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PubMed2000

[Study on relationship between levels of leptin in maternal blood, amniotic fluid, and umbilical blood and newborn's weight].

OBJECTIVE: To explore the relationship between leptin's quantity in maternal blood, amniotic fluid, umbilical blood and maternal and newborn's weights. METHODS: Levels of leptin in maternal blood, amniotic fluid, and umbilical blood of 34 pregnant women were detected by radioimmunoassay (RIA) method. Results were analyzed by the correlative analysis. RESULTS: (1) Leptin can be detected either from maternal blood or amniotic fluid or umbilical blood. (2) There was an obvious correction between newborn's weight and leptin's quantity of maternal blood (relative coefficient r = 0.53, P < 0.01), amniotic fluid (r = 0.73, P < 0.01) and umbilical blood (r = 0.67, P < 0.01). (3) There was an obvious correction between maternal weight and leptin's quantity of maternal blood (r = 0.61, P < 0.01). (4) There was an obvious correction between leptin's quantity of amniotic fluid and umbilical blood (r = 0.72, P < 0.001). (5) There was not obvious correction between maternal weight and leptin's quantity of amniotic fluid and umbilical blood (r = 0.22, r = 0.18, respectively. P > 0.05). CONCLUSION: It may be of important significance in detection of leptin's quantity in amniotic fluid and maternal blood in pregnant women for predicting the weight and growth of newborns.

Amniotic Fluid↗
PubMed1998

Characterisation of non-maternal serum proteins in amniotic fluid at weeks 16 to 18 of gestation.

Proteins found in amniotic fluid are mainly serum proteins, probably of maternal origin. About 5% of the total protein concentration has the potential of being fetal or decidual in origin. Only a few of these proteins have been isolated and characterised. In order to describe the foetal and decidual components in amniotic fluid more extensively, a polyspecific antiserum to amniotic fluid at weeks 16-18 of gestation was raised. Specificities in the antiserum to serum proteins were removed by adsorption. Several proteins of non-serum protein origin reacted with the antiserum. Three of these proteins were chosen for isolation and further characterisation. With the use of immunological methods, SDS-PAGE and N-terminal sequencing we identified two of the proteins as C-terminal propeptides of procollagen Type I and Type III, which have not hitherto been described in amniotic fluid. The third protein, called here protein-4, showed up as homologous to fetal antigen-1 (FA-1) and human dlk, containing EGF-like domains and associated with growth in neuroendocrine tissues and tumours.

Amino Acid Sequence↗
PubMed1988

Assay of bacterial endotoxin (lipopolysaccharide) in human amniotic fluid: potential usefulness in diagnosis and management of preterm labor.

The long-range goal of our research is to determine whether the presence of bioactive agents of infection in amniotic fluid may serve as sensitive indexes of the existence of infection as the cause of preterm labor in a given pregnancy. The aim of this study was to explore the possibility that bacterial endotoxin (lipopolysaccharide) could be detected and quantified in amniotic fluid. In particular, we sought to ascertain (1) if amniotic fluid could be collected in a manner to prevent endotoxin contamination, (2) whether there were inhibitors of lipopolysaccharide in amniotic fluid, and (3) if Limulus amebocyte lysate-based assays could be used to identify and quantify lipopolysaccharide in this fluid. We found that the Limulus amebocyte lysate assays (gelation assay and chromophore generation assay) were useful in the qualitative and quantitative analysis of lipopolysaccharide in amniotic fluids. Lipopolysaccharide-mediated generation of chromophore in the presence of amniotic fluid was accelerated strikingly compared with that of lipopolysaccharide in endotoxin-free water. In three amniotic fluid samples obtained during preterm labor, lipopolysaccharide was detectable in aliquots of 1 to 10 microliters by use of the gelation assay and lipopolysaccharide was quantifiable by use of chromophore generation assays. Two of these amniotic fluid samples were sterile as determined by bacteriologic examination; in the third sample, Fusobacterium species was identified. We suggest that these assays may be extremely useful in the identification of lipopolysaccharide in amniotic fluid. Indeed, lipopolysaccharide may serve as one marker of infection useful in establishing the cause of preterm labor.

Amniotic Fluid↗
PubMed1995

Effect of amniotic fluid volume on ultrasonic fetal weight estimation.

We evaluated the relationship between the amniotic fluid index and the accuracy of fetal weight estimation using ultrasonography. Six hundred and sixty-four patients, between 20 and 42 weeks' gestational age, who were delivered within 1 week of a sonographic examination were studied. Five formulas for estimating fetal weight also were studied. Systematic and random errors in predicting birth weight were analyzed relative to birth weight and amniotic fluid index. The accuracy of sonographic fetal weight estimation was independent of amniotic fluid index across all gestational ages and birth weights. Each of the five formulas had similar error percentages, and no significant differences were detected. Predicted fetal weight was significantly underestimated with each of the formulas studied, a finding that was also independent of birth weight and amniotic fluid index. We conclude that ultrasonography can be used reliably to estimate fetal weight in patients with altered amniotic fluid volumes.

Amniotic Fluid↗
PubMed1989

The missing link in amniotic fluid volume regulation: intramembranous absorption.

Although fetal urine output and swallowing are major contributors to amniotic fluid regulation, other pathways for fluid movement must be involved in the regulation of amniotic fluid volume because many studies report fetal urine output to be greater than swallowing. This study was designed to examine the possibility of fluid transfer between the amniotic cavity and the fetal blood that perfuses the fetal membranes and surface of the placenta in the ovine fetus. We injected warmed distilled water into the amniotic fluid in three groups of chronically catheterized fetal sheep. In normal fetuses, there was rapid absorption of the water into the fetal circulation, resulting in highly significant decreases in fetal osmolality, plasma electrolytes, and heart rate as well as increases in arterial pressure and fetal hemolysis. Concomitantly, there was a small, delayed fall in maternal osmolality. In a second group of fetuses with ligated esophagi, these same responses occurred except that the fetal osmolality and electrolyte changes occurred earlier and were significantly greater. In a third group of fetuses killed just before the water injection, maternal osmolality was unchanged. These data suggest the intramembranous pathway as a major route of amniotic fluid absorption in the ovine fetus. In addition, esophageal ligation appears to augment the conductance of this pathway, as evidenced by a significantly greater estimated filtration coefficient and rate of water absorption in the ligated animals than in controls. Finally, the transmembranous pathway directly to the mother does not appear to be a major route.

Absorption↗
PubMed1996

Effect of amniotic fluid on cationic lipid mediated transfection and retroviral infection.

In preparation for foetal gene therapy by intra-amniotic gene application, we have investigated the effect of amniotic fluid on several gene transfer systems. In vitro lipofection of embryonically derived 3T3 cells by several of the tested cationic lipids decreases in the presence of human amniotic fluid, while two formulations, Lipid 67 and Tfx-50, remain highly active. As some body fluids are known to inactivate most retroviral vectors, we investigated the influence of amniotic fluid on the efficiency of infection of 3T3 cells by murine leukaemia virus (MoMLV)-based vectors, including amphotropic and ecotropic retrovirus, and a vesicular stomatitis virus G (VSV-G) glycoprotein pseudotyped retroviral vector. All showed a decrease of infectivity from 21 to 56% in the presence of amniotic fluid. The ecotropic retrovirus is the most infectious under normal conditions as well as in amniotic fluid. Our results suggest that intra-amniotic injection may allow efficient gene transfer using either amniotic fluid-resistant cationic lipids or ecotropic retroviral vectors in a murine in vivo model for foetal gene therapy. The VSV-G-pseudotyped vector, although displaying a decrease of infectivity, remains of great interest for gene delivery, because of its broad host range and because of the high virus titers achievable. Finally, a baculovirus-based vector shows no decrease of its infectivity and does not seem to be affected by amniotic fluid but has only low infectivity on the tested foetal fibroblast cell line.

3T3 Cells↗
PubMed2004

[Determination of tramadol and its active metabolite O-desmethyltramadol in plasma and amniotic fluid using LC/MS/MS].

AIM: To determinate tramadol and O-desmethyltramadol in human plasma and amniotic fluid by LC/MS/MS, and distribution of tramadol and O-desmethyltramadol in maternity and fetus were studied. METHODS: Samples containing tramadol, O-desmethyltramadol and diphenhydramine (internal standard, IS ) were extracted using liquid-liquid extraction, followed by liquid chromatographic separation and on-line MS/MS using atmospheric pressure chemical ionization as an interface detection. The analytes were detected in the selected reaction monitoring mode. RESULTS: The calibration curves for tramadol and O-desmethytramadol in plasma and amniotic fluid were linear in the range from 8.0 to 800.0 microg x L(-1) (plasma) and 1.0 to 400.0 microg x L(-1) (amniotic fluid). The method was applied to the measurement of tramadol and O-desmethytramadol concentrations in maternal vein, umbilical vein, umbilical artery and amniotic fluid. Following intramuscular pre-operative administration 1.5 mg x kg(-1) doses of tramadol to parturients, plasma concentrations of tramadol were significantly higher than those in amniotic fluid. The concentrations of O-desmethyltramadol in plasma were lower, and were not detected in amniotic fluid. CONCLUSION: The method is shown to be accurate, robust and convenient, and suitable for clinical pharmacokinetics studies of tramadol and O-desmethyltramadol.

Amniotic Fluid↗
PubMed1999

Relationship between graded degrees of anemia and amniotic fluid volume in the ovine fetus.

OBJECTIVE: Severe fetal anemia is associated with polyhydramnios in both human and ovine fetuses. This study examined the relationship between varying degrees of anemia and amniotic fluid volume in fetal sheep. STUDY DESIGN: Eleven long-term catheterized ovine fetuses at 126 +/- 1 days' gestation (mean +/- SE) were subjected to hemorrhage of 20 to 80 mL daily for 9 consecutive days to produce varying degrees of fetal anemia. Five additional animals served as time control animals. Statistical analysis was by least squares regression and 3-factor analysis of variance. RESULTS: Amniotic fluid volume was 793 +/- 147 mL and did not change with time in the control fetuses. In the fetuses that were subjected to hemorrhage the amniotic fluid volume changed little through the hematocrit range of 40% to 25%. As fetal hematocrit fell below approximately 25%, amniotic fluid volume began to increase. With greater degrees of anemia the amniotic fluid volume increased as an exponential function of hematocrit and approached 2000 mL excess fluid as hematocrit dropped to <15%. According to bivariate regression the increase in amniotic fluid volume was related to fetal hematocrit, PaO(2), and urinary flow rate as well as to plasma and amniotic fluid lactate concentrations. According to multivariate regression only fetal PO(2) and urinary flow rate were significantly related to the increase in amniotic fluid volume. CONCLUSIONS: Although mild anemia was not associated with increased amniotic fluid volume, moderate to severe fetal anemia was associated with an exponential rise in amniotic fluid volume. This rise may have been mediated by a hypoxemia-induced diuresis, by a diuresis related to a lactate-induced osmotic accumulation of fetal fluid, or by both mechanisms.

Amniotic Fluid↗
PubMed1978

Insulin levels in amniotic fluid. Management of pregnancy in diabetes.

A correlation between high insulin levels in amniotic fluid and the appearance of diabetogenic fetal morbidity was found in radioimmunoassays of 487 samples of the fluid. The mean insulin level in metabolically normal pregnancies rose from 9 muU/ml (Week 27) to 15 muU/ml (Week 40). The insulin level in amniotic fluid of diabetic patients was elevated up to 27 times the mean. Insulin levels in the umbilical cord and urine of newborns of diabetic mothers were also elevated, to 29 and 21 times the mean, respectively. Elevation of insulin levels in amniotic fluid portends diabetogenic fetal morbidity. High and rising insulin levels at an early stage (26-28 weeks) may indicate a high risk of preterm onset of labor. Regular adjustment of metabolic compensation on the basis of amniotic fluid insulin made it possible to reduce the level in 12 of 17 pregnant diabetic women by increasing insulin dosage. The 12 women were thereby enabled to carry their pregnancies to term and to await the onset of spontaneous labor without diabetogenic fetal morbidity. Beta-stimulating agents affect glucose management and may cause elevated insulin levels in amniotic fluid.

Amniotic Fluid↗
PubMed1994

Corticotrophin releasing hormone levels in human plasma and amniotic fluid during gestation.

OBJECTIVE: Corticotrophin releasing hormone, a hypothalamic neuropeptide also made in placenta, may regulate fetal maturation in a stress-responsive manner. The objectives of this study were: (1) to determine if levels of corticotrophin releasing hormone in the amniotic fluid correlate with fetal lung maturation; (2) to confirm that third trimester plasma levels of corticotrophin releasing hormone are increased in patients with pregnancy-induced hypertension compared to normotensives, and (3) to increase the recovery of extracted corticotrophin releasing hormone from plasma and amniotic fluid. DESIGN: (1) Levels of corticotrophin releasing hormone in amniotic fluid during the third trimester were compared with those of saturated phosphatidyl choline. (2) Corticotrophin releasing hormone levels were measured in a group of normotensive pregnant women during the entire gestation period. Corticotrophin releasing hormone levels during the third trimester were compared in normotensives and patients with pregnancy-induced hypertension. PATIENTS: Twenty-one non-pregnant normal volunteers and 63 pregnant women. MEASUREMENTS: Blood pressure, corticotrophin releasing hormone in plasma and amniotic fluid, and saturated phosphatidyl choline in amniotic fluid. RESULTS: Corticotrophin releasing hormone levels in amniotic fluid samples during the third trimester ranged from 12 to 98 pmol/l and positively correlated with the saturated phosphatidyl choline levels, but not with gestational age. A significant difference existed in plasma corticotrophin releasing hormone concentration between gestational age-matched third trimester normotensive and hypertensive gravids: corticotrophin releasing hormone levels were significantly lower in normotensives (223 +/- 65 pmol/l) than in patients with pregnancy-induced hypertension (544 +/- 106 pmol/l, P = 0.001). Plasma corticotrophin releasing hormone increased with gestational age from 51 pmol/l (range 8.4-85) at 25-32 weeks to 375 pmol/l (range 35-1386) at 33-40 weeks. During the third trimester the rise in plasma corticotrophin releasing hormone conformed to an exponential mathematical model of a positive feedback loop between placental corticotrophin releasing hormone and fetal adrenal cortisol. CONCLUSIONS: During the third trimester of pregnancy there is a positive correlation between the level of amniotic fluid corticotrophin releasing hormone and that of saturated phosphatidyl choline. The positive correlation between amniotic fluid corticotrophin releasing hormone and saturated phosphatidyl choline, but not between amniotic fluid corticotrophin releasing hormone and gestational age, suggests that a factor(s), such as stress, may affect both amniotic fluid corticotrophin releasing hormone and saturated phosphatidyl choline in parallel. Furthermore, our data are consistent with the hypothesis that the rise in placental corticotrophin releasing hormone is coupled to an increase in fetal glucocorticoid and lung maturation, and that stresses such as pregnancy-induced hypertension may accelerate this process.

Amniotic Fluid↗
PubMed2003

The clinical significance of detecting Ureaplasma urealyticum by the polymerase chain reaction in the amniotic fluid of patients with preterm labor.

OBJECTIVE: This study was undertaken to determine the clinical significance of a detection of Ureaplasma urealyticum by using the polymerase chain reaction (PCR) in the amniotic fluid of patients with preterm labor and intact membranes. STUDY DESIGN: Amniocentesis was performed in 257 patients with preterm labor and intact membranes. Amniotic fluid was cultured for aerobic and anaerobic bacteria as well as genital mycoplasmas. U urealyticum was detected by PCR using specific primers. Patients were divided into 3 groups according to the results of amniotic fluid culture and PCR for U urealyticum: those with a negative culture and negative PCR (n=228), those with a negative culture but positive PCR (n=6), and those with a positive culture regardless of the results of PCR (n=23). RESULTS: The prevalence of positive amniotic fluid culture was 9% (23 of 257). U urealyticum was detected by PCR in 6% (15 of 254) of cases. Of the 15 cases with positive PCR for U urealyticum, amniotic fluid culture was negative in 40% (6 of 15). Patients with a negative culture but positive PCR for U urealyticum had significantly shorter median amniocentesis-to-delivery interval and higher amniotic fluid interleukin-6 and white blood cell count than those with a negative amniotic fluid culture and negative PCR (P<.01 for each). Patients with a positive PCR for U urealyticum but a negative amniotic fluid culture had a higher rate of significant neonatal morbidity than those with a negative culture and negative PCR (P<.05). However, no significant differences in perinatal outcome were observed between patients with a negative culture but positive PCR and those with a positive amniotic fluid culture. CONCLUSION: Patients with preterm labor and a positive PCR for U urealyticum but negative amniotic fluid culture are at risk for impending preterm delivery and adverse perinatal outcome.

Adult↗
PubMed1989

Vasopressin is metabolized by a trypsinlike enzyme in guinea pig amniotic fluid.

We have demonstrated that arginine vasopressin (AVP) is degraded to desglycinamide AVP by a trypsinlike enzyme found in guinea pig amniotic fluid. Incubation of [3H]AVP with guinea pig amniotic fluid in vivo or in vitro produced a metabolite that comigrated on high-pressure liquid chromatography with desglycinamide AVP in three different buffer systems. Also, AVP antisera that cross-reacted with standard desglycinamide AVP could detect this amniotic fluid metabolite. Because the enzyme responsible for the cleavage of glycinamide from AVP was likely to be trypsin, experiments with aprotinin, a trypsin inhibitor, were conducted. Results demonstrated that the production of the amniotic fluid AVP metabolite could be completely blocked in the presence of the trypsin inhibitor. In addition, examination of amniotic fluid collected from fetuses in the second half of gestation (term = 68 days) showed that AVP could not be metabolized to desglycinamide AVP until after 52 days of gestation. In conclusion, AVP appears to be metabolized by a trypsinlike enzyme in amniotic fluid, and because trypsin is a general proteolytic enzyme, the amniotic compartment may also serve as a clearance site for other proteins.

Amniotic Fluid↗
PubMed1981

Effect of meconium contamination on amniotic fluid lecithin: sphingomyelin ratio.

Studies on the lecithin: sphingomyelin (L:S) ratio in amniotic fluid were made before and after the addition of meconium in 130 normal pregnancies. The meconium was collected from premature and term infants after delivery. That which was collected from premature neonates had no significant effect on the mean L:S ratio of amniotic fluid; in 28% (17 of 60), however, the L:S ratio was elevated by 0.1 to 0.2, though in none by more than 0.2. When meconium collected from term neonates was added to amniotic fluid, it significantly increased the mean L:S ratio of amniotic fluid when the baseline L:S ratio was between 1.0 and 1.9 (P less than .01); in 56% (39 of 70), the L:S ratios were elevated by 0.1 to 0.5, though none increased by more than 0.5. This study suggests that when amniotic fluid is contaminated with meconium, an L:S ratio of 2.2 in premature pregnancies and 2.5 or greater in term pregnancies retains its original predictive value.

Amniotic Fluid↗
PubMed1993

Dynamics of prolactin in amniotic fluid and extraembryonic coelomic fluid in early human pregnancy.

Concentrations of prolactin were measured by an immunoradiometric assay in 26 matched samples of amniotic fluid, extraembryonic coelomic fluid and maternal serum from 9 to 12 weeks of pregnancy and in a further 131 amniotic fluid samples from 9 to 20 weeks. Low levels of prolactin (median 40 MU/l) were present in amniotic fluid from 9 to 12 weeks. Levels in the coelomic fluid were higher (median level 371 MU/l; P < 0.0001) than in amniotic fluid. From 13 weeks, there was a rapid rise in amniotic fluid prolactin to reach a peak at 19 weeks (median level 99,850 MU/l). The pattern of increase of prolactin in amniotic fluid is similar to, but occurs 2 weeks later than that for insulin-like growth factor-binding protein-1, another major decidual product.

Amniotic Fluid↗
PubMed1996

GRO alpha in the fetomaternal and amniotic fluid compartments during pregnancy and parturition.

PROBLEM: GRO alpha/MGSA is a new member of the chemokine superfamily CXC(alpha) and is produced by a variety of cells including macrophages, fibroblasts, epithelial, and endothelial cells, and keratinocytes. This chemokine has chemoattractant activity and may participate in neutrophil recruitment and activation during the course of intrauterine infection. This study was conducted to investigate the effect of labor and microbial invasion of the amniotic cavity (MIAC) on amniotic fluid, fetal, and maternal plasma GRO alpha concentrations. METHOD: A cross-sectional study was designed using parameters that included gestational age, results of amniotic fluid (AF) cultures, and labor status at the time of amniocentesis. Fluid was retrieved by transabdominal amniocentesis. MIAC was defined as a positive amniotic fluid culture for bacteria. Umbilical cord blood was retrieved at the time of delivery. Amniotic fluid, maternal and fetal plasma GRO alpha concentrations were measured with a sensitive and specific ELISA (Quantikine, R&D Systems, Minneapolis, MN). RESULTS: 1) GRO alpha was detectable in amniotic fluid, umbilical cord, and maternal plasma samples; 2) GRO alpha concentrations in amniotic fluid increased with advancing gestational age; 3) Both term and preterm gestations with MIAC were associated with higher amniotic fluid GRO alpha concentrations than those with sterile amniotic fluid, independent of the labor status (term, MIAC, labor: median 2.7 ng/ml, range 1.4-12.7 vs. term, no MIAC, labor: median 2.1 ng/ml, range 0.7-3.4, vs term, no MIAC, no labor: median 1.9 ng/ml, range 1.8-4.2; P < 0.005; preterm: MIAC median 5 ng/ml, range 0.6-47.9 vs. no MIAC: median 2.3 ng/ml, range 0.5-10; P < 0.008); 4) A strong correlation was found between umbilical cord plasma GRO alpha concentrations and neonatal neutrophil count, and between GRO alpha concentrations and white blood cell count in the amniotic fluid (r = 0.67, P < 0.0005 and r = 0.38, P < 0.001, respectively). CONCLUSION: GRO alpha is a physiologic constituent of amniotic fluid and cord blood. Amniotic fluid GRO alpha concentrations increase with gestational age. Intrauterine infection both preterm and at term is associated with an increase in GRO alpha concentrations of amniotic fluid, suggesting that GRO alpha may play an important role in recruitment of neutrophils into the amniotic cavity.

Amniotic Fluid↗
PubMed1978

Detectability and pattern of immunoglobulins in normal amniotic fluid throughout gestation.

Immunoglobulin (Ig) M, IgA, and IgD class and IgA, and IgA2 subclass levels were detected in normal amniotic fluid throughout gestation with a hemagglutination-inhibition assay: IgG was measured by single radial immunodiffusion. In 161 tested samples, IgA, IgA, IgA2, and IgG were measurable in all cases; IgM was measurable in 99.4 per cent and IgD, in 90.6 per cent of the fluids. IgA, IgG, and IgD concentrations increased toward midpregnancy and thereafter decreased to term in a pattern similar to that for amniotic fluid total protein. IgM, on the other hand, remained relatively constant through week 35 of gestation; thereafter, it increased to term. There was no correlation in this normal group between amniotic fluid and cord blood levels of Ig class or subclass at term. Mean IgA values were 2.2 times higher in amniotic fluid than in cord serum. This was in sharp contrast to IgM, which was 16 times higher, IgG, which was 66 times higher, and IgD, which was 2.4 times higher in cord serum than in amniotic fluid. The inverse data for IgA as compared to other Ig classes suggest that amniotic fluid IgA may be partially derived from IgA in fetal gastrointestinal and pulmonary secretions. Determination of the concentration of the different Ig classes (and eventually subclasses) in amniotic fluid may be useful in diagnosis of intrauterine infections, malformations, and immunodeficiencies.

Amniotic Fluid↗
PubMed1998

Do multiple measurements employing different ultrasonic techniques improve the accuracy of amniotic fluid volume assessment?

This investigation was undertaken to determine if the accuracy of the ultrasound assessment of abnormal amniotic fluid volume (oligohydramnios or polyhydramnios) is improved by employing multiple sonographic amniotic fluid measurements. Four ultrasound techniques consisting of the subjective assessment (ultrasonic visualization without measurement), largest vertical pocket, amniotic fluid index and 2-diameter pocket technique were performed followed by amniocentesis and dye-dilution confirmation of amniotic fluid volume in 66 singleton pregnancies. The ultrasound accuracy to detect abnormal amniotic fluid volume ranged from 61% with the largest vertical pocket to 70% with the 2-diameter pocket procedure used separately. Receiver operator characteristic curves demonstrated that combining the 4 ultrasonic measurements did not improve the accuracy of identifying amniotic fluid volumes.

Adolescent↗
PubMed1992

The presence of amniotic fluid leukoattractants accurately identifies histologic chorioamnionitis and predicts tocolytic efficacy in patients with idiopathic preterm labor.

OBJECTIVES: We tested these hypotheses: (1) that amniotic fluid from patients with idiopathic preterm labor and histologic chorioamnionitis contains leukoattractants and (2) that the detection of amniotic fluid leukoattractants is an accurate predictor of tocolytic efficacy. STUDY DESIGN: Amniotic fluid from 86 patients in idiopathic preterm labor was evaluated by microbiologic tests and leukotaxis assay. The tests' ability to predict histologic chorioamnionitis and response to tocolysis (51 tocolytic candidates) is established. Statistical analysis was performed with Fisher's exact test and unpaired Student t test. RESULTS: The detection of amniotic fluid leukoattractants was a better predictor of histologic chorioamnionitis (97%) than were amniotic fluid microbiologic tests (62%) (p less than 0.01). Also, in patients with detectable amniotic fluid leukoattractants tocolysis failed significantly more often than in patients without detectable leukoattractants (93% vs 7%, p less than 0.01). CONCLUSION: The presence of leukoattractants in amniotic fluid detected by the leukotaxis assay accurately identifies histologic chorioamnionitis and can additionally predict tocolytic efficacy in patients with idiopathic preterm labor.

Amniotic Fluid↗