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PubMed1985

Decreased levels of amniotic fluid alpha-fetoprotein associated with Down syndrome.

Low maternal serum alpha-fetoprotein levels have been associated with fetal aneuploidies. Amniotic fluid alpha-fetoprotein levels have been reported to be low with Down syndrome (trisomy 21) but not with other fetal trisomies. We compared the amniotic fluid alpha-fetoprotein levels from 25 cases of autosomal trisomy (18 of trisomy 21, four of trisomy 13, three of trisomy 18) diagnosed by midtrimester fetal cytogenetic studies with those from matched, cytogenetically normal pregnancies. With these normal pregnancies used as controls, statistical analyses were performed on the data for all the trisomic fetuses, on the data for trisomy 21 only, and on the data for trisomies 13 and 18 combined. Amniotic fluid alpha-fetoprotein levels were significantly lower in the 25 trisomic cases compared with controls, 0.77 +/- 0.34 versus 1.03 +/- 0.34 mg/dl (p less than 0.001). However, further analysis revealed that the difference was due to the trisomy 21 data alone. In the trisomy 21 cases there was a significant difference for alpha-fetoprotein levels between cases and controls (p less than 0.001), whereas there was no difference for the combined trisomy 13 and 18 cases compared to controls (p greater than 0.40). These findings suggest that the low maternal serum levels of alpha-fetoprotein reported in cases of Down syndrome may be related to reduced amniotic fluid concentrations. However, the reduced maternal serum alpha-fetoprotein levels reportedly associated with trisomies 13 and 18 do not seem to be explained by low amniotic fluid concentrations.

Adult↗
PubMed1995

Amniotic fluid interleukin-6: a sensitive test for antenatal diagnosis of acute inflammatory lesions of preterm placenta and prediction of perinatal morbidity.

OBJECTIVE: Our purpose was to determine whether amniotic fluid concentrations of interleukin-6 are of value in the antenatal diagnosis of acute inflammatory lesions (histologic chorioamnionitis) of preterm placenta and in the prediction of perinatal morbidity and mortality. STUDY DESIGN: The relation among placental histologic findings, perinatal outcome, and amniotic fluid interleukin-6 concentrations was examined in 50 consecutive patients who delivered preterm neonates within 72 hours after amniocentesis. Interleukin-6 was determined by enzyme-linked immunosorbent assays. Receiver-operator characteristic curve was used for analysis. RESULTS: Patients with acute histologic chorioamnionitis had significantly higher median amniotic fluid interleukin-6 concentrations than patients without histologic chorioamnionitis (median 70.8 ng/ml, range 0.7 to 499.2 ng/ml vs median 2.9 ng/ml, range 0.8 to 16.0 ng/ml, respectively; p < 0.00001). An amniotic fluid interleukin-6 concentration > 17 ng/ml had a sensitivity of 79% (23/29) and a specificity of 100% (21/21) in the diagnosis of acute histologic chorioamnionitis and a sensitivity of 69% (18/26) and a specificity of 79% (19/24) in the prediction of significant neonatal morbidity (defined as neonatal sepsis, respiratory distress syndrome, pneumonia, intraventricular hemorrhage, bronchopulmonary dysplasia, or necrotizing enterocolitis) and mortality. These sensitivities were significantly higher than those of amniotic fluid culture (79% vs 38%, p < 0.005; 69% vs 27%, p < 0.01, respectively). CONCLUSIONS: Amniotic fluid interleukin-6 is a sensitive test for the prospective diagnosis of acute histologic chorioamnionitis and the identification of neonates at risk for significant morbidity and mortality.

Amniotic Fluid↗
PubMed1994

Amniotic fluid embolism: a review of 10 fatal cases.

A study of 10 fatal cases of amniotic fluid embolism, confirmed by autopsy and post-mortem histological examination, that occurred in Singapore between 1983-1992, showed that the majority (9 cases) were multiparous, with between 2-4 previous normal pregnancies each. Seven had uneventful antenatal histories. In all cases, the clinical onset was sudden and unexpected, having occurred during the first stage of labour in 8 subjects and being associated with convulsions in 5. There were seven cases of coagulopathy, with 6 of disseminated intravascular coagulation. Overall, foetal survival was poor. Three cases were associated with induction of labour, while another 3 occurred after augmentation. Emergency caesarean sections were performed in 5 cases. Autopsy demonstrated moderate to severe pulmonary oedema in 9 cases, accompanied by pulmonary haemorrhage in 6. Mild coronary atheroma was present in 6 cases, with 3 showing subendocardial haemorrhage. Significant utero-cervical ruptures or lacerations were found in 3 cases. Microscopy demonstrated the presence of squamous epithelial emboli within the pulmonary vasculature in all cases. Other histological features included fibrin microthrombi (3 cases), alveolar and pulmonary interstitial inflammation, focal myocardial and hepatocellular necrosis, and myocardial interstitial inflammation. Although the precise pathogenesis of amniotic fluid embolism has remained somewhat enigmatic, recent evidence points towards a combination of a severe haemodynamic disturbance followed by secondary coagulopathy in about 40% of patients who survive the initial event. Leucotrienes, prostaglandins and other vasoactive substances contained in amniotic fluid are postulated to play a fundamental role in its pathogenesis. Amniotic fluid is also thought to possess thromboplastin-like properties.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1981

[The phenol turbidity test for measurement of pulmonary surfactants in amniotic fluid--rapid test for fetal lung maturity (author's transl)].

A simple and sensitive procedure for the quantitative estimation of pulmonary surfactants in the amniotic fluid is described. The method is based on the formation of turbidity from the amniotic fluid surfactants with phenol. Amniotic fluid drawn through an intrauterine catheter was centrifuged at 2000 rpm for 5 min. One ml of 5% aqueous phenol solution was added to 1.0 ml of the diluted supernatant. Control solution was prepared by addition of 1.0 ml of distilled water to the supernatant, instead of phenol solution. The turbidity was measured spectrophotometrically against control at 340 nm 5 to 10 min after agitation on a Vortex mixer for 5 sec. The turbidity obtained from amniotic fluid with phenol was proportional to the increase in total phospholipids in the fluid measured enzymatically. Moreover, only lecithin in the phospholipids was related to the turbidity formation. Sphyngomyelin, lysolecithin, phosphatidylethanolamin did not produce any turbidity with phenol. The spectrophotometric reading of 87 cases (31-41 weeks) was ranged at 0.18-3.52. Four cases with lower value (0.40) showed neonatal respiratory problem. The phenol turbidity test is more useful for the detection of fetal lung maturity comparing with the generally used shake test.

Amniotic Fluid↗
PubMed1986

[Studies on surface tension of amniotic fluid with special emphasis on evaluating fetal lung maturity].

In order to establish a simple and rapid test for the determination of fetal lung maturity, surface tension (ST) of lipid extracts prepared from amniotic fluid samples obtained from 54 women was measured by Wilhelmy's method. The patterns of ST were classified into three types. Type I: ST of 45 dyne/cm or more at 200 microliters of extract and 36 dyne/cm or more at 350 microliters. Type II: ST of 45 dyne/cm or more at 200 microliters and less than 36 dyne/cm at 350 microliters. Type III: ST less than 45 dyne/cm at 200 microliters. L/S ratio was 2 or more (greater than or equal to 2) in 7 of 23 cases (30.4%) with Type I patterns, 2 of 6 cases (33.3%) with Type II patterns, and 24 of 25 cases (96.0%) with Type III patterns. ST of mature amniotic fluid centrifuged for 10 min. at 5,000 X g and 10,000 X g was higher than ST of mature amniotic fluid centrifuged at 450 X g and 1,000 X g, but ST of immature amniotic fluid showed no significant difference in ST at different centrifugal forces. Contamination with meconium and blood was found to lower ST of immature amniotic fluid remarkably. ST of amniotic fluid lipid extract appeared to be a simple, rapid and reliable method for the assessment of fetal lung maturity.

Amniotic Fluid↗
PubMedDate not supplied

Isolation of Mycoplasma hominis and Ureaplasma urealyticum from amniotic fluid at 16-20 weeks of gestation: potential effect on outcome of pregnancy.

Samples from 61 amniotic fluids (33 discolored and 28 clear) collected by amniocentesis between 16 and 20 weeks gestation were cultured for microorganisms. Two of the discolored fluids were positive for Mycoplasma hominis, and two were positive for Ureaplasma urealyticum. Neither organism was isolated from samples of clear amniotic fluids. No other bacteria, viruses, or chlamydiae were isolated from fluids of any patient. The results prove that both M. hominis and U. urealyticum can infect the amnionic sac early in gestation without rupture of the fetal membranes. U. urealyticum was shown to cause a clinically silent, chronic (up to two months) intrauterine infection characterized by an intense inflammatory response. Complications in three of the four patients from whom mycoplasmas were isolated suggest, but do not prove, that mycoplasmal infection of amniotic fluid may have an adverse effect on outcome of pregnancy. Further studies are necessary to substantiate this implication and to determine the relationship between infection and discoloration of amniotic fluid.

Adult↗
PubMed1985

Dynamics of human chorionic gonadotropin, prolactin, and growth hormone in serum and amniotic fluid throughout normal human pregnancy.

This study was performed to establish the dynamics of human chorionic gonadotropin, prolactin, and growth hormone throughout pregnancy in serum and amniotic fluid. Two hundred fifty healthy women at 8 to 42 weeks' gestation were studied. The highest serum human chorionic gonadotropin level was measured between weeks 8 to 12 (53,715 +/- 3574 mIU/ml, mean +/- SEM), with a decline to a mean plateau of 11,806 +/- 1250 mIU/ml from week 18. Amniotic fluid human chorionic gonadotropin had a similar pattern with a mean of 68,100 +/- 8422 mIU/ml at weeks 8 to 10, declining from week 18 to a plateau of 2005 +/- 260 mIU/ml. Human chorionic gonadotropin showed a significant correlation (r = 0.85, p less than 0.001) between levels of both compartments demonstrating an even distribution. Prolactin levels showed a dichotomy of patterns and levels. Serum prolactin showed a continuous rise from 45.3 +/- 14 ng/ml at week 8 to 224 +/- 20 ng/ml at week 36. In contrast, amniotic fluid prolactin remained low until week 14 (33.1 +/- 0.8 ng/ml), followed by a sharp and significant (p less than 0.001) increase to a plateau of 3750 +/- 200 ng/ml between weeks 18 to 26, declining to a second plateau of 500 +/- 50 ng/ml at week 36. Serum growth hormone increased from a mean of 3.5 +/- 1.4 ng/ml seen at weeks 8 to 10 to a mean of 14 +/- 2.0 ng/ml at weeks 28 to 30, followed by a plateau of similar levels. The pattern of growth hormone secretion in amniotic fluid demonstrated a sharp increase during the 14-16 interval with a maximum mean level of 15.5 +/- 1.5 ng/ml and a slow steady decline thereafter. In conclusion, the similar pattern and concentration of human chorionic gonadotropin throughout pregnancy in both maternal and amniotic fluid are probably the result of direct human chorionic gonadotropin diffusion from the placenta. The dissimilar pattern and concentration of prolactin are the result of two different sources of prolactin secretion during pregnancy. Serum prolactin originates from the pituitary and amniotic fluid prolactin from the decidua. Since the pattern of growth hormone secretion resembles that of prolactin, it is possible that growth hormone, like prolactin, is secreted by the same sources.

Amniotic Fluid↗
PubMed1984

Amniotic fluid C-peptide and phosphatidyl glycerol in diabetic pregnancy.

The concentrations of C-peptide and phosphatidylglycerol in the amniotic fluid were determined in 36 pregnant diabetic women. Twenty-one patients who were being treated with insulin for gestational diabetes as well as 15 patients who were insulin dependent were studied. All patients were subjected to a program of strict metabolic control, and amniocentesis was performed at gestational week 36-37. Phosphatidyl glycerol was present in the amniotic fluid in 15 cases and absent in 21. The mean concentration of C-peptide did not differ whether phosphatidyl glycerol was present or absent. (C-peptide: 0.56 +/- 0.06 and 0.43 +/- 0.05 nmol/l respectively). Although the mean value for amniotic fluid C-peptide in both groups was close to that in diabetic pregnancies with an uneventful neonatal outcome, it was significantly higher than that in non-diabetic pregnancies, indicating minor fetal hyperinsulinemia. The level of C-peptide in the amniotic fluid showed a correlation to the subsequent birthweight of the infant (r = 0.50; p less than 0.01). It is concluded that with rigorous metabolic control of the pregnant diabetic patient, the presence or absence of phosphatidyl glycerol, as an index of fetal lung maturity, is apparently not related to the level of C-peptide in the amniotic fluid.

Amniocentesis↗
PubMed1990

[Diagnostic value of amniotic fluid alkaline ribonuclease activity in anencephaly and IUGR].

Amniotic fluid and maternal serum alkaline ribonuclease (RNase) activities were measured in women with normal pregnancy, fetus, neural tube defect, and fetal intrauterine growth retardation (IUGR). Amniotic fluid alkaline RNase activity was high in anencephaly and IUGR. The mechanism of these changes and the clinical application of these findings are discussed.

Amniotic Fluid↗
PubMed1995

Amniotic fluid interleukin-10 concentrations increase through pregnancy and are elevated in patients with preterm labor associated with intrauterine infection.

OBJECTIVE: To better understand the role of the antiinflammatory cytokine interleukin-10 in preterm labor and infection, we evaluated the amniotic fluid interleukin-10 concentrations through pregnancy, in term, and in preterm labor. STUDY DESIGN: Amniotic fluid interleukin-10 levels were measured in 147 women throughout pregnancy including patients in the second trimester, patients at term with and without labor, and in patients in preterm labor with and without an intrauterine infection. We compared the amniotic fluid interleukin-10 concentrations among these five groups using the Mann-Whitney U test. RESULTS: Amniotic fluid interleukin-10 was detected in 70% to 91% of patients in each of the five study groups. Higher concentrations were found at term compared with the second trimester (p < 0.001) and concentrations were significantly greater in patients with preterm labor and intrauterine infection compared with those patients in preterm labor without infection (p < 0.001), patients at term in labor (p < 0.001), or patients at term not in labor (p < 0.001). When the patients in preterm labor with infection were analyzed by gestational age, those patients at < 30 weeks had significantly higher amniotic fluid concentrations of interleukin-10 (p = 0.014). CONCLUSIONS: Interleukin-10 was present in the amniotic fluid of the majority of pregnancies, with higher concentrations found at term compared with the second trimester. Intrauterine infection was associated with significantly increased concentrations, with even higher concentrations found in the very premature pregnancies. Interleukin-10 has a prominent yet undefined role in pregnancy and preterm labor complicated by intrauterine infection.

Amniotic Fluid↗
PubMed1981

Amniotic fluid infection as determined by transabdominal amniocentesis in patients with intact membranes in premature labor.

The rate of microbial infection of amniotic fluid among patients in premature labor with intact membranes and the effect of this condition on perinatal morbidity and mortality are not known. Two study this question, specimens of amniotic fluid were collected by transabdominal amniocentesis from 31 patients in premature labor with intact membranes. Microorganisms were isolated from 25% (8/31) of the specimens; 87% (7/8) of these mothers underwent delivery within 48 hours of amniocentesis, and 75% (6/8) of positive culture were from mothers who were never febrile. Perinatal morbidity was significantly greater among mothers with positive amniotic fluid cultures, as evidenced by earlier gestational age at delivery (31 vs. 36 weeks), lower newborn weight (1,740 vs. 2,613 grams), and longer hospitalization (39 vs. 9 days). A few simple, commonly available laboratory tests (amniotic fluid Gram stain, lactic dehydrogenase levels, and white blood cell count) appear to be useful in making a rapid diagnosis. The data suggest that the presence of microorganisms in the amniotic fluid of afebrile patients in premature labor with intact membranes represents an infectious process rather than an innocuous condition and raises questions with regard to current obstetric trends in the management of premature labor. The routine evaluation of similar patients by transabdominal amniocentesis is not recommended unless prospective studies can demonstrate a decrease in perinatal morbidity and mortality with this approach.

Amniocentesis↗
PubMed1994

Oral administration of fluoride in pregnant women, and the relation between concentration in maternal plasma and in amniotic fluid.

The aim was to measure the ionic fluoride concentration in maternal plasma and in amniotic fluid after oral administration of different doses of sodium fluoride (NaF) to 121 pregnant women. They were divided into six groups, according to the dose administered; 0 for the control group and 0.25, 0.50, 0.75, 1.00 or 1.25 mg of F- for the others. The subjects were instructed to take the corresponding NaF dose both 24 and 3 h before amniocentesis. Amniotic fluid (5 ml) and venous blood (5 ml) were obtained from each subject. Ionic fluoride concentration was measured with an expanded-scale potentiometer and a selective fluoride electrode. The results showed that F- concentration in amniotic fluid and, presumably, in fetal circulation, was not significantly different in groups taking 0.25, 0.50, 0.75 or 1.00 mg/day of F-. The F- concentration in amniotic fluid of the 1.25 mg/day group was, however, significantly higher than in all the other groups.

Administration, Oral↗
PubMed1979

Gonadotrophins during second trimester of pregnancy: I. LH and hCG levels in maternal serum and amniotic fluid and their relationship to the sex of the foetus.

Luteinizing hormone and chorionic gonadotrophin levels were selectively measured by using radioimmunoassays in 98 maternal sera and 116 amniotic fluid samples obtained 10--20 weeks of pregnancy. Levels of hCG in serum were clearly high during 10--14 weeks and thereafter declined gradually. In contrast, serum concentrations of LH during 10--20 weeks were either unmeasurable (less than 1 ng/ml) or lower than those observed during the luteal phase of the menstrual cycle suggesting a decreased responsiveness of pituitary and/or a higher clearance rate for LH during this period of pregnancy. Neither LH nor hCG levels in maternal sera showed significant differences between male and female foetus bearers. A striking similarity was observed between maternal serum and amniotic fluid hCG patterns, despite hCG levels in maternal sera being always higher (1.5--26.9 fold). On the other hand amniotic fluid concentrations of LH became elevated following 12 weeks of gestation while maternal serum LH continued to be at low levels until 20 weeks. Furthermore a sexual dichotomy was observed in amniotic fluid LH concentrations but not in hCG levels during 14--20 weeks of pregnancy, with significantly lower LH levels in male foetus bearers than in female foetus bearers. Of interest is the clear demarcation in LH levels at 16 weeks of gestation. This sequential pattern of change in the concentrations of amniotic fluid LH is similar to those patterns reported by other investigators for foetal serum and pituitary LH during 10--20 weeks of gestation suggesting that the foetus may be the source of the increased levels of LH in amniotic fluid following 12 weeks of pregnancy.

Amniotic Fluid↗
PubMed1982

Correlation of quantitative amniotic fluid cultures with endometritis after cesarean section.

At the time cesarean section, amniotic fluid was collected transabdominally from 60 patients, and quantitative cultures were performed on the amniotic fluid. A culture was defined as positive if greater than or equal to 10(2) colony-forming units per milliliter of a high-virulence organism were isolated. Any other result was defined as negative. In 24 patients with no labor or rupture of the membranes, no positive cultures were found, but there was a 25% incidence of endometritis. Among 36 patients with labor or rupture of the membranes, or both, 13 (36%) had a positive culture. Twelve of the 13 (92%) developed endometritis, whereas nine of the 23 (39%) patients with a negative culture had endometritis (p less than 0.002). The usual clinical risk factors for endometritis were not different between the positive and negative culture groups. However, the patients with positive cultures had a significantly shorter time interval from cesarean section to endometritis than did the patients with negative cultures (p less than 0.02). There was an excellent correlation between a positive amniotic fluid culture and endometritis after cesarean section.

Adult↗
PubMed1975

The blood group I and i antigens of amniotic fluid. I. Association of I and i antigens with blood group A, B and H antigens.

Human amniotic fluid has been shown to contain blood group i as well as I antigens. Crude extracts of amniotic fluids at 16-23 weeks of gestation were in general more active than those obtained at term. A pool of amniotic fluids which had A, B, H as well as I and i activity was fractionated with an insolubilized anti-I (Group 3 type) immunoadsorbent column. There was evidence for the occurrence of I and i determinants on macromolecules carrying A, B and H determinants, for the fraction specifically retained by the column was enriched by 50-60-fold in I and i activity and by at least 10-fold in A, B and H activity. In the fraction not retained by the column there remained the bulk of the A, B, H activity in addition to I activity of Group I type which is known to be distinct from the Group 3 determinant. With the aid of specific immunochemical fractionation procedures, human amniotic fluid should prove useful in structural studies of the several I and i determinants and of their relationship to other blood group determinants.

ABO Blood-Group System↗
PubMed2004

Vascular endothelial growth factor activation of intramembranous absorption: a critical pathway for amniotic fluid volume regulation.

OBJECTIVE: The purpose of this review is to propose a critical role for vascular endothelial growth factor (VEGF) in mediating the transfer of amniotic fluid from the amniotic compartment through the fetal membranes and fetal surface of the placenta into fetal blood. METHODS: Experimental findings in humans and animal models on the action of VEGF in mediating fluid transfer are reviewed and interpreted in order to postulate a proposed mechanism for VEGF regulation of amniotic fluid absorption through the fetal membranes and placenta. RESULTS: Recent scientific advances suggest that up-regulation of VEGF gene expression in the amnion and chorion is associated with increased transfer of amniotic fluid into fetal blood. The possible mechanisms of action for VEGF appear to involve regulation of intramembranous blood vessel proliferation and membrane transport via passive permeation as well as nonpassive transcytotic vesicular movement of fluid. CONCLUSION: Currently evolving concepts suggest that amniotic fluid volume is regulated through modulation of the rate of intramembranous absorption of amniotic fluid by both passive and nonpassive mechanisms. The permeability factor VEGF appears to be a critical regulator of amniotic fluid transport in the fetal membranes.

Absorption↗
PubMedDate not supplied

Intrapartum amniotic fluid index and two-diameter pocket are poor predictors of adverse neonatal outcome.

OBJECTIVE: The objective of this study was to determine whether amniotic fluid index < or = 5.0 cm or two-diameter pocket volume < or = 15 cm2 is a predictor of abdominal delivery because of fetal distress or of Apgar score < 7 at 1 or 5 minutes. STUDY DESIGN: The study was prospective and involved 209 parturients in early labor who had ultrasonographic assessment of amniotic fluid volume by both methods. RESULTS: The incidences of cesarean delivery because of fetal distress and of Apgar scores < 7 at 1 and 5 minutes were 8.1%, 9.0%, and 1.9%, respectively. Only Apgar scores < 7 at 1 minute were significantly higher among patients with a two-diameter pocket < 15 cm2 (16/114) as compared with > 15(2) (3/95, p = 0.007). Oligohydramnios by either method was a poor predictor of adverse outcomes (p values ranging from 0.06 to 0.21). Receiver-operating characteristic curves generated for the amniotic fluid index or two-diameter pocket to predict abdominal delivery because of fetal distress or Apgar scores < 7 at 1 minute indicate that both methods are poor diagnostic tests to predict these complications. CONCLUSION: Intrapartum assessment of amniotic fluid volume, by amniotic fluid index or the two-diameter pocket technique, is a poor predictor of adverse neonatal outcome.

Amniotic Fluid↗