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PubMed1985

Amniotic fluid embolism in Sweden, 1951-1980.

Amniotic fluid embolism is one of the least frequent complications of parturition, but the most dangerous of all. 38 cases of fatal amniotic fluid embolism were diagnosed in Sweden during the years 1951-1980, i.e. 1 case for every 83,000 live births. The proportion of amniotic fluid embolism in maternal mortality as a whole increased from 1.2 to 16.5% during this period. Predisposing factors identified were gemini/polydyramnios, abruptio placentae, hypertonic labor, rupture of the birth canal, macrosomia, and obstetrical interventions such as administration of oxytocin and fundal pressure. The main symptoms were cardiovascular shock with right heart strain, and hemorrhage with pathologic proteolysis. Four cases of presumed amniotic fluid embolism with survival of the patient were diagnosed during the years 1972-1980--a case fatality rate of 66% (4/12).

Adult↗
PubMed1977

Influence of fetal sex on the concentration of amniotic fluid testosterone: antenatal sex determination?

Amniotic fluid testosterone was measured by radioimmunoassay in 226 samples taken between the 12th week of pregnancy and birth. The effect of fetal sex on the level of this androgen was determined and the usefulness of the parameter for predicting fetal sex assessed. Testosterone was measured using an antibody raised in rabbits against testosterone-3-carboxymethyloxime-BSA. The antiserum cross-reacted strongly with 5alpha-dihydrotestosterone so that the values reported were refered to as measuring "immunoreactive testosterone" levels. Male fetal values were highest between the 12th and 15th week of pregnancy reaching a maximum mean of 501 +/- 185 pg/ml gradually falling during the remainder of pregnancy to 281 +/- 74 pg/ml, the difference in values between the first half and the end of pregnancy being highly significant (p less than 0.0005). Female fetal values did not vary significantly during the course of gestation, the minimum mean value being 179 +/- 50 and maximum 253 +/- 98 pg/ml. The fetal amniotic fluid sex difference was highly significant during the first half of pregnancy (p less than 0.0005) and at 12-15 weeks a successful prediction of fetal sex was possible, using testosterone, in 39 out of 41 cases. At birth on the other hand there was no difference between male and female fetal fluid levels. The method can also be used to detect disturbances of intrauterine sexual development as exemplified by the case of a Klinefelter syndrome where female testosterone values were found at the time of sexual differentiation. Thus the measurement of unconjugated testosterone in amniotic fluid would seem to offer not only an addition to chromosomal analysis for prediction of fetal gender but also be a valuable tool for detection of disturbances of intrauterine sexual development i.e. when genetic sex and sex-specific hormone production are discrepant.

Amniotic Fluid↗
PubMed1993

Amniotic fluid volume: fluid dynamics and measurement technique.

Evaluation of amniotic fluid volume is an important aspect of obstetrical ultrasound. Several methods are currently used to describe amniotic fluid volumes. The most common are the subjective assessment of fluid and the semiquantitative methods. The reproducibility of these methods is excellent in experienced hands. Because of the multiple methods used to assess fluid, both oligohydramnios and polyhydramnios have numerous definitions. Regardless of which definition is used, it is clear that both of these entities are associated with a variety of fetal and maternal conditions. Abnormal amniotic fluid volume may be the only or earliest sonographic sign of an obstetrical problem. Therefore, it is important that sonologists are familiar with amniotic fluid volume assessment. Although subjective and semiquantitative techniques may produce similar results, a numerical scale is no substitute for experience and training. One should be able to recognize lesser degrees of fluid abnormality and be able to assess the trend of amniotic fluid volume in serial examinations.

Amniotic Fluid↗
PubMedDate not supplied

Rapid identification of glial cells in human amniotic fluid with indirect immunofluorescence.

Direct preparations were made from human amniotic fluid and from suspensions of cultured amniotic fluid cells by cytocentrifugation. Specific cell types were identified by indirect immunofluorescence staining using antibodies against different types of intermediate filament proteins. In cases of anencephaly, spina bifida and Meckel's syndrome, specific staining for glial fibrillary acidic protein (GFAP) showed a fine fibrillar fluorescence in many cells, indicating their glial origin. Blood cells were abundant in the amniotic fluid preparations, and the cell types of normal amniotic fluid were also present but with the fibroblastoid cells as the dominating cell type. In normal amniotic fluid, the main cell types were terminally differentiated keratinocytes, negative for both keratin and vimentin, keratin-positive epithelial cells and vimentin-positive fibroblastoid cells. In addition, blood cells, including macrophages, were occasionally seen. GFAP-specific staining of cytocentrifuged amniotic fluid samples appears to be a rapid and reliable way of revealing glial cells in fresh (uncultured) amniotic fluid and could thus serve as an aid in the prenatal diagnosis of neural tube defects.

Adult↗
PubMed1977

Amniotic fluid androgens and estrogens in midgestation.

Amniotic fluid androgen and estrogen levels associated with 48 male and 72 female fetuses between 14 and 20 weeks of gestation were measured. Amniotic fluid testosterone levels were significantly higher (P less than 0.001) in the male (224 +/- 11 pg/ml) than the female fetuses (39 +/- 2 pg/ml) with no overlap of values. Amniotic fluid androstenedione concentrations were also significantly higher (P less than 0.001) with male (1024 +/- 53 pg/ml) than female fetuses (668 +/- 39 pg/ml), but there was overlap. There was no difference between anmiotic fluid dehydroepiandrosterone levels for the two sexes. Estrone concentrations were slightly but not significantly higher with the male (353 +/- 33 pg/ml) than with female fetuses (331 +/- 28 pg/ml), while estradiol concentrations were significantly higher (P =0.002) with the female (96 +/- 8 pg/ml) than male (64 +/- 4 pg/ml) fetuses. It is interpreted that the higher amniotic fluid testosterone and androstenedione levels for the male fetuses reflect fetal testicular secretion. The significantly higher estradiol concentrations for the female fetuses may reflect early ovarian secretion.

Amniotic Fluid↗
PubMed1989

Developmental changes in the glycosylation and binding properties of human fibronectins. Characterization of the glycan structures and ligand binding of human fibronectins from adult plasma, cord blood and amniotic fluid.

Fibronectins from human adult plasma, fetal plasma and from amniotic fluid obtained during early and late gestation were compared with respect to (i) their reactivity with lectins, (ii) their binding to the physiological ligands gelatin and heparin, and (iii) the role of the carbohydrate residues in the binding to these two ligands. The two fibronectin isoforms displayed distinct developmental differences in both glycosylation and binding properties: (i) Proportions of tri/tetraantennary complex glycans compared to the fraction of biantennary structures, as inferred from the reactivity with concanavalin A, were highest in amniotic fluid fibronectin from late pregnancy, lower in amniotic fluid fibronectin from early gestation, and even lower in fetal and adult plasma fibronectins. Likewise, fucose (alpha 1-6) linked to the innermost N-acetylglucosamine of the chitobiosyl core, defined by reactivity with Lens culinaris agglutinin (LCA), was present primarily in amniotic fluid fibronectin, and decreased in content during gestation from the 2nd. to the 3rd. trimenon. Both fetal and adult plasma fibronectins were only weakly reactive with LCA, indicating a low content of (alpha 1-6) linked fucose residues. After prior treatment with sialidase, both plasma and amniotic fluid fibronectins strongly reacted with erythrocyte phytohaemagglutinin (E-PHA), indicating that both fibronectin isoforms contain bisecting (beta 1-4) N-acetylglucosamine residues. Amniotic fluid fibronectins showed much greater reactivity than adult and fetal plasma fibronectins with wheat germ agglutinin; binding of this lectin to amnion fluid fibronectins was not decreased by desialylation indicating the presence of poly(N-acetyllactosamine) units. Whereas amniotic fluid fibronectins were strongly reactive with peanut agglutinin, neither adult nor fetal plasma fibronectins did bind to this lectin unless after prior desialylation. Hence, both fibronectin isoforms contain O-glycan residues that are fully sialylated in fetal and adult plasma fibronectins, but only partly sialylated in amniotic fluid fibronectins. According to these differences, glycosylation of plasma and amniotic fluid fibronectins is under developmental regulation. (ii) Amniotic fluid fibronectins had a significantly lower binding activity for both heparin and gelatin than plasma fibronectins. Moreover, amnion fibronectin from late gestation displayed a significantly lower binding to these two ligands than amnion fibronectin from early gestation. Fetal plasma fibronectins had a lower binding activity for gelatin than adult plasma fibronectin. (iii) Treatment of fibronectins with sialidase, fucosidase and removal of N-glycans with endoglycosidases H and F did not affect binding to gelatin and heparin, indicating that the interaction of plasma and amnion fibronectin with these two ligands is not influenced by their oligosaccharide moieties.

Adult↗
PubMed1988

Regulation of cholesterol metabolism in fetal rabbit aorta: role of amniotic fluid factors.

This study shows that amniotic fluid enhances cholesterol esterification in arterial wall, as measured by in vitro assay of acyl-CoA:cholesterol acyltransferase (ACAT) activity and by incorporation of oleic acid to cholesteryl esters in cultured fetal aortas and smooth muscle cells. This property is mostly evident in the fraction of molecular weight greater than 100,000, and it is abolished by delipidation, indicating that stimulating factor is probably lipoprotein in nature. Despite an increased cholesterol esterification by the presence of amniotic fluid in medium of cultured fetal aortas, the content of cholesterol and cholesteryl esters was much lower. The cellular structures are better preserved in explants cultured with amniotic fluid than in control animals. This study indicates that amniotic fluid contains factors that may have a pronounced effect on arterial wall during development.

Amniotic Fluid↗
PubMed1980

Origin of lactate dehydrogenase in amniotic fluid.

The origin of protein including enzymes in amniotic fluid is of clinical and research interest. 8 patients were evaluated, with their informed consent, prior to therapeutic abortion. Amniotic fluid, placentas and blood were obtained and lactate dehydrogenase (LDH) isozyme patterns of cell-free amniotic fluid was compared to the LDH patterns of uncultured amniotic fluid cells, maternal serum and RBC, placentas and placental membranes. The LDH isozyme pattern of amnion closely corresponded to that of cell-free amniotic fluid and represents the major source of this enzyme in amniotic fluid.

Adolescent↗
PubMed1985

Vitamin B12 binding proteins in amniotic fluid.

The cobalamin-binding proteins in amniotic fluid are determined by assaying the unsaturated cobalamin-binding capacity of haptocorrin (R-proteins, cobalophilin, or transcobalamin I-like protein and any coexisting intrinsic factor) and non-haptocorrin. Forty-five specimens obtained by amniocentesis, and ninety-two obtained at parturition are analysed. The haptocorrin cobalamin-binding capacity increases rapidly after a gestational age of about 15 weeks. At parturition the concentration varies from 1.4 to 26.8 nmol/l. The non-haptocorrin cobalamin-binding capacity is less than 1% of the total binding capacity. The unsaturated cobalamin-binding capacities do not correlate significantly with birth weight, placental weight, or total protein concentration of the amniotic fluid. The ratio between haptocorrin concentration in amniotic fluid and maternal plasma is about 3:1. The unsaturated cobalamin-binding capacity of haptocorrin in amniotic fluid is significantly higher in pregnancies with female than with male fetuses, and is relatively high in one case of twins. It is suggested that haptocorrin in amniotic fluid originates mainly from the fetus, and may have a bacteriostatic effect.

Amniocentesis↗
PubMed1994

The value of amniotic fluid interleukin-6, white blood cell count, and gram stain in the diagnosis of microbial invasion of the amniotic cavity in patients at term.

PROBLEM: Subclinical microbial invasion of the amniotic cavity occurs in 18.8% of women with term labor and intact membranes and in 34% of patients with term PROM and is a risk factor for the development of puerperal infection related morbidity. Although amniotic fluid white blood cell count, interleukin-6 determination, and Gram stain examination have been used for the diagnosis of intrauterine infection in patients with preterm labor and preterm premature rupture of membranes, no information is available about the accuracy and specific cut-off values for these tests in patients at term. The purpose of this study was to compare the performance of the amniotic fluid Gram stain examination, white blood cell count, and interleukin-6 determination in the identification of microbial invasion of the amniotic cavity in patients at term with and without PROM. METHOD: Amniotic fluid was retrieved from 148 patients with term gestations (90 patients with spontaneous labor and intact membranes and 58 patients with PROM). Samples were cultured for bacteria and Mycoplasma species. Amniotic fluid Gram stain, white blood cell count, and interleukin-6 determinations (ELISA, sensitivity: 43 pg/ml) were performed in all samples. Microbial invasion of the amniotic cavity was defined as a positive amniotic fluid culture for microorganisms. Analysis was conducted using Mann-Whitney U test, Fisher's exact test, receiver operating characteristic curves and logistic regression. RESULTS: Patients with spontaneous labor and intact membranes: The prevalence of microbial invasion of amniotic cavity in this group was 15.6% (14/90). The most sensitive test for the detection of microbial invasion of the amniotic cavity was amniotic fluid interleukin-6 determination (sensitivity for: interleukin-6 > or = 5.7 ng/ml = 86%, white blood cell count > or = 20 cells/mm3 = 64%, Gram stain = 28%). The most specific test was the Gram stain of the amniotic fluid (specificity for: Gram stain = 84%, interleukin-6 = 79% and white blood cell count = 63%). Multiple logistic regression demonstrated that amniotic fluid interleukin-6 concentration was the only covariate that retained statistical significance when intrauterine infection was used as outcome variable. Patients with PROM: The prevalence of a positive amniotic fluid culture in this group was 39.7% (23/58). Logistic regression demonstrated that only interleukin-6 retained a significant relationship with the results of amniotic culture when all variables were entered simultaneously into a model to predict amniotic fluid culture results. The most sensitive tests for the detection of intrauterine infection were interleukin-6 determination and white blood cell count (sensitivity for interleukin-6 > or = 3.4 ng/ml and white blood cell count > or = 20 cells/mm3 = 69.6% for both). The most specific test was Gram stain (97.1%). CONCLUSIONS: Amniotic fluid interleukin-6 determination is the best rapid test for the detection of microbial invasion of the amniotic cavity in patients at term with and without PROM. When this test is not available, amniotic fluid Gram stain and white blood cell count represent valid diagnostic tools to assess the microbial state of amniotic cavity.

Amniotic Fluid↗
PubMed1988

Antimicrobial activity of amniotic fluid against Chlamydia trachomatis, Mycoplasma hominis, and Ureaplasma urealyticum.

Amniotic fluids obtained by amniocentesis at 16 weeks to term were examined for the presence of Chlamydia trachomatis, Mycoplasma hominis, and Ureaplasma urealyticum. Of 140 fluids tested, none harbored chlamydiae, and only one harbored mycoplasma, M. hominis. A number of amniotic fluids were subsequently tested for their ability to inhibit the growth of these microorganisms. Amniotic fluids and chlamydial suspensions in a 2:1 ratio were incubated 30 to 90 minutes before their inoculation in McCoy cells. Procedures were followed for chlamydial isolation. Genital mycoplasmas were incubated with amniotic fluid samples for 24 or 48 hours at 35 degrees C. Growth in amniotic fluid specimens was compared with growth in pseudoamniotic fluid and broth controls. Fourteen amniotic fluid specimens collected from gestations of 16 to 40 weeks, were found to be inhibitory to the formation of inclusions of C. trachomatis in McCoy cells. Ten amniotic fluid specimens (16 to 39 weeks, gestation) demonstrated various degrees of inhibition against M. hominis, and three fluids were inhibitory to the growth of Ureaplasma. The inhibitor was heat and protease resistant and activity was proportional to concentration. The molecular weight of the inhibitor was probably greater than 10,000 daltons, and pH, although perhaps a contributing factor, was not the cause of the inhibition.

Amniotic Fluid↗
PubMed1990

Amniotic fluid index: an appropriate predictor of perinatal outcome.

Qualitative amniotic fluid volume determination is a routine part of the fetal biophysical profile score. Quantitative amniotic fluid volume measurement, however, is not a factor in the determination of the standard biophysical profile score. This study is a retrospective analysis of antepartum assessment of amniotic fluid volumes and their relationship to neonatal outcomes. The amniotic fluid index was calculated for all patients examined and perinatal outcome was studied for all patients assessed. Patients with reduced or increased amniotic fluid volume had a significant increase in meconium-stained amniotic fluid, Apgar scores less than 7 at 1 and 5 minutes, major congenital anomalies, admission to the neonatal intensive care unit, and were more likely to require delivery by cesarean section for fetal distress. This study suggests that a quantitative ultrasound measurement of amniotic fluid volume represents an effective discriminatory test to be used in pregnancy evaluation.

Amniotic Fluid↗
PubMed1994

Very echogenic amniotic fluid: ultrasonography-amniocentesis correlation.

Very echogenic amniotic fluid has been variably attributed to meconium, blood, or vernix caseosa. However, most previous reports have been case reports, and most cases have not had proof by amniocentesis. In a larger series of patients with proof by amniocentesis, we sought to determine the relative frequency of these substances as causes of very echogenic amniotic fluid. We retrospectively identified obstetric sonograms in which the amniotic fluid was homogeneously filled with innumerable echogenic particles. The cause of the increased echogenicity was determined by fluid appearance at amniocentesis. Of 86 cases identified, immediate proof by amniocentesis was available in 19 patients for whom the gestational age ranged from 32.8 to 39.4 weeks. Vernix was present in 18 (95%) patients and meconium in one (5%) patient. Very echogenic amniotic fluid in the third trimester is most often due to vernix and infrequently due to meconium. This sonographic finding is not a reliable indicator of meconium or blood in amniotic fluid and should not typically alter antenatal management.

Amniocentesis↗
PubMed1975

Creatinine, urea and uric acid in amniotic fluid, maternal and umbilical cord blood at delivery.

Amniotic fluid, maternal vein serum and umbilical cord serum were obtained almost simultaneously from 31 women after an uneventful course of pregnancy. Specimens of amniotic fluid contaminated by blood or meconium were excluded. Creatinine, urea and uric acid were measured by autoanalyser techniques. The concentrations of creatinine, urea and uric acid in amniotic fluid were significantly higher when compared with the levels in maternal vein serum or umbilical cord serum. Between maternal and umbilical cord serum there were only small or no differences. The linear correlations of creatinine, urea and uric acid between maternal and umbilical cord serum were greater than those between amniotic fluid and maternal serum of amniotic fluid and cord serum. It is suggested that the high levels of creatinine, urea and uric acid in amniotic fluid are primarily determined by fetal urine.

Amniotic Fluid↗
PubMed1999

Antenatal testing among 1001 patients at high risk: the role of ultrasonographic estimate of amniotic fluid volume.

OBJECTIVE: Our goal was to compare the accuracy of the amniotic fluid index and the 2-diameter pocket technique with respect to accuracy in predicting an adverse pregnancy outcome among patients at high risk undergoing antenatal testing. STUDY DESIGN: All women with high-risk pregnancies and intact membranes who underwent antenatal testing during an 18-month period were prospectively enrolled. Ultrasonographic estimates of amniotic fluid volume were performed by means of the amniotic fluid index and the 2-diameter pocket technique. Relative risks with 95% confidence intervals and receiver operator characteristic curves were calculated for patients with an ultrasonographic estimate of oligohydramnios (amniotic fluid index of </=5 cm or 2-diameter pocket of </=15 cm2) versus normal fluid level (amniotic fluid index of >5 cm or 2-diameter pocket of >15 cm2). Outcome variables studied were intrapartum and neonatal complications. RESULTS: Among 1001 patients the mean (+/-SD) amniotic fluid index was 10.5 +/- 5 cm and the mean (+/-SD) 2-diameter pocket was 18.7 +/- 13.6 cm2. Significantly more patients (46%) were considered to have oligohydramnios according to the 2-diameter pocket criteria than according to the amniotic fluid index (21%, P <.0001, relative risk 1.7, 95% confidence interval 1.5-1.8). No significant differences in the incidences of nonreactive nonstress test results, meconium-stained amniotic fluid, cesarean delivery for fetal distress, low Apgar scores, or infants with cord pH of <7.10 were observed between the oligohydramnios and normal amniotic fluid groups (P >.05) when assessed by relative risk with confidence interval and by receiver operator characteristic curves. CONCLUSIONS: Current ultrasonographic measurements with the amniotic fluid index and the 2-diameter pocket technique are poor diagnostic tests to determine whether a patient is at high risk for an adverse perinatal outcome.

Adult↗
PubMed1984

Critical assessment of antibacterial properties of human amniotic fluid.

A low molecular weight fraction of human amniotic fluid was found to be rapidly bactericidal for Escherichia coli ATCC 33908. Incubation in an atmosphere of CO2 but not N2 diminished the antibacterial effect suggesting that loss of CO2 and change in pH may be partly responsible for the observed antibacterial activity of the low molecular weight fraction of amniotic fluid. Incubation in pH 8.5 buffers did not duplicate the rapid killing of bacteria observed in the low molecular weight fraction of amniotic fluid, suggesting that elevated pH and an antibacterial factor from amniotic fluid act synergistically. The pH change in amniotic fluid which occurs in room atmosphere may account for some of the antibacterial effect which has been reported for amniotic fluid incubated aerobically.

Amniotic Fluid↗
PubMed1988

Capnocytophaga species: a cause of amniotic fluid infection and preterm labour.

Subclinical amniotic fluid infection and subsequent preterm labour may occur with intact membranes. We report two cases of subclinical amniotic fluid infection with intact membranes presenting in preterm labour. Capnocytophaga species, fastidious Gram-negative bacilli normally found in oral flora, were isolated in pure culture from amniotic fluid obtained by transabdominal amniocentesis. The distinctive microbiological features and spectrum of infections associated with Capnocytophaga species, and the importance of recognition of subclinical amniotic fluid infection as a cause of preterm labour, are discussed.

Adult↗
PubMed1983

Amniotic fluid phospholipids and glucocorticoids in multiple pregnancy.

The phospholipid composition of amniotic fluid has been examined in 30 twin pregnancies with a mean gestation of 37.7 weeks. Before the onset of labour there was no difference in ratios of lecithin (L), phosphatidylinositol (PI), phosphatidylethanolamine (PE) and phosphatidylglycerol (PG) to sphingomyelin (S) between the first and second twin. With the start of contractions (6 patients) there was a significant increase in the L/S and PE/S ratios in the first twin (L/S ratio twin I 10.8 +/- 5.2, twin II 7.0 +/- 3.8; PE/S ratio twin I 0.7 +/- 0.2, twin II 0.4 +/- 0.1). Growth retardation of one fetus did not alter the phospholipid profile in the amniotic fluid. Amniotic fluid concentrations of glucocorticoids, measured before and during labour in both twins by specific immunoassay, were the same in both sacs before labour. During labour concentrations of unconjugated and conjugated glucocorticoids were significantly increased in the first sac (twin I unconjugated 113.2 +/- 16.6, conjugated 505.1 +/- 115.9; twin II unconjugated 69.5 +/- 41.4, conjugated 284.3 +/- 124 nmol/l). Amniotic fluid from growth retarded fetuses did not show higher glucocorticoid levels. In subsequent studies the glucocorticoids were separated by chromatography and only cortisol reacted significantly with the antibody used under the conditions of the assay.

Adult↗