New method for determining lecithin and sphingomyelin in amniotic fluid.

We describe a new method of complete analysis for lecithin, lysolecithin, and sphingomyelin in amniotic fluid. The analysis is based on alkaline hydrolysis of the lecithins and the enzymic hydrolysis of sphingomyelin. The choline formed in each instance is enzymically phosphorylated with [gamma-32P]ATP to yield [gamma-32P]phosphorylcholine, which is isolated by anion-exchange chromatography and shown to be stoichiometrically related to lecithin, lysolecithin, and sphingomyelin. Other phospholipids do not interfere. Using this methodology, we developed three potential approaches to the assessment of fetal lung maturity: the ratio of lecithin plus lysolecithin (total lecithin) to sphingomyelin, the total lecithin concentration, and total lecithin as a percentage of total amniotic fluid phospholipids. All three indices were compared with the lecithin/sphingomyelin ratio obtained by a chromatographic procedure. Our data suggest that measuring the percentage of total lecithin may provide the best means of evaluating fetal lung maturity, but a final judgment must await clinical investigation.