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A fluid that is present in the membranous sac (amnion) that surrounds the fetus
FUNCTIONS
1. Provide protective cushion for the fetus
2. Allows fetal movement
3. Stabilize the temperature to protect the fetus from extreme temperature changes
4. Permit proper lung development
5. Allow the exchange of water and chemicals between the fluid, fetus, and the maternal
circulation
FORMATION
Amniotic fluid is regulated by a balance between the production of fetal urine and lung fluid
absorption from fetal swallowing and intramembranous flow
Intramembranous flow- absorption of amniotic fluid water and solutes into the fetal
vascular system
The amount of amniotic fluid increases throughout pregnancy
-Reaches approximately 1L at the 3rd trimester
- Gradually decreases prior to delivery
1st trimester: 35 mL of amniotic fluid is derived primarily from the maternal circulation
Latter third to half of pregnancy: The fetus secretes a volume of lung liquid necessary to
expand the lungs with growth
- Fetal breathing movement: lung liquid enters the amniotic fluid which is evidenced by
lung surfactants that serve as index of fetal lung maturity
After the 1st trimester: Fetal urine is the major contributor to the amniotic fluid
At the time fetal urine production occurs, fetal swallowing of the amniotic fluid begins and
regulates the increase in fluid from the fetal urine
POLYHDYRAMNIOS
Excessive accumulation of amniotic fluid
Results from the failure of the fetus to swallow the fluid
Indicates fetal distress, often associated with neural tube defects
Also associated with fetal structural abnormalities, cardiac arrhythmias, congenital
infections or chromosomal abnormalities
OLIGOHYRAMNIOS
Decreased amniotic fluid
Results from increased fetal swallowing, urinary tract deformities, and membrane
leakage
Associated with umbilical cord compression, resulting in decelerated heart rate and fetal
death
CHEMICAL COMPOSITION
Placenta is the major source on amniotic fluid water and solutes
Has a similar composition to maternal plasma and contains a small amount of sloughed
fetal cells form the skin, digestive system, and urinary tract
- These cells provide the basis for cytogenetic analysis
Contains bilirubin, lipids, enzymes, electrolytes, nitrogenous compounds, and proteins
- Can be tested to determine the health or maturity of the fetus
A portion of the fluid comes from the fetal respiratory system, fetal urine, amniotic
membrane, and the umbilical cord
When fetal urine production begins, creatinine, urea, and uric acid increases while
glucose and protein decreases
The cells must be separated through centrifugation ASAP to prevent the consumption of
chemicals to be tested
COLOR AND APPEARANCE
Normal- colorless and may exhibit slight turbidity from cellular debris
Blood-streaked fluid- may be present as a result of traumatic tap, abdominal trauma, or
intra-amniotic haemorrhage
Yellow- presence of bilirubin and indicates RBC destruction
Green- First bowel movement of the fetus (Meconium)
Dark red-brown- Fetal death
*KLEIHAUER-BETKE- A test used to differentiate maternal blood from fetal blood
TESTS FOR FETAL DISTRESS
HEMOLYTIC DISEASE OF THE NEWBORN
The measurement of bilirubin in the fluid determines the extent of hemolysis, and the
danger that the anemia presents to the fetus may be assessed
Bilirubin measurement is performed by spectrophotometric analysis
The fluid is measured in intervals between 365nm and 550 nm
Normal fluid OD is highest at 365nm and decreases linearly to 550nm
When bilirubin is present, a rise in OD is seen at 450nm because this is the
wavelength of maximum bilirubin absorption
Maximum absorbance of oxyhemoglobin is at 410nm and can interfere with the
bilirubin absorption peak
The absorbance difference at 450nm is plotted on a Liley graph
LILEY GRAPH
Plots the absorbance change at 450nm against gestational age and is divided into
three zones that represent the extent of hemolytic disease
ZONE I- indicates no more than a mildly affected fetus
ZONE II- Require carefu monitoring
ZONE III- Suggests a severly affected fetus
Increased lamellar body is indicated by an increase in amniotic fluid phospholipid and L/S
ratio
Lamellar body increases the OD of amniotic fluid, it is examined at 650nm
An OD of 0.150 has been shown to correlate well with an L/S ratio equal to 2.0 and
presence of phosphatidyl glycerol
Lamellar body diameter is similar to that of small platelets: therefore lamellar body counts
(LBCs) can be obtained rapidly with use of platelet channel hematology analyzers