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PubMed1999

Amniotic fluid index in normal pregnancy: a longitudinal study.

OBJECTIVE: This longitudinal study was undertaken to characterize the change in the amniotic fluid volume in normal pregnancy. METHODS: Prospectively, patients with uncomplicated gestations underwent serial amniotic fluid index by a single sonographer. RESULTS: Fifty-six patients underwent a total of 378 determinations of amniotic fluid volume (6.8 +/- 2.5 examinations per patient). The variation in mean amniotic fluid index between 24 and 40(+6) weeks was not significantly different (p = 0.381). Among the 42 patients who delivered at term there was no significant decrease in the amniotic fluid index between their first and last measurement (p = 0.86). However, in the 14 patients who delivered after 41 weeks, there was a significant decrease in the index over time (p = 0.04). CONCLUSION: The longitudinal study on amniotic fluid volume in normal pregnancy reveals that amniotic fluid index does not change significantly with gestational age.

Adult↗
PubMed1975

The use of amniotic fluid bubble stability, L/S ratio, and creatinine concentration in the assessment of fetal maturity.

Amniotic fluid bubble stability and creatinine concentration are analyzed in relation to the L/S ratio and clinical outcome. Bubble stability by the standard method showed 20.5 per cent (31/151) initial disagreement between two laboratories, 53.6 per cent (81/151) correlation with L/S ratio, and did not correlate well with patient outcome. However, a "foamy" test, i.e., foam noticeable at a distance, in both 1:1 and 1:2 dilutions, indicated an elevated L/S ratio and mature pulmonary outcome. Amniotic fluid creatinine levels showed an estimated 5 to 6 per cent risk for RDS at levels we formerly thought to be safe (greater than or equal to 2.0 mg. per 100 ml. with maternal serum less than or equal to 0.9 mg. per 100 ml.), and has many false-negative values. Fetal maturity can be estimated with clinical data and amniotic fluid analysis. Amniotic fluid sampling is necessary in all instances where the clinical data leave a reasonable doubt of actual gestational age and in all cases for elective preterm delivery. We recommend a sequential approach to amniotic fluid analysis. First a bubble stability test (a "foamy" at both 1:1 and 1:2 dilutions indicates pulmonary maturity). If the bubble stability test is not "foamy", an L/S ratio. The risk of RDS associated with creatinine concentration makes this test unacceptable in any case of elective delivery; however, it may be useful as a weighing factor in emergency situations where phospholipid analysis is unavailable.

Amniocentesis↗
PubMed1975

The prediction of fetal lung maturity from the surface tension characteristics of amniotic fluid.

In recent years fetal lung maturity has been assessed by chemical determination of lung surfactant components in the amniotic fluid. The variation in the results, however, limits the clinical usefulness of these methods. To establish reliable criteria for fetal lung maturity 98 specimens of amniotic fluid were obtained in the 23rd to 41st week of gestation and their surface properties measured in the surface balance (Fig 1). A continuous rise in surface activity of amniotic fluid was observed during this period (Fig. 2). In the evaluation of the surface activity of amniotic fluid y-min appears to be the most suitable parameter because it shows a considerable change during the course of pregnancy and has low variations (Fig. 3). In 64 prematures amniotic fluid was obtained during delivery and its surface properties measured. The correlation of clinical symptoms of the premature with y-min of the amniotic fluid makes it possible to predict the fetal lung maturity at a given y-min value (Fig. 4). When the results are arranged according to the incidence of RDS (lethal RDS, recovered from RDS and without RDS) three y-min-ranges can be clearly distinguished. When y-min of the amniotic fluid is over 27 dyn/cm the probability of lethal RDS is 100%, whereas when y-min is under 17 dyn/cm a mature lung can be expected. In the range between 27 to 17 dyn/cm any degree of lung maturity can be encountered. By division of this range in two additional ones a more accurate prediction of fetal lung maturity is possible: In the y-min-range 27-23 dyn/cm RDS-probability is approximately 70%, in the range 23-17 dyn/cm it is only 30% (Fig. 4). Measurements of surface activity of the amniotic fluid make it possible to predict fetal lung maturity and estimate RDS-probability.

Amniotic Fluid↗
PubMed1985

Catecholamines in amniotic fluid as indicators of intrapartum fetal stress.

Catecholamines were measured in the amniotic fluid and in the first voided newborn urine obtained from appropriate-for-date infants of term deliveries. Catecholamine values in the amniotic fluid and urine were nearly equal when expressed in terms of creatinine. Significant positive correlations were observed between the amniotic fluid and urine of norepinephrine and epinephrine. In normal cases (n = 32) that underwent uneventful vaginal delivery, the 95% confidence limits for norepinephrine and epinephrine in the amniotic fluid were 1.53 to 2.33 ng/ml and 0.16 to 0.30 ng/ml, respectively. In cases of moderate stress (n = 12), only norepinephrine showed significantly higher values than the normal cases, while in cases of severe stress (n = 12), norepinephrine became more significantly high, and epinephrine was found to be elevated significantly. A significant difference was noted in the incidence of fetal stress between the infants with more than and those with less than 2.30 ng/ml of norepinephrine, the upper limits of the normal 95% confidence limits. However, for epinephrine such a significant difference was not noted. It was concluded that amniotic fluid catecholamines are of fetal origin and reflect fetal sympathoadrenal activity directly, even during labor, and that their level may be a good indicator of fetal condition and stress.

Amniotic Fluid↗
PubMed1991

[Discolored amniotic fluid--results of prenatal diagnosis and clinical significance].

7000 pregnancies were analysed after genetic amniocentesis in respect of the further course and results of prenatal diagnosis (observation period 1975-1988). In 3.1% (217 cases) samples of amniotic fluid were discoloured. Vaginal haemorrhages prior to amniocentesis were recorded with significantly higher incidence (18%) in patients with discoloured amniotic fluid than in a control group (n = 217) with normal colour of the amniotic fluid (4.6%) (p less than 0.001). Miscarriages and chromosome anomalies occurred more often in the study group (3.7%/2.8%, control group: 0.9%/1.8%, n.s.). The risk of miscarriages was increased in cases with sanguineous amniotic fluid if the amniotic fluid alpha-fetoprotein values were enhanced at the same time. Significant differences were observed in respect of the incidence of foetal malformations in patients with discoloured amniotic fluid (7.8%) and in the control group (2.3%) (p less than 0.01). Borderline or definitely pathological amniotic fluid AFP concentrations were found often if the amniotic fluid was discoloured (6.9%, control group 3.2%). If discoloured amniotic fluid was sampled, foetal malformations should be excluded sonographically. In 82% of all cases with discoloured amniotic fluid and foetal malformations pathological sonographic findings and/or enhanced MS-AFP values were recorded even prior to amniocentesis.

Amniocentesis↗
PubMed1981

Effect of centrifugation on fluorescence polarization of amniotic fluid.

Fluorescence polarization was measured on amniotic fluids of different gestational ages before and after centrifugation at relative centrifugal forces of 34 to 4955 x g. Centrifugation significantly increased the fluorescence polarization values over those of uncentrifuged amniotic fluids. The greatest increase was observed in the most "mature" fluids centrifuged at 34 to 230 x g. Almost without exception, use of centrifugal forces greater than 1239 x g did not further increase fluorescence polarization values.

Amniotic Fluid↗
PubMed1977

Thromboplastic activity in amniotic fluid during pregnancy.

Thromboplastic activity of amniotic fluid (TAAF) was determined in 97 normal and pathologic pregnancies using a modification of Quick's one-stage method for prothrombin time. It was shown that amniotic fluid (AF) has thromboplastic activity. This activity was found to increase with the progression of pregnancy, showing a very high correlation coefficient (r = -0.86). In cases of pathologic pregnancies such as those associated with diabetes, toxemia, IUGR, and Rh incompatibility, the values of TAAF do not differ from normal pregnancies. However, in 7 of 10 cases of postmature pregnancies the TAAF was below 45 seconds while no preterm or term pregnancy showed TAAF of less than 45 seconds.

Amniotic Fluid↗
PubMed1998

The relationship between amniotic fluid interleukin-6 concentration and histologic evidence of chorioamnionitis.

BACKGROUND: Chorioamnionitis is considered to be one of the important causes of preterm labor. To investigate the relationship between inflammatory cytokines in amniotic fluid and the histologic evidence of chorioamnionitis, we studied amniotic fluid interleukin-6 (IL-6) levels in patients with preterm labor. METHODS: Between 1993 and 1996, we obtained amniotic fluid by amniocentesis from 110 patients before 32 weeks of gestation who had preterm labor on admission. We measured IL-6 levels in the amniotic fluid with an ELISA method. Histologic examination of placentae and fetal membranes after delivery was evaluated. As controls, we measured IL-6 levels in the amniotic fluid of 37 patients without preterm labor. Seventy-eight patients delivered after 35 weeks of gestation, and 32 patients delivered before 34 weeks of gestation. Analysis was conducted using Mann-Whitney U test and Scheffe's multiple comparison test. RESULTS: Amniotic fluid IL-6 levels in patients delivering before 34 weeks were significantly higher than those in patients delivering after 35 weeks (p<0.01). IL-6 levels in the amniotic fluid were significantly different among control patients, patients without chorioamnionitis and those with histologic stages I, II and III which means subchorionic intervillositis, chorionitis and amnionitis, respectively (controls vs patients with stage I, II, III: p<0.001, patients without chorioamnionitis vs those with stage II, III, stage I vs II, stage II vs III: p<0.01). The IL-6 concentration in the amniotic fluid associated with histologic stages II or III was above 3500 pg/ml (sensitivity: 87.5%, specificity: 89.5%). CONCLUSIONS: Our findings indicate that amniotic fluid IL-6 may have a sensitive diagnostic and prognostic value in the management of preterm labor and is an index of the severity of chorioamnionitis during pregnancy.

Amniotic Fluid↗
PubMed1987

[Study of the profiles of prolactin and other hormones in both maternal plasma and amniotic fluid during labor].

The effects of a dopamine antagonist and stress of labor on prolactin (PRL) concentrations were studied in maternal plasma and amniotic fluid during term delivery. In procedure 1, maternal blood and amniotic fluid samples were obtained from 5 normal full-term deliveries at 20-minute intervals for 180 minutes after the intravenous bolus of 10 mg metoclopramide (MCP) during labor just before delivery. Amniotic fluid samples were drawn through a transcervical intrauterine pressure catheter to avoid contamination with maternal blood. PRL, 17 beta-estradiol (E2), progesterone (P) and cortisol were measured by means of radioimmunoassay (RIA), and free MCP concentrations were measured by high pressure liquid chromatography. In procedure 2, maternal blood and amniotic fluid samples were obtained from 12 full-term pregnancies with spontaneous delivery and 10 cases of elective cesarean section when birth was imminent. The amniotic fluid was obtained by direct sampling from the forewaters in spontaneous delivery and by means of a syringe inserted through amniotic membrane after the uterine wall had been incised in cesarean section. PRL, beta-endorphin (beta-EP) and cortisol were measured by RIA. The PRL levels in maternal plasma increased significantly (p less than 0.01) after the MCP injection. The peak value of PRL net increase (delta PRL) was 676.5 +/- 189.6 ng/ml. However, the PRL levels in amniotic fluid did not change significantly after the administration of this drug. Although the delta PRL levels in maternal plasma were significantly (p less than 0.001) correlated with MCP concentrations (r = 0.812) after the MCP injection, there was no correlation between delta PRL and MCP concentrations in amniotic fluid. No significant changes in E2, P and cortisol levels in both samples were observed after the MCP injection. The plasma PRL levels in vaginal delivery cases were significantly (p less than 0.05) lower than those in elective cesarean section cases (123.3 +/- 15.8 ng/ml vs. 181.0 +/- 22.2 ng/ml), and the plasma beta-EP and cortisol levels in vaginal delivery cases were significantly (p less than 0.01, p less than 0.001) higher than those in elective cesarean section cases respectively (beta-EP: 134.8 +/- 25.6 pg/ml vs. 49.7 +/- 12.3 pg/ml, cortisol: 79.4 +/- 5.8 micrograms/dl vs. 30.2 +/- 3.3 micrograms/dl). Therefore, a significant reduction in plasma PRL levels was accompanied by a marked rise in plasma beta-EP and cortisol levels during labor. In amniotic fluid, however, there were no significant differences of PRL, beta-EP and cortisol levels in vaginal delivery cases and elective cesarean cases.(ABSTRACT TRUNCATED AT 400 WORDS)

Amniotic Fluid↗
PubMed1987

Decreased amniotic fluid magnesium concentration in diabetic pregnancy.

Amniotic fluid samples from 21 diabetic pregnant women were pair-matched for gestational age with 21 samples obtained from nondiabetic women, and analyzed for magnesium concentration. Mean +/- standard deviation amniotic fluid magnesium concentration (mg/dL) was 0.86 +/- 0.21 in the diabetic group and 1.06 +/- 0.22 in the control group (P less than .001). It is concluded that in the diabetic pregnancy, a state of fetal magnesium deficiency exists. This deficient state may contribute to neonatal hypocalcemia in infants of diabetic mothers.

Amniotic Fluid↗
PubMedDate not supplied

[Bacteriologic studies of the amniotic fluid following amniocentesis].

After transabdominal amniocentesis puncture needles and samples of amniotic fluid were microbiologically examined. The antibacterial activity of the amniotic fluid after inoculation of different germs was compared. Positive microbiological results were found in 43 of total 573 puncture needles, but there were germs of the skin flora in 40 cases. Five amniotic fluid samples out of total 424 were contaminated, whereby skin commensals were detected in four samples. The bacteriostatic activity against the examined germs was individually. Complete growth inhibition over 24 hours was observed in cultures with coagulase-negative Staphylococcus, Staph. aureus and E. coli, a less growth inhibition over nearly 10 hours for Pseudomonas aeruginosa. The growth of Strep. faecalis was not suppressed. As result of the frequent observation of skin commensals in amniocentesis puncture needles and amniotic fluid samples clear lines for the performance of the amniocentesis on antiseptic condition basis and for the diagnostic and therapeutic procedure in case of positive microbiological findings were recommended.

Amniocentesis↗
PubMed2001

[Alpha-amylase/glucose index in amniotic fluid as a new method in prenatal assessment of fetal maturity].

Prenatal diagnosis of amniotic fluid enables fetal maturity evaluation, particularly that of fetal lungs. The aim of the study is to evaluate the diagnostic value of on alpha-amylase/glucose index in amniotic fluid in comparison to routinely performed tests, used for prenatal fetal lung maturity evaluation, particularly in respect of PG concentration, whose predictive value is almost 100%. The study was carried out on 180 pregnant women, chosen by random selection, hospitalized in Polish Mother's Health Centre Hospital in the period from 15.06.1994 to 31.12.1995. 223 samples of amniotic fluid were tested- in all samples following assays and tests were performed: bubble stability test (BST), optical density, orange cells test, phosphatidylglycerol concentration (PG), glucose concentration, alpha-amylase activity urea and creatinine concentration. The alpha-amylase/glucose index in amniotic fluid is statistically significant with PG concentration. The value of the alpha-amylase/glucose index is < 6.0 when amniotic fluid assay indicates fetal immaturity, but when amniotic fluid assay indicates fetal maturity, its value is 36.0. The evaluation of fetal lung maturity on the basis of the alpha-amylase/glucose index multiply decreases the cost of examinations. Authors make a suggestion to implement this method in all hospital departments of the country.

Adolescent↗
PubMed1993

Origin of CA125 and SCC antigen in human amniotic fluid.

Levels of CA125 and SCC antigen in amniotic fluids were examined in 26 cases. All samples showed high levels of CA125 and SCC antigen. Statistically significant decreases in CA125 (p < 0.05) and increases in SCC antigen (p < 0.01) from the second to the third trimesters were recognized. We focused on amnion cells as likely sources of the 2 tumor markers in amniotic fluid. Analysis of in vitro culture of amnion cells and amniotic membranes revealed an accumulation of CA125 and no accumulation of SCC antigen in the culture supernatant. A Northern blot analysis using a cDNA probe of SCC antigen ensured that there was no mRNA expression of SCC antigen in the amnion, the cord or the placenta. It is likely that the amnion is a major source of CA125 in amniotic fluid, and that the fetus is the origin of SCC antigen.

Amniotic Fluid↗
PubMed1981

Catecholamines in human amniotic fluid.

This study was undertaken to determine the amniotic fluid levels of epinephrine (E), norepinephrine (N), and dopamine (D) at different gestational ages in the human. Amniotic fluid obtained from 32 pregnant women undergoing amniocentesis for medical indications was analyzed with a radioenzyme assay for these catecholamines. The gestational ages ranged from 17 to 39 weeks. No patient was in active labor at the time of amniocentesis. The data obtained in this study demonstrated a rise of all three catecholamines at the end of the third trimester: N = 362.7 +/- 61.2 pg/ml (+/- SEM), E = 179.6 +/- 45.4 pg/ml (p < 0.05), and D = 2717.0 +/- 836.6 pg/ml (p < 0.01). The physiologic role for the increasing amounts of catecholamines, especially D, in amniotic fluid is known; however, these amines could be the stimulus for the intrauterine synthesis of prostaglandins as parturition approaches.

Amniotic Fluid↗
PubMed1994

Swallowing of lung liquid and amniotic fluid by the ovine fetus under normoxic and hypoxic conditions.

OBJECTIVE: The lungs of the mammalian fetus secrete large volumes of fluid daily. The purpose of this study was to estimate the fraction of the lung liquid that is swallowed as it exits the fetal trachea versus that which enters the amniotic fluid under normoxic and hypoxic conditions. STUDY DESIGN: In chronically catheterized fetal sheep at 119 to 133 days' gestation the volume of fluid swallowed by the fetus was monitored five times per day for three consecutive 24-hour periods: control, hypoxia, and recovery. The Na+, K+, and Cl- concentrations of the swallowed fluid, lung liquid, and amniotic fluid were measured simultaneously. The fraction of the swallowed fluid that originated from the lungs or amniotic fluid was calculated from 24-hour average compositions and the assumption that the fetus swallowed only amniotic fluid and lung liquid. RESULTS: During the control, hypoxia, and recovery periods the fetuses swallowed 264 +/- 43 (SE), 92 +/- 23, and 271 +/- 24 ml/kg of fetal weight per day, respectively. As determined from Cl- concentrations, this swallowed fluid was composed of 17.7% +/- 2.7%, 24.8% +/- 5.8%, and 11.9% +/- 3.4% lung liquid, respectively, with the remainder being amniotic fluid. Throughout the three 24-hour observation periods there was an inverse relationship between the net 24-hour swallowed volume and the fraction of the swallowed fluid that originated from the lungs. Calculations based on Na+ concentrations yielded essentially the same results with slightly more scatter, whereas calculations based on K+ concentrations were unreliable. CONCLUSIONS: (1) Chloride concentrations provide the best of the three index values for a compositional analysis of fluids swallowed by the fetus. (2) Under normoxic conditions around 18% of swallowed fluid is derived from the fetal lungs. (3) On the basis of published fluid secretion rates for the fetal lung, an average of 50% of the liquid that exits the fetal trachea is swallowed and the rest mixes with the amniotic fluid.

Amniotic Fluid↗
PubMed1979

Origin of the alkaline phosphatases in amniotic fluid.

The nature and origins of amniotic fluid ALP activity were investigated early (14 to 22 weeks) and late (25 to 44 weeks) in pregnancy. The total enzyme activities for both stages were significantly different and considerable changes in the activities of individual enzyme components occurred. Early activity consists of intestinal (81%), bone/liver/kidney (15%), and placental (4%) ALP. In late fluids, the values are 5%, 69% and 27%, respectively. The intestinal enzyme is shown to be of fetal origin, presumably arising from the direct entry of desquamated intestinal mucosal cells into the amniotic fluid. The bone/liver/kidney enzyme is mostly of maternal serum origin early with an increased fetal contribution toward term. Early in pregnancy, the placental ALP activity is probably derived both directly from the placenta and from the placental activity in maternal serum. The latter source contributes more toward term.

Alkaline Phosphatase↗
PubMed1987

Comparison of the specific binding of cortisol in human amnion, amniotic fluid, and plasma.

The purpose of this study was to compare the specific cortisol-binding protein found associated with human amnion with specific cortisol binding in human amniotic fluid and plasma. The electrophoretic mobility on polyacrylamide gels of the specific cortisol binding in amnion, amniotic fluid, and maternal plasma was identical. The influence of pH on cortisol binding activity was similar in all tissues and the cortisol binding was immunoprecipitable by a polyclonal antibody raised against human corticosteroid-binding globulin. The interaction of the cortisol binding protein with concanavalin A was studied in preterm amniotic fluid, term amniotic fluid, term amnion, and plasma from pregnant women at term and women under oral contraceptive treatment. Binding to concanavalin A was similar in term amnion and term amniotic fluid but was less than that found with both preterm amniotic fluid and term plasma. These results indicate that the cortisol binding protein associated with human amnion has similar characteristics to plasma corticosteroid-binding globulin, but that its state of glycosylation appears to be more like that of the cortisol binding protein in term amniotic fluid rather than in plasma.

Amnion↗