Assessment of Fetal Lung Maturity - 1
Saturday, July 26, 2008
Kenneth F. Trofatter, Jr., MD, PhD
However, some of the patients show up on our doorsteps either unclear about what “assessing fetal lung maturity” entails, or in denial of the same, or hoping, if they play dumb, I won’t figure out why they’re there. Unfortunately for them, I always ask, “What is your understanding of what your doctor would like us to do for you today?” Even if some of them have difficulty telling me that they are there to have an amniocentesis done, usually I will drag out of them that their doctor would like to “get me delivered.” That usually breaks down the barriers to discussing what an amniocentesis entails and the importance of assessing fetal lung maturity.
Some, honestly do not realize that “figuring out if the baby’s lungs have a reasonable chance of working well when they’re born” involves an invasive diagnostic study with a very long (but thin) needle. In fact there isn’t a day that goes by when we don’t have a patient ask, after we have done the preliminary ultrasound evaluation to determine fetal position, amniotic fluid volume, and placental location in preparation for the amniocentesis, “Well do the lungs look mature?” as they are sitting up and starting to clean off the ultrasound gel in premature preparation for leaving. When I then tell them that “we cannot determine that simply by looking” and start explaining what an amniocentesis is all about, and their eyes get as large as saucers and they start hyperventilating, it is clear they weren’t completely informed by their provider as to the nature of the evaluation. However, once they understand that their doctor does not plan to deliver them without that information, the discussion, again, becomes much more straightforward.
We have already discussed amniocentesis in other contexts and there is no reason to rehash the procedure or the risks associated with it, which are generally, quite small late in pregnancy. Instead, in our next post, I will discuss what it is we are looking for when we do fetal lung maturity testing and then we will describe some of the diagnostic tests currently available for that purpose…
Labels: amniocentesis, fetal lung maturity
6 Comments:
At Tue Aug 12, 09:03:00 AM 2008,
Anonymous said…
I am 36, 37 weeks into my 8th pregnancy (after 2 miscarriages). This is our 6th baby. I have a hx of cardiomyopathy, eclampsia, Pulmonary embolism (all with last delivery 18 months ago) and severe kidney stone issues since late April. We are trying to advocate for an earlier delivery, with the aid of several doctors who see me for emergent care at L&D to help me deal with the stones causing tremendous pain, sometimes 2 to 3 times per week, for the last couple of weeks. The doctors are talking about performing an amnio in conjunction with a sono in 2 days to determine if this little one can be delivered safely. I am scheduled to be induced on the 28th, but every day is living hell for me, trying to deal with excruciating pain in my kidneys and bladder area, and trying to be extremely careful with the pain medication I have been prescribed... which is never enough to relieve the pain, but only makes it easier for me to move around for short periods of time. I am losing weight, and have not actually gained any weight since April, when the stones began to move. I barely sleep and cannot eat much. The baby, however, looks beautiful every time she is on the monitor. She appears to be gaining weight in and is in the 42 percentile on the growth chart. I am extremely worn out, in constant pain, physically ill from all the stress on my body. I am not one of those moms who is looking to be delivered early because I just want to get it over with. Contrarily, during my last pregnancy when my midwives were blabbering on about how I just missed my husband during tax season (who is an accountant) I held off going into the ER and begging them to deliver me (rather than have another home birth which was planned) until the baby's actual due date (determined by sono)... at which point the eclampsia was manifesting, I threw a PE and was found within days to have PPCM. In my case, with the present problems of kidney stones, weight loss, etc. what would you recommend doing?
At Tue Aug 12, 01:45:00 PM 2008,
Anonymous said…
As to my post above, I realize it appears that I am asking for professional advice. What I am truly interested in is some idea or opinion of whether or not an amnio will do any good, at this late juncture, with all I am dealing with. In no way would I hold you liable for any advice or opinion given.
At Sat Aug 16, 05:14:00 PM 2008,
Kenneth F. Trofatter, Jr., MD, PhD said…
To anonymous Aug 12: I would do the amnio now to get some perspevtive on the baby's risk for respiratory complications, deliver you if it is "mature", discuss the risks to your understanding if it is "borderline" and consider delivery anyway, and try to hold off another week or so if it is clearly very "immature." Sorry for all your problems. Let us know what happens. Dr T
At Mon Aug 18, 03:41:00 AM 2008,
Anonymous said…
Dr. T.
Thank you for your insight. I am running into a bit of bias with this medical community in Bangor, Maine who is focusing only on my baby. While I very much appreciate that they are concerned with her safety, well-being, growth and maturity, they are very stubbornly refusing to take into consideration my health, at all. My Baby girl, at her last sono on 8/14, was an estimated 6#13oz at 37 weeks. Still I am not gaining weight, in constant pain, injecting heparin twice daily to ward off another PE and taking T3 (between 2 and 4 pills )daily. I thought that having her earlier might ward off eclampsia, relieve my kidney of the pressure, allow me to have lithotripsy sooner, and get me off the horrid narcotics and heparin.
I suppose I am just confused, though...
Thank you again, for the insight.
At Fri Aug 22, 06:10:00 PM 2008,
Kenneth F. Trofatter, Jr., MD, PhD said…
To anonymous Aug 18: Wish I could more to help. Still think the amnio for fetal lung maturity would be very reasonable under these circumstances. Good luck and I hope it is all over soon!
Dr T
At Tue Sep 02, 12:09:00 PM 2008,
Anonymous said…
Dr. T.
On Aug 19 I was admitted with horrific kidney pain, and enormous amounts of blood in my urine. I was hooked into morphine immediately. Finally, and without an amnio, my ob scheduled delivery and my daughter was delivered 3 days later on the 22nd. She is beautiful, but needed 5 days of NICU care, not for lung immaturity, but for withdrawl sxs from the narcotics my doctor threw at me to shut me up during months and months of kidney pain, rather than check out the problem. 4 days after my daughter was born a urologist went in to place a stent from my right kidney down to my bladder. She found my kidney 90% occluded by a stone and a corkscrew kink in my right ureter. I guess better late than never...except that now my baby girl is an "NAS" baby who will need special services for the rest of her life.
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