الفهرس 
Introduction and Aim of the Work
The Fetal LungOnly 14 pages are availabe for public view
 |  | from | 174 |  |  |
| | | from | 174 | | |
Abstract
Assessment of fetal lung maturity in amniotic fluid plays an important role in the management strategies to prevent RDS particularly in women at risk for preterm delivery. Fetal lung maturity status can be assessed with different methods, including lecithin/ sphingomyelin ratio, phosphatidylglycerol and lamellar bodies count.
Lamellar bodies are surfactant containing lamellated structures that is secreted by type II pneumocyte and released into amniotic fluid by fetal breathing movements. Due to their size (0.2- 2 µm) which corresponds to the one of platelets (1- 3 µm), they can easily be quantified by electronic cell counters.
The advantage of lamellar bodies count over other physical tests is that it is not operator dependent, simple, rapid, inexpensive and can be performed with equipment found in most clinical analysis laboratories.
The aim of this study was to evaluate the role of lamellar bodies count in the prediction of neonatal respiratory distress syndrome in women with preterm premature rupture of membranes.
This study was conducted in Ain Shams university maternity hospital in the period between March 2011 and June 2013. Ninety three pregnant women with preterm premature rupture of membranes were recruited from labor ward.
All recruited women had fulfilled the inclusion criteria which were: gestational age between 28- 36 weeks confirmed by either documented ultrasound during first trimester of pregnancy or by knowing regular last menstrual period and documented ultrasound during second trimester of pregnancy, the fetus was alive with regular heart beats by ultrasound and delivery was within two days after amniotic fluid sampling.
Women were excluded from the study if they had one of; uncertain gestational age, inadequate sample volume of amniotic fluid, when the sample contained obvious mucous or blood, samples with haematocrit value exceeding 1 %, samples stained with meconium, intra uterine fetal death, presence of clinical amnionitis, occurrence of placental abruption or delivery more than two days after amniotic fluid sampling.
Amniotic fluid samples were obtained vaginally by a sterile speculum inserted in the posterior fornix and lamellar bodies were counted using electronic cell counter (Cell- Dyn 1800). After delivery, the neonates were assessed for development of RDS.
Statistical analysis of the obtained results showed that the gestational age at both rupture of membranes and delivery and latency period were a significantly longer in neonates who did not develop RDS in comparison to neonates who developed RDS.
In this study, lamellar bodies count was significantly higher in neonates who did not develop RDS in comparison to neonates who developed RDS.
In the current study, there was a significantly lower incidence to develop RDS in neonates whose mothers had antenatal steroid therapy than neonates whose mothers had not.
The present study showed no significant statistical difference in presentation and gender of the fetuses between neonates who developed RDS and neonates who did not. Abdominal delivery was associated with significantly higher incidence of RDS development than vaginal delivery and there was a highly significant statistical difference in birth weight and APGAR score at 5 minutes being higher in neonates who did not develop RDS than neonates who developed RDS.
In this study, there were highly significant positive correlations between lamellar bodies count and each of gestational age (at rupture of membranes and at delivery), neonatal birth weight and APGAR score at 5 minutes. While, there was a significant negative correlations between lamellar bodies count and the duration of stay in NICU and grades of RDS.
According to this study, receiver operating characteristics curve shows that lamellar bodies count of 41x 103/μL was the best cut-off value for predicting neonatal respiratory distress syndrome with sensitivity 86.11%, specificity 95.24%, positive predictive value 98.41 % and negative predictive value 66.67 %. The area under the curve was 89.9 %.