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Questions and Answers
Amniotic fluid is present in the ______
Amniotic fluid is present in the ______
amnion
Amniotic fluid is involved in the exchange of water and chemicals between the fluid, the fetus, and maternal circulation.
Amniotic fluid is involved in the exchange of water and chemicals between the fluid, the fetus, and maternal circulation.
True
Amniotic fluid provides a ______ cushion for the fetus.
Amniotic fluid provides a ______ cushion for the fetus.
protective
Amniotic fluid allows for ______ movement.
Amniotic fluid allows for ______ movement.
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Amniotic fluid helps to stabilize the ______ to protect the fetus from extreme temperature changes.
Amniotic fluid helps to stabilize the ______ to protect the fetus from extreme temperature changes.
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Amniotic fluid permits proper ______ development.
Amniotic fluid permits proper ______ development.
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During the first trimester, 35mL of amniotic fluid is derived from ______ circulation.
During the first trimester, 35mL of amniotic fluid is derived from ______ circulation.
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After the first trimester, ______ becomes the major contributor to the amniotic fluid volume.
After the first trimester, ______ becomes the major contributor to the amniotic fluid volume.
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When fetal urine production occurs, fetal swallowing of amniotic fluid begins.
When fetal urine production occurs, fetal swallowing of amniotic fluid begins.
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The amount of amniotic fluid ______ in quantity throughout pregnancy.
The amount of amniotic fluid ______ in quantity throughout pregnancy.
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Amniotic fluid peaks to 800-1200 ml during the ______ trimester.
Amniotic fluid peaks to 800-1200 ml during the ______ trimester.
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Match the following conditions related to amniotic fluid volume with their descriptions:
Match the following conditions related to amniotic fluid volume with their descriptions:
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What is a possible cause of Polyhydramnios?
What is a possible cause of Polyhydramnios?
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Which of these is NOT a possible cause of Oligohydramnios?
Which of these is NOT a possible cause of Oligohydramnios?
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The method of collecting amniotic fluid is called ______
The method of collecting amniotic fluid is called ______
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How much amniotic fluid is typically collected during an amniocentesis?
How much amniotic fluid is typically collected during an amniocentesis?
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The first 2-3 ml collected during an amniocentesis are discarded because they may be contaminated by maternal blood, tissue fluid, and cells.
The first 2-3 ml collected during an amniocentesis are discarded because they may be contaminated by maternal blood, tissue fluid, and cells.
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During which trimester is an amniocentesis performed to assess genetic defects?
During which trimester is an amniocentesis performed to assess genetic defects?
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Which of the following is NOT a reason for amniocentesis during the third trimester?
Which of the following is NOT a reason for amniocentesis during the third trimester?
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Amniocentesis is indicated at 15 to 18 weeks' gestation to determine early treatment or intervention for conditions like a mother's age of 35 or older at delivery.
Amniocentesis is indicated at 15 to 18 weeks' gestation to determine early treatment or intervention for conditions like a mother's age of 35 or older at delivery.
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Amniocentesis is indicated later in pregnancy, between 20-42 weeks, to evaluate which of the following?
Amniocentesis is indicated later in pregnancy, between 20-42 weeks, to evaluate which of the following?
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Amniotic fluid and maternal urine have distinct chemical compositions which can be analyzed to assess the risk of premature membrane rapture or accidental bladder puncture during specimen collection.
Amniotic fluid and maternal urine have distinct chemical compositions which can be analyzed to assess the risk of premature membrane rapture or accidental bladder puncture during specimen collection.
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What is a test used to evalaute premature rupture of the membrane?
What is a test used to evalaute premature rupture of the membrane?
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Ferns like crystals form on a slide when the vaginal fluid is dried in the air.
Ferns like crystals form on a slide when the vaginal fluid is dried in the air.
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The Fern Test can detect an early pregnancy.
The Fern Test can detect an early pregnancy.
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Fetal Lung Maturity Test specimens are placed in ______ for delivery and kept ______
Fetal Lung Maturity Test specimens are placed in ______ for delivery and kept ______
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It is recommended to filter the Fetal Lung Maturity Test sample to prevent the loss of phospholipids.
It is recommended to filter the Fetal Lung Maturity Test sample to prevent the loss of phospholipids.
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Bilirubin test specimens should be protected from light at all times.
Bilirubin test specimens should be protected from light at all times.
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Cytogenetics and Microbial studies are typically kept at ______ or ______
Cytogenetics and Microbial studies are typically kept at ______ or ______
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Match the color of amniotic fluid with its potential clinical significance:
Match the color of amniotic fluid with its potential clinical significance:
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The test for Hemolytic Disease of the Newborn (HDN) is measured by spectrophotometric analysis.
The test for Hemolytic Disease of the Newborn (HDN) is measured by spectrophotometric analysis.
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Bilirubin causes a rise in OD at ______
Bilirubin causes a rise in OD at ______
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Oxyhemoglobin, which peaks at 410 nm, can interfere with the bilirubin test, so specimens contaminated with blood are not accepted.
Oxyhemoglobin, which peaks at 410 nm, can interfere with the bilirubin test, so specimens contaminated with blood are not accepted.
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Specimens with meconium will cause false low bilirubin values and are not accepted for the test.
Specimens with meconium will cause false low bilirubin values and are not accepted for the test.
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In the Liley Graph, Zone 1 indicates a ______ fetus.
In the Liley Graph, Zone 1 indicates a ______ fetus.
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In the Liley Graph, Zone 2 indicates a ______ fetus that requires close monitoring.
In the Liley Graph, Zone 2 indicates a ______ fetus that requires close monitoring.
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In the Liley Graph, Zone 3 indicates a ______ fetus that requires intervention.
In the Liley Graph, Zone 3 indicates a ______ fetus that requires intervention.
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Neural tube defects (NTD) are one of the most common birth defects in the United States.
Neural tube defects (NTD) are one of the most common birth defects in the United States.
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Which of the following is NOT a method of detecting Neural Tube Defects?
Which of the following is NOT a method of detecting Neural Tube Defects?
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Spina bifida is also known as ______
Spina bifida is also known as ______
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Anencephaly is a neural tube defect that results in the absence of the major part of the brain.
Anencephaly is a neural tube defect that results in the absence of the major part of the brain.
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Alpha-fetoprotein is often used as a ______ test for Neural Tube Defects, while Acetylcholinesterase is a ______ test.
Alpha-fetoprotein is often used as a ______ test for Neural Tube Defects, while Acetylcholinesterase is a ______ test.
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Alpha-fetoprotein levels are elevated in Neural Tube Defects and decreased in Down Syndrome.
Alpha-fetoprotein levels are elevated in Neural Tube Defects and decreased in Down Syndrome.
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Respiratory Distress Syndrome (RDS) is a frequent complication of early delivery.
Respiratory Distress Syndrome (RDS) is a frequent complication of early delivery.
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RDS is caused by insufficient lung surfactant production and structural immaturity of the fetal lungs.
RDS is caused by insufficient lung surfactant production and structural immaturity of the fetal lungs.
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Which of the following is a common method to assess Fetal Lung Maturity?
Which of the following is a common method to assess Fetal Lung Maturity?
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Lecithin is the primary surfactant, essential for alveolar stability, while sphingomyelin serves as a control for contrast production.
Lecithin is the primary surfactant, essential for alveolar stability, while sphingomyelin serves as a control for contrast production.
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An L/S ratio of greater than 2 indicates mature lungs.
An L/S ratio of greater than 2 indicates mature lungs.
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It is important to discard specimens contaminated with blood and meconium for the L/S ratio test.
It is important to discard specimens contaminated with blood and meconium for the L/S ratio test.
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Amniostat-FLM is an immunologic test that measures phosphatidylglycerol (PG) levels in amniotic fluid.
Amniostat-FLM is an immunologic test that measures phosphatidylglycerol (PG) levels in amniotic fluid.
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Amniostat-FLM replaces the L/S ratio as a test for fetal lung maturity.
Amniostat-FLM replaces the L/S ratio as a test for fetal lung maturity.
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PG production is delayed in diabetic mothers.
PG production is delayed in diabetic mothers.
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In the Amniostat-FLM test, a low or high positive result indicates mature lungs, while a negative result indicates immature lungs.
In the Amniostat-FLM test, a low or high positive result indicates mature lungs, while a negative result indicates immature lungs.
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The foam stability test involves shaking amniotic fluid with 95% ethanol for 15 seconds.
The foam stability test involves shaking amniotic fluid with 95% ethanol for 15 seconds.
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In the Foam Stability test, a continuous line of bubbles or foam indicates mature lungs.
In the Foam Stability test, a continuous line of bubbles or foam indicates mature lungs.
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Microviscosity, the presence of phospholipids, decreases microviscosity in amniotic fluid.
Microviscosity, the presence of phospholipids, decreases microviscosity in amniotic fluid.
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Lamellar bodies are produced by type II pneumocytes and are essential for the production of alveolar surfactants.
Lamellar bodies are produced by type II pneumocytes and are essential for the production of alveolar surfactants.
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A lamellar body count of 32,000/uL indicates adequate fetal lung maturity.
A lamellar body count of 32,000/uL indicates adequate fetal lung maturity.
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The presence of lamellar bodies in amniotic fluid increases optical density, which can be measured at 650 nm.
The presence of lamellar bodies in amniotic fluid increases optical density, which can be measured at 650 nm.
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A creatinine level of 1.5 to 2.0 mg/dL in amniotic fluid indicates a fetal age of less than 36 weeks.
A creatinine level of 1.5 to 2.0 mg/dL in amniotic fluid indicates a fetal age of less than 36 weeks.
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A creatinine level greater than 2.0 mg/dL indicates a fetal age of over 36 weeks.
A creatinine level greater than 2.0 mg/dL indicates a fetal age of over 36 weeks.
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Study Notes
Amniotic Fluid Physiology
- Amniotic fluid is present within the amnion, a membranous sac surrounding the fetus.
- It facilitates the exchange of water and chemicals between the amniotic fluid, fetus, and maternal circulation.
Functions of Amniotic Fluids
- Provides a protective cushion for the fetus.
- Allows fetal movement.
- Stabilizes fetal temperature to protect from extreme temperature changes.
- Permits proper lung development.
Amniotic Fluid Volume
- First Trimester: 35 mL of amniotic fluid is derived from maternal circulation.
- After First Trimester: Fetal urine becomes the major contributor to amniotic fluid volume.
- Fetal urine production triggers fetal swallowing of amniotic fluid, contributing to increasing volume over pregnancy.
- Amniotic fluid volume peaks at 800-1200 mL during the third trimester, then gradually decreases prior to delivery.
Variation in Amniotic Fluid Volume
-
Polyhydramnios: Increased amniotic fluid volume (>1200 mL).
- Causes: decreased fetal swallowing of urine, neural tube defect.
-
Oligohydramnios: Decreased amniotic fluid volume (<800 mL).
- Causes: increased fetal swallowing of urine, membrane leakage, urinary tract deformities.
Specimen Collection and Handling
- Amniocentesis: Procedure for collecting amniotic fluid.
- Up to 30 mL is collected using a sterile syringe.
- First 2-3 mL may be discarded due to contamination.
- Second Trimester: Collection to assess genetic defects (e.g., Down syndrome)
- Third Trimester: Collection for assessing fetal lung maturity (FML) and fetal hemolytic disease (HDN).
Indications for Performing Amniocentesis
- Maternal age of 35 or older at delivery.
- Family history of chromosome abnormalities (e.g., Down syndrome).
- Parents with abnormal chromosome rearrangements.
- Previous pregnancy with birth defects.
- Family history of metabolic disorders.
- History of genetic diseases (e.g., sickle cell disease).
- Elevated maternal serum alpha-fetoprotein.
- Abnormal triple marker screening.
- Previous child with a neural tube defect.
- Three or more miscarriages.
Amniocentesis (later in pregnancy)
- Fetal lung maturity evaluation
- Fetal distress evaluation
- Evaluation of hemolytic disease (Rh incompatibility).
- Infection evaluation.
Amniotic Fluid vs. Maternal Urine
- Essential for differentiating between amniotic fluid and maternal urine to avoid misdiagnosis.
- Creatinine: Amniotic fluid <3.5 mg/dL, Maternal urine up to 10 mg/dL
- Urea: Amniotic fluid <30 mg/dL, Maternal urine up to 300 mg/dL
Specimen Handling and Storage
- Fetal Lung Maturity Test: Place in ice for delivery and store refrigerated
- Filtration: Recommended to prevent loss of phospholipids.
- Bilirubin Test: Protect from light.
- Cytogenetics and Microbial Studies: Maintain at body temperature (37°C) for optimal cell preservation.
Laboratory Examination of Amniotic Fluids: Color and Appearance
- Colorless: Normal
- Blood-streaked: Traumatic tap, intra-amniotic hemorrhage
- Yellow: Hemolytic disease of the newborn (increased bilirubin)
- Dark green: Meconium (newborn's first bowel movement)
- Dark red-brown: Fetal death
Laboratory Examination of Amniotic Fluids: Tests for Hemolytic Disease of the Newborn
- Measured by spectrophotometric analysis.
- Bilirubin: Causes a rise in optical density (OD) at 450 nm.
- Oxyhemoglobin: Peaks at 410 nm and may interfere with analysis; contaminated specimens are not considered.
- Meconium: Contaminated specimens result in false low bilirubin value measurement and are not used.
Laboratory Examination of Amniotic Fluids: Testing for Hemolytic Disease of the Newborn.
- Reporting with Liley graph
- Zone 1: non-affected/mildly affected fetus.
- Zone 2: moderately affected (close monitoring required).
- Zone 3: severely affected (requires intervention).
Tests for Neural Tube Defects
- Neural tube defects (NTDs) common birth defects.
- Diagnosed using maternal serum alpha-fetoprotein (MSAFP) blood tests, high-resolution ultrasound, and amniocentesis.
- Common NTDs include spina bifida and anencephaly.
- Screening test: Elevated alpha-fetoprotein in NTDs, lower in Down syndrome.
- Confirmatory test: Acetylcholinesterase.
Tests for Fetal Lung Maturity
- Respiratory Distress Syndrome (RDS): Frequent complication of premature delivery.
- Lecithin-Sphingomyelin (L/S) Ratio: Ratio of lecithin to sphingomyelin as a measure of fetal lung maturity.
- L/S Ratio > 2.0 = Mature lungs.
- Amniostat-FLM: Immunologic test replacing L/S ratio because it is not affected by blood or meconium and can be used in diabetic mothers.
- Foam Stability (Foam Shake Test): Measure fetal lung maturity; amniotic fluid + ethanol, shaken vigorously; > 15 sec = mature lungs.
- Lamellar Body Count (LBC): Number of lamellar bodies (Type II pneumocytes produce alveolar surfactants) = Adequate fetal lung maturity (FLM)
- OD of >0.15 = L/S ratio >2.0, with evidence of phosphatidylglycerol (+)
Test for Fetal Age
-
Creatinine:
- 1.5-2.0 mg/dL = Prior to 36 weeks of gestation
-
2.0 mg/dL = Fetal age is over 36 weeks.
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Description
Explore the essential aspects of amniotic fluid, including its physiology, functions, and variations in volume throughout pregnancy. This quiz covers key concepts like the protective roles of amniotic fluid and the changes in volume from the first trimester to delivery.
