Question

A 28-year-old woman is pregnant for the second time, having miscarried a year ago. At the time she miscarried, she was working as a volunteer in Haiti and did not seek medical care. Her doctor is concerned that the baby that she is carrying now may have hemolytic disease due to Rh incompatibility. She also has diabetes. She has an increase in optical density at 450 nm on her amniotic fluid screen with a Liley graph reading of 0.6 and is approximately 34 weeks of gestation. Her L/S ratio was 2.1. The physician is considering inducing labor. Further testing of the amniotic fluid shows an FLM II reading of 55 mg surfactant/g of albumin.

Questions:

What is the patient's diagnosis?

What do the tests reveal? Why was the FLM II reading ordered in this case when the patient already had the L/S ratio performed?

Why is the physician considering inducing labor?

Answer 1

1 Rhesus -isoimmunized pregnancy.

2 The relation between lecithin/sphingomyelin ratios and the optical density suggests that the more rapidly obtainable optical density measurement could be used as a screening procedure for fetal pulmonary maturity.Fetal Lung Maturity is determined by measiring the amount of a substance called pulmonary surfactant on the surface of the lungs.The test makes use of probes that are equally able to bind to albumin,a protein in amniotic fluid and pulmonary surfactant.The more pulmonary surfactant is present ,the more the probes will bind to it instead of albumin..The ratio of how much probe is bound to pulmonary surfactant relative to how much is bound to albumin indicates the level of pulmonary surfactant aand hence fetal lung maturity.

3 if the amniotic fluid IL-6 ,a marker of inflammation ,is elevated ,the fetus is at high risk and delivery should be considered.