Amniotic Fluid Analysis
Also known as:Amniocentesis; Amnio; Culture - amniotic fluid; Culture - amniotic cells; Fetal Lung Maturity Tests
Formal name:Amniotic Fluid Analysis
Related tests:Second Trimester Maternal Serum Screening; Blood Typing; Bilirubin; First Trimester Down Syndrome Screen; Chorionic Villus Sampling; fFN; Chromosome Analysis
Why Get Tested?
To detect and diagnose certain birth defects, genetic diseases, and chromosomal abnormalities in a fetus, especially if maternal serum screening tests are abnormal; to evaluate fetal lung maturity when there is an increased risk of premature delivery; sometimes to diagnose a fetal infection; occasionally to help diagnose and monitor hemolytic disease in a fetus
When to Get Tested?
Between 15 and 20 weeks of gestation to test for genetic diseases, chromosomal abnormalities, and open neural tube defects; after 32 weeks to evaluate fetal lung maturity; when it is suspected that a fetus has an infection or other illness; serially, about every 14 days, when it is suspected that a pregnant woman has an Rh or other blood type incompatibility with her fetus
A sample of amniotic fluid obtained using a procedure called amniocentesis
Test Preparation Needed?
You may be instructed to have either a full or empty bladder prior to amniocentesis, depending on when during your pregnancy the testing is being performed; follow any instructions you are given.
How is it used?
Amniotic fluid analysis may used for several different purposes and the specific testing that is done depends on the reason for testing. The following list includes some of the more common ways that this analysis may be used:
To detect chromosomal abnormalities or genetic disorders
- Chromosome analysis, a cytogenetics test that may also be called karyotyping. Chromosome analysis will detect chromosomal abnormalities associated with a variety of disorders. It evaluates the 22 paired chromosomes and the sex chromosomes (X, Y) in the nucleus of cells cultured from those collected in the sample of amniotic fluid and can be used to diagnose a variety of disorders, including:
- Down syndrome (Trisomy 21), caused by an extra chromosome 21 in all or most cells of the body
- Edwards syndrome (Trisomy 18), associated with severe mental retardation; caused by an extra chromosome 18
- Patau syndrome (Trisomy 13), caused by an extra chromosome 13
- Klinefelter syndrome, the most common sex chromosome abnormality in males; caused by an extra X chromosome
- Turner syndrome, caused by missing one X chromosome in females
- Due to the nature of this type of testing, chromosome analysis can also definitively determine the sex of a fetus.
- Genetic testing, also called molecular testing. It looks at fetal DNA to identify specific gene mutations and diagnose a variety of inherited diseases. Each test is ordered separately based upon the parents' personal and family histories. If a specific gene mutation is known to be present in the mother's or father's family, then that specific gene mutation can be tested for. While there are hundreds of genetic tests that can be performed, only a few are associated with relatively common disorders. Typically, only the most common mutations are tested; therefore, a fetus could still have an inherited disorder even though genetic testing did not identify one. A few examples of genetic tests more frequently performed include those for:
- Cystic fibrosis
- Tay-Sachs disease
- Canavan disease
- Familial dysautonomia
- Sickle cell anemia
To detect birth defects
Testing for open neural tube defects (NTDs), such as spina bifida or anencephaly, detects chemicals that may be present in abnormal quantities when a fetus has an anatomic abnormality. For example:
- AFP (alpha-fetoprotein) is increased with neural tube defects.
- Acetylcholinesterase is increased with neural tube defects and also other anatomic abnormalities.
To evaluate fetal lung maturity
Testing to evaluate fetal lung maturity may be performed if a woman is at an increased risk for premature delivery or an early birth is necessary for the baby or mother's health. The tests are based upon the presence of adequate protective liquid substances called surfactants in the lungs, which are necessary for proper lung function. If there are insufficient surfactants, a newborn may develop life-threatening neonatal respiratory distress syndrome (RDS). Tests include:
- Lamellar body count
- Phosphatidylglycerol (PG)
- Lecithin/sphingomyelin (L/S) ratio
To detect Rh and other blood type incompatibilities and diseases
When a mother has been previously exposed through prior pregnancies or blood transfusions to red blood cell antigens that she does not have on her own red blood cells, she may develop antibodies against those red cell antigens (become sensitized). If the antigens are present on the red blood cells of the fetus (inherited from the father), then the fetus is at risk for a maternal-fetal incompatibility. The mother's antibodies can cross the placenta and bind to and destroy the fetus's red blood cells, causing hemolytic anemia. An affected fetus can be born with hemolytic disease of the newborn. One of the most commonly encountered incompatibilities is due to ABO group differences, but there are many other blood types that may also cause this problem.
- Tests for bilirubin may be performed on a regular basis, starting at about 25 weeks of pregnancy, to detect, evaluate and monitor the severity of the hemolytic anemia in a fetus.
To evaluate fetal distress
Evaluation of amniotic fluid color may be indicative of fetal distress.
To detect fetal infections
There are a few tests that can be performed on amniotic fluid to detect infections that are passed from mother to baby during pregnancy (congenital infections). Some of these infections may have serious consequences for the developing fetus. A few examples include tests for:
- Cytomegalovirus (CMV)
- Parvovirus B19 (Fifth disease)
- Cultures for bacterial infections
When is it ordered?
While amniocentesis is safe and has been performed for many years, it is an invasive procedure that poses a slight risk of injury to the fetus and of miscarriage. For this reason, it is not performed routinely with each pregnancy.
Genetic amniotic fluid analysis may be offered as part of second trimester prenatal testing and is performed primarily between 15 and 20 weeks gestation if:
- A woman is 35 years of age or older
- A woman has an abnormality on a First Trimester Down Syndrome Screen or second trimester maternal serum screen, such as an increased or decreased alpha-feto protein (AFP) level
- A woman had a previous child or pregnancy with a chromosomal abnormality or birth defect
- There is a strong family history of a specific genetic disorder
- A parent has an inherited disorder or both parents have a gene for an inherited disorder
- An abnormality has been detected on a fetal ultrasound
Fetal lung maturity amniotic fluid testing is ordered when there is a risk of premature delivery, at any time after 32 weeks gestation.
Biochemical testing is sometimes ordered to monitor bilirubin levels when a woman has been sensitized or it is suspected that she has become sensitized (has developed antibodies) to red blood cell antigens and there may be an Rh or other blood type incompatibility with the fetus. In this case, serial testing for bilirubin may be performed, usually about every 14 days.
An amniotic fluid analysis may be performed in late pregnancy to check for fetal distress and to diagnose a fetal infection.
What does the test result mean?
Genetic tests, chromosome analysis and testing for birth defects
Women should discuss their test results with their health practitioner and with a genetic counselor.
If a chromosomal abnormality or a genetic disorder is detected, then the baby likely will have the associated condition. However, test results may not predict the condition's severity or prognosis.
Normal results make it less likely that a fetus has an inherited condition, but all genetic conditions cannot be ruled out. Not every genetic disorder or chromosomal abnormality will be detected with this testing.
If an increased or decreased alpha fetoprotein suggests a structural abnormality, such as an open neural tube defect, then additional testing and imaging may be performed to determine the severity of the condition and the best course of action.
Fetal lung maturity
If testing indicates that there are low levels of surfactants, then a fetus's lungs have not yet matured and measures can be taken to attempt to delay delivery, to promote lung maturity, and - when necessary - to treat the baby as soon as it is born. If the levels of surfactants are deemed high enough, then the baby may be safely delivered without increased risk of complications from lung immaturity.
Rh or other blood type incompatibility
Increasing bilirubin concentrations in a fetus with a fetal-maternal blood type incompatibility indicate increasing destruction of red blood cells (RBCs) and the likelihood that the fetus will be born with hemolytic disease of the newborn, requiring treatment depending on the severity.
Fetal distress or infection
Evaluation of amniotic fluid color:
- Green-tinged indicates that meconium, the fetus's first stool, has been released.
- Yellow to amber may indicate bilirubin in the fluid.
- Red-tinged indicates blood from the mother or the fetus.
Cultures of the amniotic fluid will indicate whether or not an infection is present.
Is there anything else I should know?
Both blood contamination and stool from the baby (meconium) in the amniotic fluid can affect some chemical test results.
An alternative to amniotic fluid analysis for chromosomal analysis and genetic testing is chorionic villus sampling (CVS), which can be performed earlier, between 10 and 12 weeks of pregnancy. This first trimester procedure collects a placenta tissue sample at the site of implantation and carries about the same risks as amniocentesis. CVS cannot, however, detect neural tube defects.
Performed on a blood sample obtained from the mother, the first trimester screen for Down syndrome and the second trimester screen for Down syndrome and open neural tube defects assess the risk of a fetus having these conditions but are not diagnostic. In most cases, the subsequent amniotic fluid analysis will be normal; only a small percentage of those with an abnormal blood screening test result will actually have an affected baby.
What is being tested?
Amniotic fluid surrounds, protects, and nourishes a growing fetus during pregnancy. Amniotic fluid analysis involves a variety of tests that can be performed to evaluate the health of a fetus.
Amniotic fluid allows a fetus to move relatively freely within the uterus, keeps the umbilical cord from being compressed, and helps maintain a stable temperature. Contained within the amniotic sac, amniotic fluid is normally a clear to pale yellow liquid that contains proteins, nutrients, hormones, and antibodies.
Amniotic fluid begins forming one to two weeks after conception and increases in volume until there is about a quart at 36 weeks of pregnancy. The fluid is absorbed and continually renewed.
The fetus swallows and inhales amniotic fluid and releases urine into it. Cells from various parts of the fetus's body and chemicals produced by the fetus are present in the amniotic fluid. This allows the fluid to be sampled and tested to evaluate fetal health.
The tests are performed on a sample of amniotic fluid that is obtained through a procedure called amniocentesis. Testing may be performed between 15 and 20 weeks of pregnancy to detect certain genetic diseases, chromosomal abnormalities such as Down syndrome, and neural tube defects. Amniotic fluid analysis may be performed at any point after 32 weeks of gestation to evaluate fetal lung maturity when there is an increased risk of or a need for premature delivery. It may also be done when it is suspected that a fetus has an infection or other illness or a blood type incompatibility with the mother and is therefore at risk of developing hemolytic disease.
For genetic testing and chromosome analysis, fetal cells in the amniotic fluid are cultured and grown for 10-12 days in the laboratory, then are analyzed. Biochemical tests, such as bilirubin and alpha-fetoprotein (AFP), and sometimes genetic tests can be performed directly on the amniotic fluid.
The American College of Obstetricians and Gynecologists (ACOG) recommends that all pregnant women should be given the option of having amniocentesis performed. A health practitioner can help a pregnant woman weigh the pros and cons. Some women are at increased risk of birth defects due to their age or family/medical history while others may be advised against having the procedure if they have a history of premature labor, placental problems, or an incompetent cervix, for example. The procedure has some risks associated with it, such as a small chance of miscarriage, and provides information that can have a significant impact of the management of a pregnancy.
While still very much in use, recent advances in testing technology may eventually result in the decline in the use of amniocentesis. For example, there is a newer test called cell-free fetal DNA (cffDNA) that only requires a blood sample from the pregnant woman to screen for certain fetal chromosomal abnormalities, including Down syndrome, Edwards syndrome, and Patau syndrome (trisomy 13), and it can be performed as early as the 10th week of pregnancy. However, at this time, invasive diagnostic tests such as amniocentesis and chorionic villus sampling (CVS) are still needed to confirm the results.
How is the sample collected for testing?
A sample (about 1 ounce) of amniotic fluid is obtained using a procedure called amniocentesis that involves inserting a thin needle through the belly and uterus into the amniotic sac.
NOTE: If undergoing medical tests makes you or someone you care for anxious, embarrassed, or even difficult to manage, you might consider reading one or more of the following articles: Coping with Test Pain, Discomfort, and Anxiety, Tips on Blood Testing, Tips to Help Children through Their Medical Tests, and Tips to Help the Elderly through Their Medical Tests.
Another article, Follow That Sample, provides a glimpse at the collection and processing of a blood sample and throat culture.
Is any test preparation needed to ensure the quality of the sample?
Depending upon the gestational age of the fetus, either a full or empty bladder may be required at the time the amniocentesis is performed. Be sure to follow any instructions provided.
- What is amniocentesis and how is it performed?
Amniocentesis is the removal of a small amount of fluid (about an ounce) from the sac that surrounds a developing fetus using a needle and syringe. Before the procedure, ultrasound is used to find the position of the fetus in the womb. The area on the mother's abdomen is cleaned and a local anesthetic is applied to or injected into the skin.
During the procedure, the needle is inserted through the walls of the abdomen and uterus and into the thin-walled sac of fluid that surrounds the developing fetus. A small amount of amniotic fluid is withdrawn and sent to a laboratory for analysis. Depending on the specific tests being performed, results may be available within a few days to 2 weeks or, in the case of fetal lung maturity testing, within a few hours.
There is a slight risk with amniocentesis that the needle inserted into the amniotic sac might puncture the baby, cause a small amount of amniotic fluid leakage following the procedure, cause a uterine infection, or, in rare cases, cause a miscarriage.
- Can disorders detected through amniotic fluid analysis be prevented?
Genetic and chromosomal abnormalities cannot be prevented. The risk for open neural tube birth defects can be minimized by a woman getting plenty of folic acid prior to and during pregnancy. The number of women with Rh sensitization has greatly decreased since injections of Rh immune globulin (RhoGam) to prevent the formation of Rh antibodies became routine in prenatal and postnatal care.
- Should every pregnant woman have amniotic fluid analysis?
The decision is best made by a woman and her health care provider together. The American College of Obstetricians and Gynecologists (ACOG) recommends that all pregnant women should at least be given the option of having amniocentesis performed. The slight risks associated with amniocentesis must be weighed against the information gained. Speaking with a genetic counselor may also be helpful to learn more about the testing included in amniotic fluid analysis and what to expect from the information that can be learned.
- Can amniotic fluid analysis be performed in my doctor's office?
No, the testing requires specialized equipment and training to interpret. It needs to be performed in a laboratory and may need to be sent to a reference laboratory. However, the procedure for collecting the amniotic fluid can be done in an outpatient setting such as a health practitioner's office.
- Is there a non-invasive test for these disorders?
There is a newer test called cell-free fetal DNA (cffDNA) that only requires a blood sample from the pregnant woman and can be used to screen for certain fetal chromosomal abnormalities, including Down syndrome, Edwards syndrome, and Patau syndrome (trisomy 13). It can be performed as early as the 10th week of pregnancy. Several organizations support its use in pregnant women at high risk of having a child with a disorder caused by an abnormal number of chromosomes. However, invasive diagnostic tests such as amniocentesis and chorionic villus sampling (CVS) are still needed to confirm the results. The test is also still seen as experimental by many insurance companies, so the test may not be a covered expense, and it may not be available everywhere. For more information, see New Blood Test for Detecting Fetal Abnormalities Gaining Interest.
- Is the amount of amniotic fluid present important?
Yes. Separate testing may be performed to evaluate the quantity of amniotic fluid that surrounds a fetus. Too little (oligohydramnios) early in a pregnancy can cause birth defects or miscarriage. Late in a pregnancy, it can cause poor fetal growth or even stillbirth. Too much amniotic fluid (polyhydramnios) may cause few symptoms. When it is severe, however, it may affect a pregnant woman's breathing and increase the risk of premature birth and postpartum hemorrhage.
© 2017 American Association for Clinical Chemistry, republished from Lab Tests Online.*
Descriptions of clinical laboratory tests were originally prepared for use on Lab Tests Online, an award-winning patient education website on clinical laboratory testing. Lab Tests Online is produced by the American Association for Clinical Chemistry (AACC), a global scientific and medical professional organization dedicated to clinical laboratory science and its application to healthcare. The Lab Tests Online website is developed in collaboration with other laboratory professional societies and is funded in part through corporate sponsorships.