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PubMed1984

The value of ultrasound measurement of amniotic fluid volume in the management of prolonged pregnancies.

Ultrasound assessment of amniotic fluid volume was used to monitor 335 patients with prolonged pregnancy. Reduced amniotic fluid was diagnosed when no single vertical pool of amniotic fluid measured greater than 30 mm. Sixty-five patients with reduced amniotic fluid had labour induced while 270 patients with normal amniotic fluid were managed expectantly unless the cervix was favourable. Patients with reduced amniotic fluid had a statistically significant increase in meconium-stained amniotic fluid and growth-retarded babies and were more likely to require delivery by caesarean section for fetal distress. There were no perinatal deaths in the series and the perinatal outcome was satisfactory in both groups. Ultrasound measurement of amniotic fluid represents an effective discriminatory test in post-term pregnancy.

Amniotic Fluid↗
PubMed1992

Intrapartum amniotic fluid index and its relationship to fetal distress.

Amniotic fluid index was measured in 50 consecutive laboring women after membrane rupture. The 10th percentile of the normal range was 6.2 cm. Thirty-three women had a repeat measurement by a second observer. Although there was no systematic bias between the two observers, the limits of agreement were wide: 95% of the measurements by one observer were between 0.59 and 2.07 times those of the second. Closer agreement was observed when amniotic fluid index was low (less than 6.2 cm). The relationship between intrapartum amniotic fluid index and fetal distress was then investigated in a further 60 laboring women. When compared with women with a normal intrapartum amniotic fluid index, women with a low amniotic fluid index had higher incidences of fetal heart rate abnormalities during the first stage of labor (64% vs 20%, p less than 0.01), meconium (grade II or III) at delivery (64% vs 35%, p less than 0.05), and operative delivery for fetal distress (57% vs 17%, p less than 0.01). Umbilical artery pH and Apgar scores were, however, similar for the two groups. Measurement of intrapartum amniotic fluid index may be an appropriate method for selecting women suitable for intrapartum aminoinfusion.

Amniotic Fluid↗
PubMed2005

The syndrome of amniotic fluid embolism: a potential contribution of bradykinin.

OBJECTIVE: Amniotic fluid embolism is a potentially fatal complication of pregnancy; although several hypotheses have been formulated, the pathophysiology of this condition is not well known. An exaggerated release of bradykinin, which is activated by products of the amniotic fluid that enter the maternal circulation, could explain the symptoms that are present in amniotic fluid embolism. The objective of this study was to assess whether bradykinin is involved in amniotic fluid embolism. STUDY DESIGN: The plasma bradykinin-generating capacity was measured serially in a patient who experienced amniotic fluid embolism. RESULTS: The plasma bradykinin-generating capacity was found to be very low at the time of the initial clinical manifestations, which were characterized by severe hypotension, cardiorespiratory arrest, and coagulopathy. CONCLUSION: This study suggests a potential role for bradykinin release in the pathophysiology of amniotic fluid embolism.

Adult↗
PubMed1991

Amniotic fluid contains tissue factor, a potent initiator of coagulation.

A primary clinical manifestation of amniotic fluid embolism is coagulopathy. Prior studies have identified a poorly characterized yet potent procoagulant property in amniotic fluid that increases with gestational age. One possible source of procoagulant activity is tissue factor, a primary biologic initiator of coagulation. We used sensitive immunoassays and functional assays to identify substantial quantities of tissue factor antigen and tissue factor-specific procoagulant activity in amniotic fluid, which increased with gestational age. Moreover, tissue factor accounted for virtually all of the coagulant potential of amniotic fluid. Amniotic tissue factor appeared intact and membrane bound and, when reconstituted into synthetic microvesicles of optimal phospholipid content, displayed nearly full activity. Calcium chelation and sonication experiments suggested that the presence of inhibitors and the physical configuration of membrane-bound tissue factor in amniotic fluid might explain the modest reduction in tissue factor procoagulant activity relative to total antigen levels observed in vivo. We postulate that the substantial quantities of functionally active tissue factor in amniotic fluid account for the coagulation changes accompanying amniotic fluid embolism and could indirectly contribute to the characteristic hemodynamic derangements of amniotic fluid embolism.

Amnion↗
PubMed2001

Value of amniotic fluid neutrophil collagenase concentrations in preterm premature rupture of membranes.

OBJECTIVE: Neutrophils in amniotic fluid are thought to be of fetal origin, and therefore the detection of these cells and/or their products in amniotic fluid may reflect the fetal inflammatory status. We propose that amniotic fluid neutrophil collagenase (matrix metalloproteinase-8) is a useful parameter to predict adverse neonatal outcome, impending preterm labor/delivery, and intrauterine infection in the setting of preterm premature rupture of the membranes. STUDY DESIGN: Amniotic fluid was obtained by transabdominal amniocentesis from 101 patients with preterm premature rupture of the membranes (gestational age, 24-36 weeks). Fluid was cultured for aerobic and anaerobic bacteria and Mycoplasmas. Amniotic fluid analysis included Gram stain, white blood cell count, and determination of interleukin-6 and matrix metalloproteinase-8 concentrations (enzyme-linked immunosorbent assay). RESULTS: Neonates with adverse neonatal outcome were born to mothers with a significantly higher median amniotic fluid matrix metalloproteinase-8 concentration than those without adverse neonatal outcome (median, 54.4 ng/mL; range, 0.82-14,500 ng/mL vs median, 28.9 ng/mL; range, 0.78-2451.8 ng/mL; P <.05, respectively). The higher the amniotic fluid matrix metalloproteinase-8 concentrations, the shorter the interval to delivery (Cox proportional hazards model adjusting for gestational age at delivery; hazard ratio, 1.9; 95% CI, 1.1-3.5; P <.03). Amniotic fluid matrix metalloproteinase-8 concentration was more sensitive than an amniotic fluid white blood cell count and interleukin-6 in the detection of microbiologically proven intra-amniotic infection. CONCLUSION: Increased concentrations of neutrophil collagenase (matrix metalloproteinase-8) in amniotic fluid are associated with intra-amniotic infection, impending preterm delivery, and adverse neonatal outcome in patients with preterm premature rupture of the membranes. Moreover, matrix metalloproteinase-8 in amniotic fluid is a stronger predictor for the duration of pregnancy and intra-amniotic inflammation than interleukin-6 and an amniotic fluid white blood cell count.

Amniotic Fluid↗
PubMed1988

Binding of fluorescent phosphatidylcholine in amniotic fluid.

Fetal lung maturity can be predicted by the technique of fluorescence polarization using fluorescent phosphatidylcholine instead of diphenylhexatriene. To further elucidate the mechanism of this assay, we used high-speed centrifugation to isolate amniotic fluid lamellar bodies. Each of 75 amniotic fluid samples was separated into two fractions: a lamellar body pellet and a lamellar body-free supernatant fluid. Amniotic fluid and these fractions were assessed in a fluorescence polarization assay using a fluorescent phosphatidylcholine. Regardless of the maturity of the fetal lung, the lamellar body fractions had low polarization values (0.127-0.216), whereas the lamellar body-free fractions had high polarization values (0.266-0.344). Compared with the polarization of amniotic fluid, the fluorescence intensity of the lamellar body fractions had a strong inverse correlation (r = -0.871). The polarization of lamellar body pellets was not linearly related to the polarization of amniotic fluids. These findings do not support the theory that this fluorescence polarization assay measures the microviscosity of surfactant lipids. Instead, we propose that this assay indicates the quantity of surfactant relative to the quantity of nonsurfactant receptors of fluorescent phosphatidylcholine in amniotic fluid.

Amniotic Fluid↗
PubMed1990

Immunoreactive corticotropin-releasing hormone in amniotic fluid.

Immunoreactive corticotropin-releasing hormone in the amniotic fluid of both human beings and rats was measured by a specific radioimmunoassay. In human subjects the hormone was detectable in all amniotic fluid samples (obtained during the sixteenth and eighteenth weeks of gestation) (2.5 +/- 1.7 fmol/ml, mean +/- SD, n = 17) and the thirty-eighth to fortieth weeks (9.3 +/- 5.4 fmol/ml, n = 24). The levels of concentration of this hormone in this amniotic fluid correlated significantly with the levels in both maternal plasma and placenta for each patient. Gel filtration of amniotic fluid extracts revealed two major peaks of immunoreactive corticotropin-releasing hormone, one at the elution position of the rat hormone and the other at a small-molecular-weight region. Immunoreactive corticotropin-releasing hormone was not detectable in rat amniotic fluid or placenta. We concluded that immunoreactive corticotropin-releasing hormone, which may be derived from the placenta, is present in human amniotic fluid and that its detection in the human placenta but not in rat placentas suggests that the mechanism of corticotropin-releasing hormone gene expression in the placenta is species specific.

Adolescent↗
PubMed1984

[Origin of low molecular weight protein in amniotic fluid].

This study was designed to clarify the origin of some low molecular weight (M.W.) proteins in amniotic fluid. Fragments of amniotic membrane were incubated in Krebs solution for six hours. During the incubation period, 2 ml samples of solution were collected at 5, 15, 30, 60, 120, 180, 360 minutes. The protein concentration of samples was measured with a LASER"NEPHELOMETER. The protein concentration increased significantly from 1.25 +/- 0.21 mg/g.w.w. at 60 minutes to 2.33 +/- 0.67 mg/g.w.w. of amniotic membrane at 360 minutes (p less than 0.001). Samples were also analyzed by sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE). Proteins of M.W. less than 56 X 10(3) formed several bands, including band 15 (M.W. = 38 X 10(3)), bands 18-19 (M.W. = 23-25 X 10(3)) and band 21-23 (M.W. = 13-19 X 10(3)). Neonatal saliva and urine were also analyzed by SDS-PAGE. The saliva contained proteins of bands 15 and 20 (M.W. = 22 X 10(3)), and the urine a protein of band 14-15 (M.W. = 38-45 X 10(3)). Although the protein of band 20 was the greatest percentage of total protein in saliva samples, it could not be detected in amniotic fluid. Therefore, saliva was probably not a source of low M.W. proteins in amniotic fluid. Amniotic fluid proteins of band 15 probably originated from fetal urine. And proteins of band 21-23 were probably synthesized by the amniotic membrane.

Amnion↗
PubMed2004

Gender differences in amniotic fluid cytokine levels.

OBJECTIVE: Placental trophoblast invasion and amniotic fluid cytokine receptor levels have been reported to vary with fetal gender. We investigated whether fetal gender affects amniotic fluid levels of the inflammatory cytokines interleukin (IL)-6 and IL-10 and the pro-angiogenesis cytokine angiogenin. METHODS: Specimens from singleton gestations undergoing mid-trimester amniocentesis for genetic indications were used. Inclusion criteria were (1) outcome information available, (2) no structural or chromosomal anomaly and (3) no conditions associated with preterm delivery. Amniotic fluid IL-6, IL-10 and angiogenin levels were measured by immunoassay. Statistical analysis included the Mann-Whitney U test and Fisher's exact test with p < 0.05 indicating significance. RESULTS: A total of 74 samples were analyzed. Angiogenin levels were significantly lower in amniotic fluid samples from pregnancies with a male than with a female fetus (median (range): 22.2 (5.9-66.4) vs. 32.0 (11.4-159.2) ng/ml, p=0.007), in contrast to no differences in amniotic fluid IL-6 and IL-10 levels (p=0.4 and p=0.1, respectively). In pregnancies with male fetuses delivering preterm (< 37 weeks), angiogenin was also detected at lower levels (p=0.02). There were no gender differences with respect to race, nulliparity or maternal age. CONCLUSION: Angiogenin levels, but not IL-6 or IL-10 levels, are significantly lower in second-trimester amniotic fluid of women with male compared with female fetuses, including those women delivering preterm.

Adult↗
PubMed2004

Determination of oligosaccharides and glycolipids in amniotic fluid by electrospray ionisation tandem mass spectrometry: in utero indicators of lysosomal storage diseases.

Prenatal diagnosis is available for many lysosomal storage disorders (LSD) using chorionic villus samples or amniocytes. Such diagnoses can be problematical if sample transport and culture are required prior to analysis. The purpose of this study was to identify useful biochemical markers for the diagnosis of lysosomal storage disorders from amniotic fluid. Amniotic fluid samples from control (n=49) and LSD affected (n=36) pregnancies were analysed for the protein markers LAMP-1 and saposin C by ELISA, and for oligosaccharide and lipid metabolite markers by electrospray ionisation-tandem mass spectrometry. Lysosomal storage disorder samples include; aspartylglucosaminuria, galactosialidosis, Gaucher disease, GM1 gangliosidosis, mucopolysaccharidosis types I, II, IIIC, IVA, VI, and VII, mucolipidosis type II, multiple sulfatase deficiency, and sialidosis type II. Each disorder produced a unique signature metabolic profile of protein, oligosaccharide, and glycolipid markers. Some metabolite elevations directly related to the disorder whilst others appeared unrelated to the primary defect. Many lysosomal storage disorders were clearly distinguishable from control populations by the second trimester and in one case in the first trimester. Samples from GM1 gangliosidosis and mucopolysaccharidosis type VII displayed a correlation between gestational age and amount of stored metabolite. These preliminary results provide proof of principal for the use of biomarkers contained in amniotic fluid as clinical tests for some of the more frequent lysosomal storage disorders causal for hydrops fetalis.

Amniotic Fluid↗
PubMedDate not supplied

Evaluation of human fetal urine as a source of amniotic fluid phospholipids.

The accumulation of surface active material in amniotic fluid during gestation is assumed to result from lung fluid secretion through the trachea. Some animal studies, however, have indicated that virtually all of the tracheal fluid is swallowed, whereas little if any enters the amniotic cavity. Following these observations fetal urine has been considered by some authors as an alternative source of amniotic fluid phospholipids. However, the phospholipid content of human fetal urine has not yet been determined. We have determined the L/S ratio and lamellar body concentration in human amniotic fluid and fetal urine obtained during 3 term cesarean deliveries. While both the L/S ratio and lamellar body particle concentration in the amniotic fluid samples were equivalent to values reported in term pregnancies, no measurable lecithin or sphingomyelin peaks were demonstrated in the urine samples and very few, if any, particles were counted. The lack of similarity between determinants of surface activity in human amniotic fluid and fetal urine does not support a major contribution of fetal urine to the phospholipid content of amniotic fluid.

Amniotic Fluid↗
PubMed1985

[Antibacterial activity of amniotic fluid and lysozyme].

In order to investigate the antibacterial activity of amniotic fluid, the growth curves of several bacterial species in human amniotic fluid were observed by plate counting methods. The concentration of the bacteriolytic enzyme lysozyme in amniotic fluid was measured, and the relationship between lysozyme and antibacterial activity was discussed. The following results were obtained: Amniotic fluid had an antibacterial effect on B. subtilis, Staph. aureus and E. coli. When amniotic fluid was heated at 100 degrees C for 5 minutes, its antibacterial properties were lost or weakened. The lysozyme concentration in amniotic fluid increased gradually with gestational age, rising to 19.1 +/- 8.3 mu/ml at term. When lysozyme was added to amniotic fluid that had lost its antibacterial properties through exposure to heat, the antibacterial effect on B. subtilis was recovered. The growth of Staph. aureus in amniotic fluid exposed to heat was inhibited by the concomitant addition of lysozyme and aminobenzyl penicillin.

Amniotic Fluid↗
PubMed1994

Characteristic morphologic abnormality of harlequin ichthyosis detected in amniotic fluid cells.

We have examined cells from amniotic fluid obtained at 17 and 21 weeks' gestation and fetal skin biopsy samples from a fetus at risk of harlequin ichthyosis by light and electron microscopy. Clumps of abnormally keratinized cells that had a large number of lipid droplets in the cytoplasm were seen within both the 17- and 21-week amniotic fluid cell pellets. The cells in these clumps were similar to the thick layers of keratinized cells observed in the skin biopsy and autopsy samples. Morphologic examination of the fetal skin biopsy samples obtained at 21 weeks gestation revealed the characteristic changes of harlequin ichthyosis. The intraepidermal portions of hair canals had an excessive number of layers of keratinized cells. Normal lamellar granules were absent but abundant membrane-bound vesicles of a similar size and a number of dense bodies were observed in the cells of the upper intermediate layers of the epidermis. Autopsy skin samples of the terminated fetus at the twenty-third week of gestation showed structural changes that corresponded to those of the amniotic fluid cells and the fetal skin biopsy samples, although the periderm was gone in all the regions. Our findings of amniotic fluid indicate that the characteristic epidermal abnormality of harlequin ichthyosis has been expressed at 17 weeks gestation in some parts of the body or structures of fetal skin (e.g., hair canals) that keratinize before interfollicular epidermis. Moreover, the results suggest that harlequin ichthyosis can be detected in utero by morphologic analysis of amniotic fluid cells obtained by amniocentesis.

Adult↗
PubMed1995

Prenatal detection of the cholesterol biosynthetic defect in the Smith-Lemli-Opitz syndrome by the analysis of amniotic fluid sterols.

The Smith-Lemli-Opitz (SLO or RSH) syndrome is an autosomal recessive disorder characterized by a recognizable pattern of minor facial anomalies, congenital anomalies of many organs, failure to thrive, and mental retardation. Its cause is a defect in cholesterol biosynthesis characterized by abnormally low plasma cholesterol levels and concentrations of the cholesterol precursor 7-dehydrocholesterol (7DHC) elevated up to several thousand-fold above normal. We used capillary column gas-chromatography to quantify sterols in amniotic fluid, amniotic cells, plasma, placenta, and breast milk from a heterozygous mother who had previously given birth to an affected son and in cord blood and plasma from her affected newborn daughter. The cholesterol concentration in amniotic fluid at 16 weeks gestation was normal, but 7DHC, normally undetectable, was greatly elevated. In cultured amniocytes, the level of 7DHC was 11% of total cholesterol, similar to cultured fibroblasts from patients with SLO syndrome. At 38 weeks, a girl with phenotype consistent with the syndrome was born. Cholesterol concentrations were abnormally low in cord blood and in the baby's plasma at 12 weeks, while levels of 7DHC were grossly elevated, confirming the prenatal diagnosis. The mother's plasma cholesterol increased steadily during gestation but remained below the lower 95% limit reported for normal control women. We conclude that it is now possible to detect the SLO syndrome at 16 weeks gestation by analyzing amniotic fluid sterols.

Amniotic Fluid↗
PubMed1998

The role of amniotic fluid L-selectin, GRO-alpha, and interleukin-8 in the pathogenesis of intraamniotic infection.

OBJECTIVE: Our purpose was to compare and correlate amniotic fluid GRO-alpha, interleukin-8, and L-selectin in patients with and without intraamniotic infection. STUDY DESIGN: Amniocentesis was performed on 45 pregnant women with preterm contractions, labor, or rupture of membranes. Fourteen patients had intraamniotic infection, and 31 did not. Intraamniotic infection was defined as the presence of a positive amniotic fluid culture. Amniotic fluid tests for Gram stain, glucose, neutrophil counts, creatinine, pH, and specific gravity were performed. Amniotic fluid levels of soluble L-selectin, interleukin-8, and GRO-alpha were measured by an enzyme-linked immunoassay and normalized by amniotic fluid creatinine levels. The Mann-Whitney Utest and Spearman's rank correlation test were used for statistical analyses. RESULTS: Amniotic fluid median levels of soluble L-selectin, interleukin-8, and GRO-alpha were significantly higher in pregnant women with intraamniotic infection than in those without intraamniotic infection (soluble L-selectin: median 3334.6 ng/mg creatinine, range 408.4 to 15,956.8 vs 717.2 ng/mg creatinine, range 129.4 to 4601.9, p = 0.009; GRO-alpha: median 841.6 ng/mg creatinine, range 28.1 to 8591.7 vs 56.8 ng/mg creatinine, range 0.0 to 440.2, p < 0.0001; interleukin-8: median 4932.7 ng/mg creatinine, range 0.0 to 55,058.7 vs 28.3 ng/mg creatinine, range 0.0 to 1161.6, p = 0.0004). Patients with intraamniotic infection had significantly higher amniotic fluid leukocyte counts and leukocyte esterase activities and significantly lower amniotic fluid glucose concentrations compared with those without intraamniotic infection. Amniotic fluid GRO-alpha, interleukin-8, and soluble L-selectin were positively correlated, and each was positively correlated with amniotic fluid leukocytes and negatively correlated with amniotic fluid levels of glucose. CONCLUSIONS: Our data indicate amniotic fluid GRO-alpha and interleukin-8 may be two potent leukocyte chemoattractants and activators, and L-selectin is rapidly shed from leukocytes in the amniotic fluid in patients with intraamniotic infection.

Adult↗
PubMed1997

The effect of amniotic fluid ingestion on the nociception of cows.

The effect of the ingestion of the afterbirth on the nociception of cows was studied in two experiments. In both trials, the dependent variable was the thermal threshold of the animal, recorded as temperature and measured using nociceptive tests (NT). In the first experiment, 32 animals were randomly distributed in a 2 x 2 factorial design. The drug factor was an intravenous injection of morphine sulfate or of a saline solution. The fluid factor was the orogastric infusion of amniotic fluid or water. A pretreatment NT was considered as a baseline. Other NTs were performed after the drug injection and after the fluid infusion. In the second experiment, 28 multiparous Holstein cows were randomly assigned to 2 x 2 factorial treatments. The factors were amniotic fluid, either removed or not from the calves' surface immediately after delivery; and placenta, either left available or removed. A NT was performed before and 1, 6 and 36 h after the calf's delivery. In experiment 1, the morphine dose used did not produce an increase of the thermal threshold (p > 0.17) and neither did the amniotic fluid on the morphine-treated cows (p > 0.83). However, the amniotic fluid had an effect (p < 0.04) on the group injected with saline solution. In experiment 2, a linear rise occurred (p < 0.001) in the pain tolerance of the cows as parturition approached. Placenta ingestion and placenta and amniotic fluid ingestion had no effect (p < 0.26) on the thermal threshold of the cows. However, cows ingesting amniotic fluid had a significantly higher thermal threshold in the 1-h test than in the 6-h and 36-h tests (p < 0.004). The nociception of the cows not receiving amniotic fluid did not change across the same periods (p > 0.587). The results indicate that the ingestion of amniotic fluid enhances the ongoing opioid-mediated analgesia at parturition in bovines.

Amniotic Fluid↗
PubMed2002

Is there a relationship between fetal weight and amniotic fluid index?

OBJECTIVE: To establish whether there is a relationship between the amniotic fluid index and estimated fetal weight in the third trimester. The presence of a relationship would require adjustment of amniotic fluid index to take account of estimated fetal weight with potential improvement in its prediction of adverse perinatal outcomes. METHODS: Paired measurements of amniotic fluid index and estimated fetal weight from 274 low-risk pregnancies enrolled in a longitudinal study of fetal growth. Measurements were made at fortnightly intervals from 30 weeks' gestation until delivery. A relationship between amniotic fluid index and estimated fetal weight was sought at gestational age week intervals of 30-32, 33-35, 36-38 and 39-41. RESULTS: One thousand and three pairs of measurements of amniotic fluid index and estimated fetal weight were available for analysis. Mean amniotic fluid index decreased towards term as expected. There was no correlation between amniotic fluid index and estimated fetal weight. Furthermore, there was no correlation between amniotic fluid index and estimated fetal weight at any of the gestational age intervals. CONCLUSIONS: There is no clinically relevant correlation between amniotic fluid index and estimated fetal weight. It should remain clinical practice to take account of gestational age when interpreting amniotic fluid index but it is not necessary to make adjustments for estimated fetal weight.

Adult↗
PubMed1993

Effect of fetal movement on the amniotic fluid index.

OBJECTIVES: Fetal movement has been shown to change the size and location of amniotic fluid pockets during measurement of the amniotic fluid index. The effect of redistributing the fixed intrauterine fluid volume on the amniotic fluid index is unknown. Therefore we tested the hypothesis that the amniotic fluid index was unaffected by fetal movement. STUDY DESIGN: A single examiner prospectively determined the amniotic fluid index before and after three discrete episodes of fetal movement during 96 biophysical profiles. A reliable blinded examiner provided a second postmovement measurement as a control. Data were analyzed by the paired t test. RESULTS: The mean change in the amniotic fluid index after fetal movement was 1.5 +/- 0.1 cm and 2.5 +/- 0.2 cm for postmovement determinations by the same examiner and blinded observer, respectively (p < 0.001). CONCLUSION: Interobserver and intraobserver variation can account for the change in the amniotic fluid index after fetal movement.

Amniotic Fluid↗