Maternal-Fetal-Medicine

To have a better discussion around this topic, let's start with a case presentation, and then we can have an open discussion around it in the comment section below..

" A 32-year-old white, G3P2, patient has a known complete previa in the setting of poorly controlled gestational diabetes and is carrying a male fetus. She is 35-37 weeks, with the uncertainty a result of her late entry to prenatal care and the possibility of an large for gestational age (LGA) baby because of her diabetes. An amniocentesis for lung maturity is recommended to aid with delivery planning. Curiously, although there is no transplacental passage of the needle, the amniotic fluid is noted to be slightly blood tinged.

The Lamellar count comes back within the hour at 42,000. Because of concern that this is not over the threshold value of 50,000 recommended for diabetic mothers and because results may be falsely increased, at least initially, by blood contamination, the decision is made to wait for L:S and PG results before delivery ( a cascade approach ).

Later that day, the L:S ratio is noted to be 1.9 and the PG is negative. Although the L:S may be falsely lowered by the presence of blood, it would be hard to imagine the ratio would be above 3.0, the value required in a diabetic patient. PG should not be affected by blood at all and the presence of PG ( or its equivalent such as LBC > 50,000 or L:S > 3.0 ) must be achieved to indicated delivery on the basis of pulmonary maturity in a diabetic. The decision is made to defer delivery and continue antepartum testing. Assuming no bleeding from the previa or fetal issues that would prompt delivery regardless of fetal lung maturity status, the amniocentesis will be repeated in 1 week. "

[ from ' Management of High-Risk Pregnancy' by John T. Queenan et al, 5th edition ]

Nice case.. isn't it !!

OK.. let's discuss FLM testing then in the comment section below..