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PubMed1995

Fibroblast growth factor 2 is elevated in term maternal and cord serum and amniotic fluid in pregnancies complicated by diabetes: relationship to fetal and placental size.

We previously detected immunoreactive fibroblast growth factor 2 (FGF-2) in maternal and fetal circulations. Here, we determined whether the amounts of FGF-2 in term maternal serum, cord serum, and amniotic fluid were altered in pregnancies complicated by diabetes, as these are associated with a higher incidence of fetal macrosomia and increased placental size. Serum and amniotic fluid were collected at term from normal pregnancies (n = 17), women with pregestational insulin-dependent diabetes (n = 37; group A), patients with previously undiagnosed diabetes (n = 32; group B), women with gestational diabetes (n = 85; group C), and women with a milder form of glucose intolerance in pregnancy (n = 16; group D). Mean newborn weight and length, and placental weight did not significantly differ between normal and diabetic pregnancies, although the placental weight tended to be higher in the latter. However, 24% of the infants in group A and 19% in group B had a birth weight in excess of the 90th percentile. Levels of insulin in cord serum and amniotic fluid in groups A and B were significantly elevated compared to control values. FGF-2 was extracted from serum and amniotic fluid by heparin-Sepharose affinity chromatography and subjected to Western blot analysis or quantified by specific RIA. Western blot analysis of maternal serum, cord serum, and amniotic fluid from diabetic pregnant patients revealed, in each case, a single immunoreactive FGF-2 species of 18 kilodaltons; this was absent from nonpregnancy serum. In normal term pregnancies, the mean immunoreactive FGF-2 level in cord serum was 119 +/- 28 pmol/L, and that in amniotic fluid was 91 +/- 35 pmol/L. Values were significantly increased (2- to 4-fold) in both cord serum and amniotic fluid for all groups of diabetic patients. The mean FGF-2 level in normal term maternal serum was 104 +/- 24 pmol/L, and this was significantly increased in diabetic patients in groups B and C. The amount of FGF-2 in maternal serum showed a positive correlation with newborn weight and length, and placental weight (P < 0.05 or better, by Spearman rank correlation), and significant positive correlations also existed between the amounts of FGF-2 in cord serum and newborn or placental weight. The results suggest that the FGF-2 levels in maternal serum, cord serum, and amniotic fluid at term are elevated in pregnancies complicated by diabetes, and that the amounts of FGF-2 in maternal serum and cord serum are correlated with fetal and placental size.

Adult↗
PubMed1978

[The evaluation of cortisol in amniotic fluid and in maternal blood as parameter for foetal lung maturity (author's transl)].

The lecithin/sphingomyelin-ratio (L/S-ratio) in amniotic fluid has become established in recent years as a valuable laboratory parameter for determining foetal lung maturity and has thus helped to avoid the neonatal respiratory distress syndrome. Since glucocorticosteroids are a decisive factor in stimulating foetal lung development, we were prompted to investigate whether the determination of cortisol in amniotic fluid or maternal blood could also serve as an indicator of foetal lung maturity. The cortisol concentration was measured by radioimmunoassay in amniotic fluid (n = 91) and in maternal venous plasma (n = 70) from normal and complicated pregnancies and was compared with the L/S-ratio. A significant correlation between gestational age and cortisol in amniotic fluid (r = 0.711) and in maternal venous plasma (r = 0.625) was observed. There was also a significant correlation between the L/S-ratio and amniotic fluid cortisol (r = 0.701). However, compared to the L/S-ratio, measurements of cortisol yielded 10% false positive and 11% false negative results. A significant correlation between the L/S-ratio and the maternal plasma cortisol could also be demonstrated (r = 0.631). Here the comparison with the L/S-ratio gave even poorer results: 16% false positive and 6% false negative. The high percentage of false results, especially false positive results yielded by cortisol estimations in both fluids leads to the conclusion that the L/S-ratio remains the superior diagnostic parameter in determining foetal lung maturity.

Amniocentesis↗
PubMed1993

Soluble interleukin-2 receptor and interleukin-2 in human amniotic fluid of normal and abnormal pregnancies.

In the present study, 63 specimens of human amniotic fluid were tested for the presence of free soluble interleukin-2 receptor (IL-2R). Thirty-two of these were also tested for the presence of IL-2. Significant reduction in free soluble IL-2R (IU/ml) or free IL-2R (IU/mg albumin) levels were found in the amniotic fluid obtained from pregnant women with Down's syndrome fetuses as compared with normal pregnancies. In addition normal amniotic fluid was found to contain low levels of IL-2, while no IL-2 was found in amniotic fluid from pregnant women with Down's syndrome fetuses when tested by two different tests.

Amniotic Fluid↗
PubMed1988

Amniotic fluid alpha-fetoprotein concentrations in twin gestations: dependence on placental membrane anatomy.

Placental membrane anatomy was evaluated after delivery in 65 twin pregnancies undergoing genetic amniocentesis with amniotic fluid alpha-fetoprotein and acetylcholinesterase determinations when indicated. Each twin member in the 57 uncomplicated twin pregnancies was found to have an amniotic fluid alpha-fetoprotein concentration similar to that of singleton pregnancies of an equivalent gestational age. Eight twin pregnancies were found to be discordant for fetal anomalies associated with an elevated amniotic fluid alpha-fetoprotein and acetylcholinesterase level. The amniotic fluid alpha-fetoprotein concentration in the unaffected fetus in these eight cases was found to be dependent on placental membrane structure. Of the five discordant twin pregnancies with diamnionic-dichorionic placentas, all unaffected twins demonstrated an amniotic fluid alpha-fetoprotein concentration within the normal range for gestational age with a normal acetylcholinesterase level. In three twin pairs with diamnionic-monochorionic placentas, the unaffected twin member had significantly elevated amniotic fluid alpha-fetoprotein and acetylcholinesterase levels, which suggested diffusion of alpha-fetoprotein and acetylcholinesterase through the amnion-amnion interface.

Acetylcholinesterase↗
PubMed1979

Uncultured cells in amniotic fluid from normal and abnormal foetuses.

Direct smears of uncultured amniotic fluid cells were analysed in 41 pregnancies between 17 and 22 weeks of gestation. These included 27 normal pregnancies where a healthy child was born at term, six anencephalic and five spina bifida pregnancies, and three other abnormal pregnancies. In normal amniotic fluid, epithelioid cells predominated but small numbers of histiocyte-like cells, typical macrophages and elongated cells were also present. The proportion of macrophages and elongated cells was significantly increased in all anencephalic cases. Two of the spina bifida cases also showed abnormal cellular proportions. Haemosiderin and lipid material was demonstrated in some of the cellular proportions. Haemosiderin and lipid material was demonstrated in some of the macrophages. Tissue smears and histological preparations suggest that these cells may originate from both the amnion and the fibrovascular membrane covering the neural lesion. This direct method of observation of amniotic fluid cells, not involving culture techniques, could provide a rapid means of prenatal diagnosis of anencephaly, and may help in the diagnosis of spina bifida.

Amniotic Fluid↗
PubMed2005

Maternal dietary fat alters amniotic fluid and fetal intestinal membrane essential n-6 and n-3 fatty acids in the rat.

We investigated whether maternal fat intake alters amniotic fluid and fetal intestine phospholipid n-6 and n-3 fatty acids. Female rats were fed a 20% by weight diet from fat with 20% linoleic acid (LA; 18:2n-6) and 8% alpha-linolenic acid (ALA; 18:3n-3) (control diet, n = 8) or 72% LA and 0.2% ALA (n-3 deficient diet, n = 7) from 2 wk before and then throughout gestation. Amniotic fluid and fetal intestine phospholipid fatty acids were analyzed at day 19 gestation using HPLC and gas-liquid chromotography. Amniotic fluid had significantly lower docosahexaenoic acid (DHA; 22:6n-3) and higher docosapentaenoic acid (DPA; 22:5n-6) levels in the n-3-deficient group than in the control group (DHA: 1.29 +/- 0.10 and 6.29 +/- 0.33 g/100 g fatty acid; DPA: 4.01 +/- 0.35 and 0.73 +/- 0.15 g/100 g fatty acid, respectively); these differences in DHA and DPA were present in amniotic fluid cholesterol esters and phosphatidylcholine (PC). Fetal intestines in the n-3-deficient group had significantly higher LA, arachidonic acid (20:4n-6), and DPA levels; lower eicosapentaenoic acid (EPA; 20:5n-3) and DHA levels in PC; and significantly higher DPA and lower EPA and DHA levels in phosphatidylethanolamine (PE) than in the control group; the n-6-to-n-3 fatty acid ratio was 4.9 +/- 0.2 and 32.2 +/- 2.1 in PC and 2.4 +/- 0.03 and 17.1 +/- 0.21 in PE in n-3-deficient and control group intestines, respectively. We demonstrate that maternal dietary fat influences amniotic fluid and fetal intestinal membrane structural lipid essential fatty acids. Maternal dietary fat can influence tissue composition by manipulation of amniotic fluid that is swallowed by the fetus or by transport across the placenta.

Amniotic Fluid↗
PubMed1983

Amniotic fluid embolism after transabdominal amniocentesis.

Amniotic fluid embolism following transabdominal amniocentesis is a very rare and mostly fatal event. A case history is presented with the characteristic clinical findings in addition to disseminated intravascular coagulation immediately following an amniocentesis to assess fetal lung maturity.

Adult↗
PubMed2000

Amniotic fluid embolism: the UK register.

Amniotic fluid embolism is rare but is a significant cause of maternal death. No clear risk factors seem to be identifiable from previous cases. A register has been established in the UK to look at possible therapies.

Adult↗
PubMed1995

Assessment of fetal activity and amniotic fluid volume in the prediction of intrauterine infection in preterm prelabor amniorrhexis.

OBJECTIVE: Our purpose was to assess fetal activity, fetal heart rate patterns, and amniotic fluid volume in the prediction of intrauterine infection in pregnancies complicated by preterm prelabor amniorrhexis. STUDY DESIGN: A prospective study was performed on 89 patients with preterm prelabor amniorrhexis undergoing fetal blood and amniotic fluid sampling for microbiologic investigations. Within 2 hours before cordocentesis and amniocentesis, computerized fetal heart rate monitoring was carried out and ultrasonographic examination was performed for assessment of biophysical profile and amniotic fluid volume. RESULTS: In the pregnancies with microbiologic evidence of intrauterine infection compared with those with no infection, there was a tendency for a lower biophysical profile score and amniotic fluid index and an increased fetal heart rate. However, in the majority of pregnancies with positive amniotic fluid or fetal blood cultures the results of the various tests were normal. CONCLUSION: In pregnancies complicated by preterm prelabor amniorrhexis assessment of fetal activity and amniotic fluid volume do not provide useful prediction of intrauterine infection.

Amniotic Fluid↗
PubMed1994

Fetal vascular pressure responses to nonlabor uterine contractions: dependence on amniotic fluid volume in the ovine fetus.

OBJECTIVE: This investigation tested the hypothesis that elevations in fetal vascular pressures during nonlabor uterine contractions would be eliminated during polyhydramnios and augmented during oligohydramnios. STUDY DESIGN: Twenty-two chronically catheterized fetal sheep were divided into three groups: (1) control with normal amniotic fluid volume, (2) polyhydramnios produced by amnioinfusion, and (3) oligohydramnios produced by fluid drainage. Fetal arterial pressure, venous pressure, and amniotic fluid pressure were continuously recorded with on-line computer techniques. Amniotic fluid pressure was continuously subtracted from fetal arterial pressure and fetal venous pressure to correct to the fetal zero pressure reference. One minute averages were collected for 30 minutes centered around the nonlabor uterine contraction. RESULTS: Amniotic fluid pressure increased significantly during nonlabor uterine contractions in the control group. During polyhydramnios the amplitude and duration of the amniotic fluid pressure elevation were similar to those of controls (not significant). During oligohydramnios the duration of the uterine contractions was similar to that of both controls and polyhydramnios groups; however, the amplitude was less (p < 0.001). Fetal vascular pressures increased significantly during nonlabor uterine contractions in the control group (p < 0.001) but did not change significantly during nonlabor contractions in the polyhydramnios group. The contraction-induced elevations in fetal arterial pressure and fetal venous pressure in the oligohydramnios group were significantly greater than those in the control group (p < 0.001). CONCLUSION: This study shows that the fetal vascular pressure responses to nonlabor uterine contractions were modified significantly by increases or decreases in amniotic fluid volume. The fact that the fetal arterial pressure and fetal venous pressure responses were augmented during oligohydramnios and eliminated during polyhydramnios suggests that direct compression or a conformational change of the fetus may be the cause of the vascular pressure changes during nonlabor contractions.

Amniotic Fluid↗
PubMed1993

Intraobserver and interobserver variability of the amniotic fluid index.

OBJECTIVE: We assessed intraobserver and interobserver variations in the performance of the amniotic fluid index. STUDY DESIGN: A total of 34 women in the third trimester with intact membranes were examined twice by each of three examiners. The amniotic fluid index was measured once by each of the three examiners in order, then repeated by each examiner in the same order. Numeric displays on the video terminal screen were covered so that the examiners were blinded to actual measurement values. Results were recorded on hard copy for later data analysis. A senior investigator supervised all examinations to monitor consistency of technique. RESULTS: Overall, the coefficient of variation for amniotic fluid index measurements varied from 10.8% within examiners to 15.4% between examiners. Both between and within variation of absolute differences increased as the amniotic fluid index value increased, while the percent difference decreased. Simply repeating the test by the same examiner will decrease the coefficient of variation significantly. CONCLUSION: Although intraobserver and interobserver variability cannot be eliminated, its impact can be minimized by use of the same examiner for serial studies.

Amniotic Fluid↗
PubMed2005

Increasing amniotic fluid magnesium concentrations with stable maternal serum levels: a prospective clinical trial.

OBJECTIVE: To compare the effect of prolonged maternal intravenous MgSO4 administration on amniotic fluid and serum concentrations of magnesium over time in preterm labor patients. STUDY DESIGN: Patients at 24-34 weeks of singleton gestation who presented with contractions (> 8 in 60 minutes) underwent amniocentesis to rule out intrauterine infection after signing an informed consent form. Some of these women who were clinically judged to have preterm labor received intravenous MgSO4: a 4-g loading dose followed by a 2 g/h maintenance dose. For technical reasons some patients had amniocentesis performed before initiation of MgSO4 (controls), while others had the procedure during tocolytic therapy (study subjects). Duration of treatment until amniocentesis was recorded, and blood samples were drawn at the time of amniocentesis. Maternal serum and amniotic fluid magnesium levels were measured using a colorimetric end point method. Data were evaluated using the Student t test and linear regression analysis. RESULTS: Mean magnesium levels in maternal serum rose from 1.74 +/- 0.2 mg/dL in controls to 4.01 +/- 0.4 mg/dL in the study group. Mean magnesium levels in Mean magnesium levels in amniotic fluid were 1.41 +/- 0.18 mg/dL in the controls versus 2.28 +/- 0.53 mg/dL in the treatment group. Duration of MgSO4 treatment ranged from 3 to 22 hours. Amniotic fluid magnesium concentrations increased significantly during therapy (correlation coefficient = 0.89; p < 0.001), while maternal serum levels remained stable over time (correlation coefficient between maternal serum levels and time = -0.39; p=0.34). CONCLUSION: Although maternal serum magnesium levels remained stable with intravenous MgSO4 therapy, concentrations continued to rise in amniotic fluid over time. However, amniotic fluid magnesium levels never exceeded maternal serum concentrations during the study period.

Adult↗
PubMed1999

Measurement of the amniotic fluid index with and without color Doppler.

AIMS: The purpose of this study was to assess the effect, if any, of color Doppler on the measurement of the amniotic fluid index in term pregnancies. It is hypothesized that color Doppler may enhance the detection of oligohydramnios. METHODS: The amniotic fluid index was performed with and without color Doppler on pregnancies greater than or equal to 36 weeks gestational age. Differences in the mean amniotic fluid index measurements were assessed. The incidence of oligohydramnios was examined using both techniques. Differences in continuous variables were assessed with the paired t test, differences in categorical variables were assessed using the Fisher Exact Test. RESULTS: There were 155 pregnancies examined, the amniotic fluid index was significantly decreased when color Doppler was added to the standard technique. (P < .0001) The incidence of oligohydramnios was higher with the application of color Doppler to the standard amniotic fluid index. (P < .05). CONCLUSIONS: Color Doppler results in a significantly lower amniotic fluid volume measurement and may enhance the detection of oligohydramnios.

Adult↗
PubMed1976

A simple and rapid determination of the lecithin/sphingomyelin (LS) ratio in amniotic fluids and in pharyngeal aspirates of newborn infants.

A simple, rapid method for the routine determination of the lecithin/sphingomyelin (L/S) ratio in amniotic fluid and/or in pharyngeal aspirate of the newborn has been developed. In 33 samples of amniotic fluid at various gestational ages, an L/S ratio corresponding to the fetal age was found: in 16 samples of biochemically immature amniotic fluid (gestation age less than 34 weeks) the mean of the ratio was 1.26 and in 17 samples of mature amniotic fluid (gestation age greater than 35 weeks) the mean value was 3.02. Pharyngeal aspirates of 55 non-selected newborn were examined by the same method. The L/S ratio of 39 infants (gestation age greater than 38 weeks) gave a mean value of 7.3 and that of 16 premature infants (gestation age less than 37 weeks) a mean value of 5.5. In none of these cases did RDS develop after birth. The results suggest that the method is useful for the determination in both amniotic fluid and pharyngeal aspirate.

Amniotic Fluid↗
PubMed1977

Relationship of maternal, fetal, and amniotic fluid prolactin levels.

Serum prolactin (PRL) was measured by radioimmunoassay in 80 women in serum and amniotic fluid during various stages of normal pregnancy and at delivery. In addition, prolactin levels were measured in cord sera at 60 newborns. PRL levels in maternal serum progressively increased during pregnancy, and they were lower than the corresponding levels in amniotic fluid. A relative decline in the amniotic fluid prolactin between the 39th and the 40th week of gestation was observed. The mean concentration of PRL in umbilical blood was significant lower than that in maternal blood at delivery. The lack of correlation between the PRL in amniotic fluid and the levels found in maternal and newborns serum suggests an independient source of PRL in each of the three compartments.

Amniotic Fluid↗
PubMed1976

Fetal intestinal disaccharidases in human amniotic fluid.

Based on data from two human fetuses, a correlation exists between amniotic fluid and intestinal disaccharidase activities suggesting that the fetal intestine is the source of these amniotic fluid enzymes. Intestinal disaccharides are apparently released into the amniotic cavity by fetal defecation. As indicated by the drop of disaccharidase activities in amniotic fluid at 22 weeks gestation, defecation stops at this period of gestation.

Amniotic Fluid↗
PubMed1997

Amniotic fluid distribution in predicting perinatal outcome in patients with ruptured membranes.

OBJECTIVE: To determine if amniotic fluid distribution predicts perinatal outcome in women with spontaneously ruptured membranes. METHODS: Patients presenting for labor and delivery with spontaneously ruptured membranes had amniotic fluid indices determined upon admission. Those with greater than 50% of their amniotic fluid in the upper quadrants were placed in the upper-greater group and those with greater than 50% in the lower quadrants were placed in the lower-greater group. The groups were compared with respect to meconium staining, 1- or 5-minute Apgar scores below 7, persistent variable or late decelerations, umbilical arterial or venous pH below 7.20, cesarean for non-reassuring fetal heart rate monitoring, and neonatal intensive care unit admissions. RESULTS: One hundred women were studied, 60 in the upper-greater group and 40 in the lower-greater group. Significant differences between upper-greater and lower-greater distributions were noted in meconium staining (28.3% compared with 0%, P < .001), 1-minute Apgar score below 7 (16.7% compared with 2.5%, P < .027), variable decelerations (63.3% compared with 25.0%, P < .001), late decelerations (23.3% compared with 0%, P < .001), and cesarean for non-reassuring fetal heart tracing (11.6% compared with 0%, P < .025). The negative predictive values for all of the variables studied were in the range 92.5-100%, with the exception of variable decelerations (75%). CONCLUSION: Amniotic fluid distribution predicts perinatal outcome in patients with ruptured membranes. This test's high negative predictive value indicates its potential as a valuable screening tool. These results may provide additional guidance in defining the intrapartum management of patients presenting with ruptured membranes.

Adult↗
PubMed2006

Perinatal outcome in monochorionic twin pregnancies complicated by amniotic fluid discordance without severe twin-twin transfusion syndrome.

OBJECTIVES: To assess the natural history and perinatal outcome in monochorionic diamniotic twin pregnancies with discordant amniotic fluid volume without signs of severe twin-twin transfusion syndrome (TTTS). METHODS: This was an observational study of 84 consecutive monochorionic twin pregnancies which did not meet the criteria for severe TTTS and endoscopic laser coagulation of placental anastomoses at initial presentation. The population was subdivided into two groups. Group 1 consisted of 64 pregnancies (median gestational age, 20.1 (range, 15.6-24.7) weeks) with amniotic fluid discordance and no signs of congestive heart failure in the twin with the larger amniotic fluid volume (Twin 1) and positive end-diastolic flow in the umbilical artery of the twin with the smaller amniotic fluid volume (Twin 2). Group 2 (median gestational age, 19.1 (range, 16.0-24.4) weeks) consisted of 20 pregnancies with amniotic fluid discordance and intrauterine growth restriction (IUGR) (abdominal circumference < 5th percentile) in combination with absent or reversed end-diastolic (ARED) flow in the umbilical artery of Twin 2. After exclusion of one patient from Group 1, who opted for termination of pregnancy, nine patients in Group 1 and one in Group 2 developed severe TTTS, and laser coagulation was offered. The remaining 54 pregnancies of Group 1 were compared with the remaining 19 pregnancies of Group 2. RESULTS: Fetuses in Group 1 showed significantly higher survival rates (overall survival, 100/108 (92.6%) vs. 23/38 (60%), P < 0.0001; survival of both fetuses, 49/54 (90.7%) vs. 9/19 (47.4%), P = 0.0002) and median gestational age at delivery (33.6, (range, 27.6-37.8) weeks vs. 32.0 (range, 26.9-36.3) weeks, P = 0.0457). Overall, there was a significantly higher incidence of complications, defined as necessity for intrauterine intervention, fetal or neonatal death or delivery prior to 32 weeks, in Group 2 (Group 1: 30/63 (47.6%); Group 2: 16/20 (80%), P = 0.0188). CONCLUSIONS: Our data suggest that amniotic fluid discordance in monochorionic diamniotic twin pregnancies in combination with IUGR and umbilical artery ARED flow in one fetus represents an extremely high-risk constellation for adverse pregnancy outcome.

Adult↗