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PubMed1980

Calcium-regulating hormones and ions in amniotic fluid.

Concentrations of the hormones and ions involved in calcium homeostasis were analyzed in simultaneous samples of amniotic fluid and maternal blood obtained from normal pregnant women between 14 weeks' gestation and term. Amniotic fluid total calcium, magnesium, and phosphorus levels fell progressively and markedly despite constant or only declining maternal serum levels. Ionized calcium was constant in both amniotic fluid (mean 2.22 mEq/L) and maternal serum (mean 2.33 mEq/L) throughout gestation. Parathyroid hormone levels in amniotic fluid declined after 20 weeks' gestation, despite rising maternal serum levels, consistent with suppressed fetal parathyroid activity secondary to the relative hypercalcemia of late fetal life. Calcitonin levels in both amniotic fluid and maternal serum were unchanged throughout gestation, with amniotic fluid levels being significantly lower than those in maternal serum.

Amniotic Fluid↗
PubMed2006

Elevated amniotic fluid leptin levels in pregnant women who are destined to develop preeclampsia.

OBJECTIVE: To analyze whether leptin levels of the amniotic fluid elevate during early pregnancy in women destined to develop preeclampsia and to evaluate the relationship between amniotic fluid leptin levels and gestational age, maternal body mass index, and fetal sex. STUDY DESIGN: Leptin levels of the amniotic fluid were compared in two groups of women, preeclamptic (n = 20) and normotensive pregnant (n = 40), matched for fetal sex, maternal body mass index at sampling, gravidity and fetal gestational age at sampling. Furthermore, amniotic leptin levels in 400 normotensive pregnant women were analyzed for their correlation with gestational age, maternal body mass index, and fetal sex. RESULTS: Median leptin concentrations were significantly higher (p < 0.001) in the women with preeclampsia (7.3+/-0.7 ng/ml) than in the normotensive pregnant women (4.1 +/- 0.3 ng/ml), independent of fetal sex. The leptin levels in the amniotic fluid decreased with advanced gestational age (r = 0.24, p < 0.001). Amniotic fluid leptin levels in the pregnant women carrying a female fetus (5.6+/-0.3ng/ml) were significantly higher than those carrying a male fetus (4.7+/-0.2 ng/ml) (p = 0.004). CONCLUSION: Higher amniotic fluid leptin levels were observed in the preeclamptic pregnant women, and they decreased as gestational age advanced. Furthermore, the women with a female fetus were noted to have higher amniotic fluid leptin levels.

Amniotic Fluid↗
PubMed1991

Amniotic fluid glucose and intraamniotic infection.

Thirty-nine patients with either premature labor and/or preterm premature ruptured membranes underwent transabdominal amniocentesis to enable the following amniotic fluid analyses to be performed: culture and sensitivity, Gram's stain, and glucose determination. All nine patients with intraamniotic infection had amniotic fluid glucose values less than 10 mg/dl. Three patients with amniotic fluid glucose levels less than 10 mg/dl but without chorioamnionitis were delivered of infants within 72 hours of admission. The mean amniotic fluid glucose level of patients with intraamniotic infection (5 +/- 2.4 mg/dl) was significantly lower than in those without intraamniotic infection (39.8 +/- 18.42 mg/dl). All patients with amniotic fluid glucose values less than 10 mg/dl had either bacteria and/or white blood cells on Gram's stain. Two patients without chorioamnionitis had white cells on Gram's stain and amniotic fluid glucose values greater than 10 mg/dl. It appears that amniotic fluid glucose is more sensitive and more specific than Gram's stain in the diagnosis of intraamniotic infection. All 12 patients with low amniotic fluid glucose values were delivered of infants within 72 hours as the result of either the presence of infection or the progression of labor.

Amniotic Fluid↗
PubMed1977

Characterization of a protein in mid-term human amniotic fluid which reacts in the somatomedin-C radioreceptor assay.

Amniotic fluid contains materials other than insulin which react in a somatomedin C radioreceptor assay using human placental membranes. The material in mid-gestational amniotic fluid which reacted with the somatomedin C radioreceptor assay eluted slightly after albumin from a Sephadex G-150 column equilibrated with 0.1M NH4HCO3. Neither boiling nor treatment of this fraction with 1% formic acid yielded small molecular weight somatomedin-like peptides. Separation of the somatomedin reactive material (Sm RM) from albumin was achieved by gel filtration through Ultrogel AcA44 in 3.1M NH4HCO3. The active product had an apparent molecular weight of 33,000 to 35,000 Daltons; its isoelectric point determined by focusing was between 4.1 and 5.1. The purified amniotic fluid protein displaced somatomedin C in the somatomedin C radioreceptor assay but did not compete with insulin in the insulin radioreceptor assay. Sm RM produced only a slight stimulation of thymidine uptake in human fibroblasts but was inactive in stimulating sulfate uptake in hypox rat costal cartilage. In human fibroblast cultures Sm RM inhibited the stimulation of thymidine uptake induced by human serum and by purified rat somatomedin. When Sm RM was added to the 125I somatomedin C, some of the radioactivity eluted from gel filtration at pH 8.6 was converted to a molecular weight complex of about 43,000. We conclude that the material which we have isolated from mid-gestational amniotic fluid is a protein which may bind somatomedin and make it unavailable to the somatomedin receptor of human placenta and human fibroblasts.

Amniotic Fluid↗
PubMed1990

[Enzymatic colorimetric determination of phosphatidylglycerol in amniotic fluid].

Although the concentration of phosphatidylglycerol (PG) in amniotic fluid is generally considered indicative of fetal lung maturity, the thin layer chromatographic techniques currently used to measure this concentration have been criticized. We have investigated a highly sensitive method for determining amniotic fluid phosphatidylglycerol by using L-glycerol-3-phosphate (G-3-P).dihydroxyacetone phosphate enzymatic cycling reaction and relate this finding to the assessment of fetal lung maturity. Under the assay conditions described above, glycerol oxidase eliminates endogenous glycerol in the amniotic fluid prior to analysis. The subsequent enzymatic reaction sequence involves conversion of phosphatidylglycerol to G-3-P by phospholipase D and glycerol kinase in the presence of ATP. G-3-P is subsequently determined with amplification by enzymatic cycling reaction of G-3-P oxidase and G-3-P dehydrogenase in the presence of oxygen and NADH2. The absorbance is measured at 542 nm. The quantitation of phosphatidylglycerol is linear over the concentration range of 0-20 microM and the detection limit is 0.4 mumol/l. Within run CV's were found to be 1.25% at 13.8 mumol/l (n = 7) and 3.0% at 4.2 mumol/l (n = 7). The results obtained from 48 samples using this procedure, revealed that a level less than 1.0 mumol/l of PG persisted until the 29th week of gestation. A gradual increase in PG (more than 1.0 mumol/1) beginning in the 30th week of gestation was observed. A sharp increase in PG was also found in the 37th week of gestation.

Amniotic Fluid↗
PubMed1995

[Insulin concentration in amniotic fluid in mid-term pregnancy].

Insulin concentrations of 284 amniotic fluid samples were assessed, obtained from pregnant women by genetic amniocentesis between the 16-18 gestational weeks. The indication of amniocentesis was either advanced maternal age (> 35 years) or high risk genetic history. The amniotic fluid insulin concentration (mean +/- SD) was found 3.8 +/- 3.0 microIU/ml. The insulin concentration in 4.3% of all pregnant women was higher than the mean value +2 SD (9.8 microIU/ml) which represents individual pathological value, characteristic for gestational diabetes. Our data suggest that one part of gestational diabetes might be detected between the 16-18 gestational weeks, therefore we propose an earlier screening as the usual one. At institutes where the possibility of genetic amniocentesis is given the determination of insulin level in amniotic fluid may be reasonable. We could analyze the outcome of 230 pregnancies analysed. A close correlation was found between the amniotic fluid insulin concentration and birthweights of female newborns. It could not found such correlation at male newborn. A more careful screening test for gestational diabetes should be performed at mothers with female fetuses.

Amniocentesis↗
PubMed1984

Prenatal diagnosis of glutaric aciduria type II by direct chemical analysis of dicarboxylic acids in amniotic fluid.

A method for the measurement of dicarboxylic acids in amniotic fluid was developed that utilizes isolation of the acids by liquid partition chromatography and quantification by ammonia chemical ionization selected ion monitoring, gas chromatography-mass spectrometry. The concentrations of dicarboxylic acids in ten normal samples of amniotic fluid (mumol/l +/- 1 S.D.) were glutaric acid 0.91 +/- 0.15, adipic acid 0.33 +/- 0.08, suberic acid 0.27 +/- 0.08, and sebacic acid 0.21 +/- 0.10. A highly elevated concentration of 14.48 mumol/l glutaric acid was found in the amniotic fluid of a pregnancy in which the fetus was affected with glutaric aciduria type II. Adipic, suberic and sebacic acids were also significantly elevated. The dicarboxylic acids were normal in the amniotic fluid of a pregnancy at risk for glutaric aciduria type II in which the fetus was unaffected. This method is suitable for the rapid prenatal diagnosis of glutaric aciduria types I and II and of potential value for the prenatal diagnosis of other inherited disorders in which dicarboxylic acids accumulate.

Adipates↗
PubMed2002

[Quantitation of hepatitis C virus RNA in amniotic fluid of gravida infected by hepatitis C virus].

OBJECTIVE: To detect hepatitis C virus (HCV) RNA in amniotic fluid of gravida and investigate mother-to-infant transmission of HCV. METHODS: Thirty-four HCV seropositive gravida (experimental group) were engaged. Fluorescence quantitative polymerase chain reaction (PCR) based on amplisensor assay and reverse transcription -PCR (RT-nPCR) was used. Serum HCV RNA positive sera were genotyped by RFLP analysis of PCR products from 5'NC region. Sera and amniotic fluid samples of 40 normal gravida were set as the control group. RESULTS: In the experimental group, HCV RNA was detected in amniotic fluid (5.9%, 2/34) of 2 cases. HCV RNA titers were 10(5) and 10(6) copy/ml respectively. No HCV RNA was detected in the amniotic fluid and sera of the control (n = 40). CONCLUSIONS: HCV RNA was rarely detected in amniotic fluid. The amniotic fluid is not the main route of HCV mother-to-infant transmission.

Adult↗
PubMed1995

Intrapartum amniotic fluid index for predicting fetal acidemia. Results of receiver operating characteristic curve analysis.

OBJECTIVE: The objective of this study was to determine if the discriminatory intrapartum amniotic fluid index can reliably predict respiratory or metabolic acidosis in the newborn. STUDY DESIGN: Among 256 parturients at 37 weeks' gestation or more, the intrapartum amniotic fluid index was obtained in early labor, and umbilical arterial blood gas analysis was performed within 30 minutes of delivery. The mean (+/- SD) amniotic fluid indices in labor among newborns with no acidosis versus those with respiratory or metabolic acidosis were compared. A receiver operating characteristic curve was used to determine the best discriminatory intrapartum amniotic fluid index for respiratory and metabolic acidosis. RESULTS: Statistical analysis revealed that the mean intrapartum amniotic fluid index among 12 newborns with respiratory acidosis and 26 with metabolic acidosis was significantly lower than the mean index in 218 newborns without fetal acidemia. Despite the differences in the mean intrapartum amniotic fluid index in the three groups analyzed, the receiver operating characteristic curve indicated that an intrapartum amniotic fluid index alone is a poor test for predicting acidosis (respiratory or metabolic) in the neonate. CONCLUSION: The mean intrapartum amniotic fluid index in labor among newborns with respiratory or metabolic acidosis was significantly lower than that among nonacidotic newborns. The receiver operating characteristic curve indicated that the intrapartum amniotic fluid index cannot reliably distinguish nonacidotic infants from those with respiratory or metabolic acidosis.

Acidosis↗
PubMed1998

Is amniotic fluid analysis the key to preterm labor? A model using interleukin-6 for predicting rapid delivery.

OBJECTIVE: Our purpose was to create a model for predicting amnionitis and rapid delivery in preterm labor patients by use of amniotic fluid interleukin-6 and clinical parameters. STUDY DESIGN: Amniotic fluid was cultured and analyzed, and a clinical score (incorporating gestational age, amniotic fluid Gram stain, glucose, leukocyte esterase, and maternal serum C-reactive protein) was determined in 111 patients diagnosed with preterm labor. Statistical analysis involved t tests, chi2, logarithmic regression, and multivariate regression analysis (P < or = .05). RESULTS: The incidence of positive amniotic fluid cultures was 8.7% (9 of 103 patients). Patients with positive cultures of the amniotic fluid had a shorter delivery interval (4.8 +/- 7.5 vs 28.9 +/- 25.4 days, P < .001). Patients with elevated amniotic fluid interleukin-6 (> or = 7586 pg/ml) were more likely to have a positive amniotic fluid culture (relative risk = 8.8, 95% confidence interval = 1.6 to 47.4, P < .001) and to be delivered within 2 days (relative risk = 16.8, 95% confidence interval = 4.5 to 62.7, P < .001). Stepwise multivariate regression analysis yielded a model using interleukin-6, cervical dilatation, and gestational age (r2 = 0.63, P < .001) with a specificity of 100% for predicting delivery within 2 days of amniocentesis. CONCLUSIONS: A mathematical model using maternal amniotic fluid interleukin-6 seems to be a useful clinical tool for quantifying the interval to preterm birth for patients in preterm labor.

Amniotic Fluid↗
PubMedDate not supplied

HLA-G antigen and parturition: maternal serum, fetal serum and amniotic fluid levels during pregnancy.

OBJECTIVE: To determine whether soluble HLA-G1 (sHLA-G1) concentrations in maternal serum and in amniotic fluid are lower at term than in the second trimester. METHODS: In this prospective study amniotic fluid and maternal serum samples were aspirated from 21 pregnant women during genetic amniocentesis at 16-20 weeks' gestation, and from 19 women undergoing a cesarean section at term. In the latter group arterial umbilical cord blood was aspirated as well. sHLA-G1 levels were determined using ELISA assay. This assay included the anti-HLA-G monoclonal antibodies 87G and 16G1, both as capture antibodies and horseradish-peroxidase-labeled rabbit anti-human beta(2)-microglobulin antibodies, as the detection antibody. The relative concentrations of sHLA-G1 were measured from the absorbancy of the blue product at 650 nm. Student's t test was used for statistical analysis. RESULTS: sHLA-G1 levels in amniotic fluid were significantly lower at term than in the second trimester (0.160 +/- 0.05 vs. 0.272 +/- 0.150 OD units; p < 0.05). Levels of sHLA-G1 in maternal serum declined toward term, but the difference from the second trimester was not statistically significant (0.266 +/- 0.157 vs. 0.205 +/- 0.120 OD units; p = 0.193). There was a strong correlation of sHLA-G1 concentrations between cord serum and maternal serum (R(2) = 0.79; p < 0.001), but not between cord serum and amniotic fluid (R(2) = 0.00004) or amniotic fluid and maternal serum (R(2) = 0.02). CONCLUSIONS: sHLA-G1 antigen expression is higher in amniotic fluid than in maternal-fetal compartments and significantly decreases toward term. We speculate that the declining amniotic fluid sHLA-G1 levels may stimulate a maternal immunological response against the fetus and contribute to the initiation of parturition.

Amniotic Fluid↗
PubMed2001

Meconium concentration and amniotic fluid index influence the outcome of amnioinfusion.

BACKGROUND: To determine the usefulness of amnioinfusion as a function of meconium concentration and amniotic fluid index. METHODS: This was a prospective study of 206 pregnant women in whom amniotic fluid was moderately or heavily stained with meconium, according to subjective evaluation. The women were assigned randomly to receive amnioinfusion (n=103) or no amnioinfusion (control group, n=103). The results were compared in women with =/<15 % or >15 % meconium in the amniotic fluid (measured by centrifugation), and in women in whom the amniotic fluid index calculated 60 min after insertion of the amnioinfusion catheter was <10 or =/>10. RESULTS: In women with >15% meconium, amnioinfusion decreased the rate of cesarian sections motivated by fetal distress (2.5% vs 22.2%), and in women with =/<15% meconium, amnioinfusion decreased the presence of meconium below the vocal cords (6.4% vs 25.9%). Greater benefits after amnioinfusion were seen in women with an amniotic fluid index =/>10: the rate of cesarian sections was lower (1.3% vs 13.3%), as was the frequency of meconium below the vocal cords (10.1% vs 33.3%). CONCLUSIONS: Beneficial effects of amnioinfusion were seen in women with high and low concentrations of meconium, and with high and low amniotic fluid indexes. These criteria should therefore not be used to decide whether amnioinfusion is indicated when the amniotic fluid is moderately or heavily stained with meconium.

Adult↗
PubMed1998

The influence of amniotic fluid on prostaglandin synthesis and metabolism in human fetal membranes.

OBJECTIVE: To investigate the effect of amniotic fluid on prostaglandin synthesis and metabolism in the fetal membranes. DESIGN: A cell culture study of amnion and chorion obtained at elective cesarean section incubated with amniotic fluid collected following either spontaneous labor and delivery, or elective cesarean section. SUBJECTS: Forty-eight pregnant women at 3742 weeks gestation: 24 in spontaneous labor and 24 delivered by elective cesarean section. RESULTS: Significantly more PGE2 and PGF2alpha were produced by amnion and chorion treated with amniotic fluid from spontaneous labor compared with elective cesarean section. Spontaneous labor amniotic fluid favors PGE2 and PGFM production by amnion and chorion respectively; while elective section fluid stimulates PGE2 synthesis by both tissues (reflected as PGEM in chorion). Amniotic fluid, from either spontaneous labor or elective section, had no effect on the metabolism of exogenous PGE2 or PGF2alpha by chorion cells. CONCLUSION: Spontaneous labor is associated with the presence of a substance in amniotic fluid which facilitates prostaglandin synthesis in the fetal membranes, but which is without effect on prostaglandin metabolism.

Amnion↗
PubMed1994

Type IV collagenases in human amniotic fluids and amnion epithelial cells.

Gelatin zymograms revealed in human second trimester amniotic fluids a constant M(r) 66,000 proteolytically active polypeptide that in immunoblotting was recognized by antiserum against the human fibroblast gelatinase/type IV collagenase. Isolated cultured human amnion epithelial cells produced the M(r) 66,000 proteinase and frequently a M(r) 92,000 one. The production of the former was enhanced by transforming growth factor-beta and that of the latter by tetradecanoyl phorbol acetate. Immunoprecipitation experiments indicated that the M(r) 66,000 amnion epithelial cell proteinase was identical with that found in the amniotic fluids and that the M(r) 92,000 one corresponded to the human macrophage/granulocyte gelatinase/type IV collagenase. Approximate quantifications of the M(r) 66,000 proteinase in amniotic fluids and sera from same individuals were assessed by comparison of dilution series of the samples and standard enzyme preparations in zymography. These measurements indicated that the amount of the proteinase in the amniotic fluids was about 5-10 micrograms/ml representing 0.1-0.2% of total proteins. In sera the corresponding figures were 30-40 micrograms/ml and 0.03-0.06%, respectively. Thus the relative concentration of the M(r) 66,000 proteinase in amniotic fluids was approx. 3-4-fold that in sera, suggesting local production of the protein. The proteinase may be produced by amnion epithelial cells that under so far unknown physiologic stimulus also may start secreting the M(r) 92,000 enzyme.

Amnion↗
PubMed1997

Effect of hypoxia on amniotic fluid erythropoietin levels in fetal rats.

Erythropoietin (EPO) levels in amniotic fluid and serum were measured in hypoxic (fraction of inspired oxygen, FiO2, 0.09) and posthypoxic (following a 24-hour period of hypoxia, FiO2 0.09) fetal rats on day 21 of gestation. Each of the study groups comprised 12-20 fetuses. Each of the control groups consisted of 21 or 22 fetuses. Fetal serum EPO levels at 3, 6, 9, 12, and 24 h of hypoxia were significantly higher than the control level. Amniotic fluid EPO levels at 9, 12, and 24 h of hypoxia were also significantly increased compared to the control level. Fetal serum EPO levels returned to baseline during the 12- to 48-hour period after hypoxia. During the 0- to 48-hour posthypoxic period, amniotic fluid EPO levels were significantly higher than the control level. These data demonstrate that rates of appearance and turnover of amniotic fluid EPO are different from those of fetal serum EPO.

Amniotic Fluid↗
PubMed1981

The concentration of the elements Zn, Cu, Mg, Fe, Na, K in human amniotic fluid during birth.

In order to determine the influence of the course of pregnancy and exogenous factors on the quantitative distribution of the cations sodium, potassium, magnesium, zinc, copper and iron in amniotic fluid, these cations were assayed in the amniotic fluid of 197 pregnant women with atom absorption spectrophotometry. There were 124 normal pregnancies, 34 with toxemia, 23 with green amniotic fluid and 15 smokers. The results of sodium, potassium, and magnesium concentrations correspond well with values found by other authors. In contrast, normal mean values for zinc, copper, and iron are different from those published to date. The course of pregnancy and exogenous factors do not influence sodium concentration in the amniotic fluid. Smokers when compared with normal controls showed a significantly increased potassium in green amniotic fluid. Magnesium concentration in green amniotic fluid is also significantly increased. Similarly, values for zinc, copper and iron in pathologic amniotic fluid was significantly above normal means. This corresponds to the significantly decreased in copper and zinc values in blood and serum of newborns and infants in various disease states. The essential elements zinc, copper and magnesium are important both for the course of pregnancy as well as for the development of fetus and newborn. APGAR and others have indicated the importance of the replacement of bioelements, especially zinc, during pregnancy. We also may conclude that during pregnancy essential cations should be determined in serum or better yet in avoid the pathophysiologic consequences of severe cation disturbances in mother and infant by appropriate replacement therapy.

Amniotic Fluid↗
PubMedDate not supplied

Amniotic fluid gram stain and leukocyte count in the prediction of intrauterine infection in preterm prelabour amniorrhexis.

The purpose of the study was to examine the sensitivity and specificity of the amniotic fluid Gram stain and leukocyte count in the prediction of positive fetal blood and amniotic fluid cultures in 80 patients with preterm prelabour amniorrhexis. Amniocentesis and cordocentesis were performed and amniotic fluid and fetal blood were cultured for aerobic and anaerobic bacteria. Amniotic fluid was also cultured for Ureaplasma urealyticum and Mycoplasma hominis. The sensitivity of the Gram stain in the prediction of positive fetal blood and amniotic fluid cultures was 50 and 40% and the respective false positive rates were 12 and 4%. In the detection of aerobic or anaerobic infection of the amniotic fluid, the sensitivity and false positive rate of the Gram stain were 80 and 3% respectively. This compared favourably with the respective values of 66 and 35% for amniotic fluid leukocyte count > 30/mm3. Positive amniotic fluid Gram stain provides useful prediction of intra-uterine infection with aerobic or anaerobic organisms.

Amniocentesis↗
PubMed1989

Concentration and physicochemical characterisation of unsaturated cobalamin binding proteins in amniotic fluid.

Indirect evidence for the presence of intrinsic factor in amniotic fluid has been provided recently, using either a radioisotope binding assay or a radioimmunoassay. We have determined the unsaturated cobalamin binding capacity and the physicochemical properties of the 3 cobalamin binding proteins in 59 amniotic fluids using radioisotope binding assay, gel filtration and isoelectrofocussing. A good correlation with gestational age was found for the total unsaturated Cbl binding capacity (r = 0.735) and for the concentration of unsaturated haptocorrin (r = 0.746), but not for the concentration of unsaturated intrinsic factor (r = 0.003). When their binding capacities were expressed as a percentage of the total unsaturated Cbl binding capacity, the percentage of intrinsic factor, transcobalamin II and transcobalamin III (the less acidic fraction of haptocorrin) decreased and the percentage of haptocorrin increased in function of gestational age. The physicochemical properties of intrinsic factor in amniotic fluid were close to those in gastric juice: the molecular mass was estimated to 49,200 +/- 4,900 Da (n = 24) in Sephacryl S 300 gel filtration, the cobalamin-protein complex was resolved in 2-6 isoproteins isoelectric at a pH range of 4.6-5.8 and with a mean isoelectric point of 5.18 +/- 0.16 (n = 5) in isoelectrofocusing and it crossreacted with anti-intrinsic factor autoantibodies (from a Biermer anaemia serum). Amniotic fluid collected at 13 wk of gestational age was found to contain intrinsic factor and haptocorrin with less acidic isoproteins than those usually observed in gastric juice and serum. This could indicate that sialic acid is less involved in the composition of the carbohydrate core of cobalamin binding glycoproteins in this period of the gestational age than later on and that cobalamin binding proteins have mainly a foetal origin.

Amniotic Fluid↗