LBC 11 LBC LBC LBC RDS < LBC / L RDS 100% 98.4% 66.7% 100% 4. LBC / L

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2 LBC 11 LBC LBC LBC RDS < LBC / L RDS 100% 98.4% 66.7% 100% 4. LBC / L / L t= p= LBC / L t=-2.86,p= LBC LBC 2

3 3 The use of Lamellar body counts to predict fetal lung maturity in pregnancies with abnormal glucose metabolism Objective To evaluate the predictive value of amniotic fluid lamellar body counts in prediction of fetal lung maturity in pregnancies with abnormal glucose metabolism and observe the influence of maternal abnormal glucose metabolism on fetal lung maturity. Materials and methods 147 amniotic fluid obtained from 136 patients who delivered in our hospital were collected from March 2003 to October 2003.Among them amniotic fluid lamellar body counts were tested, 11 patients were tested twice. Neonatal outcomes could be traced in 128 patients who delivered after 28 gestational weeks. 42 of them were patients with abnormal glucose metabolism, the other 86 women with normal glucose metabolism. We compared LBC in amniotic fluid from the two groups, and LBC from the two samples. The sensitivities and specificities of various lamellar body counts cutoff values were calculated with neonatal respiratory distress syndrome. Result (1)lamellar body counts were correlated with gestational age, as the gestational age increased, LBC increased gradually.(2) There were 4 NRDS among the 136 neonates, all gestational age of them were less than 37 weeks. None of them occurred in pregnancies with abnormal glucose metabolism. (3) If the cutoff value of lamellar body counts was less than / L, the sensitivity was 100% specificity was 98.4% positive predictive value was 6.7% and negative predictive value was 100% (4) LBC from women with abnormal glucose metabolism was / L the control group was / L,there was no statistic difference between the two groups t= p=0.208 (5) LBC was significantly increased after antenatal corticosteroid therapy for fetal maturation. t=-2.86,p= Conclusion 1. The lamellar body count is a valid, rapid screening 3

4 4 test for the determination of biochemical fetal maturity in pregnancy complicated with abnormal glucose metabolism. 2. In strict glucose controlled patients with abnormal glucose metabolism, FLM is not delayed. If the gestational age is exceeded 37 weeks, the fetal lung maturity should not detect before delivery. 3. LBC increased after antenatal corticosteroid therapy for fetal maturation. Keyword lamellar body count, amniotic fluid, fetal lung maturity, abnormal glucose metabolism, surface active material 4

5 5 Neonatal Respiratory Distress Syndrome NRDS 28% [1] NRDS 10% NRDS [2] NRDS surface active material, SAM SAM SAM lamellar body LB [3] 1-5 m 5

6 6 [4] (Lecithin, L) (Sphingomyelin S) (phosphatidylinositol PI), (phosphatidylserine PS), (phosphatidylethanolamine PE), (phosphatidyl- glycerol PG) [4] 34 / (L/S ratio) PG PI 35 LB 20~24 [5 6] L/S Lamellar body count,lbc NRDS hyaline membrane disease, HMD [7] 6

7 7 22~24 [7] NRDS 1971 Usher [8] NRDS <30 NRDS >60% 31~32 NRDS 35% 33~34 NRDS 20.5% 35~36 NRDS 5.4% >37 NRDS <1% [9] NRDS NRDS % 36 35~36 46% NRDS 7

8 8 NRDS 30~37%, 10~15% [12-14] ~38 L/S L/S NRDS :6.2% [15] Curet [16] Hallman [17] 1986 [18] 2 105mg% 120mg% 1986 Fadel [19] Gabbe [12] Curet [13] 1990 Kjos [20] 584 L/S PG

9 9 Piper [21] ~ L/S PG PG PG + L/S > NRDS 8% 30/384 NRDS 6% 6/97 34 NRDS 29% 4/14 12% 25/207 [21-24] 1971 Gluck [25] L/S L/S 9

10 10 [26] Hagen 36 L/S 2 95% 32~ % 25~ % L/S 1972 Clements [27] Anceschi [28] 50% 86% 28% 95% 1976 Hallman [29] PG (PI) L/S <1,PG PI 0-2.5% L/S 2 PI % L/S >2 PG PI PG + L/S PG PI [30 31] PG 34 10

11 11 L/S 2 L/S 2 RDS PG L/S PG L/S Hallman [29] PG Tsai [32] Taos [33] [34] 1989 PG Golde [35] %PG(+) 40 10% PG Whittle [36] PG L/S 1992 Tsao [37] PG PG 1mmol/ml PG NRDS 1976 Sbarra [38] OD 11

12 12 Sbarra [38] [39] 400nm 450nm OD nm OD 650 L/S OD 650> Shinitzky [40], [ ] TDx FLM PC16 [41] NBD-PC [42] 1989 Dubin [43] LB LB 1-5 m LBC 12

13 13 LBC LBC Wijinberger [44] MEDLINE L/S LBC 6 6 NRDS ROC ROC LBC NRDS L/S 1 LBC NRDS NRDS NRDS NRDS TP FN FP TN / L % % Bowie [45] g Ashwood [5] g Dalence [46] g Fakhoury [47] g Greenspoon [48] Lee [49] g LBC 2001 Neerhof [50] ROC 13

14 14 LBC 97.7%, L/S ratio 96.8% PG 94.7% p=0.048 Szallasi [51] Coulter Gen-S Beckman Coulter Sysmex XE-2100(Sysmex) ADVIA 120(Bayer Corporation) Cell-dyn 3500(Abbott Laboratories), [52] 1999 Coulter 450, 276g 5 LBC 25000/ L 100.0%, 91.2%, [53-55] 61.5%, 100.0% LBC LBC LBC 1971 Gluck [25] L/S 1973 Gluck [56] L/S White A B C L/S Gabbe [12] ~

15 15 L/S 200 L/S 2 10 L/S 1.5~ L/S 2 L/S 200 RDS 3% 6/200, L/S 1.5~ % 7/10 RDS L/S [18,36,57-59] L/S 1972 Donald [59] 425 L/S NRDS 3.7% L/S <2 NRDS 63% 30/48 L/S L/S 2 NRDS 7.4% NRDS 1.3% L/S Hallman [14] L/S Curet [13] L/S [61-63] L/S 15

16 16 Farrell [64] PC PC NRDS PG PC PC PC 50% [22-24] LBC L/S PG 1990 Kjos [20] 584 L/S PG % L/S 9% PG 3% OD Liggin [65] NRDS 25.8% 9% 15% 3.2% Senat [66] Rotmensch [67] Noel [68] % 1cm 16

- MP <34 P<0.001 UA UA/MCA MCA P<0.05 UA UA/MCA UtA PI RI P<0.05 UtA 24 BP 24 MP III

- MP <34 P<0.001 UA UA/MCA MCA P<0.05 UA UA/MCA UtA PI RI P<0.05 UtA 24 BP 24 MP III 98017624 Changes of maternal and fetal hemodynamics in early-onset severe preeclampsia : : 98017624 : 98-6 : : : : : OO - MP 46 30 16 92