M5: Amniotic Fluid (Part 1: Physiology) Flashcards by Geno Alinsub

T or F

Although the testing of amniotic fluid is frequently associated with microscopic analysis, the clinical laboratory also performs several significant tests on amniotic fluid

F (Although the testing of amniotic fluid is frequently associated with cytogenic analysis, the clinical laboratory also performs several significant tests on amniotic fluid

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Amniotic fluid is a product of ?

fetal metabolism

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Amniotic fluid is a product of fetal metabolism that provide information about metabolic processes taking place when?

(2)

During
Progress of fetal maturation

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PHYSIOLOGY

Is present in the amnion which is a membranous sac that surrounds the fetus

Amniotic fluid

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PHYSIOLOGY

A membrane composed of cuboidal cells
Metabolically active and is involved in the exchanges of water and chemicals between the fluid, the fetus, and the maternal circulation
Produces peptides, growth factors, and cytokines

Amnion

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PHYSIOLOGY

Amnion is a mebrane composed of what cells?

cuboidal cells

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PHYSIOLOGY

T or F

Amnion is metabollically active and is involved in exchanges of plasma and chemicals between the fluid, fetus and maternal circulation

F (involved in exchanges of water and chemicals between the fluid)

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PHYSIOLOGY

Amnion, involved in exchange of water and chemicals occurs between what (3) components?

fluid
fetus
maternal circulation

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PHYSIOLOGY

Amnion produces what (3) constituents?

Peptides
Growth factor (GF)
Cytokines

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PHYSIOLOGY

Familiarize the primary functions of amniotic fluid

Provide a protective cushion for the fetus
Allow fetal movement
Stabilize the temperature to protect the fetus from extreme temperature changes
Permit proper lung development

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PHYSIOLOGY

Which does not belong to primary functions of amniotic fluid

i. Provide a protective cushion for the fetus
ii. Restricts fetal movement
iii. Stabilize the temperature to protect the fetus from extreme temperature changes
iv. Delays proper lung development

a. i, ii, iv
b. i and iii only
c. i, ii, iii, iv
d. ii, iv only
e. none

d. ii, iv only

ii. Restricts fetal movement - amniotic fluid allows fetal movement

iv. Delays proper lung development amniotic fluid permits flung development

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VOLUME

regulated by a balance between
the production of fetal urine and lung fluid and the absorption from fetal swallowing and intramembranous flow.

Amniotic fluid volume

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VOLUME

Amniotic fluid volume is regulated by a balance between:

(1) production of (blank) and (blank)

sorry nabubura pag underscore

production of fetal urine and lung fluid

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VOLUME

Amniotic fluid volume is regulated by a balance between:

(2) (blank) from fetal swallong

sorry nabubura pag underscore

absorption from fetal swallowing

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VOLUME

Amniotic fluid volume is regulated by a balance between:

(3) (blank) flow

sorry nabubura pag underscore

intramembranous flow

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VOLUME

is the absorption of amniotic fluid
water and solutes into the fetal vascular system

Intramembranous flow

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VOLUME

What happens to the volume of amniotic fluid as fetus grows

Volume increases

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VOLUME

T or F

Amniotic fluid volume decrease = fetus further grows

F (amniotic fluid volume increase = fetus further grows

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Volume of AF at 12 weeks of gestation?

60 mL

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T or F

The amount of amniotic fluid increases in quantity throughout pregnancy

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VOLUME

The amount of amniotic fluid increases in quantity throughout pregnancy, reaching a peak of what volume range during 3rd trimester

800-1,200 mL

this then gradually decreases prior to delivery

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VOLUME

Amniotic fluid increases or decreases prior to delivery of baby?

decreases

palabas na

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VOLUME

(Polyhydramnios or Oligohydramnios?)

Amniotic fluid volume
greater than 1200 ml

Failure of the fetus to begin
swallowing

Seen in:
* fetal distress/fetal structural anomalies
* cardiac arrythmias
* neutral tube disorders/defects
* congenital infections
* chromosome abnormalities

Polyhydramnios

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VOLUME

(Polyhydramnios or Oligohydramnios?)

Amniotic fluid volume
less than 800 ml

Increased AF swallowing

Seen in:
* premature rupture of amniotic membrane
* urinary tract deformities
* membrane leakage
* congenital malformations
* umbilical cord compression

Oligohydramnios

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# VOLUME (Polyhydramnios or Oligohydramnios?) Amniotic fluid volume greater than 1200 ml

Polyhydramnios

# VOLUME (Polyhydramnios or Oligohydramnios?) Failure of the fetus to begin swallowing

Polyhydramnios ## Footnote kasi masyadong marami na

# VOLUME (Polyhydramnios or Oligohydramnios?) fetal distress/fetal structural anomalies

Polyhydramnios

# VOLUME (Polyhydramnios or Oligohydramnios?) cardiac arrythmias

Polyhydramnios

# VOLUME (Polyhydramnios or Oligohydramnios?) neutral tube disorders/defects

Polyhydramnios

# VOLUME (Polyhydramnios or Oligohydramnios?) congenital infections

Polyhydramnios

# VOLUME (Polyhydramnios or Oligohydramnios?) chromosome abnormalities

Polyhydramnios

# VOLUME (Polyhydramnios or Oligohydramnios?) Amniotic fluid volume less than 800 ml

Oligohydramnios

# VOLUME (Polyhydramnios or Oligohydramnios?) Increased AF swallowing

Oligohydramnios | kasi onti lang af so need niya more, hence iincrease niya pagswallow ## Footnote sana all

# VOLUME (Polyhydramnios or Oligohydramnios?) premature rupture of amniotic membranes

Oligohydramnios

# VOLUME (Polyhydramnios or Oligohydramnios?) premature rupture of amniotic membranesurinary tract deformities

Oligohydramnios

# VOLUME (Polyhydramnios or Oligohydramnios?) membrane leakage

Oligohydramnios

# VOLUME (Polyhydramnios or Oligohydramnios?) congenital malformation

Oligohydramnios

# VOLUME (Polyhydramnios or Oligohydramnios?) umbilical cord compression

Oligohydramnios

# VOLUME * approximately 35 mL of amniotic fluid is derived primarily from the maternal circulation | What stage of pregnancy

1st trimester

# VOLUME 1st trimester a. 35 ul of AF b. derived from maternal circulation c. both d. NOTA

b. derived from maternal circulation | **a should be 35 mL** of AF to be correct

# VOLUME * fetus secretes a volume of lung liquid necessary to expand the lungs with growth | What stage of pregnancy

2nd trimester or latter third to half of pregnancy

# VOLUME During each episode of fetal respiratory movement what process occurs which then (1) bathes lungs (2) wash pumonary and alveolar content

lung movement of fetus secretes lung liquid and enters amniotic fluid ## Footnote which then (1) bathes lungs (2) wash pumonary and alveolar content

# VOLUME Each episode of fetal respiratory movement secretes lung liquid enetrs amniotic fluid which a. bathe lungs b. wash pulmonary and alveolar contents (such as lecithin, sphingomyelin, phosphatidyl glycerol) c. both d. NOTA

c. both

# VOLUME What pulmonary and elveolar contents does lung liquid wash?

lecithin, sphingomyelin, and phosphatidyl glycerol ## Footnote into the amniotic fluid surrounding the fetus

# VOLUME These (3) lung surfactants serve as an index of fetal lung maturity

lecithin, sphingomyelin, and phosphatidyl glycerol

# VOLUME * fetal urine is the major contributor to the amniotic fluid volume * Fetal swallowing of the amniotic fluid begins and regulates the increase in fluid from the fetal urine | What stage of pregnancy

After the first trimester

# VOLUME After the first trimester, this is the major contributor to the amniotic fluid volume

fetal urine

# VOLUME This act regulates the increase in fluid from the fetal urine

Fetal swallowing | of amniotic fluid

# VOLUME T or F The fetus swallows amniotic fluid, which is absorbed through the gastrointestinal tract and reexcreted by the kidneys from the blood into fetal urine and back into amniotic fluid

T | kadiri

# CHEMICAL COMPOSITION is the ultimate source of amniotic fluid water and solutes

placenta

# CHEMICAL COMPOSITION Amniotic fluid has a composition similar to that of what, which contains a small amount of sloughed fetal cells from the skin, digestive system, and urinary tract.

composition similar to **maternal plasma**

# CHEMICAL COMPOSITION * has a composition similar to that of the maternal plasma * contains a small amount of sloughed fetal cells from the skin, digestive system, and urinary tract

Amniotic fluid

# CHEMICAL COMPOSITION Part of composition of amniotic fluid which provide the basis for cytogenetic analysis | clue: cyto

Sloughed cells

# CHEMICAL COMPOSITION Familiarize the biochemical substances produced by fetus that are in amniotic fluid

bilirubin, lipids, enzymes, electrolytes, urea, creatinine, uric acid, proteins, hormones

# CHEMICAL COMPOSITION Condition which allow fetal cerebrospinal fluid to enter the amniotic fluid directly

Neural tube defects

# CHEMICAL COMPOSITION (2) biochemical markers for neural tube defects

Alpha-fetoprotein, Acetylcholinesterase

# CHEMICAL COMPOSITION T or F A portion of the fluid arises from the fetal respiratory tract, fetal urine, the amniotic membrane, and the umbilical cord

# CHEMICAL COMPOSITION The chemical composition of amniotic fluid changes when what begins?

when fetal urine production begins

# CHEMICAL COMPOSITION When fetal urine production begins, themical composition of amniotic fluid changes, what the the components that are increased?

* Creatinine * Urea * Uric acid | CUU

# CHEMICAL COMPOSITION When fetal urine production begins, themical composition of amniotic fluid changes, what the the components that are decreased?

* Glucose * Protein

# CHEMICAL COMPOSITION These components are affected as fetal urine production begins a. creatinine, urea, uric acid b. glucose and protein c. electrolytes, enzymes, hormes, metabolic end products d. all e. NOTA

d. all ## Footnote electrolytes, enzymes, hormes, metabolic end products but are of little clinical significance ok?

# CHEMICAL COMPOSITION Measurement of amniotic fluid creatinine has been used to determine?

fetal age

# CHEMICAL COMPOSITION * This is when amniotic fluid creatinine level ranges between 1.5 and 2.0 mg/dL | fetal age

before 36 weeks’ gestation

# CHEMICAL COMPOSITION * This is when amniotic fluid rises above 2.0 mg/dL | fetal age

greater than 36 weeks

# DIFFERENTIATING MATERNAL URINE FROM AMNIOTIC FLUID Differentiating maternal urine from amniotic fluid is important to dtermine what (2)

* possible premature membrane rupture * accidental puncture of maternal bladder during specimen collection

# DIFFERENTIATING MATERNAL URINE FROM AMNIOTIC FLUID What are the (4) parameters in chemical analaysis which helps to differentiate maternal urine from amniotic fluid?

Creatinine, Urea, Glucose, Protein

# DIFFERENTIATING MATERNAL URINE FROM AMNIOTIC FLUID Maternal fluid or Amniotic fluid? Creatinine: As high as 10 mg/dL Urea: As high as 300 mg/dL Glucose and Protein: Not present in normal circumstances pH: Acidic

Maternal urine

# DIFFERENTIATING MATERNAL URINE FROM AMNIOTIC FLUID Maternal fluid or Amniotic fluid? Creatinine: <3.5 mg/dL Urea: <30 mg/dL Glucose and Protein: More commonly seen under normal circumstances pH: Alkaline

Amniotic fluid

# DIFFERENTIATING MATERNAL URINE FROM AMNIOTIC FLUID Maternal fluid or Amniotic fluid? Levels of creatinine and urea are much lower in?

Amniotic fluid

# DIFFERENTIATING MATERNAL URINE FROM AMNIOTIC FLUID T or F Measurement of glucose and protein by a reagent strip is a reliable indicator

F (Measurement of glucose and protein by a reagent strip is a **less reliable** indicator) ## Footnote because glucose and protein are not uncommon urine constituents during pregnancy

# DIFFERENTIATING MATERNAL URINE FROM AMNIOTIC FLUID What are the 3 tests used to diagnose PROM ? | PREMATURE RUPTURE OF MEBRANES

1. pH test 2. Nitrazine test 3. Biomarker testing

# DIFFERENTIATING MATERNAL URINE FROM AMNIOTIC FLUID * Can differentiate amniotic fluid from urine and other body fluids * Used to evaluate premature rupture of the membranes * a vaginal fluid specimen is spread on a glass slide and allowed to completely air dry at room temperature; then it is observed microscopically * presence of “fern-like” crystals due to the **protein** and **sodium chloride** content is a positive screen for amniotic fluid | Test

Fern test

Specimen used in fern test?

Vaginal fluid specimen ## Footnote spread on a glass slide and allowed to completely air dry at room temperature; observed microscopically

Fern-like crystals are seen in fern test due to presence of what (2) components?

Protein, Sodium chloride fluid | a positive screen for amniotic fluid

* A test for pH * If the pH of the fluid being tested turns blue, the pH is greater than 6 and it suggests that the membrane has ruptured | test

Nitrazine test

Positive result for nitrazine?

change to Blue color ## Footnote suggests membrane has ruptured

Vaginal fluid or amniotic fluid? pH test: 4.5 - 6.0 NItrazine: Negative Fern test: Non-appearance of fern like crystal

Vaginal fluid

Vaginal fluid or amniotic fluid? pH test: 7.1 - 7.3 NItrazine: Positive Fern test: Appearance of fern like crystal

Amniotic fluid

WHat are the (3) biomarker testing in amniotic fluid

* AmniSure ROM * Actim Prom * ROM Plus

Priciple: Immunochromatogrpahic test Biomarkers: Placental alpha macroglobulin (PAMG-1) | (3) biomarker testing in amniotic fluid

AmniSure ROM

Priciple: Rapid immunoassay point-of-care test Biomarkers: Insulin-likegrowth factor binding protein-1 (IGFBP-1) Placental protein 12 (pP12) | (3) biomarker testing in amniotic fluid

Actim PROM

Priciple: Immunoassay Biomarkers: Alpha-fetoprotein (AFP) IGFBP-1

ROM Plus

Biomarker: IGFBP-1 A. Actim PROM b. ROM Plus c. both d. NOTA

c. both

M5: Amniotic Fluid (Part 1: Physiology) Flashcards

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