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PubMed1999

Perinatal risks associated with borderline amniotic fluid index.

OBJECTIVE: Our purpose was to determine whether a borderline amniotic fluid index observed during antepartum testing confers a significant risk of adverse perinatal outcome. STUDY DESIGN: We conducted a retrospective review of all patients entering antepartum testing at Los Angeles County-University of Southern California Women's and Children's Hospital during a 4-month period beginning January 1, 1996. Women with singleton pregnancies who underwent antepartum testing within 1 week of delivery and who were delivered at our institution were identified for our study. An amniotic fluid index >5 and <10 cm was defined as "borderline" and an amniotic fluid index of 10 to 24 cm was considered normal. Markers of adverse perinatal outcome included intrapartum fetal distress, 5-minute Apgar score <7, meconium-stained amniotic fluid, and intrauterine growth restriction. RESULTS: There was a 2-fold increase in the incidence of adverse perinatal outcome among the women with borderline amniotic fluid index in comparison with control subjects with normal amniotic fluid volume. This difference reflected a 4-fold increase in the incidence of fetal growth restriction among women with a borderline amniotic fluid index. CONCLUSIONS: A borderline amniotic fluid index observed in antepartum testing is associated with an increased risk of intrauterine growth restriction and overall adverse perinatal outcome. These observations suggest that borderline amniotic fluid index merits twice-weekly antepartum testing.

Amniotic Fluid↗
PubMed1988

The influence of abnormal pregnancies on fluorescence polarization of amniotic fluid lipids.

The fluorescence polarization of amniotic fluid, a measure of fetal lung maturity, was determined in 518 amniotic fluid samples obtained by amniocentesis. The subjects were divided into seven clinical groups: premature contractions, premature rupture of the membranes, pregnancy-induced hypertension, diabetes, intrauterine growth retardation, vaginal bleeding, and "other" for gestational-age groups of 30 weeks or less, 31-36 weeks, and 37 or more weeks. The proportion of mature values (fluorescence polarization 0.285 or lower) increased progressively from 12.5% at 27-28 weeks to 100% at 39-40 weeks. In the 31-36-week gestation group, the proportion of mature values in subjects with premature rupture of the membranes (84.6%) was significantly higher than in those with premature contractions (60%), severe pregnancy-induced hypertension (50%), mild pregnancy-induced hypertension (55.2%), diabetes class A (50%), insulin-dependent diabetes (60%), and other (63.5%). The mean +/- SD fluorescence polarization value was significantly lower in premature rupture of the membranes (0.256 +/- 0.030) than in premature contractions (0.274 +/- 0.032), mild and severe pregnancy-induced hypertension (0.280 +/- 0.027 and 0.280 +/- 0.035, respectively), and class A and insulin-dependent diabetes (0.285 +/- 0.018 and 0.277 +/- 0.030, respectively). The severity of pregnancy-induced hypertension and diabetes did not appear to influence either the fluorescence polarization value or the proportion of mature results. With the exception of a marked influence of premature rupture of the membranes, abnormal pregnancy conditions did not appear to have a significant effect on fluorescence polarization of amniotic fluid.

Amniotic Fluid↗
PubMed1986

Determination of fetal lung maturity by fluorescence polarization of the amniotic fluid lamellar bodies.

High-speed centrifugation of amniotic fluid enables separation of surfactant-containing lamellar bodies. Fifty-three amniotic fluid samples from pregnancies of 28 to 39 weeks' gestation were examined for fetal lung maturity by measuring fluorescence polarization (P). For each sample the P value was determined at 37C on both the whole amniotic fluid and on the surfactant-containing lamellar bodies obtained by centrifugation at 10,000 X g. A close linear correlation (r = 0.80) was found between the P value of the amniotic fluid samples and that of the lamellar bodies. There was no difference in the specificity for discrimination of hyaline membrane disease cases by both methods (93.5%) with 95% confidence limits of 82.1 to 98.6%. Because high-speed centrifugation enables the selective sedimentation of pulmonary surfactant, determination of the lamellar body P value may offer a practical solution for the estimation of fetal lung maturity in amniotic fluid samples contaminated with blood.

Amniotic Fluid↗
PubMed1994

The value of amniotic fluid interleukin-6 determination in patients with preterm labor and intact membranes in the detection of microbial invasion of the amniotic cavity.

OBJECTIVES: Our purpose was to (1) determine the value of amniotic fluid interleukin-6 determination in the detection of microbial invasion of the amniotic cavity and (2) compare interleukin-6 to other rapid tests in the evaluation of preterm labor. STUDY DESIGN: Amniotic fluid interleukin-6 was determined quantitatively by enzyme-linked immunosorbent assay in 91 amniotic fluid specimens obtained by amniocentesis in 89 patients with preterm labor. Amniotic fluid cultures for aerobes, anaerobes, and mycoplasma species were performed. Receiver-operator characteristic curve analysis, logistic regression analysis, and Cox's proportional-hazards model were used to explore the relationship between several explanatory and outcome variables. Diagnostic index values of interleukin-6, glucose level, Gram stain, leukocyte esterase, and limulus amebocyte lysate assay for prediction of a positive amniotic fluid culture, preterm delivery, clinical infection, and neonatal sepsis were calculated. RESULTS: The prevalence of positive amniotic fluid cultures was 13% (12/89). The median interleukin-6 concentration in patients with positive cultures was 241.8 ng/ml, in contrast to 0.291 ng/ml in patients with negative cultures (p. < 0.005). Sensitivity and specificity of an interleukin-6 level > or = 6.17 ng/ml was 75% and 79%, in contrast to that of glucose, < or = 12 mg/dl (83% and 86%) for a positive amniotic fluid culture and sensitivity (p = 0.26, z test). All patients with an interleukin-6 level > 6.17 ng/ml were delivered preterm, in contrast to 85.2% of patients with a glucose level < or = 12 mg/dl. When all rapid tests and clinical parameters were considered simultaneously in the logistic model, only interleukin-6 maintained a significant relationship to preterm birth (odds ratio 35, p = 0.003). Cox's proportional analysis demonstrated a strong relationship between interleukin-6 and the amniocentesis-to-delivery interval after clinical variables were controlled for (hazard ratio 3.01, p < 0.00001). CONCLUSION: Amniotic fluid interleukin-6 determination may be a useful adjunct to our armamentarium of rapid tests to exclude infection and predict delivery in patients with preterm labor and intact membranes.

Amniocentesis↗
PubMed1998

Elevated Amniotic Fluid Interleukin-6 as a Predictor of Neonatal Periventricular Leukomalacia and Intraventricular Hemorrhage.

> Objective: To investigate the relationship between amniotic fluid interleukin-6 levels and the development of periventricular leukomalacia and intraventricular hemorrhage in the preterm neonate and to compare the value of amniotic fluid interleukin-6 with amniotic fluid culture and histologic chorioamnionitis in the prediction of periventricular leukomalacia and intraventricular hemorrhage. Methods: 119 women, between 20 and 34 weeks gestation, in preterm labor with intact membranes, underwent transabdominal amniocentesis. Amniotic fluid was cultured for aerobic and anaerobic bacteria, Ureaplasma urealyticum and Mycoplasma hominis. Amniotic fluid interleukin-6 levels were determined by enzyme-linked immunosorbent assay. The placentas were examined for histopathologic evidence of inflammation. Where the birth weight was <2,000 g, transfontanelle cranial sonography was performed on the 3rd and 7th days of life for diagnosis of periventricular leukomalacia and intraventricular hemorrhage. Student's t test, the Mann-Whitney U test, likelihood ratio chi2, logistic regression, and receiver-operator characteristic curve were used for analysis. Results: 33 women were excluded from the analysis because they delivered at other institutions. The neonates of 33 women did not have sonography because they weighed >2,000 g at birth. Two neonates died before sonography was performed; four neonates who weighed <2,000 g at birth did not have sonography. In the definitive study group of 47 women, those with neonates who developed periventricular leukomalacia and intraventricular hemorrhage (n = 14) had higher median amniotic fluid interleukin-6 levels (42,795 pg/ml versus 8,020 pg/ml; P = 0.009), more positive amniotic fluid cultures (64% vesus 21%; P < 0.003), and a shorter median amniocentesis-to-delivery interval (16 h versus 24 h; P = 0.045) than women (n = 33) who delivered neonates without periventricular leukomalacia or intraventricular hemorrhage. The groups did not differ in gestational age at admission (P = 0.15), birth weight (P = 0.09), or histologic chorioamnionitis (P = 0.37). An amniotic fluid interleukin-6 level >/=20,000 pg/ml had a sensitivity of 71% and a specificity of 70% compared with a sensitivity of 69% and specificity of 79% for amniotic fluid culture, and a sensitivity of 71% and specificity of 42% for histologic chorioamnionitis in the prediction of periventricular leukomalacia and intraventricular hemorrhage. Women with amniotic fluid interleukin-6 levels >/=20,000 pg/ml (n = 20) had more neonates with periventricular leukomalacia or intraventricular hemorrhage than women with amniotic fluid interleukin-6 levels <20,000 pg/ml (n = 27) (50% versus 15%; P = 0.009). They also were of lower birth weight (P = 0.02), had more neonatal morbidity (P = 0.01), had more positive amniotic fluid cultures (P = 0.01), and more histologic chorioamnionitis (P = 0.02). Logistic regression analysis demonstrated that amniotic fluid interleukin-6 was an independent risk factor for the development of periventricular leukomalacia and intraventricular hemorrhage (odds ratio, 5.81; 95% confidence interval, 1.02-33.16; P = 0.05) after controlling for gestational age, birth weight, histologic chorioamnionitis, and amniotic fluid culture (odds ratio, 7.94; 95% confidence interval 1.22-51.77; P = 0.03). Conclusions: In women in preterm labor with intact membranes amniotic fluid interleukin-6 is useful in predicting neonatal periventricular leukomalacia and intraventricular hemorrhage.

Journal Article↗
PubMed1999

Effect of fetal presentation on the amniotic fluid index.

OBJECTIVE: The aim of this study was to determine whether the amniotic fluid index differs according to whether a fetus is in breech or cephalic presentation. STUDY DESIGN: Between January 1995 and April 1996 the amniotic fluid index was measured both immediately before and after attempted external cephalic version. Amniotic fluid indexes were measured by a senior obstetric resident or attending physician. Preprocedure amniotic fluid indexes and change in amniotic fluid index after successful and failed external cephalic version were compared with unpaired and paired Student t tests, respectively. P <.05 was considered statistically significant. RESULTS: Thirty consecutive women between 36 and 40 weeks' gestation with breech presentations were evaluated before undergoing an attempt at external cephalic version. The preprocedure amniotic fluid index was not different (P =.61) between women who had success (12.1 cm) and failure (11.4 cm) of attempts at external cephalic version. Successful external cephalic version was associated with a statistically significant increase (P <.0001) in amniotic fluid index with respect to gestations with a persistent breech presentation (3.14 vs -0.35). CONCLUSION: Successful version from a breech to a cephalic presentation resulted in a significant increase in the amniotic fluid index. This should be considered when a breech presentation with a low normal amniotic fluid index is evaluated. Presentation of the fetus should be considered in evaluating amniotic fluid index distribution curves.

Adult↗
PubMed1981

Surface ultrastructure of amniotic fluid cells and fetal tissues of the Rhesus monkey.

Amniotic fluid cytology is considered to reflect other organ maturity more faithfully than the L/S ratio. In order to assess the origin of amniotic fluid cells a pilot study was undertaken in the Rhesus monkey with the purpose of correlating the surface ultrastructure of amniotic fluid cells and various tissues facing, or communicating with the amniotic cavity. Three distinct cell types were found in the amniotic fluid, out of which two were obviously related to maturational events in fetal skin. The remaining cell type seemed to be derived from umbilical cord, fetal vagina and to some extent oral mucosa. No exfoliation was observed in the urinary bladder, trachea, lungs or amniotic membranes. It is concluded that correlation of cytology and tissue surface morphology in the monkey amniotic fluid compartment may give clues to the origin of amniotic fluid cells in the human.

Amnion↗
PubMed2004

Regulation of amniotic fluid volume: intramembranous solute and volume fluxes in late gestation fetal sheep.

OBJECTIVE: Recent studies suggest that amniotic fluid volume is regulated by the rate of intramembranous absorption of amniotic fluid into fetal blood. The purpose of the present study was to determine the simultaneous intramembranous solute and water fluxes to gain insight into the intramembranous transport and amniotic fluid volume regulatory mechanisms. STUDY DESIGN: All major amniotic inflows and outflows, except intramembranous flow, were eliminated in 10 fetal sheep over 8 hours by occlusion of the fetal trachea and esophagus; the fetal urine was drained to the exterior. Amniotic fluid composition and volume were measured before and at the end of the 8 hours. Solute and volume fluxes through the intramembranous pathway were calculated from amniotic fluid concentration and volume changes. Statistical analyses included t-tests, linear regression, and analyses of variance. RESULTS: Amniotic fluid volume decreased by 128 +/- 24 (SE) mL over 8 hours (P < .001), which was correlated only marginally with the fetal to amniotic fluid osmotic gradient (r=0.59; P = .072). Amniotic fluid sodium, chloride, calcium, and bicarbonate concentrations increased (P < .0001), even though there were net outward fluxes of these solutes; these outward fluxes occurred against concentration gradients; and the clearances of these solutes were the same despite widely differing amniotic fluid concentrations and fetal blood to amniotic fluid concentration gradients. With the use of multivariate regression, intramembranous solute fluxes separated into 2 components, which were a primary outward flux that correlated with the volume flux and a minor inward component that correlated with the fetal plasma to amniotic fluid concentration gradient for sodium, chloride, calcium (P < .001), and bicarbonate (P < .02). The concentration-dependent fluxes averaged approximately one third of the bulk fluxes and were in the opposite direction. CONCLUSION: The poor correlation of amniotic fluid volume reduction with the fetal-to-amniotic fluid osmotic gradient shows that the primary mechanism that mediates intramembranous volume flow is not passive osmosis in the normal fetus under basal conditions. The strong correlations of solute fluxes simultaneously with volume flux and concentration gradients suggest that intramembranous solute fluxes are mediated by both bulk flow and passive diffusion. The small size of the passive component relative to the size of the bulk component suggests that intramembranous solute transfer is mediated primarily by bulk flow with a smaller and usually oppositely directed contribution by diffusion down concentration gradients. Bulk flow by vesicular transport is the only known physiologic transport mechanism that is compatible with these data, but it is not known whether this occurs in the amnion or intramembranous blood vessels or both.

Amniotic Fluid↗
PubMed1990

[Evaluation of amino acids in plasma and amniotic fluid of women from genetic risk groups].

Plasma and amniotic fluid amino acids were assayed in 20 women of genetic risk groups in the second trimester of pregnancy. The age of patients ranged from 19 to 38 years. Indication for amnio-puncture were: chromosomal aberration or neural tube defect in previous pregnancy or age of pregnant women over 35 years. Blood and amniotic fluid were obtained with transabdominal amnio-puncture performed routinely in prenatal diagnosis. Amino acids were assayed with ion exchange column chromatography, using automatic amino acids analyzer LKB 4400. The obtained results were compared with plasma and amniotic fluid amino acids patterns in healthy women at the same trimester of pregnancy. The comparison of plasma aminograms revealed increased concentrations (above 100%) of cystine and alanine in the examined group. In women with neural tube defect in previous pregnancy and in those over 35 years of age, increased proline, leucine and valine (above 50%) concentrations were found. Decreased concentrations of glutamic acid (about 60%) was detected in women with chromosomal aberration in previous pregnancy and in those older than 35 years. Amniotic fluid amino acid pattern showed in all three patients groups decreased values arginine and ornitine (amino acids of the urea cycle), and also of cystine and taurine. In women with neural tube defect in previous pregnancy and in those older than 35, decreased concentration of lysine, serine and leucine was found. Also in the above 2 groups increasing tendency in comparison to the values in healthy women was observed for alanine (30-40%) and asparagine (150-215%). No correlation was observed between particular amino acids plasma concentration and amniotic fluid in our patients. Ratios of plasma to the amniotic fluid (P/FA) amino acid concentrations were calculated for the examined group and compared with those in healthy pregnant women. While in the last population most of the analyzed scores is below 1 which points higher amino acid concentration in amniotic fluid than that in plasma, performed analysis revealed; an increase in P/AF ratio by 214% in the group of "neural tube defect" women, alanine, glutamine and ornitine P/AF ratios were 35-50% than the normal value. P/AF ratio for cystine by 176%, for tyrosine--100% and for ornitine and arginine--55-65% respectively higher than normal in patients of "chromosomal aberration". P/AF ratio for glutamine acid was decreased by about 50%. In patients examined because of age above 35 years, P/AF ratio for cystine was increased by 200%, for alanine by 125%, for proline, histidine, ornitine, phenylalanine, I-leucine and metionine were increased by 30%-50%.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1986

A weaker gelatin-binding affinity and increased glycosylation of amniotic fluid fibronectin than plasma fibronectin.

Human amniotic fluid fibronectin had different carbohydrate moieties from plasma fibronectin. Nearly 90% of glycopeptides released from amniotic fluid fibronectin was not bound by concanavalin A-Sepharose, whereas 75% of glycopeptides from plasma fibronectin was bound. Amniotic fluid fibronectin showed a significantly lower gelatin-binding affinity than plasma fibronectin at 25 degrees C. When the incubation temperature was lowered to 4 degrees C, no significant difference in this activity was found. Cell-attachment promoting activity of the two fibronectins was not significantly different.

Amniotic Fluid↗
PubMed1986

Effect of blood contamination on the fluorescence polarization value of amniotic fluid lamellar bodies.

Estimation of fetal lung maturity by examination of amniotic fluid samples is unreliable in the presence of blood. Centrifugation of amniotic fluid at 10,000 X g separates the surfactant-containing lamellar bodies from contaminants, such as serum lipids. The influence of serum contamination of amniotic fluid was evaluated using the fluorescence polarization technique for determination of fetal lung maturity. Addition of serum changed the amniotic fluid P value of both the amniotic fluid and the lamellar body pellets in the direction of the P value of serum. After centrifugation at 10,000 X g, there was no significant difference in the P value of the pre- and postcontamination samples, demonstrating that centrifugation resulted in the removal of pulmonary nonrelevant lipids in contaminated amniotic fluid specimens. In 24 patients in whom the amniotic fluid sample was blood stained, the P value on the lamellar body pellet compared favorably to that obtained from noncontaminated samples.

Amniotic Fluid↗
PubMed1994

Analysis of skin-derived amniotic fluid cells in the second trimester; detection of severe genodermatoses expressed in the fetal period.

Amniotic fluid contains skin-derived cells. To determine whether populations of amniotic fluid cells reflect genetic conditions, we surveyed the population of amniotic fluid cells from 36 fetuses at 16-21 weeks estimated gestational age at risk for junctional epidermolysis bullosa, recessive dystrophic epidermolysis bullosa, epidermolysis bullosa Dowling-Meara, harlequin ichthyosis, lamellar ichthyosis (nonbullous congenital ichthyosiform erythroderma), or Sjögren-Larson syndrome. Periderm cells, keratinocytes, cells of unknown epithelial origin, fibroblasts, fibrin clots, and urinary cast-like materials were seen in the amniotic fluid from normal fetuses. A large number of small macrophages phagocytizing collagen fibers was found in the amniotic fluid from all recessive dystrophic epidermolysis bullosa, some junctional epidermolysis bullosa fetuses, and a single epidermolysis bullosa Dowling-Meara fetus. Immuno-gold electron microscopy with anti-lysozyme and anti-CD68 antibodies confirmed that the cells morphologically identified as macrophages were active macrophages containing many lysosomes. The percentage of macrophages/total amniotic fluid cells in amniotic fluid samples from the fetuses affected with recessive dystrophic epidermolysis bullosa was significantly increased (12.30 +/- 0.20%) compared with that in the amniotic fluid from normal fetuses (1.30 +/- 0.65%) (p < 0.001). In amniotic fluid samples from fetuses affected with harlequin ichthyosis and lamellar ichthyosis, clumps of keratinized cells that contained disease-specific abnormal granules and lipid droplets were observed. These results indicate that the morphologic analysis of amniotic fluid cells can provide important supportive information for the prenatal diagnosis of several severe genodermatoses.

Amniotic Fluid↗
PubMed1997

Elevated amniotic fluid nitric oxide metabolites and cyclic guanosine 3',5'-monophosphate in pregnant women with intraamniotic infection.

OBJECTIVE: Our purpose was to compare amniotic fluid nitric oxide metabolites and cyclic guanosine 3',5'-monophosphate in pregnant women with and without intraamniotic infection. STUDY DESIGN: Amniocentesis was performed on 72 pregnant women with preterm contractions, labor, or rupture of membranes. Fourteen patients had intraamniotic infection and 58 did not. Intraamniotic infection was defined as the presence of a positive amniotic fluid culture. Amniotic fluid Gram stain, glucose, leukocyte counts, leukocyte esterase activity, creatinine, pH, and specific gravity were performed. Endogenous nitrite was determined using Griess reagent. Amniotic fluid nitric oxide metabolites (nitrite and nitrate) were measured after reduction of nitrate to nitrite with Aspergillus nitrate reductase. Tests for amniotic fluid cyclic guanosine monophosphate levels were determined by enzyme immunoassay. Two-tailed t test, contingency table methods, linear regression, and correlation were used for statistical analyses. RESULTS: Amniotic fluid levels of nitric oxide metabolites, endogenous nitrite, nitrate, and cyclic guanosine monophosphate were significantly higher in pregnant women with intraamniotic infection than in those without intraamniotic infection (2.66 +/- 0.49 vs 1.77 +/- 0.07 mumol/mg creatinine, p = 0.002; 0.69 +/- 0.15 vs 0.38 +/- 0.03 mumol/mg creatinine, p = 0.003; 1.99 +/- 0.41 vs 1.38 +/- 0.07 mumol/mg creatinine, p = 0.02; and 1.47 +/- 0.22 vs 0.90 +/- 0.08 nmol/mg creatinine, p = 0.004, respectively). Both amniotic fluid nitric oxide metabolites and cyclic guanosine monophosphate were positively correlated with amniotic fluid leukocyte counts and leukocyte esterase activity and negatively correlated with amniotic fluid glucose concentrations. CONCLUSIONS: Our data indicate that amniotic fluid nitric oxide and cyclic guanosine monophosphate may play important roles in the pathogenesis of intraamniotic infection. Measurements of amniotic fluid nitric oxide metabolites and cyclic guanosine monophosphate may be part of a panel of tests that can be used to detect intraamniotic infection.

Adult↗
PubMed1997

The relationship between second-trimester amniotic fluid insulin and glucose levels and subsequent gestational diabetes.

Associations between elevated amniotic fluid glucose and insulin levels in the second trimester and the subsequent development of gestational diabetes have been reported. We conducted a case-control study to determine which analyte best predicts future maternal glucose intolerance. Thirty-nine women diagnosed with gestational diabetes (criteria of Carpenter and Coustan, Am. J. Obstet. Gynecol., 144, 768, 1982) who had undergone genetic amniocentesis for advanced maternal age were matched with euglycaemic controls. Glucose and insulin concentrations were determined by analysis of stored amniotic fluid samples. No significant difference was detected between cases and controls for amniotic fluid glucose concentrations. Amniotic fluid insulin concentrations were significantly higher in cases (mean rank 4.44, P < 0.01, using matched rank analysis of variance, where 1 is the lowest and 6 is the highest rank). After conversion to multiples of the median, 20 per cent of women with subsequent gestational diabetes were found to have amniotic fluid glucose levels at or above the 90th centile, while 35 per cent of cases had similarly elevated amniotic fluid insulin levels. We conclude that second-trimester amniotic fluid insulin is a more sensitive predictor of impending glucose intolerance than amniotic fluid glucose, although neither is sufficiently powerful to use alone as a screening test.

Adult↗
PubMed1986

Preterm labor associated with subclinical amniotic fluid infection and with bacterial vaginosis.

Maternal genital infection, particularly subclinical amniotic fluid infection, may cause preterm labor and a premature delivery. The prevalence of subclinical amniotic fluid infection was studied in 54 consecutive afebrile women in preterm labor with singleton gestations and intact fetal membranes. Microorganisms were recovered from the amniotic fluid by transabdominal amniocentesis in 13 (24%) of 54 patients. Bacteria or Candida albicans were recovered from six (11%), and genital mycoplasmas from seven (13%). Compared with women with sterile amniotic fluid, patients whose amniotic fluid contained bacteria or Candida organisms had a shorter interval from onset of preterm labor until delivery (0.6 versus 34.3 days, P less than .01), were less responsive to tocolytic therapy (0 versus 81% success rate, P less than .005), and more frequently developed subsequent intrapartum fever (83 versus 2.4%, P less than .005). In contrast, women whose amniotic fluid contained genital mycoplasmas did not differ in these parameters from those with sterile fluid. Also compared was cervical-vaginal infection among these patients in preterm labor with matched control subjects without preterm labor. In this analysis, bacterial vaginosis was identified in 43% of patients with and 14% of women without preterm labor (P = .02), yielding a relative risk of preterm labor for patients with bacterial vaginosis of 3.8. These data underscore the importance of amniotic fluid bacterial infections in preterm labor and premature delivery, and suggest that bacterial vaginosis is associated with prematurity.

Adult↗
PubMed1994

Meconium-stained amniotic fluid. Current controversies.

Meconium-stained amniotic fluid is commonly found in obstetrics: it occurs in 9-20% of deliveries. Meconium passage into the amniotic fluid may be an antepartum or intrapartum event. Meconium aspiration may occur antepartum or intrapartum or at the infant's first breath. The prognosis in neonates with meconium aspiration syndrome appears to be related to antepartum hypoxemic damage to the lungs. This paper covers the pathophysiology of meconium aspiration and meconium aspiration syndrome, treatment options to prevent meconium aspiration and practical information on assessing fetal heart rate tracings. The necessity of tracheal suctioning in all neonates with meconium-stained amniotic fluid is controversial.

Amniotic Fluid↗
PubMed1998

Amniotic fluid insulin levels in nondiabetic pregnant women: an update.

Elevated amniotic fluid insulin levels in diabetes are frequently described but there are few systematic data on metabolically healthy women to define normal ranges. Previous studies had too high normal ranges because they were based on unspecific insulin binding radioimmunoassays. The aim of the study was to update normal amniotic fluid insulin data and to define a reliable normal range in the course of a nondiabetic pregnancy. Amniotic fluid insulin levels were measured in 841 amniotic fluid samples of 707 nondiabetic women undergoing amniocentesis for hydramnios, suspected malformation, determination of lung maturation, Rhesus antibodies and cordocentesis. Mean (+/- SD) of amniotic fluid insulin level was 3.6 (+/- 2.1) microU/mL at 31.5 (+/- 4.9) weeks of pregnancy. The 97th percentile was 8.2 microU/mL. Insulin levels show a biphasic course between 16th and 42nd weeks of pregnancy with a zenith at 30th week. Only two cases (0.3%) had unexplicably elevated amniotic fluid insulin levels > or = 10 microU/mL. Thus, in nondiabetic women amniotic fluid insulin levels > 10 microU/mL are unlikely.

Amniotic Fluid↗
PubMed1980

Prenatal diagnosis of I-cell disease by measuring altered alpha-mannosidase activity in amniotic fluid.

Prenatal diagnoses of I-cell disease were carried out by examination of the amniotic fluid and cultured amniotic cells in four cases of high-risk pregnancy in three different families. Three of the four fetuses were diagnosed as having I-cell disease, on the basis of observation of abnormally increased activity of lysosomal acid hydrolases in the amniotic fluid and their decreased activity in cultured amniotic cells, thus leading to therapeutic abortion. alpha-Mannosidase in the amniotic fluid of the fetuses with I-cell disease exhibited significant alterations in pH profile Km value, thermal stability and isoelectric focusing pattern, compared with the enzyme in normal controls. The results indicate that prenatal diagnosis of I-cell disease may be accomplished by demonstration of altered enzymological characteristics of alpha-mannosidase in the supernatant of amniotic fluid. The significance of the alteration of alpha-mannosidase in the amniotic fluid is not known.

Amniotic Fluid↗