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PubMed2003

Correlation of elevated leptin levels in amniotic fluid and maternal serum in neural tube defects.

OBJECTIVE: To measure maternal serum and amniotic fluid leptin concentrations in pregnant women diagnosed antenatally as having fetuses with a neural tube defect in the second trimester. METHODS: Twenty pregnant women who had fetuses with a neural tube defect detected on ultrasonography (neural tube defect group) in the second trimester and 20 women who had abnormal triple screens indicating an increased risk for Down syndrome but had healthy fetuses (control group) were enrolled in the study. Amniotic fluid was obtained by amniocentesis, and maternal serum samples were taken simultaneously. RESULTS: The mean leptin levels in amniotic fluid (P <.001) and maternal serum (P <.05) of patients who had fetuses with a neural tube defect were found to be significantly higher than control group levels. The mean leptin levels in maternal serum of both groups were also higher than leptin levels in amniotic fluid (P <.05 for the neural tube defect group and P <.001 for the control group). Although there were significant correlations between maternal weight, weight gain, body mass index at the time of amniocentesis, and maternal serum leptin concentrations in both groups, a significant correlation between leptin concentrations in maternal serum and amniotic fluid was found only in the neural tube defect group (P <.05). CONCLUSIONS: We found significantly higher leptin levels in both amniotic fluid and maternal serum of patients who had fetuses with a neural tube defect. We suggest that the main source of leptin in amniotic fluid of pregnant women who had fetuses with a neural tube defect is the leakage into amniotic fluid from cerebrospinal fluid. The increase of maternal serum leptin concentrations has been attributed to the transportation of amniotic fluid leptin to the maternal circulation.

Adult↗
PubMed1987

Four-quadrant assessment of amniotic fluid volume. Interobserver and intraobserver variation.

While the use of the four-quadrant technique, or the amniotic fluid index (AFI), for amniotic fluid volume assessment has been shown to correlate with perinatal outcome, one concern among clinicians is the reliability of a single AFI measurement. The purpose of this investigation was to ascertain the margin of error using this technique among 23 term and postterm women. The AFI was obtained using linear array real-time B-scan ultrasound to measure the vertical diameter of the largest amniotic fluid pocket in each of the four quadrants. The sum of these measurements was expressed as the AFI. Eight women underwent ten consecutive AFI measurements by the same sonographer to determine intraobserver variation. Interobserver variation between five sonographers was measured by assessing the AFI in 15 additional patients. With the amniotic fluid volume in the low or normal range, our results demonstrated the intraobserver and interobserver variations in AFI to average 1.0 and 2.0 cm, respectively. With an above-normal amniotic fluid volume, a 2.5- to 3-fold greater variation was observed. A relatively small margin of error appears to exist between observers using the four-quadrant technique to assess amniotic fluid volume.

Amniotic Fluid↗
PubMed1994

Premature rupture of the membranes between 20 and 25 weeks' gestation: role of amniotic fluid volume in perinatal outcome.

OBJECTIVE: Our purpose was to prospectively study the relationship between amniotic fluid volume and perinatal outcome in pregnancies complicated by premature rupture of the membranes before fetal viability. STUDY DESIGN: The study population consisted of 178 singleton pregnancies with premature rupture of membranes between 20 and 25 weeks' gestation who were managed expectantly. Serial amniotic fluid volume measurements were made and their relationship to the neonatal survival rate, incidence of chorioamnionitis, and other perinatal outcomes was determined. RESULTS: Seventy-four patients were delivered before 25 weeks of gestation and only five infants (6.7%) survived. In contrast, 104 patients were delivered between 26 and 34 weeks, and 93 infants (89.4%) survived (p < 0.001). There were 107 pregnancies with adequate amniotic fluid volume after premature rupture of membranes on admission. Of these 16 patients were delivered before 25 weeks of gestation, and the remaining 91 patients were able to carry their pregnancies beyond 25 weeks of gestation. This was significantly different from 71 patients who demonstrated inadequate amniotic fluid volume on admission to the hospital, of whom 58 were delivered before 25 weeks and only 13 continued the pregnancy beyond 25 weeks (p < 0.05). At gestations between 26 and 34 weeks chorioamnionitis occurred in 22 of 91 (24.1%) patients with adequate amniotic fluid volume versus nine of 13 patients (69.2%) with inadequate amniotic fluid volume (p < 0.001). The incidence of perinatal death for pregnancies between 26 and 34 weeks with adequate versus inadequate amniotic fluid volume was 2.1% and 69.2%, respectively (p > 0.001). Overall survival rate and incidence of chorioamnionitis were 55% and 26.4%, respectively. CONCLUSIONS: Delivery of pregnancies between 20 and 25 weeks of gestation with premature rupture of membranes carries very high risk of neonatal mortality. The results of this study suggest that women with adequate amniotic fluid volume have a better chance to continue their pregnancy beyond 25 weeks of gestation and have a higher neonatal survival rate than those with inadequate amniotic fluid volume. The incidence of perinatal death and chorioamnionitis in patients who carry a pregnancy beyond 25 weeks is correlated with inadequate amniotic fluid volume.

Adult↗
PubMed1976

Studies on the antimicrobial activity of amniotic fluid.

Sixty-one amniotic fluid samples from women in their second and third trimesters of pregnancy were examined for antimicrobial activity. Seventy per cent of the fluids were found to be active. The factor or factors responsible for this activity were present in low concentrations. The presence of spermine in the fluids accounted for some of the antimicrobial activity.

Amniotic Fluid↗
PubMed1979

Thyrotropin-releasing hormone and thyroid hormones in amniotic fluid.

Immunoassayable TRH (iTRH) was measured in 50 amniotic fluid specimens with a mean concentration of 207 +/- 26 (SE) pg/ml. This iTRH demonstrates parallelism with the standard curve for synthetic TRH. With increasing gestational age there is an increase in iTRH levels in amniotic fluid with a decrease in 3,3',5'-triiodothyronine levels (rT3), while thyroxine levels (T4) remain unaltered. Preliminary data suggest that iTRH levels in amniotic fluid that are less than 150 pg/ml after 32 weeks of gestation may correlate well with low Apgar scores at birth. There was no correlation of rT3 or T4 amniotic fluid levels with the Apgar scores.

Amniotic Fluid↗
PubMed2006

Amniotic fluid embolism with isolated coagulopathy: a case report.

BACKGROUND: Amniotic fluid embolism is a life-threatening complication of pregnancy accompanied by a high mortality rate. The common clinical presentation is sudden onset of dyspnea, hypotension inappropriate to the volume of blood loss, and hypoxia, followed by cardiopulmonary arrest. Recently, cases of amniotic fluid embolism with isolated coagulopathy as an atypical presentation have been reported. CASE: A 27-year-old multigravida presented with continuous postpartum oozing after an uneventful vaginal delivery at 38 weeks of gestation. Laboratory evidence revealed disseminated intravascular coagulopathy. Despite good uterine contractions and massive blood component therapy, vaginal bleeding continued and finally led to emergency laparotomy. Histopathologic examination showed a deep cervical laceration in the endocervix, and multiple areas of amniotic fluid debris were demonstrated in the laceration site vasculature of the endocervix. After hysterectomy, the patient recovered fully, without sequelae. CONCLUSION: This case represents atypical symptoms and signs: clinical hemorrhage in the initial presentation rather than the classical pattern of cardiopulmonary collapse. In cases of suspected amniotic fluid embolism with an atypical presentation, a thorough histologic examination of the uterus, including the cervix, is critical to making the diagnosis of amniotic fluid embolism.

Adult↗
PubMed1980

Effect of blood in amniotic fluid on the detection of phosphatidylglycerol.

Samples of amniotic fluid were mixed with serum or red blood cells (RBC) in order to determine the effect of blood contamination on the detection of phosphatidylglycerol (PG). Samples of amniotic fluid was obtained from patients in the second trimester of pregnancy and at term, PG standard was added to half of the aliquots of the second-trimester fluid. The samples of fluid were tested before and after the addition of maternal or fetal serum or RBC in concentrations up to 20%. Two-dimensional thin-layer chromatographic procedures were performed to determine the presence or absence of PG. The results obtained showed that serum of RBC contamination of amniotic fluid without PG did not result in the appearance of a PG spot on the chromatographic plate. Neither serum nor RBC contamination interfered with the detection of PG in those fluids in which it was present. Maternal and fetal blood were similar in their failure to affect the detection of PG. These data suggest that PG determination for fetal lung maturity is a reliable test in the presence of bloody amniotic fluid.

Amniotic Fluid↗
PubMed1989

Determination of prolactin, growth hormone, beta-endorphin, and cortisol in both maternal plasma and amniotic fluid during human gestation.

This study focuses on PRL, GH, beta-endorphin and cortisol in maternal blood and amniotic fluid during human pregnancy. Maternal blood and amniotic fluid samples were obtained from 18 normal pregnant women in the second trimester, 12 full-term gravidas having spontaneous delivery, and 10 full-term gravidas having elective cesarean section. Two gravidas bearing anencephalic fetuses in the third trimester were also studied. In the second trimester women, levels of PRL (3215.9 +/- 458.9 micrograms/l), GH (19.1 +/- 1.7 micrograms/l) and beta-endorphin (11.1 +/- 0.9 pmol/l) were significantly higher in the amniotic fluid than in maternal plasma. In addition, PRL was significantly correlated with beta-endorphin (r = 0.670) and with GH (r = 0.547) in the amniotic fluid. However, amniotic fluid cortisol levels (0.27 +/- 0.18 nmol/l) were significantly lower than plasma cortisol levels. The amniotic fluid of the women with anencephalic fetuses had normal levels of PRL, GH and beta-endorphin. In full-term gravidas, plasma PRL levels were significantly lower in women with vaginal delivery than in those with elective cesarean section, and there was a significant negative correlation between plasma PRL and beta-endorphin, and between plasma PRL and cortisol levels. Plasma GH levels in women with vaginal delivery showed no significant difference from those in women with cesarean section. Examination of amniotic fluid yielded no significant differences in the levels of PRL, beta-endorphin and GH between these two groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1982

Cell morphology in long-term cultures of normal and abnormal amniotic fluids.

The cell morphology of long-term cultures of amniotic fluid cells from 10 fetuses with a neural tube defect (NTD) and three with omphalocele was examined and compared to 30 long-term cultures of normal amniotic fluids as well as a long-term culture of human fetal brain. Cultures from the amniotic fluids of the fetuses with NTD and omphalocele showed cells with the same general characteristics as normal amniotic fluid cells. However, the cultures of amniotic fluid cells from NTD pregnancies had an additional cell type also seen in fetal brain culture. This was a neuroblast-like cell, with small rounded refractile morphology and long branching processes forming clusters of varying sizes which lay on top of large flat cells. These neuroblast-like cells diminished in number with time in culture and were not present in subcultures. Their possible neuronal origin is discussed.

Amniotic Fluid↗
PubMed1977

Estimation of gestational age from study of amniotic fluid and clinical assessment.

Study of 108 samples of amniotic fluid obtained between 28 and 42 weeks' gestation from 101 patients revealed that in normal pregnancies the creatinine concentration, lecithin/sphingomyelin (L/S) ratio and percentage of fat cells correlated better with the gestational age of the newborn--assessed by clinical criteria--than did the bilirubin and sodium concentrations. A creatinine concentration of 1.75 mg/dL or more, an L/S ratio of 4 or more and a fat cell percentage of 10 or more correlated significantly with a gestational age of 37 weeks or more. In abnormal pregnancies (those with obstetric or medical complications, or both) the mean creatinine concentration in the amniotic fluid was significantly less than expected for gestational age in fetal dysmaturity and greater than expected when the mother had diabetes. The mean L/S ratio in the amniotic fluid was elevated when the mother had hypertension or smoked and in cases of fetal dysmaturity or long interval between rupture of the membranes and delivery, whereas it was significantly lower than normal when the mother had diabetes. The mean bilirubin concentration in the amniotic fluid was significantly lower than normal when the mother had hypertension. When the mother had diabetes, maturity of the fetal lung, liver, skin and brain appeared to be delayed, according to the values for the amniotic fluid constituents.

Amniotic Fluid↗
PubMed2004

Ultrasound evaluation of amniotic fluid volume: methods and clinical accuracy.

Ultrasound evaluation of amniotic fluid volume (AFV) is frequently used to detect fetuses at high risk for an adverse outcome - an event that is often correlated with AFV abnormalities. As is well known, ultrasound is a non invasive procedure, which makes it ideal for application on a very large scale: in practice, it can be used for routine monitoring of all pregnancies and, not infrequently, for repeat AFV determination in those cases where there is the suspect of amniotic fluid abnormalities. Sonographic quantification of AFV, whether it is performed through a simple visual estimation or through biometric measurement of one or more amniotic fluid pockets, can never represent a true "quantitative" method and its actual reliability has not consistently been proved by scientific evidence. Moreover, even though ultrasound AFV evaluation is indispensable in the management of high-risk pregnancies, there is no consensus on which ultrasound index is the most accurate in predicting perinatal morbidity and mortality. The sonographer can evaluate AFV by directly observing amniotic fluid pockets and his experience is crucial for a high reliability of the procedure. When pathological AFV changes are present, especially if the examination is performed by a not so expert sonographer, biometric measurements (Single Deepest Pocket, Amniotic Fluid Index, Two-Diameter Pocket) with their respective reference ranges might be helpful in confirming the diagnosis of oligohydramnios or hydramnios. A complete review of all tests performances and confidences is made by the Authors.

Amniotic Fluid↗
PubMed1993

Amniotic fluid index. Gestational age-specific values for normal human pregnancy.

Amniotic fluid volume is an important parameter in the assessment of fetal well-being. The purpose of this study was to define the values of the amniotic fluid index for normal pregnancy by week of gestation in our population. The amniotic fluid index was measured prospectively in 892 patients with a normal singleton pregnancy between 15 and 40 weeks and an estimated fetal weight between the 10th and 90th percentile. The results were stratified by week of gestation. From a median of 10.3 cm (range, 8.7-13.7, 5th-95th percentile) at 15 weeks' gestation, the amniotic fluid index rose progressively to a maximum median of 14.0 cm (range, 4.0-18.6) at 30 weeks. The index then gradually declined to a median of 9.1 cm (range, 4.8-14.2) by 40 weeks' gestation. The difference between the median index for preterm patients (11.9 cm) and that for the term group (10.8 cm) was found to be statistically significant (P < .05). The difference between the median amniotic fluid index for the total group and the medians for the preterm and term patients was also significant (P < .05). Gestational age-specific values of amniotic fluid index should be used, and the 5th and 95th percentiles serve as the lower and upper limits, respectively, of normal.

Amniotic Fluid↗
PubMed1996

Maternal cell contamination in uncultured amniotic fluid.

The presence of maternal cells in uncultured amniotic fluid may result in error in the interpretation of prenatal tests such as direct DNA analysis and rapid aneuploidy detection by fluorescence in situ hybridization (FISH). Using simultaneous dual colour X and Y FISH, we assessed maternal cell contamination in uncultured amniotic fluids from 500 women carrying male fetuses. The presence of maternal cells was correlated with the amount of blood present in the amniotic fluid as defined by visual examination of the cell pellet after centrifugation. The overall rate of maternal cell contamination in uncultured amniotic fluid as identified using X and Y-specific probes was 21.4 per cent, compared with 0.2 per cent in cultured fluid. Sixteen per cent of slightly bloody and 55 per cent of moderately bloody uncultured fluids had at least 20 per cent maternal cells and were classified as uninformative according to our protocol for rapid aneuploidy detection. Maternal and fetal cells could not be distinguished based on morphological characteristics alone.

Amniotic Fluid↗
PubMed1990

Standardized measurement of amniotic fluid volume by correlation of sonography with dye dilution technique.

Amniotic fluid volume was measured in two ways in 23 subjects admitted for interruption of pregnancy at gestational ages 16-24 weeks. The amniotic fluid volume calculated from sonographic measurements was plotted against the "true" amniotic fluid volume obtained by a dye dilution technique. Linear regression analysis showed a good correlation between the two methods (r = 0.815; P less than .001) and yielded a factor that may be used on a general basis to derive the true amniotic fluid volume from the value obtained by sonography. This approach thus offers a standardized procedure for amniotic fluid volume estimation in the second trimester based on the technical simplicity of ultrasonography with the relative accuracy of the dye dilution technique.

Adolescent↗
PubMed1991

Amniotic fluid volume response to esophageal occlusion in fetal sheep.

Although ovine and human fetuses swallow considerable volumes of fluid, the impact of absence of fetal swallowing on amniotic fluid volume regulation is unclear. To study the role of fetal swallowing on urine production and amniotic fluid, seven ovine fetuses (126 +/- 1 days) were chronically prepared with fetal bladder and vascular catheters, an esophageal flow probe, an inflatable esophageal cuff, and amniotic fluid catheters. In the five fetuses that underwent esophageal ligation after the control period, fetal swallowing averaged 0.27 ml/min before occlusion. In response to esophageal occlusion, significant increases were noted in fetal plasma arginine vasopressin (6.9 +/- 2.6 to 16.6 +/- 4.4 pg/ml) and urine osmolality (159 +/- 1 to 324 +/- 30 mOsm/kg), whereas urine volume (0.25 ml/min) did not change. Amniotic fluid volume increased nearly threefold after 3 days of esophageal occlusion (582 +/- 180 to 1530 +/- 271 ml). Amniotic fluid volume remained normal (334 to 419 ml) in the one fetus in which the occluder did not inflate. In the one fetus in which the esophagus was occluded at surgery, amniotic fluid volume was increased after the surgical recovery period (1489 ml). These data indicate an important role of fetal swallowing in amniotic fluid homeostasis and the potential interaction of swallowing with fetal urine production.

Amniotic Fluid↗
PubMed1993

Neutrophil attractant/activating peptide-1/interleukin-8: association with histologic chorioamnionitis, preterm delivery, and bioactive amniotic fluid leukoattractants.

OBJECTIVES: The goals of this study were (1) to determine immunoreactive neutrophil attractant/activating peptide-1/interleukin-8 levels in amniotic fluid from patients with preterm labor and (2) to compare neutrophil attractant/activating peptide-1/interleukin-8 levels, amniotic fluid culture, Gram stain, and the leukotaxis bioassay for their ability to predict histologic chorioamnionitis and clinical outcome. STUDY DESIGN: Amniotic fluid was collected by amniocentesis from 55 patients with idiopathic preterm labor and three patients with preterm labor and clinical chorioamnionitis. Gram stain, culture (aerobic, anaerobic, and Mycoplasma species), leukotaxis bioassay, and a commercially available neutrophil attractant/activating peptide-1/interleukin-8 enzyme-linked immunosorbent assay (sensitivity 1 ng/ml) were performed on the amniotic fluid samples. Placentas and chorionic membranes were evaluated for evidence of histologic chorioamnionitis in patients delivered preterm. RESULTS: All patients with detectable leukoattractants by the leukotaxis bioassay had neutrophil attractant/activating peptide-1/interleukin-8 levels above the threshold of the assay. The presence of amniotic fluid neutrophil attractant/activating peptide-1/interleukin-8 is a more sensitive marker for histologic chorioamnionitis and delivery before 34 weeks than is amniotic fluid culture (100% vs 59%, p < 0.01; and 95% vs 56%, p < 0.01, respectively). Also, of patients in idiopathic preterm labor those without amniotic fluid leukoattractants (group 1) had the lowest amniotic fluid levels, followed by patients with amniotic fluid leukoattractants and a negative culture (group 2) and patients with amniotic fluid leukoattractants and a positive culture (group 3) who had the highest levels (group 1 vs group 2, p < 0.001; group 2 vs group 3, p < 0.01). CONCLUSIONS: Amniotic fluid neutrophil attractant/activating peptide-1/interleukin-8, like the leukotaxis assay, is an accurate antepartum predictor of histologic chorioamnionitis and subsequent early delivery in patients with preterm onset of labor. This study supports the role of neutrophil attractant/activating peptide-1/interleukin-8 in the recruitment of neutrophils into chorionic membranes and placenta during developing intrauterine infection.

Amniocentesis↗
PubMed2003

Amniotic fluid embolism.

PURPOSE OF REVIEW: To review the recent literature on amniotic fluid embolism and how it may influence the clinical management and further study of the condition. Morbidity and mortality from amniotic fluid embolism in the international context will be described, given the recent Confidential Enquiries into Maternal Deaths in the United Kingdom and other studies. With this rare condition we need to look for clues as to how to facilitate diagnosis and improve outcomes. RECENT FINDINGS: Amniotic fluid embolism continues to be a leading cause of maternal death. There has been a decrease in mortality from amniotic fluid embolism in the UK from 5.1 to 3.7 per million maternities, but it is still the fifth greatest cause of direct maternal death. In France, 13% of deaths are caused by amniotic fluid embolism, the third highest cause. In Singapore, a study of postmortems found that over 30% of direct maternal deaths were caused by amniotic fluid embolism, the most common cause. Case-specific mortality may not be as high as previously thought. The early data from the UK Register of cases show only 16% mortality, although there is significant maternal and neonatal morbidity. Early diagnosis may be the best way to improve outcomes. Case reports suggest that plasma exchange techniques may be helpful after initial resuscitation. SUMMARY: With a rare condition additions to the literature are sparse. Early consideration of the diagnosis after prompt resuscitation is needed. Further data are needed to advance beyond this.

Embolism, Amniotic Fluid↗
PubMed1986

Trophic effect of amniotic fluid on fetal gastrointestinal development.

To determine if amniotic fluid or its constituent trophic factors influence fetal gastrointestinal tract development we developed models of fetal esophageal ligation to prevent swallowing of amniotic fluid and fetal esophageal cannulation with infusion of various substances to mimic fetal swallowing. A total of 43 fetuses was studied. Esophageal ligation resulted in a 32% reduction in gastric weight and a 40% reduction in serum gastrin level, compared to unoperated controls, whereas intestinal and liver weights were unchanged. Gastric acid concentration averaged 43.4 +/- 7.7 mumole/ml in control fetuses, but only 0.5 +/- 0.5 mumole/ml following esophageal ligation. Infusion of Ringer's lactate solution intragastrically did not prevent the changes in gut development seen after esophageal ligation. In contrast, infusion of bovine amniotic fluid resulted in relatively normal gut development, with a gastric acid concentration of 28.5 +/- 6.9 mumole/ml and liver and gastric weights and serum gastrin levels no different from control. Epidermal growth factor had a potent trophic effect on both somatic and gastrointestinal fetal growth and resulted in a mean gastric acid concentration of 35.2 +/- 6.6 mumole/ml. In contrast, pentagastrin, although restoring gastric weight to control values, had no effect on gastric acid secretion, with a mean of 0.1 +/- 0.1 mumole/ml. We conclude that fetal swallowing of amniotic fluid is essential in fetal gastrointestinal development, possibly via luminal trophic actions of peptides such as epidermal growth factor and gastrin.

Amniotic Fluid↗