AMNIOTIC FLUID RECORDING

Sometimes due to umbilical cord there is a compression that’s why it does not lessen the volume unit or increase but it decrease.

Decrease amniotic fluid volume affects the heart rate of the fetus which leads to fetal death.

Start of gestational period, there is an appropriate increase volume of the amniotic fluid and it is monitored if the 15 th – 18th week of gestation is
ready for collection and examination of amniotic fluid.

 There is many abnormalities in the fetus

 Medtech will not collect the amniotic fluid, only medical doctors

It does note only mean to insert syringe in the belly but with the means of
guided by ultrasound
- We cannot see anything in the belly
- We cannot assure we might prick the fetus
- Amniotic fluid might not be extracted but the maternal urine

TEST DIFFERENTIATING AMNIOTIC FLUID AND MATERNAL

URINE
 Fern test
 Kleihauer becket test- used to determine whether the source of blood is maternal blood or fetal blood. When amniotic sample contains
blood

EXAMINATION FOR BILIRUBIN

- We have to consider the hemolysis that will occur

- Measurement of bilirubin in the amniotic fluid
- Using spectrophotometric analysis

EXAMINATION FOR AFP

- Increase AFP in the circulation of the mother and also in the amniotic fluid where there is a fetal neural tube defect:
 The fetus is suffering from the spina bifida, the level of alpha feto protein increases
 AFP protein produced by the fetal liver. Measured by 15 th – 18th week
- ACHE test- considered as specific test to detect neural tube disorder
-avoid using bloody specimen (in blood, ACHE is high in content because blood gives high level
- Respiratory distress syndrome- frequent complication in early delivery

To determine if the baby is ready to love outside the mother’s womb, there are examinations done which are:

 RDS
 FLM (Fetal Lung Maturity)

In completion of gestational period, the lungs of the fetus develops until such time.

Back tap to open the airways of the lungs of the baby.

Inside the amniotic sac enclosed with amniotic fluid, we can live because of the connection of the mother on the fetus with the presence of
placenta or the nutrients passage.

The volume of amniotic fluid inside the amniotic sac is estimated with an examination if its increase/decrease with abnormalities.

ERYTHROBLASTOSIS FETALIS or “Hemolytic disease of new

born” - Erythroblastosis fetalis is hemolytic anemia in the
fetus caused by transplacental transmission of maternal
antibodies to fetal red blood cells, usually due to
incompatibility between maternal and fetal blood groups,
often Rho(D) antigens
What is triggered in this disease? When does this occur?
 Our concern is the 2 blood groups, in the case of
blood transmission, major blood groups which is ABO
are classified as type A, B, O, AB while minor blood
groups which is RH is classified as RH+ and RH-
 It has been found that concussions or white people
like americans and Europeans, 85% of them are RH-
 and about 15% of them are RH+.
 Asians are 85% RH+ and 15% are RH-
 If the major blood group are compatible but the
minor blood group are not compatible, we cannot
share blood for transmission such as the case when
you are a filipino having RH+ blood and you will get
an RH- blood from an American as donor, it is not
possible because it is incompatible.
 Female is RH- and the male is RH+, the expected
offspring will inherit from the female
 If the fetus is going to inherit the RH group of the
father, which is RH+ and the mother is RH- while the
fetus is inside the womb, the blood if the fetus or red
cells can act as an antigen to the mother because
they are not compatible. The immune system of the
mother will try to produce antibodies that fights
against the antigen. This case is like the mother is
beating up its own baby the reason why after
delivery the baby is color blue or called as “blue
baby” or eryhtroblastosis fetalis.
 Erythroblastisis fetalis is a case of haemolytic disease
of a newborn. The mother develops the antibodies to
the antigen on the fetal red cells and therefor it is
going to cause distraction on the fetal red blood cells
that’s why after delivery the baby has bruises-like on
the body or “blue baby”.
 To prevent the same case on happening to the next
pregnancy, the doctor will administer an injection of
the rhogam to the mother to increase the incidence
of HDN or Hemolytic disease of the newborn
(erythroblastisis fetalis)
 Previously, relatives should be the donor for blood
transfusion but recently, it is found out that it should
be from the relatives
 In Early or premature delivery (gestation did not
reached until 280 days), the baby’s life depends on
its lungs capability to work outside of the mother’s
womb. Examination will be done in FLM (fetal lung
maturity), LS ratio (lecithin sphingomyelin ratio) to
determine if the lungs is ready to work outside the
womb.
The parents have to decide whether they will consent the examination procedure of the amniotic fluid.

15th-18th weeks gestation is preferred by couples to for early examination.

Amniocentesis is done to know if there is an abnormality like in the case of Down syndrome.

HDN, RPS, LS ratio, Fluorescence polarization immunoassay is done in amniocentesis.

The use of liley graph to determine the severity of haemolytic disease. Whether the fetus is mildly affected or needs careful monitoring or even the
condition is severely affecting the fetus.

Cases wherein the fetus is delayed in delivery especially when the women does not have any signs of labour instead it depends now on the
physician on how it will be determined if the baby is ready to be delivered out, examination included is cs (caesarean).

The presence of the waste material in the fetus will poison the mother and the fetus which requires treatment on the fetus and mother.

The meconium or the 1st bowel movement of the baby can also cause fetal intestinal secretions. It is resulting from the fetal intestinal secretions
which can affect the life of both mother and fetus.
 SYNOVIAL FLUID
- This is found in the cavities surrounding the movable joints (knee)
- The knee has cavity which is full of synovial fluid so that the femur, tibia and fibula will not hit each other but the ends will slide while
walking or running causing it to be painful.
- Examinations are done by medtechs

There are cells to be identified:

-RA cells or Ragocytes, this are neutrophils having dark

cytoplasmic granules containing immune complexes.
-LE cell, another neutrophil containing the characteristic
ingested neutrophils or ingested round bodies.
-Reiter cell, vaculated macrophage containing ingested
neutrophils.
Conditions on the joints: determining whether it is a case of goutly arthritis or pseudo gout

 Gout- observe the presence of MSU or mono sodium urate or uric acid.
 Pseudo gout- detect the presence of calcium pyrophosphate.

Microbiologic examination
- Identify the bacteria. Whether it is haemophilus sp. Or Neisseria gonorrhoea or staphylococcus or streptococcus
- Culture is usually done in microbiology section using the required enrichment medium.
- Consider the kind of bacteria that you are going to culture to allow it to grow. Different organisms have different requirements for
growth. If you cannot provide it, they will not grow.
- Since the identification is needed especially for diagnosis and treatment, requirements are needed to supply.
- Nutritional requirement sometimes needs blood. That’s why we are preparing enrichment medium like chocolate and blood agar.
- In synovial fluid, if bacteria is involved it must be identified. Provide the required nutrients for the organisms for it to grow and identify it.

CHOCOLATE AGAR PLATE PREPARATION:

 Mix the blood to the agar while it is still hot.

 It is not solidified after autoclaving or sterilization, extract blood from the donor then mix it to the hot cultured media.
 In this way, if it is hot, the blood be cooked.
 End result is chocolate brown.

BLOOD AGAR PLATE PREPARATION:

 Mix blood on the agar, allow the agar to cool a little bit so that the blood will not be cooked but the red color will be retained only
 When the agar has been dispensed in the petri dish, if it cools down and solidified, the red color is still present.

TERMINOLOGIES:

Serous fluid:

- Pleural
- Pericardial
- Peritoneal fluid

For the collection:

- Thoracentesis
- Pericardiocentesis
- Paracentesis

Usually the other body fluids, some of this require the addition of anticoagulants to prevent coagulation of the fluid, depending on where this
particular specimen will be examined and what the tests are like:

- Heparin, for serous fluids used to contain specifically for the purposes of doing chemical, serologic, microbiological and cytological
analysis.

Some specimens do not need anticoagulants instead the specimen can be exposed in cold temperature where ice is used to expose the specimen
for pH detection.

Manner to determine/identify transudate and exudates:

Exudates- contains pus. They have color yellow or green. Transudates-colorless and no pus.