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AUBF > FINALS - AMNIOTIC FLUID > Flashcards

FINALS - AMNIOTIC FLUID Flashcards

1
Q

Amniotic Fluid is found in the ___ providing a cushion for protection (amnion)

A

membranous sac that surrounds the fetus called AMNION

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2
Q

how do amniotic fluid are formed?

A

Formed from the metabolism of fetal cells, transfer of water across
the placental membrane and in the 3rd trimester by fetal urine.

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3
Q

The ____ is metabolically active and is involved in the exchanges of water and
chemicals between the fluid, the fetus, and the maternal circulation; and produces peptides, growth factors, and cytokines.

A

amnion

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4
Q

what are the functions of amniotic fluid

A

➔ Provides a protective cushion for the fetus
➔ Allows fetal movement
➔ Stabilize the temperature to protect the fetus from extreme temperature changes
➔ Permits proper lung development

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5
Q

amniotic fluid balance is regulated by the balance between what production and processes?

A

Regulated by the balance between the production of fetal urine and
lung fluid, and absorption from fetal swallowing and
intramembranous flow

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6
Q

do amniotic fluid increases or decreases during the course of pregnancy

A

Volume INCREASES on the course of pregnancy reaching a
peak of approximately 800 to 1200 mL during the third trimester, and then gradually DECREASES prior to delivery

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7
Q

what is the volume of the amniotic fluid During the first trimester

A

Amniotic fluid is derived from the MATERNAL CIRCULATION
(35mL)

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8
Q

what is the major contributor of amniotic fluid after the first trimester

A

Urine is the major contributor of amniotic fluid

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9
Q

after the first trimester, ____ starts to regulates the increase in fluid from the fetal urine

A

Fetal swallowing

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10
Q

the lung fluid secreted will help the fetus lungs to develop, every respiratory movement of the fetus, the lung fluid will enter the amniotic fluid, bathing the lungs and washing the pumonary and alveolar contents such as the ______

these are the lung surfactant that serve as an index of fetal lung maturity. What are those?

A

lecithin, sphingomyelin, and phosphatidylglycerol

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11
Q

what is happening in the latter third to half of the pregnancy in terms of the amniotic fluid’s volume?

A

Fetus secretes a volume of lung liquid which will enter the amniotic fluid

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12
Q

An amniotic fluid volume greater than ___ is called polyhydramnios,

A

1200 ml

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13
Q

amniotic fluid volume less than___ is
termed oligohydramnios

A

800 mL

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14
Q

Abnormal increase of the fluid volume

A

Polyhydramnios

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15
Q

polyhydramnios is caused by the ___

A

Accumulation of amniotic fluid due to fetus’
failure to swallow the urine

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16
Q

the failure to swallow amniotic fluid of the fetus is mainly caused by the

A

a. Fetal distress
b. Neural tube defects
c. Secondary effects like congenital infection, urinary tract deformities

in the book, secondarily associated to fetal
structural anomalies, cardiac arrhythmias, congenital infections or chromosomal abnormalities.

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17
Q

Abnormal decrease amniotic fluid

A

Oligohydramnios

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18
Q

Oligohydramnios is associated with what conditions

A

a. Umbilical cord compression
b. Decelerated heart rate
c. Fetal Death

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19
Q

The ___ is the ultimate source of amniotic fluid water and solutes

A

placenta

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20
Q

the sloughed fetal cells will provide the basis for the

A

cytogenetic analysis.

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21
Q

the chemical composition of the amniotic fluid is similar to the composition of the ___

A

maternal plasma

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22
Q

the chemical composition of the amniotic fluid contains the sloughed fetal cells such as from the ___

A

o From the Skin
o From the digestive system
o From the urinary tract

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23
Q

Biochemical substances found in the amniotic fluid that are produced by the fetus

A

o Bilirubin
o Lipid
o Enzymes
o Nitrogen compound protein

in the book;
electrolytes, urea, creatinine, uric acid, proteins, and hormones

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24
Q

it is Used to determine fetal age

A

Amniotic Fluid Creatinine

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25
Q

Prior to 36 weeks of gestation, the creatine level is

A

1.5-2.0 mg/Dl

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26
Q

> 2,0 mg/dL creatinine will indicate the age of the fetus which is

A

this indicates >36 weeks gestation

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27
Q

the testing of amniotic fluid is frequently associated with ___

A

cytogenetic analysis

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28
Q

cytogenetic analysis When conditions that adversely
affect the fetus arise, the danger to the fetus must be measured
against the ability of the fetus to survive an early delivery.

true or faLse

A

TRUE- cytogenetic analysis will measure kung kaya ba ni baby masurvive the premature delivery once there’s a danger

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29
Q

which condition or defect allows the fetal cerebrospinal fluid to enter the amniotic
fluid directly.

A

Neural tube defects

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30
Q

___ and ___ are two biochemical markers tested for neural tube defect

A

Alpha-fetoprotein and acetylcholinesterase

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31
Q

when the fetal urine production begins, what are the biochemical components of the amniotic fluid that will increase and will decrease?

A

since urine is involve, the nitrogen compound proptein will increase

creatinine, urea, and uric acid increase,

and glucose and protein will decrease

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32
Q

to distinguished amniotic fluid and maternal fluid, the level of creatinine and urea are much lower in amniotic fluid than in the normal urine

true or false

A

true

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33
Q

Creatinine does not exceed ___ and urea does not exceed ___ in amniotic fluid

A

3.5 mg/dL; 30 mg/dL

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34
Q

is glucose and protein a reliable indicator or marker for differentiating amniotic fluid and urine

A

nope as it is an uncommon urine constituent

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35
Q

what test also can differentiate amniotic fluid from urine and other body fluids.

A

The fern test

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36
Q

It is a test used to evaluate premature rupture of the membranes

A

fern test

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37
Q

how do fern test is conducted?

A

a vaginal fluid specimen is spread on a glass slide and allowed to completely air dry at room temperature; then it is observed microscopically. The presence of “fern-like” crystals due to the protein and sodium chloride content is a positive screen for amniotic fluid.

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38
Q

The presence of “______” crystals due to the
protein and sodium chloride content is a positive screen for amniotic fluid in the fern test

A

fern-like

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39
Q

is recommended for neural tube defects when screening blood tests such as the maternal serum alphafetoprotein test are abnormal or to detect genetic disorders or to evaluate the health of the fetus

A

amniocentesis

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40
Q

___ in amniotic fluid indicate the genetic material of the fetus and the biochemical substances that the fetus has produced.

A

Fetal epithelial cells

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41
Q

Biochemical substances produced by the fetus can be analyzed by ___to evaluate the health of the fetus

A

thin-layer chromatography

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42
Q

Amniocentesis may be indicated at ___ gestations to determine the

A

15 to 18 weeks

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43
Q

can we conduct amniocentesis in a mother aging 34 younger?

A

No, the mother’s age should be 35 or older at delivery

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44
Q

can we conduct amniocentesis if the patient’s family history has chromosome abnormalities such as trisomy 21 or down syndrome

A

yes,

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45
Q

can we conduct amniocentesis in if the parents carry an abnormal chromosome arrangement?

A

yes

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46
Q

can we conduct amniocentesis if the earlier pregancy has a birth defect?

A

yes

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47
Q

can we conduct amniocentesis if there’es an elevated maternal serum alpha-fetoprotein?

A

yes

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48
Q

can we conduct amniocentesis the patient has been in 3 or more miscarriage?

A

yes

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49
Q

Amniocentesis is indicated later in the pregnancy (20 to 42 weeks) to evaluate ___

A
  • Fetal lung maturity
  • Fetal distress
  • HDN caused by Rh blood type incompatibility
  • Infection
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50
Q

what can we perform in the Early (14-16 weeks) of pregnancy

A

Diagnosis of Genetic Diseases

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51
Q

what can we perform in the mid trimester of pregnancy

A

Bile Pigments level for HDN

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52
Q

what can we perform in the 3rd trimester of pregnancy

A

Renal maturity
Bile pigments level for HDN

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53
Q

Amniotic fluid is obtained by needle aspiration into the amniotic sac, a procedure called ___

A

amniocentesis

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54
Q

In amniocentesis, The procedure
most frequently performed is a ___

A

transabdominal amniocentesis.

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55
Q

Using continuous __ for guidance, the physician locates the fetus and placenta to safely perform the procedure

A

ultrasound

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56
Q

a type of amniocentesis may also
be performed; however, this method carries a greater risk of
infection.

A

Vaginal amniocentesis

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57
Q

A maximum of ____ of amniotic fluid is collected in sterile syringes

A

30 mL

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58
Q

The first ____mL collected can be contaminated
by maternal blood, tissue fluid, and cells and are DISCARDED.

A

2 or 3 ml

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59
Q

Fluid for bilirubin
analysis in cases of ____ must be protected from light at all times.

A

hemolytic disease of the newborn (HDN)

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60
Q

Fluid for fetal lung maturity (FLM) tests should be placed in____

A

ice for delivery to the laboratory and kept refrigerated

Can be kept for 72 hrs in refrigerator

Repeat freeze-thawing is not recommended

Filtration is recommended for this method to
prevent phospholipid loss

Transport with ice if for phospholipid
determination

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61
Q

is Repeat freeze-thawing recommended for the specimen used for fetal lung maturity test

A

No

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62
Q

In fetal lung maturity test, what is recommended for this method to
prevent phospholipid loss

A

filtration

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63
Q

in fetal lung maturity test, the sample should be transported with ____ if for phospholipid determination

A

ice

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64
Q

in cytogenetic studies, the sample must be maintained at ____ or at ____

A

room temperature or at body
temperature (25 or 37˚C)

65
Q

All fluid for chemical testing should be separated from cellular elements and debris as soon as possible to prevent distortion of chemical constituents by cellular metabolism or disintegration. This can be performed using ___ or __

A

centrifugation or filtration.

66
Q

NORMAL color of the amniotic fluid

A

colorless to pale yellow

67
Q

normal volume of amniotic fluid

A

1000-1500 mL at term (36 weeks)

68
Q

clinical correlation of the blood streak in amniotic fluid

A

traumatic tap
abdominal trauma
intra-amniotic hemorrhage

69
Q

The source of the blood (maternal or fetal) can be determined using the _____test for fetal hemoglobin and is important for further case management

A

Kleihauer-Betke

70
Q

clinical correlation of colored yellow amniotic fluid

A

hemolytic disease of the newborn (bilirubin)

71
Q

clinical correlation of the dark green colored amniotic fluid

A

meconium

72
Q

clinical correlation of the dark red-brown colored amniotic fluid

A

fetal death

73
Q

what is the normal color of the maternal urine

A

yellow

74
Q

creatinine value of amniotic fluid

A

3.5 mg/dl

75
Q

creatinine level of maternal urine

A

10 mg/dl

76
Q

urea level of amniotic fluid

A

30 mg/dl

77
Q

urea level of maternal urine

A

300 mg/dl

78
Q

is glucose and protein present in amniotic fluid?

A

yes

79
Q

is glucose and protein present in maternal urine?

A

nope

80
Q

surface fluids or surfactants of the fetal lung fluid

A

lecithin
sphingomyelin
phosphatidyl glycerol

81
Q

Primary surface liquid

A

lecithin

82
Q

a surfactants that is Produced at relatively low and constant rate
until 35th week of gestation

A

lecithin

83
Q

a surfactant that is Produced at constant rate after about 26th week
of gestation

A

sphingomyelin

84
Q

Essential fluid for adequate lung maturity

A

Phosphatidyl
glycerol

85
Q

a normal Lecithin/sphingomyelin ratio

A

Mature = >2.0

86
Q

normal Saturated phosphatidyl-choline value

A

> 500 ug/L

87
Q

an abnormal Lecithin/sphingomyelin ratio

A

Immature = <1.5
Transitional = 1.5-1.9

88
Q

how do hemolytic disease of the newborn starts?

A

when fetal red blood cells enter into the maternal circulation and stimulate the mother to produce antibodies to the antigen. When these antibodies present in the maternal circulation cross the placenta into the fetal circulation and bind to the antigen on the fetal cells, the cells are destroyed.

rbc ni fetal napunta sa circulation ni mother, mother creates antibodies for the fetal rbc. The antibody cross the placenta and attached to the rbc antigen of the fetal causing rbc degradation –> anemia

89
Q

rbc ni fetal napunta sa circulation ni mother, mother creates antibodies for the fetal rbc. The antibody cross the placenta and attached to the rbc antigen of the fetal causing rbc degradation –> anemia

this degradation results to a product of

A

unconjugated bilirubin in the amniotic fluid

90
Q

since there’s degradation of the fetal rbc happening in the HDN, the amount of ___ is can me measured and the extent of the hemolysis taking place can be determines as well as the danger of the anemia presents to the fetus may be assesed

A

unconjugated bilirubin

91
Q

Amniotic fluid bilirubin is measured by ___

A

spectrophotometric analysis using serial dilutions

92
Q

In amniotic bilirubin spectrophotometry for HDN,

When bilirubin is present, a rise in Optical Density is seen at ____nm because this is the wavelength of maximum bilirubin absorption.

A

450

93
Q

the difference in Optical Density, referred to as the absorbance difference at 450 nm (D A450), is then plotted on a __ to determine the severity of the hemolytic disease

A

Liley graph

94
Q

in HDN - bilirubin determination, Markedly decreased values will be obtained with as little as _____ minutes of exposure to light.

A

30 minutes

95
Q

in HDN - bilirubin determination,

Specimens contaminated with meconium will cause falsely ___D A450 values and are not acceptable for spectrophotometric analysis

A

low

96
Q

in HDN - bilirubin determination,

Specimens that are contaminated with blood are generally unacceptable because maximum absorbance of oxyhemoglobin occurs at ___nm and can interfere with the bilirubin absorption peak

A

410

97
Q

the interference such as fluid by cells, hemoglobin, and meconium as well as blood for the bilirubin test for HDN can be removed by ____

A

extraction with chloroform if necessary

98
Q

Measurement by spectrophotometric analysis and plotted in the lily curve

A

amniotic fluid bilirubin

99
Q

Amniotic Fluid Bilirubin spectophotometry

Normal: Optical density will rise at ___and will decrease linearly at ____

A

365nm ; 550nm

100
Q

in amniotic fluid bilirubin,

(+) Bilirubin: Optical density will be seen at ___ nm

A

450nm

101
Q

Amniotic Fluid Bilirubin is Elevated in ___ and ___

A

hemolytic disease of the newborn HDN and Erythroblastosis fetalis

102
Q

___ Plots A450 against gestational age

A

Liley Graph

103
Q

liley graph’s 3 zones based on hemolytic severity

A

o Zone I: Mildly affected fetus

o Zone II: Requires careful monitoring

o Zone III: Severely affected fetus, may require induction of labor or intrauterine exchange transfusion

104
Q

normal values of Bilirubin in 28 weeks

A

<0.075

105
Q

normal values of Bilirubin in 40 weeks

A

<0.025

106
Q

if the values of Bilirubin in 28 weeks is >0.075, it has a clinical correlation of

A

erythroblastosis hepatitis

107
Q

if the values of Bilirubin in 40 weeks is >0.025, it has a clinical correlation of

A

maternal infection
sickle cells

108
Q

Represent the measurement and reading of bilirubin from amniotic fluid plotted by spectrometer

A

liley’s curve

109
Q

Most common in Rh-negative mothers

A

hemolytic disease of the newborn

110
Q

Good indicator for the presence of infection in HDN in reagent strip

A

leukocyte esterase

111
Q

Neural Tube Defects can be detected by

A

maternal serum alpha-fetoprotein (MSAFP) blood test,

high resolution ultrasound

and amniocentesis

111
Q

wbc count if positive in HDN

A

> 50/ul

112
Q

are one of the most common birth defects in the United States

A

neural tube defects

113
Q

Increased levels of alpha-fetoprotein (AFP) in both the maternal circulation and the amniotic fluid can be indicative of fetal neural tube defects, such as ___ and ___

A

anencephaly and spina bifida.

113
Q

Increased levels of alpha-fetoprotein (AFP) in both the maternal circulation and the amniotic fluid can be indicative of ____

A

fetal neural tube defects

114
Q

___is the major protein produced by the fetal liver during early gestation (prior to 18 weeks).

A

Alpha feto-protein

115
Q

Increased levels are found in the maternal
serum and amniotic fluid when the skin fails to close over the ____, as occurs in anencephaly and spina bifida.

A

neural tissue

116
Q

The fetus produces maximal AFP between ___’ gestation, after which levels in amniotic fluid begin to decline.

A

12 and 15 weeks

117
Q

The
____is the laboratory’s reference level for a given week of gestation.

A

median

118
Q

Elevated amniotic fluid AFP levels are followed by measurement of ___.

A

amniotic acetylcholinesterase (AChE)

119
Q

___
The test is more specific for neural tube disorders than AFP

provided it is not performed on a bloody specimen, because blood contains AChE.

A

amniotic acetylcholinesterase (AChE)

120
Q

___, whether caused by HDN or other conditions, forces the obstetrician to consider a preterm delivery.

A

Fetal distress

121
Q

____: Confirmatory test for neural tube disorders

A

Acetylcholinesterase Test

122
Q

__is the most frequent complication of early delivery and is the seventh most common cause of morbidity and mortality in the premature infant

A

Respiratory distress syndrome (RDS)

123
Q

purpose of surfactants

A

Surfactant keeps the alveoli from collapsing by decreasing surface tension and allows them to inflate with air more easily.

124
Q

If the surfactant concentrations are too low, the alveoli will collapse, causing ___.

A

RDS - respiratory distress syndrome

125
Q

The incidence of RDS ___with increasing gestational age and lung maturity

A

decreases

126
Q

The amount of surfactant in fetal lungs can be estimated by measuring the ___

A

amount of surfactants in amniotic fluid

127
Q

The reference method to which tests of fetal lung maturity are compared is ___

A

lecithin-sphingomyelin (L/S) ratio

128
Q

___is the primary component of the surfactants (phospholipids, neutral lipids, and proteins) that make up the alveolar lining and account for alveolar stability

A

Lecithin

129
Q

Lecithin is produced at a relatively low and constant rate until the ___week of gestation

A

35th

130
Q

___is a lipid that is produced at a constant rate after about 26 weeks’ gestation

A

Sphingomyelin

131
Q

it can serve as a control on which to base the rise in lecithin.

A

sphingomyelin

132
Q

Prior to 35 weeks’ gestation, the L/S ratio is usually less than ___ because large amounts of lecithin are not being produced at this time

A

1.6

133
Q

after 35 weeks of gestation, lecithin concentration ___while the sphingomyelin concentration remains constant

A

increases

134
Q

from 1.6, the L/S ratio after 35 weeks of gestation will rise to

A

2.0 or higher as the lecithin production increases to prevent alveolar collapse.

135
Q

Therefore, when the L/S ratio reaches 2.0, a preterm delivery is usually considered to be a relatively safe procedure

true or false

A

true

136
Q

In L/S ratio test,

Falsely elevated results are encountered in fluid contaminated with __ or __ because both these substances contain lecithin and sphingomyelin

A

blood or meconium

137
Q

Quantitative measurement of lecithin and sphingomyelin is performed using ___

A

thin-layer chromatography (TLC).

138
Q

Because the procedure is labor intensive and subject to high coefficients of variation, many laboratories have replaced the L/S ratio with the quantitative ___ and ____ procedures.

A

phosphatidyl glycerol immunoassays

and

lamellar body density

139
Q

Analytical Error for L/S ratio

A

o Over centrifugation
o Blood Contamination
o Imprecision of TLC
o Meconium

140
Q

Essential for adequate fetal lung maturity

A

Phosphatidylglycerol and Phosphatidylinositol

141
Q

Immunological agglutination test for phosphatidyl glycerol

A

Amniostat FLM

142
Q

Provides rapid method for assessment of lung maturity

A

Amniostat FLM

143
Q

Mechanical screening test to measure the individual lung surface lipid concentration

A

Foam Test

144
Q

The production of ___normally parallels that of lecithin, but its production is delayed in cases of maternal diabetes

A

Phosphatidyl Glycerol

145
Q

The __ uses antisera containing polyclonal anti-PG antibodies that are specific for PG-containing lamellar bodies in the amniotic fluid

A

Aminostat-FLM

146
Q

test for fecal lung maturity that is not affected by specimen contamination with blood and meconium

A

Aminostat-FLM

147
Q

Until the development of biochemical techniques to measure the individual lung-surface lipid concentrations, a mechanical screening test, called the “_____ “ or “____” test, was used to determine their presence

A

foam” or “shake

148
Q

in foam shake test, what solution is used with a 95% concentration

A

ethanol

149
Q

in foam or shake test using 95% ethanol mixed with amniotic fluid, how many seconds is the solution shaken and stand after?

A

15 secs and allowed to sit undisturbed for 15 minutes

150
Q

an antifoaming agent used for shake or foam test

A

ethanol

151
Q

a positive result of shake or foam test for FTM

A

continuous line of bubbles around the outside edge

sufficient amount of phospholipid is available to reduce the surface tension of the fluid

152
Q

Surfactant is composed of approximately 90% phospholipid and 10% protein and is packaged into layered storage granules called ___

A

lamellar bodies

153
Q

__ are densely packed layers of phospholipids that represent a storage form of pulmonary surfactant

A

Lamellar bodies

154
Q

Lamellar bodies are secreted by the

A

type II pneumocytes of the fetal lung at about 24 weeks of gestation

155
Q

are absorbed into the alveolar spaces to provide surfactant

A

lamellar bodies

156
Q
A

AUBF (20 decks)

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