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PubMed1984

Fluorescence polarization in gastric aspirate and in amniotic fluid and its relationship to the respiratory distress syndrome.

Fluorescence polarization of diphenylhexatriene (DPH), added to amniotic fluid can be used to estimate fetal lung maturity. In this study we estimated the fluorescence polarization (FP) value of gastric aspirates of newborns and of amniotic fluids and studied the relationship between the FP value and neonatal lung function. Gastric aspirates of 51 newborns and amniotic fluids of 13 cases were mixed with a DPH-phosphate buffered saline solution and incubated for 30 minutes at 37 degrees C. Fluorescence polarization was measured at 22 degrees C. The FP values of amniotic fluid are in accordance with results previously found. A highly significant negative correlation was present between the FP value in amniotic fluid and gestational age. The highest FP values were found in amniotic fluids of infants in whom respiratory distress developed. The FP values of gastric aspirates decreased also with gestational age. A rather poor negative correlation, however, was found between these FP values and gestational age. We also noticed that, before the 36th week of gestation, the FP values in gastric aspirates tend to be lower than those in amniotic fluids. Both high and low FP values were estimated in gastric aspirates of infants with RDS and of infants without respiratory problems. These results show that the measurement of the FP value in gastric aspirates of newborns is not an useful method to determine whether the infant will develop RDS or not.

Amniotic Fluid↗
PubMed1997

Lipopolysaccharide binding protein and soluble CD14 receptor protein in amniotic fluid and cord blood in patients at term.

OBJECTIVES: Our purpose was to examine whether lipopolysaccharide binding protein and soluble CD14 are present in amniotic fluid and to determine whether the lipopolysaccharide binding protein and soluble CD14 concentrations are associated with indicators of infection or labor at term. A lipopolysaccharide-lipopolysaccharide binding protein complex activates macrophages through soluble CD14 at lipopolysaccharide concentrations up to 100 times lower than required with lipopolysaccharide alone. Thus lipopolysaccharide binding protein and soluble CD14 in amniotic fluid could explain the high concentrations of cytokines found in amniotic fluid of culture-positive patients and may even explain the presence of cytokines in some culture-negative patients. STUDY DESIGN: Healthy women at term undergoing cesarean section had amniotic fluid, chorioamnion, decidua, and cord blood obtained. Lipopolysaccharide binding protein was measured by enzyme-linked immunosorbent assay. Amniotic fluid was cultured and assayed for cytokines, and the chorioamnion and decidua were cultured and examined histologically. RESULTS: Lipopolysaccharide binding protein and soluble CD14 were present in all amniotic fluids and fetal cord blood. An elevated level of lipopolysaccharide binding protein (270 ng/ml/mg of protein) was present in the amniotic fluid of 12 (36%) of the 33 patients. An elevated level was associated with microorganisms in the chorioamnion and decidua, cytokines (tumor necrosis factor-alpha, interleukin-6, and interleukin-8) in amniotic fluid, histologic chorioamnionitis, and labor. Among patients in labor, the concentration of lipopolysaccharide binding protein appeared independent of microorganisms in the amniotic fluid. CONCLUSIONS: Lipopolysaccharide binding protein and soluble CD14 are present in amniotic fluid, and concentrations of lipopolysaccharide binding protein are elevated in patients in labor with and without evidence of infection. Lipopolysaccharide binding protein and soluble CD14 may mediate intrauterine inflammatory responses at term.

Acute-Phase Proteins↗
PubMed1976

Amniotic fluid removal prior to saline abortion.

To evaluate whether removal of the amniotic fluid prior to the instillation of 200 ml of 20% hypertonic saline has any effect on the success, speed, and safety of the abortion process, 192 patients at 15--20 weeks' gestation were aborted according to one of the following procedures: 1) instillation of 200 ml saline without removal of the amniotic fluid (92 subjects), 2) removal of 100 ml of amniotic fluid prior to saline instillation (46 subjects), and 3) removal of 150 ml of amniotic fluid prior saline instillation (54 subjects). The study indicated that there are no apparent advantages to the removal of the amniotic fluid prior to the instillation of 200 ml of hypertonic saline. The median times from instillation to abortion and rates of incomplete abortion were similar for the three groups of patients. Rates of specific complications, except for fever, were similar for the three groups.

Abortion, Induced↗
PubMed1976

Amniotic fluid removal prior to saline abortion.

To evaluate whether removal of the amniotic fluid prior to the instillation of 200 ml of 20% hypertonic saline has any effect on the success, speed, and safety of the abortion process, 192 patients at 15-20 weeks' gestation were aborted according to one of the following procedures: 1) instillation of 200 ml saline without removal of the amniotic fluid (92 subjects), 2) removal of 100 ml of amniotic fluid prior to saline instillation (46 subjects), and 3) removal of 150 ml of amniotic fluid prior saline instillation (54 subjects). The study indicated that there are no apparent advantages to the removal of the amniotic fluid prior to the instillation of 200 ml of hypertonic saline. The median times from instillation to abortion and rates of incomplete abortion were similar for the three groups of patients. Rates of specific complications, except for fever, were similar for the three groups.

Abortion, Induced↗
PubMed1994

The influence of operator transducer pressure on ultrasonographic measurements of amniotic fluid volume.

OBJECTIVE: Our purpose was to study the effect of operator transducer pressure on amniotic fluid index and single deepest pool measurements and their intraobserver and interobserver variability. STUDY DESIGN: Forty subjects in the third trimester with intact membranes were studied by two observers at three predetermined operator pressures. Pressure was measured by interfacing a flexible water-filled reservoir connected to a manometer between the maternal abdomen and the ultrasonography transducer. The amniotic fluid index and single deepest pool were measured on screen by another operator, and data were analyzed by calculating components of variance. RESULTS: Compared with medium pressure, low pressure resulted in a 13% increase in amniotic fluid index (p < 0.001), and high pressure resulted in a 21% fall in amniotic fluid index (p < 0.001). The single deepest pool was less sensitive to pressure, with a 11% increase at low pressure (p < 0.001) and a 16% fall at high pressure (p < 0.001). Intraobserver error was 17% for amniotic fluid index and 18% for single deepest pool when operator pressure was controlled at medium pressure; this increased to 28% and 24%, respectively, when pressure was not controlled (p < 0.01). Interobserver error was consistently very low. CONCLUSION: Both techniques are highly sensitive to the pressure applied to the maternal abdomen during scanning. The reproducibility of amniotic fluid index and single deepest pool is comparable. The use of the same observer for serial measurements of amniotic fluid index would appear to be less important than careful attention to transducer pressure.

Amniotic Fluid↗
PubMed1988

The effect of storage conditions on amniotic fluid phosphatidylglycerol concentration.

In certain high-risk gestations, phosphatidylglycerol in the amniotic fluid is reported to be useful in predicting respiratory distress syndrome of the neonate in high-risk patients. This study of amniotic fluid phosphatidylglycerol was performed to determine the degradation of phosphatidylglycerol in both the supernatant and the lamellar bodies of amniotic fluid samples collected from normal term pregnant patients. The objective of the study was to discover whether phosphatidylglycerol retained its stability when measured in transported and stored amniotic fluid. The results of the study showed that phosphatidylglycerol remained stable in all amniotic fluid samples stored at various temperatures over a 3-week period.

Amniotic Fluid↗
PubMed1976

Changes in appearance of amniotic fluid during pregnancy - the macroscore.

During the first two trimesters of pregnancy the amniotic fluid is clear and yellow; during the third trimester the amniotic fluid becomes colourless; then, approximately from the 33rd-34rd week on, cloudiness and flocculation occur, at first very slowly, after the 36th-37th week steadily faster (Tab. I). At term, the amniotic fluid is moderately cloudy and contains a moderate number of flakes of vernix. The appearance of the amniotic fluid depending on the degree of cloudiness and on the number of flakes, has been expressed by means of a score system, the socalled macroscore (Tab. II). Relationships were observed: a) between the disappearance of the yellow colour (bilirubin) and the initial occurrence of cloudiness and flocculation; b) between the duration of pregnancy and the macroscore; from the 32nd-36th week of pregnancy the mean macroscore increases until the second half of the 40th week; then in the 41 st week there is a drop in the mean macroscore, after which a new increase occurs (Fig. 1,2 and 3). c) between the total gestation period at birth and the progression of the macroscore (Fig. 5); when birth takes place earlier (later), the macroscore will increase earlier (later). d) between the total duration of gestation at birth and the macroscore at the end of pregnancy; with an earlier (later) birth, the macroscore is lower (higher) (Fig. 5 and 6). With the macroscore it is possible to determine the duration of pregnancy (b) and the time before birth even more accurately (c). The fairly large standard deviation of the macroscore per pregnancy week (Fig. 1) also in case of a given duration of gestation at birth (Fig. 7) points to a fairly large interindividual variation in the appearance of the amniotic fluid at a certain duration of pregnancy. The macroscore is determined by elements originating from the fetal skin; the cloudiness and flocculation are caused by release of vernix and the flaking off of cells from the stratum corneum. Hence the macroscore reflects changes in the function of the fetal skin and is an indicator of the functional maturation of the fetal skin. The considerable variation of the macroscore at a given duration of pregnancy indicates a great variation of fetal maturation. The fetus that is maturing faster, will be delivered earlier; the fetus that is maturing slower, later (c). This points to a correlation between the degree of fetal maturation and the start of labour. The higher macroscore during the last days before birth in pregnancies of longer duration (d) (Fig. 5 and 6) may be explained by a less sensitive uterus, requiring a greater maturity of the fetus for delivery to start. The drop of the mean macroscore in the 41 st week of pregnancy is due to a sudden increase of lower scores in this week (Fig. 4). A lower score at a given stage of pregnancy means a later birth (Tab. VI and VII). Thus in the 41 st week of pregnancy a considerable group of pregnant women appears, that has a total duration of gestation that is, on the average, two weeks longer than normally...

Amniotic Fluid↗
PubMed1992

Acute intrauterine hypoxia increases amniotic fluid prostaglandin F metabolites in the pregnant sheep.

OBJECTIVE: Amniotic fluid infection promotes cytokine release, prostaglandin production, and premature labor. In several tissues local hypoxia also activates the secretion of cytokines. Many patients initially seen in premature labor carry small-for-gestational-age fetuses, a condition associated with intrauterine hypoxia. The purpose of our study was to determine whether a reduction in placental blood flow and subsequent acute hypoxia affects prostaglandin secretion by the placenta. STUDY DESIGN: We chronically catheterized six pregnant sheep at 120 days of gestation. We placed catheters in the maternal and fetal femoral arteries and in the amniotic fluid cavity. A flow probe and snare were placed around the common uterine artery. RESULTS: A 30-minute uterine circulation occlusion of 30% of its control value produced an increase in prostaglandin F metabolite from 790 +/- 157 to 944 +/- 184 pg/ml within 10 minutes (p < 0.01). Additional uterine blood flow reduction to 60% of control increased the amniotic fluid prostaglandin F metabolites concentration to 894 +/- 202 (p < 0.05, analysis of variance). No increase in mean intrauterine pressure was detected (p > 0.1). CONCLUSIONS: We speculate that the prostaglandin increase in amniotic fluid in response to intrauterine hypoxia could eventually lead to premature labor. Whether the increase in prostaglandins is mediated by changes in cytokines is unknown at the present time.

Acute Disease↗
PubMed1982

The use of amniotic fluid 3-methyl histidine to creatinine molar ratio for the diagnosis of intrauterine growth retardation.

To determine if the amniotic fluid 3-methyl histidine to creatinine molar ratio (3MH:CR) could prove useful for the antepartum detection of intrauterine growth retardation (IUGR), the 3MH:CR was determined retrospectively in 3 groups of human amniotic fluids. Group A consisted of amniotic fluids from pregnancies yielding IUGR fetuses whose birth weight was less than or equal to the tenth percentile for gestational age; group B consisted of amniotic fluid from pregnancies yielding infants whose birth weight was greater than the tenth but less than or equal to the 25th percentile for gestational age; group C consisted of amniotic fluids from pregnancies yielding infants whose birth weight was greater than the 25th but less than or equal to the 75th percentile for gestational age. The mean 3MH:CR x 10(-3) for groups A, B, and C were 15.9 +/- 1.9, 5.4 +/- 0.8, and 6.2 +/- 0.5, respectively. The mean 3MH:CR x 10(-3) was statistically different between groups A and B (P less than or equal to .001) and between groups A and C (P less than or equal to .001), but not statistically different between the 2 control groups. Employing an upper limit of normal of 8 for the 3MH:CR x 10(-3), 13 of 15 IUGR neonates were correctly identified as IUGR, and 23 of 27 neonates were correctly identified as being of normal birth weight for gestational age (sensitivity 86.7%, specificity 85.2%, incidence of correct diagnosis 85.7%). No consistent relationship was shown to exist between maternal serum and amniotic fluid 3-methyl histidine level. There was no statistically significant relationship between 3MH:CR x 10(-3) and gestational age. The comparison of the data generated in this study to that obtained with previously reported ultrasonic and biochemical techniques suggests that the amniotic fluid 3MH:CR ratio may prove helpful in establishing the antenatal diagnosis of IUGR, particularly in cases where the gestational age is uncertain.

Amniotic Fluid↗
PubMed1983

Estimation of fetal maturity by amniotic fluid cytology, creatinine, lecithin/sphingomyelin ratio and phosphatidylglycerol.

The value of four amniotic fluid tests--the lecithin/sphingomyelin ratio, the presence of phosphatidylglycerol, amniotic fluid cytology and the creatinine concentration--in the prediction of fetal lung maturity was investigated. The sensitivity was high for all tests except for amniotic fluid cytology, which had a higher specificity. The overall outcome, particularly the value for predicting immaturity, was improved by various combinations of tests. The combination of amniotic fluid cytology and creatinine proved useful in predicting the gestational age. A diagram for estimation of gestational age is presented.

Amniotic Fluid↗
PubMed1988

Physiological studies of human chorionic gonadotropin and free subunits in the amniotic fluid compartment compared to those in maternal serum.

We measured intact hCG, free alpha hCG, and free beta hCG levels in amniotic fluid and maternal serum using specific monoclonal antibody-based immunoradiometric assays. Compared to maternal serum, amniotic fluid had low levels of intact hormone along with high levels of its free subunits. The mean amniotic fluid hCG level was 1 mg/L at 13 weeks, and it progressively decreased to 0.100 mg/L by the 23rd week. Amniotic fluid alpha hCG levels were highest at 15 and 16 weeks (0.340 mg/L) and rapidly declined to concentrations less than 0.050 mg/L at 21 weeks. Amniotic fluid beta hCG concentrations were about 0.200 mg/L between 13 and 16 weeks and progressively decreased until the 23rd week. In vitro stability studies of hCG and its subunits demonstrated that dissociation of hCG into its subunits was not responsible for these results. Both hCG and free subunits detected in amniotic fluid were indistinguishable from standard hCG and free subunit preparations, as analyzed by sodium dodecyl sulfate-polyacrylamide gel electrophoresis. Our findings are consistent with the hypothesis that the presence of hCG and free subunits in the amniotic fluid represents secretion from the trophoblastic tissue into the amniotic fluid compartment. Furthermore, high serum hCG levels in association with low levels of its free subunits are probably the result of polarized secretion of the intact hormone from the syncytiotrophoblasts into the maternal circulation.

Amniotic Fluid↗
PubMed1985

Correlations between PRL and chloride, sodium, potassium and calcium in amniotic fluid.

The concentration of prolactin in amniotic fluid from 91 pregnant women (Group I: 51 specimens obtained at 15th-20th week of gestation; Group II: 40 specimens at term) has been correlated with the amniotic fluid concentrations of calcium, of the ions sodium, chloride, and potassium, and with the clinical data. When the week of gestation in multiple regression analyses was predetermined for inclusion in the first step, the amniotic prolactin concentration was found to be significantly correlated with sodium or chloride in both groups and the correlation coefficients in the two groups were alike. The correlation coefficients of potassium and of calcium differed between the two groups and no general pattern could be detected. The results indicate that the amniotic sodium and chloride concentrations could be of importance for the regulation of the amniotic prolactin concentration.

Adult↗
PubMed1987

Amniotic fluid testosterone and testosterone glucuronide levels in the determination of foetal sex.

Unconjugated testosterone levels were assayed in 351 amniotic fluid samples obtained at 15-19 weeks gestation. The median values for unconjugated testosterone in the 166 female foetuses and 185 male foetuses were 137 and 712 pmol/l respectively. Sixteen amniotic fluid samples from male foetuses had unconjugated testosterone levels lower than the highest female unconjugated testosterone value (361 pmol/l). Testosterone glucuronide was measured in amniotic fluid from 48 female and 55 male foetuses. There was a significant sex difference in the median values of testosterone glucuronide between female (median 160 pmol/l, range 64-465 pmol/l) and male (median 817 pmol/l, range 68-3707 pmol/l) amniotic fluid specimens (P less than 0.001). Of the sixteen male foetuses with amniotic fluid unconjugated testosterone levels in the female range, 12 had amniotic fluid testosterone glucuronide levels within the male testosterone glucuronide range of values. Hence used in conjunction with unconjugated testosterone, testosterone glucuronide increased the predictive accuracy of foetal sexing from 95.4 to 98.9%. Testosterone sulphate was measured in 24 female and 25 male amniotic fluid samples. There was no Testosterone sulphate was measured in 24 female and 25 male amniotic fluid samples. There was no significant difference between female (median 2591 pmol/l) and male (median 2964 pmol/l) testosterone sulphate levels.

Amniocentesis↗
PubMed1991

Correlation of amniotic fluid index and nonstress test in patients with preterm premature rupture of membranes.

The amniotic fluid index and the nonstress test are commonly used in the expectant management of preterm premature rupture of membranes. This study was designed to investigate the interrelationship of the nonstress test and the amniotic fluid index during the preterm rupture of membranes latency period. Fifty patients with preterm premature rupture of membranes for greater than 48 hours were prospectively followed with daily 1-hour nonstress tests and blinded, daily amniotic fluid index examinations (totaling 422 evaluations). The overall average daily amniotic fluid index was statistically lower in the earlier gestations and nulliparous patients but was not influenced by the fetal position or nonlaboring uterine activity. An increased incidence of variable decelerations and nonreactive nonstress tests was associated with a significantly lower overall average daily amniotic fluid index, but these differences were beyond the standard precision of the amniotic fluid index examination. The daily nonstress test appears to identify clinically significant lower fluid volumes during the latency period and should remain the mainstay in the management of preterm premature rupture of membranes.

Adult↗
PubMed1983

Decreased oxygen supply enhances growth in culture of human mid-trimester amniotic fluid cells.

Human mid-trimester amniotic fluid cells were cultivated under conditions of decreased oxygen supply. Compared to control cultures the low-oxygen group showed improved growth which was quantitated by three independent assays (1) direct cell counts, (2) bromodeoxyuridine (BrdU)-Hoechst flow-cytometry, and (3) cloning efficiency. The growth promoting effects of lowered oxygen hold for all major morphologic categories of amniotic fluid cells.

Amniotic Fluid↗
PubMed1983

[Secretory immunoglobulin A in amniotic fluid].

Secretory immunoglobulin A (S-IgA) was estimated in amniotic fluid samples by means of the single radial immunodiffusion according to Mancini. A monospecific antiserum against human secretory component was used. 163 amniotic fluid samples from normal pregnancies and risk pregnancies respectively were investigated. Within the 3rd trimenon the S-IgA content in amniotic fluid increased significantly. With respect to literature and examinations performed previously a connection between S-IgA content in amniotic fluid and fetal lung maturity seems to be possible.

Amniotic Fluid↗
PubMed2003

Effect of maternal hydration on amniotic fluid volume.

OBJECTIVE: To estimate the effects of maternal intravenous hydration on amniotic fluid volume in normal pregnancies. METHODS: Women undergoing an amniocentesis for the evaluation of fetal lung maturity before an elective cesarean delivery were eligible to participate. An amniotic fluid index (AFI) was obtained before the amniocentesis, and at the time of the amniocentesis the amniotic fluid (AF) volume was determined by diazo-dye reaction with subsequent spectrophotometric analysis of AF samples. If the AF sample drawn for fetal maturity studies was mature, the patient was hydrated with 1000 mL of balanced salt solution 30 minutes before her cesarean delivery. Amniotic fluid volume was subsequently estimated after the hydration by a repeat AFI. Amniotic fluid volume was directly measured at cesarean delivery and compared with the dye-determined volume. The pre- and posthydration AFI were also compared. RESULTS: A total of 17 women participated in the study between January 2001 and June 2001. Statistically significant increases in the AF volume and AFI were found. The prehydration median AF volume was 450 mL (range 250-953), and the median increase in AF volume was 188 mL (95% confidence interval [CI] 60, 254 mL; P <.001). Median AFI was 8.6 (range 5.8-17.8) with a median change in AFI of 1.7 cm (95% CI 1.1, 3.0; P <.001). CONCLUSION: Maternal intravenous hydration appears to increase both the actual and ultrasound-estimated AF volumes in normal third-trimester pregnancies.

Adult↗
PubMed1987

Increased concentrations of arachidonic acid lipoxygenase metabolites in amniotic fluid during parturition.

This study was undertaken to examine whether spontaneous labor at term is associated with changes in the amniotic fluid concentrations of arachidonate lipoxygenase metabolites. Amniotic fluid was obtained from 15 women at term in active labor (with cervical dilatation of at least 6 cm) and from 15 nonlaboring control women matched for maternal age, parity, and gestational age. Cultures of amniotic fluid for bacteria and mycoplasma were negative. Products of arachidonate lipoxygenase metabolism--12-hydroxyeicosatetraenoic acid (12-HETE), 15-hydroxyeicosatetraenoic acid (15-HETE), and leukotriene B4--were measured by radioimmunoassay. The median concentrations of 12-HETE, 15-HETE, and leukotriene B4 in the amniotic fluid of nonlaboring women were 11.50 ng/mL, 0.45 ng/mL, and 21 pg/mL, respectively, and in the amniotic fluid of laboring women, 24.63 ng/mL, 4.34 ng/mL, and 96 pg/mL, respectively. The differences between labor and nonlabor amniotic fluid concentrations of all three lipoxygenase products were significant (P less than .05, Wilcoxon test). These observations are consistent with involvement of products of the lipoxygenase pathway of arachidonic acid metabolism in the mechanism of human parturition.

12-Hydroxy-5,8,10,14-eicosatetraenoic Acid↗