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Introduction ⬇

Amniotic fluid specimens should be visually inspected for color. The range of color may vary from clear to a pale straw-yellow color. White particles of vermin cases from fetal skin and lanugo hair may be present. In certain disorders such as missed miscarriage, chromosomally abnormal fetus, and fetal anencephaly, the amniotic fluid color is altered.

Procedure ⬆ ⬇

  1. Observe color changes and staining through amnioscopy before the amniotic membranes have ruptured.

  2. Place an amnioscope into the vagina and against the fetal presenting part. Visualize the amniotic fluid through the amniotic membranes. Problems with amnioscopy include inadvertent rupture of membranes, insufficient dilation of the cervix and consequent difficulty inserting the amnioscope, intrauterine infection, and occasional difficulty in interpreting amniotic fluid color.

  3. Be aware that the test may also be difficult to perform if the patient is in active labor.

Procedural Alert

  1. Meconium staining may also be observed when an amniocentesis is done. After the membranes have ruptured, meconium staining may be observed in the vaginal discharge. Once meconium staining is identified, more assessments (e.g., FHR patterns) must be made before delivery is contemplated to determine whether the fetus is experiencing ongoing episodes of hypoxia.

  2. The presence of meconium in the amniotic fluid is normal in breech presentations.

Clinical Implications ⬆ ⬇

  1. Yellow amniotic fluid indicates blood incompatibility, erythroblastosis fetalis, or presence of bile pigment released by red blood cell hemolysis (fetal bilirubin).

  2. Dark yellow aspirate indicates probable fetal involvement.

  3. Red color indicates blood, in which case it must be determined whether the blood is from the patient or the fetus. Fetal blood in the amniotic fluid is of grave concern.

  4. Green, opaque fluid indicates meconium contamination. The fetus passes meconium because of hyperperistalsis in response to a stressor that may be very transient or may be more serious and protracted (e.g., hypoxia). A very good correlation states that the more the meconium present, the more severe and immediate the stressor. Additional assessments, such as amnioscopy and amniography, must be made to determine whether the fetus is experiencing ongoing episodes of hypoxia or other stressors. Green color can also indicate erythroblastosis but is not necessarily indicative of it.

  5. Yellow-brown, opaque fluid may indicate intrauterine death and fetal maceration (although not necessarily from erythroblastosis), oxidized hemoglobin, or maternal trauma.

Interventions ⬆ ⬇

Pretest Patient Care

  1. Explain the purpose of the test and the procedure if amnioscopy is done.

  2. Follow guidelines in Chapter 1 for safe, effective, informed pretest care.

Posttest Patient Care

  1. Review test results; report and record findings. Modify the nursing care plan as needed. Counsel the patient and monitor appropriately.

  2. Follow guidelines in Chapter 1 for safe, effective, informed posttest care.

Reference Values ⬆

Normal