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PubMed1987

Evidence for the presence of low density and very low density lipoproteins in human amniotic fluid.

Previous analysis of amniotic fluid (AF) noted only the presence of high density lipoprotein (HDL). In this study AF lipoprotein profile was examined using gel filtration column chromatography and Ouchterlony gel diffusion. Unlike previous studies which showed only the presence of HDL, we found significant amounts of low density lipoprotein (LDL) and very low density lipoprotein (VLDL). AF-LDL and AF-VLDL were identified by reactions with anti-h-apolipoprotein AI and AII antiserum and anti-h-apolipoprotein B-antiserum, respectively. Furthermore, bulk of the cholesterol mass was carried in VLDL (53.6 +/- 7.7%) and LDL (32.5 +/- 4.3%) with minor amounts (13.9 +/- 1.3%) in HDL fraction. It is concluded that human AF contains all three lipoproteins with most of the cholesterol being carried in very low density lipoprotein fraction.

Amniotic Fluid↗
PubMed2002

Documentation of amniotic fluid embolism via lung histopathology. Fact or fiction?

OBJECTIVE: To evaluate pulmonary histopathology for confirming amniotic fluid embolism. STUDY DESIGN: The Capra hircus (goat) model with fresh, homologous amniotic fluid was used. Raw fluid (n = 8), fluid filtered through a 5-microns filter (n = 14) and meconium-stained fluid with 1-7% solid debris (n = 7) were injected. Three hours after embolization the animals were euthanized and specimens collected. Three to five areas of lung were sampled based on the most abnormal areas visually. Traditional and special stains were utilized. The study protocol was approved by the institutional review board and animal use and care committee. Statistical analysis was by chi 2 with Yates correction. Significance was defined as P < .05. RESULTS: Amniotic fluid debris (fetal squames, mucin or foreign pigments) was found in 10 of 29 animals (34.5%). Debris was found in 7/7 (100%) of the meconium group, 2/8 (25%) of the raw fluid group and 1/14 of the filtered group (7%). The likelihood of finding debris in amniotic fluid embolism with meconium-stained fluid was greater than with raw (P < .017) or filtered amniotic fluid (P < .001). CONCLUSION: In this animal model, histopathologic confirmation of amniotic fluid embolism was an unreliable marker of the event except in cases of amniotic fluid embolism involving meconium-stained fluid.

Animals↗
PubMed1980

A method for isolation by gel electrofocusing of isohormones B and C of human prolactin from amniotic fluid.

Human prolactin from amniotic fluid, consisting of isohormones B and C (major), was radio-iodinated after storage of the hormone for 3 years at -70 degrees C, and yielded a Ferguson plot in polyacrylamide gel electrophoresis that was indistinguishable from the original except that the zones of isohormone B and C were fused. However, isohormones B and C of 125I-labelled human prolactin were separated on isoelectric focusing in polyacrylamide gel, using Ampholine carrier ampholytes (pI range 5-8), taurine (pI 5.1) as anolyte and beta-alanine (pI 6.9) as catholyte. After 20 h of electrofocusing at 0-4 degrees C, 1000 V, both isohormones reached constant pH (isoelectric) positions on the gel. The apparent isoelectric points of human prolactin B and C were 5.96. Micro-preparative gel electrofocusing followed by excision and re-electrofocusing of the gel slices containing human prolactin B and C, yielded zones of homogeneous isohormones B and C.

Amniotic Fluid↗
PubMed1992

The effects of pH and osmolality on bacterial growth in amniotic fluid in a laboratory model.

In studying the effects of amniotic fluid on bacterial growth in a laboratory model, we noted that the pH of the fluid appeared to exert an independent effect. This study was designed to test the ability to control the growth of Escherichia coli in amniotic fluid simply by controlling two important growth conditions, pH and osmolality. The effects of pH and osmolality on growth of E. coli were systematically studied in a standard media and in amniotic fluid. Optimal ranges in standard media were pH of 5.6 to 6.6 and osmolality of 150 to 215 mOsm. When the results of growth at 24 hours were corrected for pH by analysis of covariance, the presence of amniotic fluid or phosphate had no effect. We found pH to be the only variable predictive of bacterial growth in amniotic fluid in this laboratory model.

Amniotic Fluid↗
PubMed1981

Chromosome analyses and anchorage-independent growth of SV40-induced morphologically transformed epithelial cells from amniotic fluids.

Epithelial cells from amniotic fluid cell cultures are morphologically transformed by simian virus 40, 20 to 30 d after infection. The cells of the transformed colonies are highly basophilic, have a high nuclear-to-cytoplasmic ratio, and show a dense growth pattern. The cells are virus producers, and ultimately, after continuous passage, the cell lines reach a crisis situation with no growth. Twelve morphologically transformed cell colonies were isolated from five different individuals for chromosome analyses after approximately 18 population doublings (second bottle passage). For all cell lines diploid cells were observed. Banding of the chromosomes revealed normal morphology of euchromatic and heterochromatic regions. The suggestion is made that chromosome alteration is not necessary, nor a prerequisite, for the morphologically transformed phenotype to be expressed and that the transformation process per se causes chromosomal instability. Tests for colony formation of the 12 cell lines in semisolid medium showed that different transformed colony isolates from the same individual donor of the cells either formed or did not form colonies in agar. The size of the colonies was also consistent within individuals as compared to between individuals. These limited results are suggestive of a dependence upon the genetic constitution of the individual donor of the cells for colony formation in soft agar.

Amniotic Fluid↗
PubMed1985

Influence of gestational age on prediction of fetal lung maturity by fluorescence polarization of amniotic fluid.

Compared are the amniotic fluid fluorescence polarization values and the neonatal outcomes of 201 pregnant women who delivered from 28 through 37 weeks of gestation within 48 hours of the fluorescence polarization determinations. Thirty-five neonates developed hyaline membrane disease. The corresponding fluorescence polarization values ranged from 0.275 to 0.391. Eight of those 35 tests results were less than 0.325. The predictiveness of the method was studied using different threshold fluorescence polarization values. At the authors' own threshold of less than or equal to 0.325, the overall predictive value was as follows: false mature predictions: 6.2%, false immature predictions: 62.5%, sensitivity: 77.1%, and specificity: 72.8%. However, the false mature prediction rate was 21 to 40% from week 28 through week 33 versus 3.4 to 5.8% from week 34 through week 37, depending on the selected cutoff fluorescence polarization value. The sensitivity and specificity before, at, or after week 34 were significantly different at all tested fluorescence polarization values (P less than .05 to P less than .01) with the exception of the sensitivity at 0.310 and at 0.316 (P = .057). Caution is advised against relying on the fluorescence polarization method to predict fetal lung maturity at least before 34 weeks of gestation.

Amniotic Fluid↗
PubMed2003

Biovar diversity of Ureaplasma urealyticum in amniotic fluid: distribution, intrauterine inflammatory response and pregnancy outcomes.

OBJECTIVE: The objective of this study was to determine the distribution of two biovars of Ureaplasma urealyticum (parvo and T960) in human amniotic fluid and to examine whether the magnitude of the intrauterine inflammatory response and pregnancy outcomes are different between patients with microbial invasion of the amniotic cavity with "parvo biovar" and those with "T960 biovar". STUDY DESIGN: This cohort included 77 preterm singleton pregnancies (gestational age < 37 weeks) in whom U. urealyticum was detected from amniotic fluid using the polymerase chain reaction (PCR). Amniotic fluid was obtained by transabdominal amniocentesis. Amniotic fluid was cultured for aerobic and anaerobic bacteria as well as mycoplasmas. U. urealyticum was biotyped by PCR methods. Amniotic fluid inflammatory response was determined by amniotic fluid white blood cell count and interleukin-6 concentration. RESULTS: 1) The "parvo biovar" was detected in 82% (63/77) and "T960 biovar" was in 18% (14/77) of cases; 2) U. urealyticum was isolated by conventional culture method from amniotic fluid in 56% (35/63) of cases with positive for "parvo biovar" and in 50% (7/14) of cases with positive for "T960 biovar"; 3) There were no significant differences in the median gestational age at amniocentesis, gestational age at delivery, birth weight, amniotic fluid white blood cell count, amniotic fluid interleukin-6 concentration and the rates of clinical chorioamnionitis, histologic chorioamnionitis, funisitis and neonatal morbidity between patients in the two biovar groups. CONCLUSIONS: 1) The "parvo biovar" is more frequently isolated from amniotic fluid of preterm gestations than the "T960 biovar"; 2) Biovar diversity of U. urealyticum in amniotic fluid was not associated with different pregnancy outcome and magnitude of the intraamniotic inflammatory response.

Amniocentesis↗
PubMedDate not supplied

Amniotic fluid disaccharidases in the prenatal detection of cystic fibrosis.

Intestinal disaccharidases in amniotic fluid were studied in 41 pregnancies with a recurrence risk for cystic fibrosis (CF). In 11 out of 13 pregnancies with CF fetuses the maltase and sucrase activities were either below the control range (8 cases) or below the 10th percentile of control values (3 cases). Trehalase and lactase were slightly less informative indicators of CF. Of the other 28 pregnancies 3 had low amniotic fluid activities of several intestinal enzymes and were terminated, 12 resulted in the birth of a healthy child and 13 are continuing. The findings in fetal CF suggest an impairment of the defaecation of intestinal contents into the amniotic fluid. Reduced or low amniotic fluid disaccharidase activities were also found in other fetal disorders with demonstrated or presumed intestinal anomalies: e.g. anal atresia (2 cases), anencephaly (3 our of the 7 cases), trisomy 13 (5 cases), trisomy 18 (3 of the 5 cases) and trisomy 21 (19 of the 22 cases). Reduced amniotic fluid disaccharidase activities, although not specific for CF, are highly informative in pregnancies at high risk for CF. Using the 10th percentile of the normal range for amniotic fluid disaccharidase activities as an action line, the sensitivity of CF detection is estimated at 80 to 90 per cent, which could in high risk pregnancies reduce the risk of having another affected child from 1 in 4 to 1 in 20.

Amniocentesis↗
PubMed1976

Prenatal prediction of respiratory distress syndrome. Measurement of surface properties and Lecithin/Sphingomyelin ratio in human amniotic fluid.

118 samples of amniotic fluid were taken from 102 patients in the 25th to the 43th week of pregnancy by amniotomy or by transabdominal amniocentesis. 76 samples were obtained from patients with normal pregnancies without evidence for either induction or retardation of lung maturity; they served to establish normal values. In 37 cases samples were taken within 72 hours prior to delivery, the decisive period for the prediction of a respiratory distress syndrome. In seven cases a respiratory distress syndrome occured which was diagnosed by an independent pediatrician. The following tests were performed for all samples: 1. Surface tension was measured biomechanically using the Wilhelmy balance and a surface tension area diagram (Fig. 1) was made: A platimum plate is immersed into the liquid placed in the trough; the surface tension is measured via a transducer. The surface film of th liquid to be studied is compressed cyclically from an initial area of 100% to 20% by a moveable barrier and is expanded afterward. Platinum plate and barrier are connected to an X-Y recorder. The surface tension area diagrams are interpreted on the basis of the following criteria: see article 2. The determination of the L/S ratio (simultaneous comparison with the standard method): The method of GLUCK as modified by BORER(planimetric interpretation of the the spots) was employed. Both methods produced normal values. For the biomechanical measurements a classification into three groups was made (25th-30th, 31st-35th, 36th-43rd week of pregnancy) (Tab.I);the L/S ratio showed the usual steep increase from the 36th week of pregnancy onwards. In cases with RDS (Tab.II) surface tension-area-diagrams show high values for gamma max and a slight decrease in surface tension on compression (high gamma min values); the stability index is low, the hysteresis is reduced. Fig. 3. Up to the 34th week of pregnancy the 2:1L/S ratio assumed as the threshold for a sufficient surfactant concentration does not permit a clear interpretation; in subsequent weeks all cases fail to coincide with the normal pattern of distribution (Fig.2). Both the L/S ratio and the criteria of the surface tension area diagrams show significant differences in cases with and without RDS. The prognostic validity of both methods was tested for the probability of predicting occurrence of RDS, probability of RDS occurence and probability of non-occurrence of FDS. The prognostic value seems equal to the L/S Ratio.

Amniotic Fluid↗
PubMed1998

Differential expression of interleukin-1 beta and interleukin-6 in human fetal serum and meconium-stained amniotic fluid.

The study was designed to investigate the expression of the inflammatory cytokines interleukin-1 beta and interleukin-6 in meconium-stained amniotic fluid and in fetal cord serum. Amniotic fluid and fetal cord serum specimens were collected from 10 and 9 women with meconium-stained and clear amniotic fluid, respectively, during Caesarean operation at labor The mean concentrations of interleukin-1 beta found in clear and meconium-stained amniotic fluid were 10.0 and 54.5 pg/ml, respectively, and the difference was not statistically significant. On the other hand, the concentrations of interleukin-6 in meconium-stained amniotic fluid (774 pg/ml) was significantly higher than that found in clear amniotic fluid (149 pg/ml) (P = 0.0036). The differences of levels of both interleukin-1 beta and interleukin-6 in fetal cord serum specimens were not significant between neonates born to mothers with either clear or meconium-stained amniotic fluid (P = 0.8702 and 0.2987, respectively). The results of this study suggest that the production of at least one of the inflammatory cytokines, interleukin-6, is associated with the meconium found in amniotic fluid.

Amniotic Fluid↗
PubMed1992

Successful pregnancy outcomes after amniotic fluid embolism.

Two patients who survived cardiorespiratory arrest occurring in association with amniotic fluid embolism syndrome were seen during the subsequent pregnancy. Both had uneventful pregnancies and delivered at term without complications. These are the only case reports of pregnancy after amniotic fluid embolism, and they support a model of amniotic fluid embolism involving chemically abnormal amniotic fluid rather than an unusual sensitivity to normal amniotic fluid.

Adult↗
PubMed1994

Effect of altitude on the amniotic fluid index.

The effect of altitude on amniotic fluid volume has not been studied previously. We sought to determine whether there is such an effect by measuring the amniotic fluid index (AFI) in pregnant women at low and high altitudes. We compared populations of pregnant women at two institutions, one located at low elevation (100 ft) and the other at relatively high altitude (6,000 ft). Uncomplicated singleton pregnancies between 20 and 42 weeks' gestation with adequate dating criteria were studied. Patients were excluded if any condition known to alter amniotic fluid volume was present. Data were stratified by gestational age at two-week intervals for analysis. The pregnant women at high altitude (n = 364) had a significantly increased (P < .001) AFI throughout gestation as compared to the low-altitude group (n = 514). The mean difference in the AFI between the two populations for the two-week intervals was 1.5 cm (95% confidence interval, 1.0-2.0). As compared to the low-altitude group, the high-altitude population had a greater proportion of women with polyhydramnios (5.8% versus 1.0%, P < .001) and fewer patients with oligohydramnios (2.5% versus 5.6%, P < .001) after categorization of AFI values utilizing previously established nomograms. This finding suggests that there is an association between high altitude and an increase in the AFI. The mechanism and clinical significance of this effect are unknown.

Altitude↗
PubMed1999

Meconium-stained amniotic fluid activates polymorphonuclear leukocytes ultrastructural and enzyme-cytochemical evidence.

The purpose of the present study was to demonstrate morphological evidence that meconium-stained amniotic fluid activates polymorphonuclear leukocytes. We used Boyden chamber techniques to determine the chemotactic activity of meconium-stained amniotic fluid for leukocytes, and ultrastructural enzyme-cytochemistry for peroxidase and alkaline phosphatase to characterize the leukocyte features induced by contact with meconium-stained amniotic fluid. Amniotic fluid with meconium staining enhanced migration of leukocytes. These leukocytes exhibited more numerous cytoplasmic processes and more prominent phagosomes compared to peripheral blood leukocytes. Peroxidase and alkaline phosphatase activity were evident on the phagosomal membranes. Our results indicate that meconium-stained amniotic fluid activates or stimulates polymorphonuclear leukocytes. Meconium-stained amniotic fluid induced leukocyte activation might play important roles in the pathophysiology of initiation of term labor or of the meconium aspiration syndrome.

Alkaline Phosphatase↗
PubMed1988

Pharmacokinetics of clearance in the maternal-fetal amniotic fluid system of the rat.

A pharmacokinetic model of the maternal-fetal amniotic fluid system was designed to permit calculation of clearances from the steady-state concentrations of p-phenylbenzoic acid (PPBA) during infusion of PPBA into the maternal vein and the amniotic fluid of pregnant rats on the 16th to the 21st day of gestation. Transplacental clearance from the fetus to the mother maintained fairly constant values until the 19th day of gestation but decreased on Days 20 and 21 of gestation. Both clearances from the fetus into the amniotic fluid and from the amniotic fluid into the fetus showed higher values during the earlier stages of gestation, indicating that amniotic fluid may play an important role in the pharmacokinetics of PPBA in the fetus during the earlier stage of gestation. Fetal tissue clearance appeared to contribute to the elimination of PPBA in the fetus on Days 20 and 21 of gestation. Transplacental clearance from the mother to the fetus and clearance by nonplacental elimination in the mother increased with the day of gestation. The relationship between developmental changes in clearances and physiological changes in placenta and fetal tissues is discussed. The present model provides a basis for calculation of clearances in the maternal-fetal amniotic fluid system.

Amniotic Fluid↗
PubMed1986

[A basic study on the initiation of human parturition--contribution of amniotic fluid and fetus to the initiation of human parturition].

In order to clarify the mechanism of initiation of human parturition, the relationship of amniotic fluid and fetus to prostaglandin synthesis was investigated. Phosphatidylinositol (PI) in amniotic fluid and phospholipase C (PLase C) activity in amniotic fluid, amnion tissue and neonatal urine were measured. The results are as follows. PI in amniotic fluid began to increase from around 30 to 36 or 37 weeks of gestation, and then gradually decreased toward term. PLase C activity in amniotic fluid was demonstrated. The activity was low before 30 weeks of gestation, but gradually increased toward term. PLase C activity in 105,000 X g supernate of amnion tissue homogenate was 43 fold higher than that in amniotic fluid. High PLase C activity was demonstrated in neonatal urine, which was 58 fold higher than that in amniotic fluid. The molecular weight of PLase C from neonatal urine was estimated to be 33,000 daltons. PLase C activity in neonatal urine has enough activity to produce arachidonic acid in amniotic fluid. It was concluded that the fetus relates to the onset of labor by producing arachidonic acid in amniotic fluid as a result of the reaction between PI from the lung and PLase C from the urine.

Amnion↗
PubMed1979

Amniotic fluid microviscosity determined by fluorescence polarization: methodology and relation to gestational age.

The fluorescence polarization of 116 amniotic fluid specimens obtained from 22 isoimmunized pregnant women was determined. The degree of fluorescence polarization of amniotic fluid provides an index of microvisocity in lipid aggregates that is dependent on the lecithin-to-sphingomyelin ratio and the degree of saturation of fatty acid side chains. We confirmed the reproducibility of the measurement of amniotic fluid microviscosity (coefficient of variation, 2.0%). The measurements are not effected by bilirubin concentration of amniotic fluid dilution. The pattern of change of amniotic fluid microviscosity during gestation parallels the expected development of the surfactant system. Amniotic fluid microviscosity is high during early gestation and abruptly and sequentially decreases between the 28th and 36th week of gestation. Since the measurements are an accurate reflection of the biochemical properties of amniotic fluid lipids and parallel the development of the surfactant system, we conclude that amniotic fluid microviscosity may well serve as an indicator of the process of fetal lung maturation.

Amniotic Fluid↗
PubMed2005

Differential expression of immune system-related components in midtrimester amniotic fluid from singleton and twin pregnancies.

OBJECTIVE: We investigated differences between singleton and twin gestations in immune mediators in midtrimester amniotic fluid. STUDY DESIGN: Amniotic fluid from 252 singleton and 46 twin gestations were tested by enzyme-linked immunosorbent assay for interleukin-1beta, interleukin-1 receptor antagonist, interleukin-4, tumor necrosis factor-alpha, nitric oxide, Clara cell protein 16, leptin, and the 70-kDa heat shock protein. A subset of amniotic fluid was also tested for leukemia inhibitory factor, angiogenin, and migration inhibitory factor-related protein 8 and migration inhibitory factor-related protein 14. Data were analyzed by the Mann-Whitney U test and Spearman rank correlation. RESULTS: Median concentrations of interleukin-1beta, tumor necrosis factor-alpha, interleukin-4, Clara cell protein 16, leptin, and angiogenin were increased in amniotic fluid from twins; median levels of the 70-kDa heat shock protein, leukemia inhibitory factor, migration inhibitory factor-related protein 8, and migration inhibitory factor-related protein 14 were highest in amniotic fluid from singletons (P < .001). CONCLUSION: Elevated levels of immune activators may contribute to the increased rate of preterm premature rupture of membranes and spontaneous preterm birth in twin populations.

Adult↗
PubMed1996

Serial amniotic fluid index in severe preeclampsia: a poor predictor of adverse outcome.

OBJECTIVE: The purpose of the study was to determine the relationship between low amniotic fluid index and intrauterine growth restriction and nonreassuring fetal testing in patients with severe preeclampsia. STUDY DESIGN: We reviewed the medical records of 136 women with severe preeclampsia managed conservatively for at least 48 hours. Patients were followed up with a daily nonstress test and amniotic fluid index. We evaluated amniotic fluid index < or = 5 cm and < or = 7 cm, measured on admission or just before delivery (i.e., final), and attempted to correlate these findings with the incidence of nonreassuring fetal testing necessitating cesarean section or the incidence of intrauterine growth restriction (birth weight < or = 10th percentile). RESULTS: One hundred seven patients had a cesarean section, but only 42 (39%) of these were for a nonreassuring fetal heart rate tracing or a persistent biophysical profile of < or = 4, and 38 (36%) of the pregnancies resulted in infants with intrauterine growth restriction. During expectant management, the amniotic fluid index worsened for 61 (45%) patients and improved or remained the same for 75 (55%). For those with an amniotic fluid index of < or = 5 cm both on admission and at delivery, there was a significantly higher incidence of intrauterine growth restriction compared with those with an amniotic fluid index > 5 cm (p = 0.007 and p = 0.029, respectively). However, there was no association between intrauterine growth restriction and an amniotic fluid index < or = 7 cm. Moreover, there was no difference in the frequency of nonreassuring fetal heart rate testing on the basis of amniotic fluid volume (p = 0.59) or intrauterine growth restriction (p = 0.4). CONCLUSIONS: For women with severe preeclampsia remote from term, an amniotic fluid index < or = 5 cm is predictive of intrauterine growth restriction but lacks sensitivity. There is no association between the amniotic fluid index status and frequency of cesarean section for fetal distress or nonreassuring fetal testing.

Adult↗