FINALS - AMNIOTIC FLUID Flashcards
(159 cards)
1
Q
Amniotic Fluid is found in the ___ providing a cushion for protection (amnion)
A
membranous sac that surrounds the fetus called AMNION
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.
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
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
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
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
7
Q
what is the volume of the amniotic fluid During the first trimester
A
Amniotic fluid is derived from the MATERNAL CIRCULATION
(35mL)
8
Q
what is the major contributor of amniotic fluid after the first trimester
A
Urine is the major contributor of amniotic fluid
9
Q
after the first trimester, ____ starts to regulates the increase in fluid from the fetal urine
A
Fetal swallowing
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
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
12
Q
An amniotic fluid volume greater than ___ is called polyhydramnios,
A
1200 ml
13
Q
amniotic fluid volume less than___ is
termed oligohydramnios
A
800 mL
14
Q
Abnormal increase of the fluid volume
A
Polyhydramnios
15
Q
polyhydramnios is caused by the ___
A
Accumulation of amniotic fluid due to fetus’
failure to swallow the urine
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.
17
Q
Abnormal decrease amniotic fluid
A
Oligohydramnios
18
Q
Oligohydramnios is associated with what conditions
A
a. Umbilical cord compression
b. Decelerated heart rate
c. Fetal Death
19
Q
The ___ is the ultimate source of amniotic fluid water and solutes
A
placenta
20
Q
the sloughed fetal cells will provide the basis for the
A
cytogenetic analysis.
21
Q
the chemical composition of the amniotic fluid is similar to the composition of the ___
A
maternal plasma
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
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
24
Q
it is Used to determine fetal age
A
Amniotic Fluid Creatinine
25
Prior to 36 weeks of gestation, the creatine level is
1.5-2.0 mg/Dl
26
> 2,0 mg/dL creatinine will indicate the age of the fetus which is
this indicates >36 weeks gestation
27
the testing of amniotic fluid is frequently associated with ___
cytogenetic analysis
28
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
TRUE- cytogenetic analysis will measure kung kaya ba ni baby masurvive the premature delivery once there's a danger
29
which condition or defect allows the fetal cerebrospinal fluid to enter the amniotic
fluid directly.
Neural tube defects
30
___ and ___ are two biochemical markers tested for neural tube defect
Alpha-fetoprotein and acetylcholinesterase
31
when the fetal urine production begins, what are the biochemical components of the amniotic fluid that will increase and will decrease?
since urine is involve, the nitrogen compound proptein will increase
creatinine, urea, and uric acid increase,
and glucose and protein will decrease
32
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
true
33
Creatinine does not exceed ___ and urea does not exceed ___ in amniotic fluid
3.5 mg/dL; 30 mg/dL
34
is glucose and protein a reliable indicator or marker for differentiating amniotic fluid and urine
nope as it is an uncommon urine constituent
35
what test also can differentiate amniotic fluid from urine and other body fluids.
The fern test
36
It is a test used to evaluate premature rupture of the membranes
fern test
37
how do fern test is conducted?
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.
38
The presence of “______” crystals due to the
protein and sodium chloride content is a positive screen for amniotic fluid in the fern test
fern-like
39
is recommended for neural tube defects when screening blood tests such as when the maternal serum alphafetoprotein test are abnormal or to detect genetic disorders or to evaluate the health of the fetus
amniocentesis
40
used to estimate gestattional age of the fetus aside from the creatinine and provide assessment to the size and growth of the fetus
it can take the fetal body measurement as well
fetal ultrasonography
41
___ in amniotic fluid indicate the genetic material of the fetus and the biochemical substances that the fetus has produced.
Fetal epithelial cells
42
Biochemical substances produced by the fetus can be analyzed by ___to evaluate the health of the fetus
thin-layer chromatography
43
Amniocentesis may be indicated at ___ gestations to determine the early treatment or intervention
15 to 18 weeks
44
can we conduct amniocentesis in a mother aging 34 younger?
No, the mother's age should be 35 or older at delivery
45
can we conduct amniocentesis if the patient's family history has chromosome abnormalities such as trisomy 21 or down syndrome
yes,
46
can we conduct amniocentesis in if the parents carry an abnormal chromosome arrangement?
yes
47
can we conduct amniocentesis if the earlier pregancy has a birth defect?
yes
48
can we conduct amniocentesis if there'es an elevated maternal serum alpha-fetoprotein?
yes
49
can we conduct amniocentesis the patient has been in 3 or more miscarriage?
yes
50
Amniocentesis is indicated later in the pregnancy (20 to 42 weeks) to evaluate ___
* Fetal lung maturity
* Fetal distress
* HDN caused by Rh blood type incompatibility
* Infection
51
what can we perform in the Early (14-16 weeks) of pregnancy
Diagnosis of Genetic Diseases
52
what can we perform in the mid trimester of pregnancy
Bile Pigments level for HDN
53
what can we perform in the 3rd trimester of pregnancy
Renal maturity
Bile pigments level for HDN
54
Amniotic fluid is obtained by needle aspiration into the amniotic sac, a procedure called ___
amniocentesis
55
In amniocentesis, The procedure
most frequently performed is a ___
transabdominal amniocentesis.
56
Using continuous __ for guidance, the physician locates the fetus and placenta to safely perform the procedure
ultrasound
57
a type of amniocentesis may also
be performed; however, this method carries a greater risk of
infection.
Vaginal amniocentesis
58
A maximum of ____ of amniotic fluid is collected in sterile syringes
30 mL
59
The first ____mL collected can be contaminated
by maternal blood, tissue fluid, and cells and are DISCARDED.
2 or 3 ml
60
Fluid for bilirubin
analysis in cases of ____ must be protected from light at all times.
hemolytic disease of the newborn (HDN)
61
Fluid for fetal lung maturity (FLM) tests should be placed in____
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
62
is Repeat freeze-thawing recommended for the specimen used for fetal lung maturity test
No
63
In fetal lung maturity test, what is recommended for this method to
prevent phospholipid loss
filtration
64
in fetal lung maturity test, the sample should be transported with ____ if for phospholipid determination
ice
65
in cytogenetic studies, the sample must be maintained at ____ or at ____
room temperature or at body
temperature (25 or 37˚C)
66
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 __
centrifugation or filtration.
67
NORMAL color of the amniotic fluid
colorless to pale yellow
68
normal volume of amniotic fluid
1000-1500 mL at term (36 weeks)
69
clinical correlation of the blood streak in amniotic fluid
traumatic tap
abdominal trauma
intra-amniotic hemorrhage
70
The source of the blood (maternal or fetal) can be determined using the _____test for fetal hemoglobin and is important for further case management
Kleihauer-Betke
71
clinical correlation of colored yellow amniotic fluid
hemolytic disease of the newborn (bilirubin)
72
clinical correlation of the dark green colored amniotic fluid
meconium
73
clinical correlation of the dark red-brown colored amniotic fluid
fetal death
74
what is the normal color of the maternal urine
yellow
75
creatinine value of amniotic fluid
3.5 mg/dl
76
creatinine level of maternal urine
10 mg/dl
77
urea level of amniotic fluid
30 mg/dl
78
urea level of maternal urine
300 mg/dl
79
is glucose and protein present in amniotic fluid?
yes
80
is glucose and protein present in maternal urine?
nope
81
surface fluids or surfactants of the fetal lung fluid
lecithin
sphingomyelin
phosphatidyl glycerol
82
Primary surface liquid
lecithin
83
a surfactants that is Produced at relatively low and constant rate
until 35th week of gestation
lecithin
84
a surfactant that is Produced at constant rate after about 26th week
of gestation
sphingomyelin
85
Essential fluid for adequate lung maturity
Phosphatidyl
glycerol
86
a normal Lecithin/sphingomyelin ratio
Mature = >2.0
87
normal Saturated phosphatidyl-choline value
>500 ug/L
88
an abnormal Lecithin/sphingomyelin ratio
Immature = <1.5
Transitional = 1.5-1.9
89
how do hemolytic disease of the newborn starts?
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
90
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
unconjugated bilirubin in the amniotic fluid
91
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
unconjugated bilirubin
92
Amniotic fluid bilirubin is measured by ___
spectrophotometric analysis using serial dilutions
93
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.
450
94
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
Liley graph
95
in HDN - bilirubin determination, Markedly decreased values will be obtained with as little as _____ minutes of exposure to light.
30 minutes
96
in HDN - bilirubin determination,
Specimens contaminated with meconium will cause falsely ___D A450 values and are not acceptable for spectrophotometric analysis
low
97
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
410
98
the interference such as fluid by cells, hemoglobin, and meconium as well as blood for the bilirubin test for HDN can be removed by ____
extraction with chloroform if necessary
99
Measurement by spectrophotometric analysis and plotted in the lily curve
amniotic fluid bilirubin
100
Amniotic Fluid Bilirubin spectophotometry
Normal: Optical density will rise at ___and will decrease linearly at ____
365nm ; 550nm
101
in amniotic fluid bilirubin,
(+) Bilirubin: Optical density will be seen at ___ nm
450nm
102
Amniotic Fluid Bilirubin is Elevated in ___ and ___
hemolytic disease of the newborn HDN and Erythroblastosis fetalis
103
___ Plots A450 against gestational age
Liley Graph
104
liley graph's 3 zones based on hemolytic severity
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
105
normal values of Bilirubin in 28 weeks
<0.075
106
normal values of Bilirubin in 40 weeks
<0.025
107
if the values of Bilirubin in 28 weeks is >0.075, it has a clinical correlation of
erythroblastosis hepatitis
108
if the values of Bilirubin in 40 weeks is >0.025, it has a clinical correlation of
maternal infection
sickle cells
109
Represent the measurement and reading of bilirubin from amniotic fluid plotted by spectrometer
liley's curve
110
Most common in Rh-negative mothers
hemolytic disease of the newborn
111
Good indicator for the presence of infection in HDN in reagent strip
leukocyte esterase
112
Neural Tube Defects can be detected by
maternal serum alpha-fetoprotein (MSAFP) blood test,
high resolution ultrasound
and amniocentesis
113
wbc count if positive in HDN
>50/ul
114
are one of the most common birth defects in the United States
neural tube defects
115
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 ___
anencephaly and spina bifida.
116
Increased levels of alpha-fetoprotein (AFP) in both the maternal circulation and the amniotic fluid can be indicative of ____
fetal neural tube defects
117
___is the major protein produced by the fetal liver during early gestation (prior to 18 weeks).
Alpha feto-protein
118
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.
neural tissue
119
The fetus produces maximal AFP between ___’ gestation, after which levels in amniotic fluid begin to decline.
12 and 15 weeks
120
The
____is the laboratory’s reference level for a given week of gestation.
median
121
Elevated amniotic fluid AFP levels are followed by measurement of ___.
amniotic acetylcholinesterase (AChE)
122
___
The test is more specific for neural tube disorders than AFP
provided it is not performed on a bloody specimen, because blood contains AChE.
amniotic acetylcholinesterase (AChE)
123
___, whether caused by HDN or other conditions, forces the obstetrician to consider a preterm delivery.
Fetal distress
124
____: Confirmatory test for neural tube disorders
Acetylcholinesterase Test
125
__is the most frequent complication of early delivery and is the seventh most common cause of morbidity and mortality in the premature infant
Respiratory distress syndrome (RDS)
126
purpose of surfactants
Surfactant keeps the alveoli from collapsing by decreasing surface tension and allows them to inflate with air more easily.
127
If the surfactant concentrations are too low, the alveoli will collapse, causing ___.
RDS - respiratory distress syndrome
128
The incidence of RDS ___with increasing gestational age and lung maturity
decreases
129
The amount of surfactant in fetal lungs can be estimated by measuring the ___
amount of surfactants in amniotic fluid
130
The reference method to which tests of fetal lung maturity are compared is ___
lecithin-sphingomyelin (L/S) ratio
131
___is the primary component of the surfactants (phospholipids, neutral lipids, and proteins) that make up the alveolar lining and account for alveolar stability
Lecithin
132
Lecithin is produced at a relatively low and constant rate until the ___week of gestation
35th
133
___is a lipid that is produced at a constant rate after about 26 weeks’ gestation
Sphingomyelin
134
it can serve as a control on which to base the rise in lecithin.
sphingomyelin
135
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
1.6
136
after 35 weeks of gestation, lecithin concentration ___while the sphingomyelin concentration remains constant
increases
137
from 1.6, the L/S ratio after 35 weeks of gestation will rise to
2.0 or higher as the lecithin production increases to prevent alveolar collapse.
138
Therefore, when the L/S ratio reaches 2.0, a preterm delivery is usually considered to be a relatively safe procedure
true or false
true
139
In L/S ratio test,
Falsely elevated results are encountered in fluid contaminated with __ or __ because both these substances contain lecithin and sphingomyelin
blood or meconium
140
Quantitative measurement of lecithin and sphingomyelin is performed using ___
thin-layer chromatography (TLC).
141
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.
phosphatidyl glycerol immunoassays
and
lamellar body density
142
Analytical Error for L/S ratio
o Over centrifugation
o Blood Contamination
o Imprecision of TLC
o Meconium
143
Essential for adequate fetal lung maturity
Phosphatidylglycerol and Phosphatidylinositol
144
Immunological agglutination test for phosphatidyl glycerol
Amniostat FLM
145
Provides rapid method for assessment of lung maturity
Amniostat FLM
146
Mechanical screening test to measure the individual lung surface lipid concentration
Foam Test
147
The production of ___normally parallels that of lecithin, but its production is delayed in cases of maternal diabetes
Phosphatidyl Glycerol
148
The __ uses antisera containing polyclonal anti-PG antibodies that are specific for PG-containing lamellar bodies in the amniotic fluid
Aminostat-FLM
149
test for fecal lung maturity that is not affected by specimen contamination with blood and meconium
Aminostat-FLM
150
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
foam” or “shake
151
in foam shake test, what solution is used with a 95% concentration
ethanol
152
in foam or shake test using 95% ethanol mixed with amniotic fluid, how many seconds is the solution shaken and stand after?
15 secs and allowed to sit undisturbed for 15 minutes
153
an antifoaming agent used for shake or foam test
ethanol
154
a positive result of shake or foam test for FTM
continuous line of bubbles around the outside edge
sufficient amount of phospholipid is available to reduce the surface tension of the fluid
155
Surfactant is composed of approximately 90% phospholipid and 10% protein and is packaged into layered storage granules called ___
lamellar bodies
156
__ are densely packed layers of phospholipids that represent a storage form of pulmonary surfactant
Lamellar bodies
157
Lamellar bodies are secreted by the
type II pneumocytes of the fetal lung at about 24 weeks of gestation
158
are absorbed into the alveolar spaces to provide surfactant
lamellar bodies
159
