Effect of blood contamination on lecithin to sphingomyelin ratio in amniotic fluid by different detection methods

Amniotic phospholipid detection methods such as cupric acetate measure unsaturated lecithin whereas others such as phosphomolybdate detect both unsaturated and saturated lecithin. Because of the extreme unsaturation in serum and red blood cell lecithin, we compared lecithin (L) and sphingomyelin (S) content of maternal blood as well as the effect of blood contamination on amniotic fluid L/S ratios. L/S ratios were obtained by thin-layer chromatography utilizing both cupric acetate and phosphomolybdate for phospholipid detection. The L/S value (mean +/- SD) of maternal serum obtained by cupric acetate was 1.90 +/- 0.19 and that for phosphomolybdate 1.78 +/- 0.17. The results of increasing serum concentrations in amniotic fluid prior to analysis suggest that as little as 0.5% contamination alter results and by 2% contamination values approach the L/S ratio of actual serum whether the amniotic fluid was initially mature or immature by either method. The serum L/S ratio by cupric acetate equaled its maturity threshold of 2.0 while the serum L/S ratio by phosphomolybdate was below its threshold of 3.0. Whereas both methods would have falsely immature values in the presence of blood only phosphomolybdate would assure against false maturity.