A 40-year-old pregnant patient, currently hospitalized for preterm labor at 34 weeks’ gestation, is discussing potential delivery options with her provider based on the results of a fetal lung maturity test.

 Which prenatal test would the provider likely order to check for fetal lung maturity? 

Choice A rationale:

Amniocentesis is the most reliable and direct method to assess fetal lung maturity. It involves the extraction of a small sample of amniotic fluid from the amniotic sac, which surrounds the fetus in the uterus. This fluid contains various substances, including surfactant, which is a crucial substance produced by the fetal lungs that enables them to expand and function properly after birth.

By analyzing the levels of surfactant and other components in the amniotic fluid, clinicians can accurately determine the maturity of the fetal lungs. This information is essential in guiding decisions about potential delivery options, especially in cases of preterm labor or other complications that may necessitate early delivery.

Amniocentesis is generally considered a safe procedure, but it does carry some small risks, such as infection, bleeding, or amniotic fluid leakage. However, these risks are typically outweighed by the benefits of obtaining accurate information about fetal lung maturity when necessary.

Choice B rationale:

Fetal fibronectin (fFN) is a protein that is found in the amniotic fluid and cervicovaginal secretions. Elevated levels of fFN in cervicovaginal secretions between 22 and 34 weeks of gestation can indicate an increased risk of preterm labor.

However, fFN testing is not a direct measure of fetal lung maturity. It is used primarily as a screening tool to assess the risk of preterm birth, not to determine the readiness of the fetal lungs for delivery.

Choice C rationale:

Chorionic villus sampling (CVS) is a prenatal diagnostic test that involves taking a small sample of chorionic villi, which are tiny finger-like projections of placental tissue. This test is typically performed earlier in pregnancy (between 10 and 13 weeks gestation) to diagnose genetic abnormalities in the fetus.

CVS is not used to assess fetal lung maturity. It does not provide any information about the development of the fetal lungs or their readiness for birth.

Choice D rationale:

Alpha-fetoprotein (AFP) is a protein produced by the fetal liver. Elevated levels of AFP in the maternal blood can indicate an increased risk of certain birth defects, such as neural tube defects.

AFP testing is not used to assess fetal lung maturity. It does not provide any information about the development of the fetal lungs or their readiness for birth.

Choice A rationale:

This statement suggests that the patient has some awareness of infertility treatments, but it does not necessarily indicate a full understanding of infertility itself.

It's important to consider that a few months of trying to conceive may not be indicative of infertility, as it can take up to a year for healthy couples to achieve pregnancy.

Jumping to fertility treatments without a proper evaluation could lead to unnecessary interventions and potential financial and emotional burdens.

Choice B rationale:

This statement is incorrect. Male factor infertility is a common cause of difficulty conceiving, accounting for about 40% of infertility cases.

It's essential to evaluate both partners when assessing fertility issues.

Choice C rationale:

This statement demonstrates the patient's understanding of the relationship between age and fertility.

Female fertility gradually declines with age, especially after the age of 35, due to a decrease in the number and quality of eggs.

This awareness indicates that the patient is realistic about her chances of conceiving and is prepared to seek appropriate help if needed.

Choice D rationale:

While family history can play a role in infertility, it's not a guarantee that someone will experience the same issues as their relatives.

Each case is unique, and multiple factors can contribute to infertility, including genetics, lifestyle, medical conditions, and environmental factors.

It's important to undergo a thorough evaluation to determine the specific causes of infertility in each individual.