS Reported:

MOM- MULTIPLES OF THE MEDIAN

Abnormal

GREATER THAN 2

more specific for detecting neural tube defects

AF Acetylcholinesterase

Most frequent complication of early delivery caused by insufficient lung surfactant and lung immaturity

RESPIRATORY DISTRESS SYNDROME (RDS)

Surfactant allows the alveoli to remain open and keeps them from collapsing by the decreasing the surface tension and allows them w/ air more easily

RESPIRATORY DISTRESS SYNDROME (RDS)

Primary component of surfactant & make the alveolar lining account for alveolar stability

LECITHIN

Produced at low at constant rate until 35TH week

LECITHIN

LECITHIN Produced at low at constant rate until ?

35TH week

Lipid that is produced at constant rate after about 26 weeks of gestation

SPHINGOMYELIN

SPHINGOMYELIN Lipid that is produced at constant rate after about ?

26 weeks of gestation

Serve asa control on w/c to base the rise in lecithin

SPHINGOMYELIN

Prior to 35" week: ? (small amount of lecithin are only produced)

<1.6

Lecithin increases while sphingomyelin at constant rate

After 35™ week:

L/S ratio: will rise to

2 or higher

L/S ratio of 2:

prevent alveolar collapse

: prevent alveolar collapse

L/S ratio of 2

QUANTITATIVE MEASUREMENT OF LECITHIN AND SPHIGOMYELIN

THIN LAYER CHROMATOGRAPHY

Also essential for lung maturity and can detected after 35 weeks

Phosphatidyl Glycerol

Phosphatidyl Glycerol Delayed production:

MATERNAL DIABETES

Uses polyclonal anti-PG antibodies

Agglutination Test (Aminostat FLM)

Agglutination Test (Aminostat FLM) Negative/ No agglutination:

Pulmonary immaturity

Agglutination Test (Aminostat FLM) Positive:

Pulmonary maturity

shaken for 15sec > stand for 15 min

amniotic fluid + 95% ethanol

amniotic fluid + 95% ethanol shaken for 15sec > stand for 15 min

Foam Stability Index/ Foam Shake Test

Semi-quantitative measure of FLM: Foam Stability Index/ Foam Shake Test

>/= 47 FLM

Storage form of pyimopary surfactant

LAMELLAR BODIES

LAMELLAR BODIES Secreted by ?and absorbed into alveolar spaces to provide surfactant

TYPE II PNEUMOCYTES

Secreted by TYPE II PNEUMOCYTES and absorbed into alveolar spaces to provide surfactant

LAMELLAR BODIES

Enter AF at 26 weeks and 1 conc:

50,000- 200, 000/ul of 3 trimester

(+): Increases the OD of the amniotic fluid at

650 nm

Same diameter as platelets

Lamellar Body Count

LBC: FLM NORMAL

>50,000/ul = FLM

LBC: Immature

<15,000/ul

Measure Surfactant to Albumin (S/A) ratio to measure FLM

Microviscosity: Fluorescence Polarization Assay

Principle: Phospholipid decreases microviscosity of AF

Microviscosity: Fluorescence Polarization Assay

Fluorescent dye bound to surfactant:

LONGER FLUORESENCE AND LOWER POLARIZATION

Fluorescent dye bound to albumin:

DECREASE FLUORESCENCE AND HIGHER POLARIZATION

USED AS INTERVAL STANDARD

albumin

S/A ratio: FLM

55 MG/G

S/A ratio: indeterminate

40-54 MG/G

S/A ratio: Immature Lung

<39 MG/G

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