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PubMed1998

Meconium stained amniotic fluid in preterm delivery is an independent risk factor for perinatal complications.

OBJECTIVE: To determine the prevalence and clinical significance of meconium stained amniotic fluid (MSAF) in women with preterm delivery. STUDY DESIGN: The study population consisted of consecutive patients who arrived with intact membranes and delivered preterm, singleton neonates at the Soroka Medical Center between 1 January 1985 and 31 December 1995. Only vertex presentation was included. Antepartum death was excluded from the study. Patients were classified according to the color of amniotic fluid into two groups: MSAF and clear amniotic fluid. Maternal puerperal complications were defined in our study as the presence of at least one of the next variables: clinical chorioamnionitis; major puerperal infection including endometritis, cesarean section or postpartum hemorrhage. Perinatal complications were defined in our study as: (1) intrapartum death (IPD) or postpartum death (PPD); (2) one or more of the following: 1-min Apgar score <3, 5-min Apgar score <7 or small for gestational age. Rates of perinatal complications were assessed at: (1) 24-27 weeks; (2) 28-31 weeks; (3) 32-36 weeks. Logistic regression was used to investigate the relationship of MSAF to perinatal complications and maternal morbidity in a multivariate model. RESULTS: During the study period, a total of 96 566 deliveries occurred in our institution and 4872 (5.0%) deliveries were preterm. Among the women delivering preterm meeting eligibility criteria, 276 (5.7%) women had intrapartum MSAF. A higher rate of IPD and PPD was observed only between 32 and 36 weeks' gestation in patients with MSAF in comparison with patients with clear amniotic fluid [6.1% (14/230) vs. 2.1% (85/4045), respectively, P=0.0001]. A statistically significant higher rate of perinatal complications was found between 28 and 31 weeks' gestation, and even a higher rate was noted between 32 and 36 weeks' gestation in the MSAF group in comparison with patients with clear amniotic fluid [51% (18/35) vs. 27.2% (93/341), respectively, P=0.003; 20% (46/230) vs. 9.8% (396/4045), respectively, P=0.0004]. CONCLUSIONS: (1) MSAF is an independent risk factor for perinatal complications in preterm deliveries (OR=1.73, CI: 1.057-2.43, P=0.001; OR=2.35, CI:1.34-4.12, P=0.002, respectively). (2) MSAF was not found to be an independent risk factor for maternal morbidity.

Adult↗
PubMed1982

[The effects of metoclopramide on maternal, umbilical and amniotic fluid prolactin at delivery].

Sixteen normal pregnant woman at delivery were administered 10 mg of Metoclopramide (MCP) intravenously, and the Prolactin (PRL) levels in the maternal plasma and in the amniotic fluid were measured by RIA before and after the administration, and in the umbilical plasma after the administration. Eight other pregnant women at term were studied similarly without the administration of MCP and served as the control. In this experiment, there was a significant increase only in the maternal plasma PRL but not in the amniotic fluid PRL nor in the umbilical plasma PRL. Furthermore, by using an intrauterine pressure catheter and a maternal intravenous cannula we measured the amniotic fluid PRL and the maternal plasma PRL about every 20 minutes during 3 hours before and after the intravenous administration of MCP 10mg. The maternal plasma PRL increased promptly and remained high for 150 minutes, while there was no significant change in the amniotic fluid PRL. This obvious discrepancy supports the hypothesis that decidua is the source of amniotic fluid PRL and suggests an independent regulation of amniotic fluid PRL.

Amniotic Fluid↗
PubMed1978

Fetal- and uterine-specific antigens in human amniotic fluid.

Removal of the major maternal serum proteins from second trimester amniotic fluid by antibody affinity chromatography revealed various soluble tissue antigens, of which two were fetal-specific skin proteins and another, of alpha2-mobility, was specific to the uterus, and was therefore designated alpha-uterine protein (AUP). These proteins could not be detected in maternal serum by antibody-antigen crossed electrophoresis. The concentration of AUP in amniotic fluid reached a maximum between 10 and 20 weeks of gestation, suggesting that there is an influx of uterine protein into the amniotic fluid at this stage of pregnancy.

Amniotic Fluid↗
PubMedDate not supplied

Amniotic fluid protease activity and the prenatal detection of cystic fibrosis.

Changes in the protease activity in amniotic fluid has been proposed as a valid method for the prenatal detection of cystic fibrosis (CF). We have studied by quantitative and qualitative procedures, sixty four amniotic fluids: two of them from CF-affected fetuses. Interpretation of the benzoyl arginine ethyl ester (BAEE)-staining patterns after isoelectric focusing was often difficult, and repeated experiments gave variable results. In order to improve gel discrimination, we performed amniotic fluid electrofocusing in the presence of detergents: 0.1 per cent Triton X-100, 0.1 per cent DOC, or 0.1 per cent SDS. In these conditions, the pattern revealed by BAEE was modified, but no differences were observed between CF and normal amniotic fluids.

Amniotic Fluid↗
PubMed1984

Correlation of amniotic fluid estrogens with L/S ratios and urinary estriols.

17 beta-estradiol (E2) and estriol-16-glucuronide in amniotic fluid from 87 patients (normal and stressed pregnancies) were studied with radioimmunoassays. Overall, amniotic fluid estradiol and estriol increased with gestation and paralleled the increase in the L/S ratio. Statistical correlations between amniotic fluid E2 and E3 with L/S were fair and better for E3 than for E2. Correlations were better from 31 to 35 weeks of gestation than from 36 to 40 weeks. A threshold of 0.34 ng/ml should be used for E2; levels above that possibly represent fetal maturity and well-being. A threshold of 540 ng/ml should be used for E3; levels above that possibly indicate fetal maturity and wellbeing. Urine E3 correlated poorly statistically with amniotic fluid E3. Serum E3 was not studied.

Amniotic Fluid↗
PubMed1994

[Significance of the glucose concentration in amniotic fluid for the prediction of chorioamnionitis in preterm labor].

For the rapid and accurate prediction of the presence of chorioamnionitis (CAM) in preterm labor, amniotic fluid analyses were performed in 46 women with preterm labor between 24 to 34 weeks' pregnancy. Ultrasound-guided transabdominal amniocentesis was performed on admission and the amniotic fluid was subjected to the measurement of cell count, glucose, protein and chlorine concentration according to cerebrospinal fluid and neutrophil esterase analysis. The data demonstrated that the amniotic fluid glucose concentration was significantly lower in women with preterm birth/CAM(+) than that with preterm birth/CAM(-) and term birth (19.0 +/- 9.1, 28.0 +/- 7.6, 51.6 +/- 14.5 mg/dl, respectively). All of the women with a glucose concentration of 20mg/dl or less showed signs of CAM. By setting up a cut off value of 25mg/dl, both high sensitivity (81.8%) and specificity (91.4%) for the prediction of CAM were obtained. Positive predictive values for CAM of a glucose concentration of 20mg/dl or less and 25mg/dl or less were 100% and 75% respectively. It was concluded that amniotic fluid glucose concentration measurement is useful for the prediction of CAM. The presence of CAM should be considered when the amniotic fluid glucose concentration is 25mg/dl or less.

Adult↗
PubMed1987

Fetal vasopressin in late pregnancy. Levels in amniotic fluid and in fetal urine.

The concentrations of vasopressin in the amniotic fluid were measured in 40 patients. The pregnancies were complicated by diabetes, toxemia or imminent premature delivery and in one case by polyhydramnion. The gestation time varied from 33 to 41 weeks. In addition, we measured vasopressin concentrations after transabdominal drainage of fetal bladder in three cases with urethral obstruction. Detectable concentrations of vasopressin in the amniotic fluid were found in all but four of the 40 cases observed. The vasopressin concentrations varied from 0.21 to 1.81 pg/ml. There were no systematic differences in the values in relation to duration of gestation or disease present. The highest vasopressin concentration was observed in the patient with polyhydramnion. No detectable amount of vasopressin was found in the urine of the three fetuses examined. The results suggest that, in contrast to earlier studies, the placenta may be permeable to small amounts of vasopressin or may itself be an origin of this hormone. The maternal complications present seem to have no effect of the vasopressin concentrations in the amniotic fluid.

Amniotic Fluid↗
PubMed2005

Urinary and amniotic fluid levels of phthalate monoesters in rats after the oral administration of di(2-ethylhexyl) phthalate and di-n-butyl phthalate.

Two studies were designed to examine amniotic fluid and maternal urine concentrations of the di(2-ethylhexyl) phthalate (DEHP) metabolite mono(2-ethylhexyl) phthalate (MEHP) and the di-n-butyl phthalate (DBP) metabolite monobutyl phthalate (MBP) after administration of DEHP and DBP during pregnancy. In the first study, pregnant Sprague-Dawley rats were administered 0, 11, 33, 100, or 300 mg DEHP/kg/day by oral gavage starting on gestational day (GD) 7. In the second study, DBP was administered by oral gavage to pregnant Sprague-Dawley rats at doses of 0, 100, or 250 mg/kg/day starting on GD 13. Maternal urine and amniotic fluid were collected and analyzed to determine the free and glucuronidated levels of MEHP and MBP. In urine, MEHP and MBP were mostly glucuronidated. By contrast, free MEHP and free MBP predominated in amniotic fluid. Statistically significant correlations were found between maternal DEHP dose and total maternal urinary MEHP (p=0.0117), and between maternal DEHP dose and total amniotic fluid MEHP levels (p=0.0021). Total maternal urinary MEHP and total amniotic fluid MEHP levels were correlated (Pearson correlation coefficient=0.968). Statistically significant differences were found in amniotic MBP levels between animals within the same DBP dose treatment group (p<0.0001) and between animals in different dose treatment groups (p<0.0001). Amniotic fluid MBP levels increased with increasing DBP doses, and high variability in maternal urinary levels of MBP between rats was observed. Although no firm conclusions could be drawn from the urinary MBP data, the MEHP results suggest that maternal urinary MEHP levels may be useful surrogate markers for fetal exposure to DEHP.

Administration, Oral↗
PubMed1995

Fetal fibronectin levels are elevated in maternal plasma and amniotic fluid of patients with severe preeclampsia.

OBJECTIVE: Our purpose was to investigate levels of fetal fibronectin in maternal plasma, amniotic fluid, and umbilical cord plasma from patients with severe preeclampsia. STUDY DESIGN: The study group comprised 20 patients with severe preeclampsia (group A). An antepartum comparison group was composed of 20 healthy patients matched for gestational age (group B). An intrapartum control group consisted of 20 term normotensive patients (group C). Maternal plasma samples were collected before labor (groups A and B), then immediately after delivery, and again at 20 to 24 hours post partum (groups A and C). Amniotic fluid was also collected in early labor, and umbilical cord blood was collected at delivery (groups A and C). Samples were assayed for fetal fibronectin by a specific enzyme-linked immunoassay. RESULTS: Before labor maternal plasma levels of fetal fibronectin were significantly elevated in preeclamptic patients compared with patients in group B (p < 0.0001). Plasma levels of fetal fibronectin were also increased in preeclamptic patients compared with patients in group C at delivery (p < 0.0001) and post partum (p < 0.05). Additionally, amniotic fluid levels of fetal fibronectin in the preeclamptic patients were significantly increased (p < 0.05). In contrast, umbilical cord plasma fetal fibronectin concentrations from the preeclamptic and control patients were similar. CONCLUSIONS: Fetal fibronectin is elevated in the maternal plasma and amniotic fluid, but not umbilical cord plasma, of patients with severe preeclampsia. These findings suggest an increase in production of fetal fibronectin from chorionic trophoblast in patients with preeclampsia or an abnormal interaction between chorionic trophoblast and decidua with resultant increased leakage into the maternal circulation and amniotic fluid.

Adult↗
PubMed1989

Plasma and amniotic fluid immunoreactive neuropeptide-Y level changes during pregnancy, labor, and at parturition.

This study was designed to determine the presence of and possible changes in plasma and amniotic fluid immunoreactive neuropeptide-Y (irNPY) levels in pregnant women during gestation and at parturition. We studied 127 healthy pregnant and 12 nonpregnant women. The peptide was extracted from plasma or amniotic fluid with a propanolformic acid mixture and measured by RIA. The mean plasma irNPY concentration in 15 pregnant women during the first trimester of gestation was 129 +/- 12 (+/- SE) pmol/L, compared to 40 +/- 8 pmol/L in nonpregnant women (p less than 0.01). The mean values were 144 +/- 13 and 156 +/- 24 pmol/L, respectively, in 15 pregnant women during the second trimester and 33 women during the third trimester. These values did not differ from that during the first trimester. Amniotic fluid irNPY levels were similar to those in plasma and did not vary among the 3 groups of women studied during the various trimesters of gestation. During labor, plasma irNPY levels progressively increased, reaching the highest levels at the most advanced stages of cervical dilatation (greater than 8 cm, 351 +/- 38 pmol/L) and at the time of vaginal delivery (416 +/- 73 pmol/L). Plasma irNPY levels then decreased significantly 2 h after vaginal delivery. The amniotic fluid irNPY levels in women during the early or late stages of labor were similar. Moreover, plasma and amniotic fluid irNPY levels at the time of elective cesarean section also were similar. These results indicate that pregnant women have high plasma and amniotic fluid irNPY levels and that the stress of labor results in a further increase in plasma levels, suggesting a possible role of NPY in human pregnancy and parturition.

Adult↗
PubMed1979

Maternal and amniotic fluid steroids throughout human pregnancy.

Concentrations of testosterone, dihydrotestosterone, androstenedione, progesterone, 17 alpha-hydroxyprogesterone, and estradiol were measured by radioimmunoassay in the amniotic fluid and maternal peripheral blood obtained from normal pregnancies between 14 and 40 weeks of gestation. There was a sex difference in the levels of all the androgenic steroids in the amniotic fluid before 20 weeks with higher levels in pregnancies with male fetuses. Amniotic fluid 17 alpha-hydroxyprogesterone levels were significantly elevated in a pregnancy with the fetus affected with congenital adrenal hyperplasia. The levels of all the steroids in the amniotic fluid were significantly elevated in the pregnancy with molar degeneration of the placenta. There was a sex difference in the levels of dihydrotestosterone in the maternal peripheral blood before 20 weeks with higher levels in pregnancies with male fetuses. There was no correlation between the steroid levels in the maternal serum and amniotic fluid even though most of the samples of maternal serum were drawn at the same time as amniocentesis.

Adrenocortical Hyperfunction↗
PubMed1980

Amniotic fluid 3,3',5'-triiodothyronine in the detection of congenital hypothyroidism.

Amniotic fluid rT3 levels were measured during pregnancy in two women who previously gave birth to infants suffering from neonatal hypothyroidism. In the first case, hypothyroidism was strongly suspected because of repeated low levels of rT3 in the amniotic fluid (20-64 ng/dl) at 16 and 31 weeks of gestation. A normal infant was delivered. He is now 10 months old and taking no treatment; he has no clinical or laboratory signs of hypothyroidism. In the second case, amniotic rT3 levels (140-180 ng/dl) were well within the normal range for 15-19 weeks of pregnancy, but an affected hypothyroid infant was born. These data suggest that amniotic fluid rT3 levels may not be a reliable tool in diagnosing intrauterine hypothyroidism.

Adult↗
PubMed1984

A survey of pregnancies complicated by decreased amniotic fluid.

Four hundred seventy-one patients undergoing diagnostic ultrasonography were identified as having moderately decreased amniotic fluid or oligohydramnios, and 339 of these cases were reviewed. Ninety-two of the patients were excluded from further statistical analysis because their decreased fluid was attributed to rupture of the membranes only. Of the remaining patients there was a 7% neonatal malformation rate. Decreased amniotic fluid before 27 weeks of gestation was associated with a significantly poor outcome. Of all the live births, infants of patients with oligohydramnios had lower Apgar scores at 1 minute and 5 minutes than did infants of patients with moderately decreased amniotic fluid. Of cases of patients with decreased fluid, 10% involved fetal distress during labor and in 17% meconium was present. Decreased levels of fluid were associated with an increased rate of abdominal deliveries. Preeclampsia was present in 24.7% of patients with decreased fluid. There was no correlation between the quantitative fluid amounts and the severity of the disease. In view of normative data and clinical experience, these observations suggest that the diagnosis of decreased amniotic fluid on routine ultrasonography requires a fetal scan to rule out anomalies, close antepartum observation to detect complications that may arise in the pregnancy, and delivery under conditions that allow appropriate support and intervention on behalf of the fetus.

Amniotic Fluid↗
PubMed1993

Amniotic fluid zinc and pregnancy outcome.

OBJECTIVE: To examine for an association between amniotic fluid zinc and pregnancy outcome. DESIGN: A prospective study. SETTING: Southmead Hospital, Bristol, UK. SUBJECTS: 191 amniotic fluid samples from 11 centers in the Southwest of England, obtained at 16-20 weeks gestation. METHOD: Samples of amniotic fluid (AF) sent for prenatal diagnosis were collected from the laboratory and analysed for zinc level. Data were then collected at a later date concerning pregnancy outcome. OUTCOME MEASURE: Antenatal complications as well as events in labour, and in particular birth weight and congenital malformations. RESULTS: 182 cases with complete data showed a mean AF zinc level (+/- S.E.) of 1.39 (+/- 0.11). There was no relation between AF zinc and antepartum haemorrhage, pregnancy-induced hypertension, post-partum haemorrhage or time and mode of delivery. Neither was there an association with birth weight. As there were no cases with major malformations, particularly of the central nervous system, possible association could not be ascertained. CONCLUSION: The study failed to demonstrate any association between AF zinc and abnormal pregnancy outcome. A modified prospective study is suggested to explore this further.

Adult↗
PubMed2002

A diminished intrapartum amniotic fluid index is a predictive marker of possible adverse neonatal outcome when associated with prolonged labor.

OBJECTIVE: To determine whether a diminished intrapartum amniotic fluid volume represents a risk of adverse neonatal outcome when it occurs in conjunction with prolonged labor. METHODS: The intrapartum amniotic fluid index (iAFI) was measured in 242 parturients over 35 weeks of gestation during 1st-stage labor, and the umbilical artery blood gas was analyzed at delivery. The subjects were divided into group A (n = 99), having a diminished amniotic fluid volume (iAFI < or = 8.0 cm) and group B (n = 143), having a normal amniotic fluid volume (iAFI 8.1-20.0 cm), and selected antenatal, delivery, and neonatal variables were compared. In addition, the two groups were subdivided according to the duration of labor. Statistical analysis was performed using independent Student's t test, Mann-Whitney U test, chi-square analysis, and Fisher's exact test where appropriate. p < 0.05 was considered significant. RESULTS: The patient characteristics and pregnancy outcomes were similar in groups A and B, as were the incidences of an umbilical artery blood pH <7.20 and/or an Apgar score <7 (group A 9.5%, group B 10.1%). In group A, however, the incidence of an adverse neonatal outcome was 23.5% in cases in whom the duration of labor was longer than 8 h which was significantly higher than in cases in whom the duration of labor was 8 h or less (2.8%; p < 0.01). In group B, the incidence of an adverse neonatal outcome was similar in the two subgroups. CONCLUSIONS: The risk of an adverse neonatal outcome is higher in patients with diminished amniotic fluid volume if labor is prolonged. Consequently, determination of the iAFI could be a useful admission test.

Adult↗
PubMed2005

The use of fetal Doppler cerebroplacental blood flow and amniotic fluid volume measurement in the surveillance of postdated pregnancies.

BACKGROUND: This prospective observational study aims at determining the distribution of fetal cerebro-placental Doppler indices and amniotic fluid volume in a homogenous group of uncomplicated postdated pregnancies at 41 weeks. The correlation with incidence of passage of thick meconium-stained liquor in labor was analyzed to decide which parameter would be useful in the surveillance of postdated pregnancies. METHODS: The amniotic fluid volume, middle cerebral artery pulsatility index, umbilical artery pulsatility index, and cerebroplacental ratio were measured and distribution determined in 118 well-dated singleton pregnancies admitted for routine induction of labor at 41 weeks. The 10th centile and the 90th centile in each Doppler parameter and amniotic fluid volume were chosen to divide each parameter into three centile groups. The prevalence of thick meconium-stained liquor in labor in different Doppler and amniotic fluid volume centile groups was compared using Chi-square test for trend with P < 0.05 taken as statistically significant. RESULTS: The prevalence of thick meconium-stained liquor in labor was significantly inversely correlated with the middle cerebral artery pulsatility index (P = 0.008), with significant difference across different middle cerebral artery pulsatility index centile groups (P = 0.02). There was no significant difference in the prevalence of thick meconium-stained liquor in labor or oligohydramnios across different umbilical artery pulsatility index centile groups. Neither was there significant difference in the prevalence of thick meconium-stained liquor in labor and oligohydramnios across different cerebroplacental ratio and amniotic fluid volume centile groups. Logistic regression using the 10th centile of middle cerebral artery pulsatility index confirmed that it was a significant independent predicting factor for risk of thick meconium-stained liquor in labor with adjusted odds ratio (95th CI) of 6.14 (1.6-24.1). CONCLUSION: Middle cerebral artery pulsatility index is better than amniotic fluid volume or umbilical artery pulsatility index in predicting the risk of thick meconium-stained liquor in labor in uncomplicated postdated pregnancy at 41 weeks.

Adult↗
PubMedDate not supplied

The effect of amniotic fluid on intraperitoneal adhesion formation--an experimental study.

In an attempt to investigate the relative paucity of intraperitoneal adhesions after cesarean sections, we tested the effect of amniotic fluid on adhesion formation in rat model. Trauma was induced to the uterine serosa in 40 rats. Amniotic fluid was intraperitoneally instilled in 20 rats and saline in another 20 rats acting as controls. No inhibitory effect of the amniotic fluid could be demonstrated. The effect of the amniotic fluid and the saline solutions on fibroblastic proliferation was examined in vitro using fibroblastic cell cultures. No direct effect on fibroblast proliferation was found. It is concluded that it is not the direct effect of the spilled amniotic fluid that inhibits adhesion formation after the performance of cesarean sections.

Amniotic Fluid↗
PubMed1989

A new method for measurement of surfactant specific apoprotein in amniotic fluid.

A simple and rapid method for the quantitative measurement of surfactant specific apoprotein concentration in amniotic fluid was developed using the measurement of immunological reactions by the nephelometric technique. Use of this method made it possible to measure 0.5-8.0 micrograms apoproteins per ml within approximately 70 min. Surfactant specific apoproteins in 54 samples of amniotic fluid were measured using the method. The surfactant specific apoprotein concentration in amniotic fluid increased from 1.03 +/- 0.51 micrograms/ml (mean +/- S.D.) at 26-30 weeks of gestation to 4.45 +/- 2.08 micrograms/ml at 36 weeks of gestation or more. Among premature infants, who were delivered within 24 h afer amniocentesis, surfactant specific apoprotein concentration was less than 1.5 micrograms/ml in three infants with respiratory distress syndrome (RDS), and more than 2.1 micrograms/ml in six without RDS. The results indicated that the quantitative measurement of surfactant specific apoprotein in amniotic fluid is effective in predicting the fetal lung maturity, and that simplicity and rapidity make our method useful for clinical application.

Amniotic Fluid↗