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PubMed1996

Normal values for amniotic fluid index during uncomplicated twin pregnancy.

OBJECTIVE: To establish the gestational age trends of amniotic fluid index (AFI) in uncomplicated twin pregnancies. METHODS: Amniotic fluid index was measured in uncomplicated twin pregnancies seen between 1985 and 1993 and meeting the following criteria: 1) no maternal medical or obstetric complications, 2) normal growth of both twins by serial ultrasound, and 3) normal amniotic fluid volume by ultrasound. Amniotic fluid index was measured by adding the deepest vertical pockets in four quadrants, defined by the umbilicus and linea nigra. The relation between gestational age and AFI was evaluated using linear regression analysis. RESULTS: Two hundred eighty-two sets of twins were considered uncomplicated; 1101 AFI measurements were performed on these pregnancies between 25.5 and 40.5 weeks' gestation. Percentile values for AFI were determined according to gestational age. The regression equation relating the median AFI to gestational age was: AFI = 19.4 - 0.12 x gestational age (P = .03). The R2 value was 0.04. CONCLUSION: Gestational age trends in normative AFI measurements for twin pregnancies have been established. Their use will facilitate a more reproducible, quantitative diagnosis of oligohydramnios in twins, compared with subjective, qualitative approaches to amniotic fluid volume assessment.

Adult↗
PubMed1979

Total cortisol and L/S-ratio in amniotic fluid in late pregnancies complicated by diabetes mellitus.

68 samples of amniotic fluid from 47 women with varying severity of diabetes mellitus and 48 samples from 43 normal women were obtained in the 31st to 40th week of pregnancy before onset of labour. The concentration of total cortisol and the L/S-ratio in amniotic flud were determined and related to gestational age. There was a continous rise of total cortisol with advancing gestational age in the diabetic pregnancies similar to that found in normal pregnancy. Diabetic pregnancies were associated with slightly lower amniotic fluid cortisol levels without significant difference to values found in normal pregnancy. The severity of the disease did not affect the cortisol levels in amniotic fluid. There was no correlation between total cortisol levels and L/S-ratios in amniotic fluid. Determination of total cortisol in amniotic fluid can thus not replace measurements of L/S-ratios to predict fetal lung maturation.

Amniotic Fluid↗
PubMed2003

Amniotic fluid and maternal serum leptin levels in pregnant women who subsequently develop preeclampsia.

OBJECTIVES: To study the correlation between amniotic fluid leptin levels and maternal serum leptin levels during the early second trimester, and to determine whether the ratios of amniotic fluid leptin levels to maternal serum leptin levels are elevated in pregnant women who subsequently develop preeclampsia. STUDY DESIGN: Samples from 120 pregnant women were included in this prospective study, of which 20 were from pregnant women who subsequently developed preeclampsia and 100 were from normal pregnant women. Both the amniotic fluid and the maternal serum leptin levels were ascertained by radioimmunoassay (RIA). RESULTS: A strong correlation between amniotic fluid leptin levels and maternal serum leptin levels was observed in both preeclamptic and normal pregnant women. In addition, the ratios of amniotic fluid leptin levels to maternal serum leptin levels were positively correlated to amniotic fluid leptin levels, but negatively correlated to maternal serum leptin levels. Furthermore, the ratios of amniotic fluid leptin levels to maternal serum leptin levels in preeclamptic women were significantly higher than those in normal pregnant women. CONCLUSIONS: Amniotic fluid leptin levels correlated with maternal serum leptin levels during the early second trimester. The ratios of amniotic fluid leptin levels to maternal serum leptin levels were elevated in preeclamptic women. However, the maternal serum leptin levels themselves showed no such elevation. Therefore, this elevated ratio may be a marker at the early stage of pregnancy in preeclamptic women.

Adult↗
PubMed1980

Cord entanglement causing premature placental separation and amniotic fluid embolism. Case report.

A woman died undelivered of amniotic fluid embolism. Postmortem examination showed that cord entanglement had caused premature placental separation with a marginal tear of the membranes and so opened a route of entry for amniotic fluid into the subplacental maternal venous sinuses. It is suggested that premature separation of the normally implanted placenta, associated with macro- or microscopic tears of or damage to the fetal membranes, provides a route of entry for amniotic fluid through the placental site in approximately one half of the fatal cases of amniotic fluid embolism.

Abruptio Placentae↗
PubMed1975

Thyroid hormones and thyrotropin in amniotic fluid.

Thyroid hormone and thyrotropin concentrations in amniotic fluid were studied by radioimmunoassays during pregnancy. The mean thyroxine concentration was 398 ng per 100 ml at 15 to 19 and 440 ng per 100 ml at 36 to 42 weeks. Although 3,3',5-tri-iodothyronine was undetectable (less than 25 ng per 100 ml), 3,3',5'-tri-iodothyronine levels were very high (range, 132 to 605 ng per 100 ml) at 15 to 30 weeks, but decreased substantially (range, 54 to 130 ng per 100 ml) thereafter. Thyrotropin was undetectable. The mean thyroxine and 3,3',5-tri-iodothyronine levels in amniotic fluid were much lower and the mean 3,3'5'-tri-iodothyronine much higher than the corresponding values in maternal serum at both 15 to 19 and 36 to 42 weeks of pregnancy. Measuring thyroid hormones in amniotic fluid, especially 3,3',5'-tri-iodothyronine, may aid in the diagnosis of fetal thyroid dysfunction and in identification of pregnancies of less than 30 weeks' gestation.

Amniotic Fluid↗
PubMed1979

Acid-base determinations in amniotic fluid and blood of normal late pregnancy.

Amniotic fluid (AF) and arterial blood were obtained almost simultaneously from 59 healthy third-trimester pregnant women. Oxygen and carbon dioxide tensions (Po2, Pco2), pH, bicarbonate (Bicarb), total carbon dioxide (TCO2), lactate (L), and pyruvate (P) concentrations were measured. Only AF-Bicarb, AF-TCO2, AF-pH, and AF-P showed a statistically significant correlation, negative, with gestational age. AF-Po2, AF-pH, AF-Bicarb, and AF-TCO2, were lower, and AF-Pco2 was higher than in maternal blood. Amniotic fluid lactate was about 6 times, and AF-P was 2 times higher than maternal blood levels. The latter, the low bicarbonate, and the high Pco2 all contributed to the acidic pH of AF. Amniotic fluid pH was affected by fetal and maternal variables, notably maternal pH. There was no correlation between AF-Po2 and Pao2 (arterial oxygen tension), between AF-Pco2 and Paco2 (arterial carbon dioxide tension), or between AF-L and blood L. AF-Po2, AF-Pco2, and AF-L may correlate better with the intrauterine fetal status than AF-pH. Normal values obtained in this study should be useful as a baseline to monitor changes in the intrauterine environment in abnormal prgenancies.

Acid-Base Equilibrium↗
PubMed1981

Correct prenatal diagnosis of a Hurler fetus where amniotic fluid cell cultures were of maternal origin.

Contamination of amniotic fluid cell cultures by maternal cells can be expected to lead to misdiagnosis of fetal genotype in 0.1 to 0.5/100 cultures, when assays are carried out directly on cultured cells. Chemical analysis of the cell-free amniotic fluid supernatant may overcome this source of error and has the added advantages of speed and independence from amniotic cell culture failure. We describe a pregnancy at risk for Hurler's disease where amniotic cells cultured at amniocentesis had a female karyotype and an alpha-iduronidase activity towards both phenyl and 4-methylumbelliferyl substrates at the lower end of the normal range, suggesting a heterozygous fetus. An affected fetus was predicted, however, because of a high concentration of dermatan sulphate in the amniotic fluid. The discrepancy between these findings was shown to be due to maternal cell contamination of amniotic fluid cell cultures by the birth of a male infant with Hurler's disease.

Amniotic Fluid↗
PubMed2005

[Activity and role of tryptase after entrance of amniotic fluid into blood in rats].

OBJECTIVE: To investigate the activity and role of tryptase after entrance of amniotic fluid into blood in rats. METHODS: Thirty female Wistar rats (20 day pregnancy) were divided into the control group (10, injected with normal saline), amniotic group (10, injected with amniotic fluid), meconium group (10, injected with 1% meconium). After injection, pulmonary tissue was taken out. Tryptase activity was measured by special substrate. The histology of pulmonary tissue was determined by immunohistochemistry (HE). RESULTS: (1) Dropsy, hemorrhage, and infiltration of neutrophil (PMN), macrophage, leukomonocyte were observed in two experimental groups, but no such changes were found in control group. (2) After injection, tryptase activity in meconium group 176.4 +/- 8.6 and amniotic fluid group 165.4 +/- 7.4 was significantly higher than preexperimental groups 146.8 +/- 8.9 and 147.8 +/- 9.5, respectively (t = 7.58 and t = 4.64, P < 0.01); tryptase activity in control group was 145.3 +/- 10.6 before injection and 146.9 +/- 9.4 after injection, respectively, there was no difference (t = 0.37, P > 0.05). After injection, tryptase activity in meconium and amniotic fluid groups was significantly increased than that in control group (F = 30.66, P < 0.05). CONCLUSION: The activity of tryptase was significantly increased after entrance of amniotic fluid into blood in rats. Degranulation of mast cells to release tryptase may be the important cause of the pathophysiologic change after entrance of amniotic fluid into blood. These results suggest a role for mast cell activation in the mechanism of amniotic fluid embolism. This method is sensitive and effective for diagnosis of amniotic fluid embolism in clinic.

Amniotic Fluid↗
PubMedDate not supplied

[Relation between procoagulant activity and fetal lung maturity in amniotic fluid].

A total of 146 samples of amniotic fluid from the 15th to 43rd weeks of pregnancy were taken by either transabdominal amniocentesis or amniotomy during birth. In addition to the palmitic/stearic ratio (P/S) the following coagulation tests were determined: clotting time, modified prothrombin time, partial thromboplastin time (PTT), recalcification time and, in selected samples, thrombelastograms. In the course of pregnancy there is a significant shortening of all coagulation tests measured in amniotic fluid. Comparing the values obtained in the 15th to 18th and the 37th to 43rd weeks of gestation and literature results the following values may indicate fetal maturity: clotting time less than 100 sec., modified prothrombin time less than 80 sec., PTT less than 30 sec. and recalcification time less than 80 sec. The lower limit for P/S ratio in normal pregnancy is 5,0. In 58 cases, amniotic fluid was obtained in the 37th to 43rd week at most 24 hours before delivery; there was no case of RDS in this group. Eliminating intermediate P/S values of 4,5 to 5,0 a false negative rate of 1,7% for the prediction of fetal lung maturity was seen. The corresponding rate for the modified prothrombin time was 3,4% and for the clotting time 6,4%. In 7 RDS cases all cases could be properly predicted from the recalcification time and the PTT. The fetal lung maturity may be estimated by means of simple and rapid coagulation tests and this may facilitate the indication for RDS-prophylaxis. The determination of the L/S or P/S ratios, however, cannot yet be dispensed with.

Amniotic Fluid↗
PubMed1995

Prostate-specific antigen immunoreactivity in amniotic fluid.

We examined whether the 33-kDa serine protease prostate-specific antigen (PSA) is present in amniotic fluid and, if so, whether its concentration changes with gestational age. Analyzing 115 amniotic fluids with a highly sensitive immunofluorometric procedure, we found PSA in all the amniotic fluids examined and established that its concentration increases with increasing gestational age from 11 to 21 weeks, decreasing at delivery. PSA in amniotic fluid is present predominantly in the free (33 kDa) form; a minor fraction (< 20%) is present bound to alpha 1-antichymotrypsin. No significant correlation was seen between PSA and alpha-fetoprotein (AFP) in amniotic fluid or maternal serum in samples with high AFP. Amniotic fluid PSA was also measurable by two different established methods for PSA. Pregnant women had higher concentrations of serum PSA than nonpregnant women. The highest PSA concentration in amniotic fluid was associated with a pregnancy that was complicated by the Rhesus incompatibility syndrome but the source of the PSA was not established. From recent literature reports, and the association of PSA with prostate and breast tumors, we think PSA may serve as a growth factor regulator in cancer and in normal fetal development during pregnancy.

Amniotic Fluid↗
PubMed1995

Amniotic fluid accumulation in the first trimester.

Amniotic fluid volume was estimated sonographically in 507 of 977 first trimester pregnancies with living fetuses and in 99 of 227 instances of missed abortion. Volume is correlated with fetal length, cross referenced by average heart rate for living fetuses. Fluid volume increases exponentially after 9 weeks, consistent with the onset of renal function. Fluid volume tends to be excessive with missed abortion. Free fluid volume is a physiologic variable, determined from morphologic features. Standards are proposed for amniotic fluid volume dynamics in the first trimester.

Abortion, Missed↗
PubMed1975

Amniotic fluid glucose: a maternal, fetal, and neonatal correlation.

While it has been noted that amniotic fluid glucose is increased in patients withdiabetes mellitus, the exact significance of this finding is not known. Our study of amniotic fluid glucose in 53 amniotic fluid samples from 41 patients shows a high correlation of amniotic fluid glucose levels of 30 mg. per 100 ml. or greater with neonatal hypoglycemia. We have also found elevated amniotic fluid glucose levels in patients whose onlyother indication of abnormal glucose metabolism was recurrent glycosuria. Thepossible significance of these findings is discussed.

Amniotic Fluid↗
PubMed1986

Amniotic fluid in baboon pregnancies with normal versus growth-retarded fetuses.

Amniotic fluid samples from 12 pregnant baboons at 173 to 176 days of gestation were studied. Five fetuses were growth retarded and seven were normally developed. Mean amniotic fluid volumes and composition (osmolality, protein concentration, delta optical density at 450 nm, and amniotic fluid/maternal plasma creatinine ratio) were similar in the two groups. Growth-retarded fetuses had amniotic fluids with a lower mean (+/- SE) pH than their normally developed peers (7.50 +/- 0.083 versus 7.85 +/- 0.084, p = 0.023). Intrauterine growth-retarded fetuses appeared to ingest amniotic fluid at a slower mean rate than normally developed fetuses (609 +/- 50.9 versus 769 +/- 48.6 ml/day, p = 0.05), but the difference disappeared when the estimates were corrected for fetal weight. Whether these data may be extrapolated to human pregnancies is speculative but appears likely in view of the similarities between amniotic fluid volume and composition in normal baboon and human pregnancies.

Amniotic Fluid↗
PubMed1995

[Concentration of magnesium in the amniotic fluid of a patient with diabetes].

Amniotic fluid magnesium concentration in normal and diabetic pregnancy was analyzed. The mean amniotic fluid concentration of this metal was 0.28 +/- 0,03 mmol/l in diabetic group and 0,43 +/- 0,09 mmol/l in control group (p < 0,0001). The role of hypomagnesemia in the course of diabetic pregnancy was discussed.

Adult↗
PubMed1993

A simple, noninvasive, sensitive method for diagnosis of amniotic fluid embolism by monoclonal antibody TKH-2 that recognizes NeuAc alpha 2-6GalNAc.

OBJECTIVE: The sialyl Tn structure (NeuAc alpha 2-6GalNAc alpha 1-O-Ser/Thr) recognized by monoclonal antibody TKH-2 is a characteristic component in meconium and amniotic fluid. The purpose of this study was to determine whether amniotic fluid embolism could be detected by quantification of this antigen in maternal serum by means of an assay using antimucin monoclonal antibody TKH-2. STUDY DESIGN: Sialyl Tn antigen was measured in the serum of women with meconium-stained amniotic fluid and compared with the level in those with clear amniotic fluid, as well as that in women with a clinical picture suggesting amniotic fluid embolism. The concentration of sialyl Tn antigen was determined by an immunoradiometric competitive inhibition assay. RESULTS: Serum sialyl Tn antigen levels in women with meconium-stained amniotic fluid (20.3 +/- 15.4 U/ml) at delivery were slightly higher than those in women with clear amniotic fluid (11.8 +/- 5.6 U/ml). A significantly elevated level of sialyl Tn antigen was observed in serum of patients with amniotic fluid embolism and amniotic fluid embolism-like symptoms (105.6 +/- 59.0 U/ml, p < 0.01). CONCLUSION: The method for detecting sialyl Tn antigen in the serum of patients with amniotic fluid embolism is a direct way to demonstrate the release of meconium- or amniotic fluid-derived mucin into the maternal circulation and is a simple, noninvasive, sensitive method for diagnosis of amniotic fluid embolism.

Adult↗
PubMed1994

Clinical value of amniotic fluid interleukin-6 determinations in the management of preterm labour.

OBJECTIVE: To ascertain whether the determination of amniotic fluid interleukin-6 (IL-6) concentrations would be a useful clinical test in the management of women with preterm contractions. SETTING: The labour and delivery unit and the Fetal Diagnostic Centre at the University of Utah. SUBJECTS: Pregnant women at various stages of gestation in the third trimester. DESIGN: Amniotic fluid samples were collected from women experiencing one of four clinical scenarios: 1. term pregnancy, not in labour with no evidence of intrauterine infection; 2. normal term labour with no evidence of infection; 3. preterm labour with no evidence of infection and undelivered within one week of sampling; and 4. preterm labour and delivered within seven days of sample collection. Amniotic fluid was obtained by amniocentesis or at the time of amniotomy or hysterotomy. IL-6 in each specimen was determined by a specific rapid ELISA. RESULTS: Amniotic fluid IL-6 levels, given as mean (SEM) in the four groups of women listed were: 1. term pregnancy, not in labour: 20.9 (7.2) pg/ml (n = 60); 2. normal term labour with no infection: 554 (90.7) pg/ml (n = 46); 3. preterm labour with no evidence of infection, undelivered: 47.0 (17.2) pg/ml (n = 35); and 4. preterm labour, delivered: 456.7 (101.7) pg/ml (n = 40). There was no significant difference in the means of amniotic fluid IL-6 for the term labour and preterm labour delivered groups. In general, amniotic fluid IL-6 levels during term labour increased with advancing cervical dilation. There was no correlation of cervical dilation and amniotic fluid IL-6 levels in women having preterm delivery. Receiver-operator curves revealed optimal IL-6 levels for discrimination of labour at term to be 50 pg/ml and for preterm delivery to be 200 pg/ml. CONCLUSIONS: IL-6 can readily be detected in the amniotic fluid of most women who are in active labour, regardless of gestational age. Our data suggest that amniotic fluid IL-6 determinations may be clinically useful in the management of preterm labour.

Adult↗
PubMed1992

[Modified method of determining phosphatidylglycerol in amniotic fluid to assess fetal maturity].

In this study the amniotic fluid of 111 cases were analyzed to assess fetal maturity by a modified method of determining phosphatidylglycerol. The L/S ratio was also determined in the amniotic fluid by thin layer chromatography at the same time. This method was found especially valuable where the L/S ratio was not less than 2.0 and the newborn infant did not have RDS. Here the fetal maturation was characterized by an early appearance of PG. Clinical evaluation showed that the rate of accuracy to assess fetal maturity of PG was 97.3%, significantly higher when compared with the 86.5% by L/S ratio (P less than 0.01). The false negative rate for PG was 5%. PG analysis in amniotic fluid as markers of surfactant seems to be of value as an additional index of prenatal evaluation of lung maturity. The modified method of PG assessment in amniotic fluid is a better method for estimating fetal maturity.

Amniotic Fluid↗
PubMed1978

Human serum Zn-alpha2-glycoprotein in amniotic fluid.

Human serum Zn-alpha2-glycoprotein (Zn-alpha2-GP) was found to be present in the amniotic fluid in the mean concentration of 0.98 +/- 0.40 mg/100 ml, which represents about one-tenth of its concentration in the maternal serum (9.65 +/- 1.18 mg/100 ml). Its concentration in the amniotic fluid was proportional to the amniotic fluid total protein and very approximately to the maternal serum Zn-alpha2-GP. The relationship between the maternal serum Zn-alpha2GP and the maternal serum total protein as well as between the amniotic fluid total protein and the maternal serum total protein was found to be not significant. The amniotic fluid Zn-alpha2-GP as well as the amniotic fluid total protein showed some increase during gestation to reach the highest values at the end of the second trimester. At present both the origin and significance of the amniotic fluid Zn-alpha2-GP are not known.

Amniotic Fluid↗