MT014-L1: ANALYSIS OF URINE AND BODY FLUIDS

LEARNING GUIDE: FINALS

1st Semester I S.Y 2022- 2023 Volume
Lecturer: Ms. Melissa B. Seriña, RMT

LESSON 13: AMNIOTIC FLUID  Regulated by the balance between the

FORMATION AND PHYSIOLOGY

Testing of amniotic fluid is necessary to:

 Get a glimpse of the metabolic processes taking

place during fetal maturation
 Gauge whether the fetus can survive an early Normal Volume
Gestational Period Volume
delivery
1st Trimester Approximately 60 mL
 Detect chromosomal abnormalities possibly (12 Weeks) (35 mL comes from
affecting the fetus maternal circulation)
2nd to 3rd Trimester 800 to 1,200 mL
Function (Peak) (Major contributor is
fetal urine)
Amniotic fluid functions to:

 Provide a protective cushion for the fetus

Intramembranous flow
 Allow fetal movement
 Stabilize temperature to protect the fetus from  Absorption of amniotic fluid water & solutes
extreme temperature changes into the fetal vascular system (blood)
 Permit proper lung development
Terms
Amnion Polyhydramnios Oligohydramnios
↑ AF volume (>1,200 mL) ↓ AF volume (<800 mL)
 A membranous sac that surrounds the fetus Causes Causes
 Made up of cuboidal cells involved in: ↓ Fetal swallowing of ↑ Fetal swallowing of
o Exchanges of water & chemicals urine urine
Neural tube defects Membrane leakage
between fluid, fetus, and maternal
Others Urinary tract
circulation
 Fetal structural abnormalities
o Production of peptides, growth factors, abnormalities Others
cytokines  Cardiac arrythmia  Congenital
 Congenital malformations
infections  Premature
 Chromosomal amniotic
abnormalities membrane
rupture
 Umbilical cord
compression

Color
Color Significance
Colorless Normal
Blood Streaked Traumatic tap
Abdominal trauma
Intra- amniotic hemorrhage
Yellow Hemolytic disease of newborn
(bilirubin)
Dark green Meconium
Dark red-brown Fetal death
 MT014-L1: ANALYSIS OF URINE AND BODY FLUIDS
LEARNING GUIDE: FINALS
1st Semester I S.Y 2022- 2023 o Protected from light (bilirubin) that may
Lecturer: Ms. Melissa B. Seriña, RMT
be present may photo oxidize, causing
SPECIMEN COLLECTION
F(-) result
 Method of collection: AMNIOCENTESIS  Chemical Test
o Needle aspiration o Separate cellular elements and debris
o May be safely done after the 14th week ASAP
of gestation
Test for Fetal Age
Gestation Period Indication
 Fetal age is determined through measuring
2nd Trimester  Assessment of GENETIC
CREATININE.
amniocentesis DEFECTS
 CHROMOSOME ANALYSIS  1.5 to 2 mg/dL = <36 weeks gestation
(e.g., detection of Trisomy  ≥ 2.0 mg/dL = 36 weeks
21/Down’s Syndrome)
3rd Trimester  Assessment of FETAL Test for HDN (Bilirubin Analysis)
amniocentesis LUNG MATURITY (FLM)
 AKA O.D. 450
 Detection of fetal
hemolytic disease  Optical density at 450 nm absorbance
(e.g., Hemolytic Disease of Fetus &  Results are plotted on a LILEY GRAPH
Newborn [HDFN])  Normal
o ↑ at 365 nm
o ↓ at 550 nm
Amniotic Fluid vs. Fetal Urine
Less Reliable Protein Pos Neg  HDN: ↑ at 450
Glucose Pos Neg
Interpretation of Results
Urea <30 >300
More (mg/dL)
reliable Creatinine <3.5 >10
(mg/dL)

Quadruple Screening Tests Prior to Performing

Amniocentesis

1. Alpha-fetoprotein (AFP)
2. Human Chorionic Gonadotropin (hCG)
3. Unconjugated estriol
4. Inhibin A

Specimen
Volume 30 mL (maximum)
Container Sterile Syringes Test for Neural Tube Defects (NTD)

1. Spina Bifida- “split spine”

Test Conducted  Incomplete closing of the backbone &
membranes around the spinal cord
 Fetal Lung Maturity Tests
2. Anencephaly
o Delivery: Placed in ice
 Absence of a major portion of the brain,
o Storage: Frozen or Refrigerated
scalp, & skull that occurs during
o Centrifugation: Low speed (500 to
embryonic development
1,000 g), for no longer than 5 minutes
 Screening Tests: ALPHA-FETOPROTEIN
 to prevent loss of phospholipids
(AFP)
 Cytogenetic Studies
o ↑ = NTD (Neural Tube Defects)
o Storage: Room Temp. or 37 degrees
o ↓ = Down Syndrome
celsius
 Confirmatory Test:
 To prolong the viability of cells
ACETYLCHOLINESTERAS
needed for analysis
 Test for HDN
 MT014-L1: ANALYSIS OF URINE AND BODY FLUIDS
LEARNING GUIDE: FINALS
1st Semester I S.Y 2022- 2023
Lecturer: Ms. Melissa B. Seriña, RMT

Test for Fetal Lung Maturity Tests for Fetal Well-Being and Maturity
Test Reference Significance
 Purpose: For assessing respiratory distress values at term
syndrome (RDS) Bilirubin scan ΔA450 >0.025 Hemolytic disease of
 RDS - caused by a deficiency in lung surfactant the fetus and
(phospholipids) production & immature lungs newborn
Alpha <2.0 MoM Neural tube
Tests Comments fetoprotein disorders
Lecithin / Reference Method: Lecithin ≥2.0 Fetal lung maturity
Sphingomyelin Ratio  Measured using Thin sphingomyelin
(L/S) Layer Chromatography ratio
(TLC) Amniostat- Positive Fetal lung maturity/
Can’t be done on spx  Ratio of >2.0 = mature FLM phosphatidylglycerol
contaminated by lungs Foam Stability ≥ 47 Fetal lung maturity
blood or meconium Index
Amniostat FLM Immunologic test for Optical ≥0.150 Fetal lung maturity
Phosphatidylglycerol density 650
Can be done on spx nm
contaminated by Production is delayed in Lamellar body ≥32,000/mL Fetal lung maturity
blood or meconium diabetic mothers count
Foam Stability Test Amniotic Fluid + 95% Ethanol
(Foam / Shake Test) → shake for 15 secs → stand
for 15 mins

(+) foam/bubbles = mature

lungs
Microviscosity Friction experienced by a
(Obsolete Test) particle undergoing diffusion
due to interaction with
environment

Phospholipids = decreases
microviscosity

Measured by Florescence
polarization
Lamellar Body Count Lamellar bodies = storage form
(LBC) of surfactants produced by
Type II monocytes

Lamellar body diameter =

similar to that of platelets

>32, 000/uL = Adequate FLM

Optical Density ↑ lamellar bodies = ↑O.D
650 nm
O.D of ≥ 0.150 = L/S Ratio of
2.0 and presence of
phosphatidylglycerol