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PubMed1995

Amniotic fluid interleukin-6: correlation with upper genital tract microbial colonization and gestational age in women delivered after spontaneous labor versus indicated delivery.

OBJECTIVE: Our purpose was to determine whether amniotic fluid interleukin-6 is increased and inversely proportional to gestational age in women with chorioamnion colonization and spontaneous labor versus women delivered for medical or obstetric indications. STUDY DESIGN: The chorioamnion and amniotic fluid were cultured at cesarean delivery for aerobic and anaerobic bacteria, fungi, mycoplasmas, Chlamydia trachomatis and Trichomonas vaginalis in 269 women with singleton gestations with intact membranes. The amniotic fluid interleukin-6 concentration was also determined. RESULTS: Amniotic fluid interleukin-6 levels were (1) higher in women with spontaneous labor versus those with indicated deliveries (15.8 +/- 5.0 vs 2.2 +/- 0.2 ng/ml, p = 0.01), (2) inversely proportional to gestational age in women with spontaneous labor (< 34 weeks: 47.4 +/- 18.0 ng/ml vs > or = 34 weeks: 8.7 +/- 4.1 ng/ml, p = 0.001) but not in women with indicated deliveries (1.5 +/- 0.4 vs 2.4 +/- 0.3 ng/ml), (3) higher in women with a positive versus a negative chorioamnion (15.1 +/- 4.8 vs 3.0 +/- 0.8 ng/ml, p < 0.001) or amniotic fluid (17.4 +/- 7.7 vs 3.8 +/- 0.9 ng/ml, p < 0.001) culture, and (4) higher in women with a negative amniotic fluid but positive chorioamnion culture compared with women in whom both cultures were negative (10.0 +/- 4.4 vs 3.0 +/- 0.9 ng/ml, p = 0.002). CONCLUSIONS: Amniotic fluid interleukin-6 levels are (1) higher and inversely proportional to gestational age in women with intact membranes and spontaneous labor versus indicated deliveries, (2) higher in women with one or more microorganisms in the chorioamnion or amniotic fluid, and (3) reflective of chorioamnion microbial colonization, even when the amniotic fluid culture is negative, and may be a useful clinical marker for infection-mediated preterm labor.

Amnion↗
PubMed1980

Pregnancy-specific beta 1-glycoprotein in amniotic fluid in high risk late pregnancy.

Pregnancy-specific beta 1-glycoprotein (PSBG) levels in amniotic fluid were studied by radioimmunoassay in 70 normal and 90 high risk pregnancies between 34 and 41 weeks. Most values from high risk singleton pregnancies were within the normal range. Intra-uterine growth retardation (n = 22) was associated with normal amniotic fluid PSBG levels. In twin pregnancies, the amniotic fluid PSBG values were usually above the normal mean, but within the normal range. The average ratio between amniotic fluid and maternal serum PSBG concentrations was 1:16. Amniotic fluid PSBG concentration did not correlate with the maternal serum PSBG level, and no relationship with fetal distress, infant birth weight or length, sex or placental weight was observed.

Amniotic Fluid↗
PubMed1994

Amniotic fluid digestive enzymes: diagnostic value in fetal gastrointestinal obstructions.

The diagnostic value of amniotic fluid gamma-glutamyl-transpeptidase (GGTP) and intestinal alkaline phosphatase (iALP) was evaluated in 55 patients who underwent amniocentesis for karyotyping because fetal gastric or small bowel dilatation had been detected by ultrasound. Gastrointestinal malformation was confirmed in 46 cases and there was no gastrointestinal anomaly in nine cases. Prenatal ultrasound was suggestive of gastroduodenal dilatation in 34 cases (group I) and small bowel dilatation in 21 cases (group II). In group I, amniotic fluid GGTP above the 99th percentile was 71 per cent sensitive and 100 per cent specific for a true anatomical defect of the digestive tract (mainly duodenal atresia). In group II, high levels of GGTP and/or iALP were 69 per cent sensitive and 83 per cent specific for a fetal digestive tract anomaly. In other words, when digestive tract dilatations were diagnosed by prenatal sonography, abnormal amniotic fluid enzyme activities were strongly suggestive of such an anomaly, the possibility of which was not precluded by normal amniotic fluid iALP and GGTP activities. But amniotic fluid digestive enzyme activities do not help in defining the prognosis.

Alkaline Phosphatase↗
PubMed1979

Acetylcholinesterase in human amniotic fluid: An index of fetal neural development?

Acetylcholinesterase (AChE) activity was detected in amniotic fluid either sampled by amniocentesis at 14--23 weeks gestation or collected at normal parturition. Activity ranged from 0.2 to 8.9 u/l in the earlier samples and from 0.2 to 4.2 u/l in the later samples. Since the fetal but not the maternal serum contained AChE activity, we suggest that the AChE in the amniotic fluid is derived from the fetus. AChE is released from both neural and nonneural tissues, and the release of the enzyme from both sources may diminish as the nervous system matures. The amount of AChE found in amniotic fluid may be affected by abnormalities of the nervous system. Amniotic fluid from two fetuses with spina bifida contained AChE activity: one, with a gestational age of 21 weeks, was in the upper levels of the normal range (4.5 u/l), whereas the other, at 36 weeks, contained 1.9 times more activity than the next highest sample. In a 20-week fetus with anencephaly, the AChE activity in the amniotic fluid was increased 2.8-fold over the activity of the highest "normal" sample.

Acetylcholinesterase↗
PubMed1992

Biochemical composition of amniotic fluid and extraembryonic coelomic fluid in the first trimester of pregnancy.

OBJECTIVE: To determine the biochemical composition of amniotic fluid and extraembryonic coelomic fluid between 8 and 12 weeks gestation. DESIGN: Prospective observational study. SUBJECTS: 40 women with a normal pregnancy between 7 and 12 weeks gestation having termination of pregnancy. INTERVENTIONS: Before termination the women had a transvaginal ultrasound guided amniocentesis. Pure samples of amniotic fluid and extraembryonic coelomic fluid were obtained from each woman and standard biochemical variables were measured in each fluid sample immediately after collection. RESULTS: Levels of sodium, potassium and bicarbonate were significantly higher in amniotic fluid whilst chloride, urea, bilirubin, protein, albumin, glucose, creatinine, calcium and phosphate were present in higher concentrations in extraembryonic coelomic fluid. All differences in concentration were significant (P less than 0.05; unpaired t-test). No relation was demonstrated between electrolyte concentrations in amniotic fluid or coelomic fluid and stage of gestation. CONCLUSIONS: Amniotic fluid and extraembryonic coelomic fluid have a widely differing biochemical composition. The biological significance of these differences remains unexplained.

Amnion↗
PubMed1982

Surfactants, L/S ratio, amniotic fluid optical density and fetal pulmonary maturity.

Optical density readings of amniotic fluids of 0.15 or greater at 650 nm have been noted to correlate with fetal pulmonary maturity. The amniotic fluid absorbance has been shown to be due not only to lecithin and sphingomyelin but also to other surfactants, including phosphatidyl glycerol and inositol. The addition of lecithin and sphingomyelin to previously centrifuged amniotic fluid (i.e., optical) density less than 0.001: L/S ratio, nondetectable) results in an increase in absorbance. At any simulated L/S ratio, the addition of phosphatidyl glycerol and/or phosphatidyl inositol results in a further increase in optical density. It is suggested that optical density readings represent more closely the surfactant composition of amniotic fluid than L/S ratios; therefore, it appears that optical density measurements are a better predictor of fetal pulmonary development than are L/S ratios.

Amniotic Fluid↗
PubMed1985

Origin of lysozyme in amniotic fluid.

We reported in a previous paper that the pattern of change in the lysozyme content of normal amniotic fluid during pregnancy resembles indices of fetal maturity such as L/S ratio, creatinine concentration and amylase activity. In order to clarify the origin of amniotic fluid lysozyme and to determine whether or not the amniotic fluid lysozyme concentration indicates the maturity of some specific fetal organ, we measured the lysozyme content of samples of materials considered to be possible sources of amniotic fluid lysozyme. These materials were amnion and--taken immediately after birth--saliva, urine and cord serum. Lysozyme content was 36.5 +/- 6.7 micrograms/ml in the saliva samples, 5.3 +/- 0.9 micrograms/ml in the urine samples, and 17.4 +/- 4.4 micrograms/ml in the cord serum samples. It is unclear, however, which material was the most important source of amniotic fluid lysozyme. The results suggested that homogenized amnion samples contained lysozyme, although the content was low, and that amnion tissue produced lysozyme in vivo. Lysozyme is an enzyme found in the lysozymes of cells. The results of this study provide evidence that amniotic fluid lysozyme originates from many sources.

Amniotic Fluid↗
PubMed1984

Amniotic fluid content of glucose, C-peptide and insulin in normal and diabetic pregnancies.

Glucose, C-peptide and insulin concentrations in amniotic fluid were measured in 63 women, 19 of whom had insulin-dependent diabetes. The amniotic fluid glucose concentration was higher in the diabetic (37.4 +/- 4.1) than in the normal women (19.4 +/- 5.1 mg/dl; P less than 0.01). The amniotic fluid insulin concentration was higher in diabetic than non diabetic women (15.9 +/- 3.1 versus 8.9 +/- 2.1 microU/ml; P less than 0.01). The C-peptide concentration was also higher in the amniotic fluid of diabetic women than normal (1.60 +/- 0.66 vs 0.26 +/- 0.15 nmol/l; P less than 0.001). The lecithin/sphingomyelin (L/S) ratio in the amniotic fluid was greater than 2 in 61 mothers; only two diabetic patients had an L/S ratio lower than 2. Five neonates of diabetic mothers were macrosomic and three of these were also hypoglycaemic. A negative correlation was observed in diabetic women between insulin and C-peptide concentrations in the amniotic fluid and Apgar score of the newborn infants both at 1 and 5 minutes; no correlation was found on the contrary with the amniotic glucose. In the prognostic evaluation of the fetus with a diabetic mother one must consider many parameters. Among these more consideration must be given to the levels of C-peptide and insulin in amniotic fluid than to glucose level.

Amniotic Fluid↗
PubMed2001

Amniotic fluid concentrations of matrix metalloproteinase 9 and tissue inhibitor of metalloproteinase 1 during pregnancy and labor.

OBJECTIVE: This study was undertaken to determine whether obstetric factors affect the concentrations of matrix metalloproteinase 9 and tissue inhibitor of metalloproteinase 1 in the amniotic fluid. STUDY DESIGN: We prospectively collected amniotic fluid samples from 109 women at various stages of pregnancy and labor and determined matrix metalloproteinase 9 and tissue inhibitor of metalloproteinase 1 concentrations by means of enzyme-linked immunosorbent sandwich assay systems. With multiple regression analysis we evaluated relationships between amniotic fluid matrix metalloproteinase 9 concentration and tissue inhibitor of metalloproteinase 1 concentration and the following factors: gestational age, presence of labor, cervical dilatation, membrane status, presence of clinical chorioamnionitis, and microbial colonization of the amniotic fluid. RESULTS: The detectable presence of amniotic fluid matrix metalloproteinase 9 was independently associated with intra-amniotic infection, labor, cervical dilatation, and spontaneous rupture of membranes. Chorioamnionitis and amniotic fluid matrix metalloproteinase 9 concentrations were correlated with tissue inhibitor of metalloproteinase 1 levels. CONCLUSIONS: Intra-amniotic infection, advanced labor, and rupture of membranes before the onset of labor were independently associated with the presence of matrix metalloproteinase 9 in the amniotic fluid. Both pathologic and physiologic processes appear to produce shifts in the balance between degradation and synthesis of the extracellular matrix.

Amniotic Fluid↗
PubMed2002

Amniotic fluid and fetal urinary responses to severe placental insufficiency in sheep.

OBJECTIVE: Our purpose was to test the hypothesis that severe placental insufficiency leads to reductions in fetal urine production and amniotic fluid volume in late-gestation fetal sheep. STUDY DESIGN: At 0.85 of gestation, chronically catheterized fetal sheep with ligated urachus were either embolized for 5 days by repeated injection of boluses of 15-microm microspheres into the common fetal umbilical artery until fetal arterial oxygen content was reduced by 50% (n = 6) or were infused with saline solution (n = 6). Amniotic fluid volume was measured daily before embolization by means of an indicator dilution technique and by drainage at autopsy. Fetal urine production, heart rate, and mean arterial blood pressure were measured continuously for 1 hour before embolization and 1 hour after embolization each day. Fetal arterial blood gases, oxygen content, electrolytes, and osmolality were also monitored. RESULTS: Five days of placental insufficiency, which reduced fetal arterial oxygen content by 50% and arrested fetal growth, resulted in a reduced amniotic fluid volume without a reduction in fetal urine production. Compared with that of controls, amniotic fluid volume was reduced over the 5-day period by 547 +/- 144 mL (-62%, P <.01). Amniotic fluid composition was also altered, with a significant increase in lactate and sodium concentrations and osmolality on days 4 to 5. On days 2 to 5, there was a progressive increase in amniotic fluid osmolality above that of controls, which paralleled the changes in amniotic fluid sodium concentration (P <.05). Fetuses became hypertensive on days 2 to 4 of embolization, although this response was attenuated by day 5. CONCLUSIONS: Chronic severe placental insufficiency caused a reduction in amniotic fluid volume not attributable to reduced fetal urine production. Changes in amniotic fluid composition induced by placental insufficiency suggest an excess intramembranous absorption of amniotic fluid water, in relation to solutes, into the fetal and maternal compartments, which may lead to the development of oligohydramnios.

Amniotic Fluid↗
PubMed1988

Amniotic fluid prostaglandin E2 in preterm labor.

These studies were designed to determine amniotic fluid concentrations of prostaglandin E2 (PGE) in women with preterm labor. Amniotic fluid was retrieved by transabdominal amniocentesis from 68 women with preterm labor (less than 37 weeks). Patients were divided into three groups according to the response to tocolysis and the presence or absence of an intraamniotic infection. Amniotic fluid concentrations of PGE2 were significantly greater in women with preterm labor and intraamniotic infection than in women without infection. Patients unresponsive to tocolysis without intraamniotic infection had a significantly greater concentration of PGE2 in amniotic fluid than those responsive to tocolysis.

Adult↗
PubMed1977

Determination of bile acid concentration in human amniotic fluid for prenatal diagnosis of intestinal obstruction.

Bile acid concentration was measured in amniotic fluid obtained for standard indications from 11 healthy pregnant women without polyhydramnios (28 to 42 weeks of gestation) and from 9 patients with polyhydramnios (28 to 38 weeks of gestation). Two of the latter women delivered infants with intestinal obstruction distal to the papilla of Vater, a condition that causes regurgitation of bile into the amniotic fluid. In the women without polyhydramios, the total bile acid concentration ranged from 1.4 to 2.4 micronmol/liter. In the seven patients with polyhydramnios not associated with fetal intestinal obstruction, the bile acid concentration in amniotic fluid was not significantly different (0.9 to 1.9 micronmol/liter). By contrast, the bile acid concentration in amniotic fluid specimens from the two patients with polyhydramnios who gave birth to children with intestinal obstruction was considerably elevated (30.3 to 83.1 micronmol/liter). These findings suggest that determination of bile acid concentration in amniotic fluid permits prenatal diagnosis of intestinal obstruction distal to the papilla of Vater.

Amniotic Fluid↗
PubMed2004

Elevated amniotic fluid leptin levels in early second trimester are associated with earlier delivery and lower birthweight in twin pregnancy.

OBJECTIVE: To explore the possibility of using early second trimester amniotic fluid leptin levels as a predictor of pregnancy outcome in twin pregnancy. STUDY DESIGN: Amniotic fluid leptin levels from 18 twin-pregnant women in early second trimester were analyzed for their correlation with gestational age at delivery and fetal birthweight. Leptin levels in 16 amniotic fluid samples collected from small for gestational age (SGA) twin pregnancies were compared with those in 20 amniotic fluid samples collected from non-SGA twin pregnancies. RESULTS: A significant correlation was observed between amniotic fluid leptin levels and gestational age at delivery (r = 0.71, p < 0.001) as well as fetal birthweight (r = 0.72, p < 0.001). There was also a significant correlation between gestational age at delivery and fetal birthweight (r = 0.92, p < 0.001). The average gestational age at delivery was 30.4 +/- 1.4 weeks in the SGA group, with a mean birthweight of 1552 +/- 200 g at delivery. For the non-SGA group, the values were 37.3 +/- 0.5 weeks and 2759 +/- 115 g ( p < 0.001), respectively. Amniotic fluid leptin levels were found to be significantly higher ( p < 0.001) for women in the SGA group (11.4 +/- 1.5 ng/mL) than for those in the non-SGA group (5.4 +/- 0.5 ng/mL). CONCLUSION: Higher amniotic fluid leptin levels in early second trimester were associated with both lower gestational age at delivery and lower birthweight. Our results suggest that amniotic fluid leptin levels in early second trimester may be a good marker for the prediction of perinatal complications in twin pregnancy.

Adult↗
PubMed1981

[DNA replication in cultured amniotic fluid cells].

A correlation was studied between replication and characteristics of the synthesis of DNA cells in amniotic fluid under in-vitro cultivation. Radioautography of DNA molecules was used to show that in the primary cultures of epithelium- and fibroblast-like cells of amniotic fluid, DNA replication proceeds at a lower rate as compared to that in diploid cells of the fetus skin. The DNA replication rate in the passaged cells of amniotic fluid does not differ from that seen in controls. The cultivated fibroblasts obtained from amniotic fluid of the fetus with anencephalia manifested a significant increase in the DNA replication rate. The size and number of the replication units do not differ as shown by the examination of all cell types. The data obtained suggest a correlation between the diminution of the DNA molecule replication rate and the decreased growth tendency under in-vitro cultivation of human amniotic fluid cells. The reasons are discussed which are likely to provoke the decreased rate of the replication fork movement in the primary cell cultures of human amniotic fluid.

Amniotic Fluid↗
PubMed1995

Concentration of fetal plasma and amniotic fluid interleukin-1 in pregnancies complicated by preterm prelabour amniorrhexis.

AIMS: To determine interleukin-1 beta (IL-1 beta) concentration in fetal and maternal plasma and amniotic fluid from pregnancies complicated by preterm prelabour amniorrhexis and to define the relation of this cytokine to intrauterine infection and the onset of labour. METHODS: Cross-sectional study of 23 pregnancies complicated by preterm prelabour amniorrhexis. Enzyme linked immunoassay was used to measure IL-1 beta concentration in fetal and maternal plasma and amniotic fluid. In each case, fetal blood and amniotic fluid were cultured for micro-organisms. RESULTS: In pregnancies with positive fetal blood and/or amniotic fluid cultures, plasma and amniotic fluid concentrations of IL-1 beta were higher and the interval between amniorrhexis and onset of labour was shorter than in the non-infected group. There were no significant associations between fetal plasma IL-1 beta and maternal plasma or amniotic fluid IL-1 beta concentrations, fetal leucocyte count or the interval between amniorrhexis and the onset of labour. CONCLUSIONS: These findings suggest that although intrauterine infection is associated with increased IL-1 beta concentrations in fetal plasma and amniotic fluid, there is no significant association between the concentration of IL-1 beta and the interval between amniorrhexis and the onset of labour.

Amniotic Fluid↗
PubMed1994

Clinical significance of amniotic fluid bacteriological cultures taken at caesarean section.

To predict postoperative infection after Caesarean section by bacteriological examination of amniotic fluid samples a prospective analysis was performed on amniotic fluid bacteriological results and infectious morbidity in 266 consecutive Caesarean sections. Culture and sensitivity results were analysed in relation to postoperative febrile complications and their antibiotic treatment. One hundred and twelve samples grew bacteria. There was a significantly higher frequency of postoperative pyrexial complications among those patients with a positive amniotic fluid culture (22.3% vs 14.2%). Eighty per cent of amniotic fluid samples with significant bacterial growth provided useful information when antibiotic treatment had been required. Routine amniotic fluid sampling for bacteriology at Caesarean section is of clinical value in the prediction and management of postoperative pyrexial complications.

Amniotic Fluid↗
PubMed1979

Serum and amniotic fluid heat labile alkaline phosphatase and aminotransferases in association with meconium stained liquor. On their origin, distribution and clinical use.

A method for detecting meconium in the amniotic fluid is described. Samples of maternal serum, cord serum and amniotic fluid were tested for alkaline phosphatase and transaminases activity in 32 healthy, term gravidas during labor in whom meconium stained amniotic fluid was found. The values obtained were compared to those of a control group consisting of 32 normal term pregnancies in whom the amniotic fluid was clear. Mean alkaline phosphatase activity was significantly higher in the study group in all three compartments - maternal, fetal and amniotic fluid. A significant and positive correlation between levels of alkaline phosphatase in the amniotic fluid and in maternal serum was found in the study group. Alkaline phosphatase value of 550 IU/L or more in maternal serum was diagnostic and levels between 350--500 IU/L were highly suggestive for the presence of menconium in the amniotic fluid. Mean levels of transaminases (SGOT and SGPT) were similar in the two groups and all were within normal range. The origin of alkaline phosphatase and the mode of transfer of the three enzymes are also discussed. It is suggested that this method can also be used during the third trimester of pregnancy.

Adult↗