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PubMed1991

Use of the drop volume of amniotic fluid in predicting fetal lung maturity. Clinical experience.

Respiratory distress syndrome (RDS), resulting from inadequate amounts of alveolar surfactant, is a leading cause of neonatal mortality. This study analyzed the drop volume for predicting the risk of neonatal RDS by evaluating the surface tension of amniotic fluid. The drop-volume method quantifies the surface tension of amniotic fluid using the fact that the volume of a falling drop of liquid is proportional to the quantity of surface-active substances (surfactant) in the solution. Distilled water is used as a reference solution. The test is simple to perform and requires only two minutes and 2 mL of amniotic fluid. Amniotic fluid was obtained by amniocentesis from 120 pregnancies, ranging from 24 to 42 weeks of gestation, within four days of delivery. Specimens contaminated with meconium or hemolyzed blood or from patients with clinical chorioamnionitis were not used. The lecithin:sphingomyelin ratio and phosphatidylglycerol tests were also determined for 54 of the study cases. A mature drop-volume test result was associated with a healthy infant with no RDS 95% of the time (negative predictive value). Fifty-two percent of the healthy infants in the study were predicted by an arbitrary unit of time (S) value of less than or equal to 85.0 (specificity). Thirteen of the 16 infants who developed RDS (81%) were predicted by an S value of greater than or equal to 85.1 (sensitivity). Of those infants with an S value of greater than or equal to 85.1, 21% developed RDS (positive predictive value).

Adult↗
PubMed1991

Slide Flask direct amniotic fluid cultures.

Slide Flask direct amniotic fluid culture enabling: to decrease the risk of abnormalities caused by the technique itself, to facilitate laboratory work, to shorten culture time (8 to 13 days).

Amniotic Fluid↗
PubMed1988

[Amniotic fluid embolism].

A case of amniotic fluid embolism during the second stage of labor is reported. Mother and newborn survived. Etiology, symptoms and therapy are discussed.

Adult↗
PubMed1988

Amniotic fluid acetylcholinesterase: implications of an inconclusive result.

The implications of an "inconclusive" acetylcholinesterase test (a faint but true band) in amniotic fluid were studied over a 2 1/2-year period in our laboratory. One thousand one hundred fifty-four amniotic fluid samples were tested for acetylcholinesterase and alpha-fetoprotein; the rate of an inconclusive acetylcholinesterase result was 3.3% (38 of 1154). Fourteen such results were found in patients with a high amniotic fluid alpha-fetoprotein level (23.3%), and 24 results were associated with normal amniotic fluid alpha-fetoprotein levels (2.19%). The rates of congenital fetal malformation associated with an inconclusive acetylcholinesterase result in the two groups were 57.14% and 37.5%, respectively. In amniotic fluid samples obtained before 15 weeks' gestation, there was a higher rate of inconclusive acetylcholinesterase tests (9.29%), but a lower percentage of malformed fetuses were found compared with later in pregnancy (2.46% and 56%, respectively). Thus we suggest the terminology "equivocal" for early specimens and "suspicious" for later specimens. If obtained in early second trimester and the ultrasound scan is normal, such findings implicate the need for a careful search for fetal malformations. A positive pregnancy outcome may be expected in most cases.

Acetylcholinesterase↗
PubMed2003

The effect of nuchal cord on amniotic fluid and cord blood erythropoietin at delivery.

OBJECTIVE: We investigated the effect of a nuchal cord on fetal hypoxia by using amniotic fluid and cord blood erythropoietin as markers of chronic and acute hypoxia, respectively. METHODS: A total of 167 full-term pregnancies without maternal complications or fetal prelabor complications except fetal growth restriction of unknown cause were studied prospectively. Of these, 47 had a nuchal cord at delivery, and 62 had one or more complications during labor and delivery (nonreassuring fetal heart rate pattern, birth weight less than 2500 g, Apgar score at 1 minute less than 7, presence of meconium-stained amniotic fluid, oligohydramnios), and 26 had both nuchal cord and at least one of the intrapartum complications. RESULTS: Erythropoietin levels (mean +/- standard error of the mean) were not significantly different between the nuchal cord group (n = 47) and the no nuchal cord group (n = 120) in either amniotic fluid (19.3 +/- 4.1 mU/mL versus 13.7 +/- 1.1 mU/mL) or cord blood (57.9 +/- 10.3 mU/mL versus 52.1 +/- 4.9 mU/mL). Similarly, in the 62 fetuses with intrapartum complications, there were no significant differences in amniotic fluid (14.3 +/- 2.0 mU/mL versus 18.8 +/- 2.9 mU/mL) or cord blood erythropoietin (66.9 +/- 16.8 mU/mL versus 72.6 +/- 12.6 mU/mL) levels between those with (n = 26) or without a nuchal cord (n = 36). Among the 107 uncomplicated cases, however, amniotic fluid erythropoietin was significantly elevated in the nuchal cord group (25.5 +/- 8.7 mU/mL, n = 21) compared with that in the no nuchal cord group (11.5 +/- 0.9 mU/mL, n = 84) (P <.05), whereas there was no significant between-group difference in cord blood erythropoietin levels between nuchal cord and no nuchal cord groups (46.8 +/- 10.0 mU/mL versus 43.3 +/- 4.1 mU/mL). Tightness of the nuchal cord did not affect amniotic fluid or cord blood erythropoietin concentrations. CONCLUSION: Although nuchal cord may not significantly increase the risk of acute or labor-associated fetal hypoxia, it appears to be an independent risk factor of mild, chronic, prelabor fetal hypoxia.

Adult↗
PubMed1996

[Evaluation of fetal condition in pregnancy complicated by hypertension--biochemical assessment of amniotic fluid. III. Acid-base balance].

Sixty two samples of amniotic fluid, collected by ultrasound guided amniocentesis, were submitted to biochemical investigation including 31 samples from women with pregnancy complicated by hypertension (studied group) and 31 samples deriving from healthy pregnant women (control group with). The following parameters of acid-base balance were measured in amniotic fluids of both groups: pH, pCO2, base deficiency, standard HCO3 and total CO2. Corning device type 168 was used. Distinct metabolic-respiratory acidosis was present in amniotic fluids of studied group showing the decrease of a pH, pO2, standard HCO3 values and an increase of CO2 values and base deficiency. Authors believe in pregnancy complicated by hypertension biochemical environment of intrauterine fetal development with regard to acid-base balance is highly unfavourable.

Acid-Base Equilibrium↗
PubMedDate not supplied

Chromosomal mosaicism in amniotic fluid cell cultures.

Six cases of chromosomal mosaicism detected in amniotic fluid cultures are described. In five of these there was no evidence of fetal mosaicism. In one case fetal mosaicism was demonstrated but only by the study of fibroblasts since blood cultures showed only normal cells. The implications of amniotic fluid mosaicism are discussed and it is concluded that this usually does not indicate fetal mosaicism. The value of repeated amniocentesis in the diagnosis of fetal mosaicism was demonstrated by findings in three of the cases. It is recommended that amniotic fluid cultures be harvested in situ for chromosome studies and that cytogenetic results be expressed as number of colonies karyotyped rather than as number of cells analyzed.

Adult↗
PubMed1997

The effect of sample storage on polymerase chain reaction-based detection of Toxoplasma gondii in amniotic fluids.

The effects of sample storage, target preparation and annealing temperature on a nested polymerase chain reaction (PCR) test for Toxoplasma gondii DNA were investigated with experimentally seeded amniotic fluids to simulate congenital infection. Aliquots of 17 amniotic fluid samples remaining after investigation for conditions other than toxoplasmosis and seeded to contain small numbers of T. gondii tachyzoites, were tested after storage for up to 2 weeks. There was no deterioration in test sensitivity on samples stored for 1-2 weeks at room temperature; thus, samples sent by post to reference laboratories are acceptable for examination. There was no significant difference in the results from two target preparation methods or two different annealing temperatures. One-to-ten parasites were detectable in 13 of 17 test samples. The significant feature in the remaining four samples was the use of washed stored parasites to seed the amniotic fluids rather than any feature of the amniotic fluids used or the test. False positive results were found in up to 15% of unseeded amniotic fluid samples, which contrasts with only 1.9% for the same PCR test in other routine or negative control samples tested as part of the laboratory's reference diagnostic work. The difference illustrates the increased risk of cross-contamination in PCR when the majority of specimens tested are positive. The results suggest that PCR techniques are likely to be sensitive and effective tools for the routine diagnosis of congenital toxoplasma infection.

Amniotic Fluid↗
PubMed1979

Polyamine conjugates and total polyamine concentrations in human amniotic fluid.

A study of the quantitative profile of polyamines in amniotic fluid from the 13th through the 40th week of gestation was undertaken. These experimental observations indicate the absence of free putrescine, spermidine and spermine throughout gestation. Quantities of acid-liberated putrescine, spermidine and spermine are highest in late first and late third trimester. Putrescine is associated with peptide or peptides of molecular weight 1000 to 10 000 throughout gestation. Spermidine is found in amniotic fluid covalently conjugated to peptide or peptides with molecular weight 10 000 to 30 000. Spermine appears to exist in amniotic fluid, both in the higher molecular weight fraction (1000 to 10 000) and as acetylated derivatives. The existance of polyamine conjugates is compatible with an in vivo function in the regulation of embryonic growth and development. Abnormalities in polymines conjugated to peptides or their concentration may be useful in the diagnosis of fetal maldevelopment.

Amniotic Fluid↗
PubMed1985

Inability of second trimester human amniotic fluid cell cultures to aromatize C19-steroids.

Amniotic fluid (AF) and fibroblast (F) cell types, derived from human amniotic fluid by amniocentesis in the second trimester, were cultured using media of varying composition and their ability to transform C19-steroids to oestrogens was investigated by fluorimetry, radioimmunoassay, tritium release and measurement of cytochrome P450. Although the cells were shown to be metabolically active by the presence of mitotic figures, the incorporation of tritiated leucine into protein and the production of the beta-subunit of hCG, no evidence of aromatization was obtained despite the inclusion in the medium of a number of steroids known to be transformed to oestrogens in several in vivo and in vitro preparations. The addition of reported stimulants of aromatase activity, viz. hCG, FSH, diethylstilbestrol, prostaglandins E2 and F2 alpha and dibutyryl cyclic AMP, was without effect.

Amniotic Fluid↗
PubMed1991

Variable decelerations in reactive nonstress tests with decreased amniotic fluid index predict fetal compromise.

A total of 3158 patients at greater than or equal to 34 weeks' gestation undergoing nonstress tests and amniotic fluid index determinations were divided into six groups according to the amniotic fluid index and the nature of the decelerations. Fetuses with antepartum decelerations had statistically significantly increased incidences of intrapartum decelerations and operative deliveries because of intrapartum "distress," regardless of the amniotic fluid index. They also had significantly increased rates of neonatal acidosis and low Apgar scores when there were "severe" decelerations and an amniotic fluid index less than 5 in the antepartum period. Thus spontaneous decelerations in reactive nonstress tests with an amniotic fluid index less than 5 may predict fetal compromise.

Adolescent↗
PubMed2003

Meconium-stained amniotic fluid is associated with puerperal infections.

OBJECTIVE: The purpose of this study was to determine whether meconium-stained amniotic fluid is associated with puerperal infection and whether the quality of the meconium is further associated with this risk. STUDY DESIGN: We designed a retrospective cohort study of all deliveries beyond 37 weeks gestational age from 1992 to 2002 at a single community hospital. Data were collected on rates of chorioamnionitis, endomyometritis, quality of amniotic fluid, and length of labor and analyzed with bivariate and multivariate analyses. RESULTS: We found that, among the 43,200 women who were delivered at term, 18.9% of the women had meconium staining (8.8% thin, 5.5% moderate, 4.6% thick). Compared with deliveries with clear amniotic fluid, those with meconium-stained amniotic fluid had higher rates of chorioamnionitis (2.3% vs 4.1%, P<.001) and endomyometritis (1.0% vs 1.7%, P<.001). Further, the severity of meconium staining was associated with increased rates of infection. CONCLUSION: We found that the presence and severity of meconium-stained amniotic fluid is associated with puerperal infection even when being controlled for confounders.

Adult↗
PubMed1976

New neonatal problems of blood coagulation and fibrinolysis. II. Thromboplastic effect of amniotic fluid and its relation to lung maturity.

Pulmonary hyaline membrane disease in newborn infants is considered an abnormality in the alveolar lining layer. Quantitative analysis of this surfactant is necessary for the intrauterine diagnosis of lung maturity of the fetus. The presence of surfactant in amniotic fluid has been demonstrated by the shaking method [1]. But it is also well known that amniotic fluid has a thromboplastic effect [3,6]. In order to compare the correlation between the shaking method and the thromboplastic effect of the amniotic fluid, recalcification time and partial thromboplastin time were measured with and without amniotic fluid using an aggregation-meter. In each of 15 cases, a shortening of these times was recorded after the addition of amniotic fluid after the 30th week of pregnancy. In all cases the addition of amniotic fluid resulting in shortening these times. Surfactant seems to have enhancing effect on the coagulation. These results demonstrate the presence of surfactant in amniotic fluid in agreement with the results of the shaking method. Although these methods are of limited utility as quantitative assays for surfactant, they are of sufficient accuracy and of great value for clinical diagnosis.

Amniotic Fluid↗
PubMed1985

[The ionic heterogeneity of human prolactin (PRL) from amniotic fluid].

The ionic heterogeneity of prolactin (PRL) secreted in the human amniotic fluid was investigated using new precise chemical techniques. From five liters of amniotic fluid, the PRL fractions were purified with 70% ammonium sulfate precipitation, ethanol fractionation, desalting by gel filtration on Sephadex G-25, and ion-exchange chromatography using Mono Q on Fast Protein Liquid Chromatography (FPLC). The last FPLC was repeated until homogeneous preparations were obtained. Hormonal activity of each fraction was determined with a NIADDK radioimmunoassay (RIA) kit for human PRL. The PRL activity of the finally-purified component was also assayed by radioreceptor analysis (RRA) using rat liver cell membranes as the receptor. From the amniotic fluid, seven components of the PRL were eluted at NaCl concentrations from 0.065M to 0.13M in 0.02M Tris-HCl, pH 8.0. The RRA/RIA values of these seven components were different from each other (from 0.32 to 0.97). The lower the NaCl concentrations, the higher the RRA/RIA values were. The molecular weight of each component determined by gel filtration on TSK-SW 3000 with HPLC, was similar (MW 23,000) corresponding to "small-PRL".

Amniotic Fluid↗
PubMed1993

The glycosylation as source of the variability in prolactin patterns of individual human amniotic fluids.

Whilst it is known that prolactin has size heterogeneity in human amniotic fluid, no studies exist concerning the heterogeneity between individual amniotic fluids and the molecular properties of the prolactin forms which are connected with such a variability. To elecit this, prolactin forms from amniotic fluid taken from 6 full-term deliveries and processed separately, were fractionated by ConA-Sepharose, and characterized by SDS-PAGE, immunoblotting, and glycan detection of blotted prolactins. Recording the absorbance at 280 nm, dimers in the wash of the ConA-Sepharose column and in the elution with methyl-alpha-D-glucoside were evident in 3 fluids. The proteins of the chromatographically more rapid and retarded migrating fractions, generating the first dimer, of unbound material consisted on average of 74-83% and 85-90% of prolactin forms. The eluted fractions (bound material) contained 10-27% of the prolactin amount of the unbound fractions. The electropherograms using 12.5% gels indicated identical patterns of bands in repeated experiments per fluid but variability between the charges. Thus, the apparent molecular masses (kDa) and the proportions to the total prolactin (%) were 14.5-16 (8-12%), 20-23 (3-5%), 24 (4-8%), 25 (6-10%), 27 (19-25%), 28-29 (6-9%), 39-43 (0.5-1.0%), 60-64 (12-19%), 87-90 (8-11%) and 117-140 (2-7%) in nonreducing electrophoretical conditions.(ABSTRACT TRUNCATED AT 250 WORDS)

Amniotic Fluid↗
PubMed1977

False positive amniotic fluid alpha fetoprotein levels resulting from contamination with fetal blood: results of an experiment.

The finding of an elevated level of alpha fetoprotein (AFP) in amniotic fluid is of value in the prenatal diagnosis of open neural tube defects. The present study was done to determine the amount of fetal blood required in amniotic fluid to produce a significant and misleading increase in AFP. Fetal blood was obtained at hysterotomy, and measured volumes were added to amniotic fluid samples. Bethe-Kleihauer tests, red cell counts, and AFP determinations were done. On the average, at 16 weeks' gestation, contamination of 5 ml. of amniotic fluid with 22 mul of fetal blood will results in an increase in AFP of 1.6 mg. per deciliter. Fetal cells in a much lower concentration can readily be detected by the Bethe-Kleihauer technique. A Bethe-Kleihauer test and red cell count should be done on all blood-stained amniotic fluid samples to determine the amount of fetal blood present. The contribution of the fetal blood AFP can then be estimated and must be considered in the interpretation of the total amniotic fluid AFP result.

Amniocentesis↗
PubMed1999

Management of meconium-stained amniotic fluid.

Meconium staining of the amniotic fluid will always be a common problem. Although several therapies may be of benefit in preventing MAS, most require further rigorous scientific investigation to assess their potential in preventing this disorder.

Amniotic Fluid↗
PubMed2001

Amniocentesis and biochemical evaluation of amniotic fluid in ewes at 70, 100 and 145 days of pregnancy.

The objectives of this study were to determine the technical viability of amniocentesis in sheep and to observe biochemical changes in the amniotic fluid components. Amniotic fluid samples were collected by puncture in the greatest curvature of the uterine horn at days 70, 100, and 145 of pregnancy. The surgical procedure for collection of amniotic fluid samples was safe and efficient. For three stages of pregnancy, the following results were obtained: pH values 8.36, 7.34 and 7.37; glucose concentrations, 16.06. 8.58, and 3.79g/dl; urea values, 42.68, 33.53, and 25.49mg/dl; creatinine, 0.85, 5.04, and 11.25g/dl; Gama-GT enzyme, 12.58, 14.20, and 12.30UI/l; sodium concentrations, 146.60, 129.42, and 103.8mmol/l: potassium concentrations, 9.79, 6.15, and 8.65mmol/l; chloride, 96.59, 85.28, and 65.35mmol/l; total protein, 0.14, 0.23, and 0.24g/dl, respectively.

Journal Article↗