ASSESSMENT OF FETAL LUNG MATURITY IN AMNI OTIC-FLUID

Although fetal lung maturity determination is carried out more and mor e rarely in the German-speaking area, a reliable information about the degree of lung maturity is still very important in the care of high-r isk pregnancies. The side effects and costs of a postpartal surfactant administration can be avoided if lung maturity is proved. Indications for determination of fetal lung maturity are the threatening preterm delivery and the premature rupture of membranes before the 34th week o f gestation and uncertain gestational age. Furthermore, in preeclampsi a resp. in diabetes mellitus, which is difficult to control, premature delivery may be necessary. To improve lung maturity testing we introd uce a new ''sequence scheme'' containing three lung maturity tests whi ch are easy to carry out (in the following sequence: Amniostat-FLM(R) ultrasensitive, counting of the lamellar bodies in amniotic fluid, sur factant/albumin ratio with TDx-FLM(R)). The principle of this scheme i s, that if any of these three tests indicates lung maturity, the seque nce is terminated and no further test is performed. Only if all three tests indicated immaturity, the child was at risk for RDS. In 87 amnio tic fluid samples with 7 RDS-cases, we achieved high predictive values for lung maturity (specificity 90%, sensitivity 100%, predictive valu e of positive test 47%, predictive value of negative test 100%). In 62 % only one test was needed for lung maturity determination. It is poss ible to use other combinations in such a scheme (e.g. the L/S ratio). This might lead to equal or perhaps better results. An advantage of th is suggested ''sequence scheme'' is that it can be performed in any cl inic.