Confirming diagnosis Alkaline pH of fluid collected from the posterior fornix turns Nitrazine paper deep blue. (The presence of blood can give a false-positive result.) If a smear of fluid is placed on a slide and allowed to dry, it takes on a fernlike pattern due to the high sodium and protein content of amniotic fluid.
Staining the fluid with Nile blue sulfate reveals two categories of cell bodies. Blue-stained bodies represent shed fetal epithelial cells, while orange-stained bodies originate in sebaceous glands. Incidence of prematurity is low when more than 20% of cells stain orange.
Physical examination also determines the presence of multiple pregnancies. Fetal presentation and size should be assessed by abdominal palpation (Leopold’s maneuvers).
Other data determine the fetus’s gestational age:
❑ historical: date of last menstrual period, quickening
❑ physical: initial detection of unamplified fetal heart sound, measurement of fundal height above the symphysis, ultrasound measurements of fetal biparietal diameter
❑ chemical: tests on amniotic fluid, such as the lecithin-sphingomyelin (L/S) ratio (an L/S ratio greater than 2 indicates pulmonary maturity); foam stability (shake test) also indicates fetal pulmonary maturity. Presence of phosphatidylglycerol (PG) in the fluid indicates that respiratory distress is unlikely.
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Source: Professional Guide to Diseases (Eighth Edition), 2005
Premature labor:
Diagnosis
(Professional Guide to Diseases (Eighth Edition))
Premature labor is confirmed by the combined results of prenatal history, physical examination, presenting signs and symptoms, and ultrasonography (if available) showing the fetus’position in relation to the mother’s pelvis. Vaginal examination confirms progressive cervical effacement and dilation.
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Source: Professional Guide to Diseases (Eighth Edition), 2005
Abruptio placentae:
Diagnosis
(Handbook of Diseases)
Diagnostic measures for abruptio placentae include observations of signs and symptoms, pelvic examination (under double setup), and ultrasonography to rule out placenta previa.
CLINICAL TIP: If a clot can be seen by ultrasound just under the placenta, delivery is generally advisable.
Decreased hemoglobin (Hb) levels and platelet counts support the diagnosis. Periodic assays for fibrin split products aid in monitoring the progression of abruptio placentae and detecting the development of DIC.
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Source: Handbook of Diseases, 2003
Premature rupture of the membranes:
Diagnosis
(Handbook of Diseases)
Characteristic passage of amniotic fluid confirms PROM. Physical examination shows amniotic fluid in the va-gina. Examination of this fluid helps determine appropriate management. For example, aerobic and anaerobic cultures and a Gram stain from the cervix reveal pathogenic organisms and indicate uterine or systemic infection. The alkaline pH of fluid collected from the posterior fornix turns nitrazine paper deep blue. (The presence of blood can give a false-positive result.) If a smear of fluid is placed on a slide and allowed to dry, it takes on a fernlike pattern due to the high sodium and protein content of amniotic fluid.
Staining the fluid with Nile blue sulfate reveals two categories of cell bodies. Blue-stained bodies represent shed fetal epithelial cells; orange-stained bodies originate in sebaceous glands. The incidence of prematurity is low when more than 20% of cells stain orange.
Physical examination also determines the presence of multiple pregnancies. Fetal presentation and size should be assessed by abdominal palpation (Leopold’s maneuvers).
Other data determine the fetus’s gestational age:
❑ historic: date of last menstrual period, quickening
❑ physical: initial detection of unamplified fetal heart sound, measurement of fundal height above the symphysis, ultrasound measurements of fetal biparietal diameter
❑ chemical: tests on amniotic fluid such as the lecithin-sphingomyelin (L/S) ratio (an L/S ratio greater than 2.0 indicates pulmonary maturity); foam stability (shake test) also indicates fetal pulmonary maturity.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
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