The lecithin–sphingomyelin ratio (a.k.a. L-S or L/S ratio) is a test of

fetal A fetus or foetus (; plural fetuses, feti, foetuses, or foeti) is the unborn offspring that develops from an animal embryo. Following embryonic development the fetal stage of development takes place. In human prenatal development, fetal develo ...

amniotic fluid The amniotic fluid is the protective liquid contained by the amniotic sac of a gravid amniote. This fluid serves as a cushion for the growing fetus, but also serves to facilitate the exchange of nutrients, water, and biochemical products betwee ...

to assess for fetal lung immaturity. Lungs require

surfactant Surfactants are chemical compounds that decrease the surface tension between two liquids, between a gas and a liquid, or interfacial tension between a liquid and a solid. Surfactants may act as detergents, wetting agents, emulsifiers, foaming ...

, a soap-like substance, to lower the surface pressure of the

alveoli Alveolus (; pl. alveoli, adj. alveolar) is a general anatomical term for a concave cavity or pit. Uses in anatomy and zoology * Pulmonary alveolus, an air sac in the lungs ** Alveolar cell or pneumocyte ** Alveolar duct ** Alveolar macrophage * ...

in the lungs. This is especially important for

premature babies Preterm birth, also known as premature birth, is the birth of a baby at fewer than 37 weeks gestational age, as opposed to full-term delivery at approximately 40 weeks. Extreme preterm is less than 28 weeks, very early preterm birth is between ...

trying to expand their lungs after birth. Surfactant is a mixture of lipids, proteins, and

glycoproteins Glycoproteins are proteins which contain oligosaccharide chains covalently attached to amino acid side-chains. The carbohydrate is attached to the protein in a cotranslational or posttranslational modification. This process is known as glycos ...

lecithin Lecithin (, from the Greek ''lekithos'' "yolk") is a generic term to designate any group of yellow-brownish fatty substances occurring in animal and plant tissues which are amphiphilic – they attract both water and fatty substances (and so ar ...

and

sphingomyelin Sphingomyelin (SPH, ˌsfɪŋɡoˈmaɪəlɪn) is a type of sphingolipid found in animal cell membranes, especially in the membranous myelin sheath that surrounds some nerve cell axons. It usually consists of phosphocholine and ceramide, or a ethano ...

being two of them. Lecithin makes the surfactant mixture more effective.

Evaluation

The lecithin–sphingomyelin ratio is a marker of fetal lung maturity. The outward flow of pulmonary secretions from the fetal lungs into the amniotic fluid maintains the level of lecithin and sphingomyelin equally until 32–33 weeks gestation, when the lecithin concentration begins to increase significantly while sphingomyelin remains nearly the same. As such, if a sample of amniotic fluid has a higher ratio, it indicates that there is more surfactant in the lungs and the baby will have less difficulty breathing at birth. An L–S ratio of 2.4 or more indicates fetal lung maturity and a relatively low risk of

infant respiratory distress syndrome Infantile respiratory distress syndrome (IRDS), also called respiratory distress syndrome of newborn, or increasingly surfactant deficiency disorder (SDD), and previously called hyaline membrane disease (HMD), is a syndrome in premature infants ...

, and an L/S ratio of less than 1.5 is associated with a high risk of infant respiratory distress syndrome. If preterm delivery is necessary (as evaluated by a

biophysical profile A biophysical profile (BPP) is a prenatal ultrasound evaluation of fetal well-being involving a scoring system, with the score being termed Manning's score.

or other tests) and the L–S ratio is low, the mother may need to receive steroids such as

betamethasone Betamethasone is a steroid medication. It is used for a number of diseases including rheumatic disorders such as rheumatoid arthritis and systemic lupus erythematosus, skin diseases such as dermatitis and psoriasis, allergic conditions such ...

to hasten the fetus'

production in the lungs.

Procedure

An amniotic fluid sample is collected via

amniocentesis Amniocentesis is a medical procedure used primarily in the prenatal diagnosis of genetic conditions. It has other uses such as in the assessment of infection and fetal lung maturity. Prenatal diagnostic testing, which includes amniocentesis, is ne ...

and the sample is spun down in a

centrifuge A centrifuge is a device that uses centrifugal force to separate various components of a fluid. This is achieved by spinning the fluid at high speed within a container, thereby separating fluids of different densities (e.g. cream from milk) or ...

at 1000 rpm for 3–5 minutes.

Thin layer chromatography Thin-layer chromatography (TLC) is a chromatography technique used to separate non-volatile mixtures. Thin-layer chromatography is performed on a sheet of an inert substrate such as glass, plastic, or aluminium foil, which is coated with a t ...

(TLC) is performed on the supernatant, which separates out the components. Lecithin and sphingomyelin are relatively easy to identify on TLC and the predictive value of the test is good.

References

{{DEFAULTSORT:Lecithin-sphingomyelin ratio Tests during pregnancy

Evaluation

Procedure

See also

References