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PubMed1975

[Oestrogens and cortisol in amniotic fluid of normal and complicated pregnancies (author's transl)].

Amniotic fluid of normal pregnancies and of pregnancies complicated with light to moderate EPH-toxaemias was investigated for oestrogens. No differences were found between normal and toxaemic pregnancies. Oestrogens increased significantly with proceeding gestational age. When amniotic fluid of normal pregnancies was analyzed for oestrogens and cortisol a significant correlation between the two hormones could be demonstrated. This is interpreted as an expression of the metabolic activity of the fetal adrenal cortex.

Adrenal Cortex↗
PubMed1989

[Determination of fetal pulmonary maturity using gas chromatographic analysis of fatty acids in the amniotic fluid. Statistic reliability of the method].

Assessment of foetal lung maturity by gas chromatographic analysis of the fatty acids in the amniotic fluid. Statistical reliability of the technique. Gas-chromatographic analysis of the fatty acids (Palmitis acid/Steric acid ratio: P/S ratio) was carried out in 432 samples of amniotic fluid obtained between the 28th and 42th weeks of gestational age. The present results from a series of normal (257) and various pathological (175) cases support the conclusions of other investigations that an amniotic fluid P/S ratio equal to or greater than 5 is a reliable indicator of attained fetal lung maturity. When correlated with gestational age the P/S ratios show regression lines that define the range of lung maturity in normal pregnancies between 32 and 33 weeks and in pathological cases around and over 36 weeks. Statistical studies stress that centrifugation in standard sample conditions before its gas chromatographic analysis is an essential step in order to avoid the serious consequences of an erroneous prediction. Finally Lecithin/Sphingomyelin (L/S) and P/S ratios were assessed in the same 100 samples of amniotic fluid: statistical analysis shows a very good correlation between the two methods and their reliability in the prediction of fetal lung maturity.

Amniotic Fluid↗
PubMed1980

The origin of plasma proteins in human amniotic fluid: the significance of alpha 1-antichymotrypsin complexes.

12 proteins were studied in serum and amniotic fluid from 20 women in late pregnancy by two-dimensional immunoelectrophoresis. A close inverse relationship was observed between the amniotic fluid/serum concentration ratios of 11 proteins and their Stokes radii. These proteins enter the liquor from the maternal blood by molecular filtration. The concentration of alpha 1-antichymotrypsin in amniotic fluid was often higher than expected and the protein was often partially complexed. alpha 1-Antichymotrypsin is probably not actively secreted into amniotic fluid but may be selectively retained after complexing.

Amniotic Fluid↗
PubMed2006

Prenatal diagnosis of some metabolic diseases using early amniotic fluid samples: report of a 15 years, experience.

BACKGROUND: In the present study, we report the results of 132 prenatal diagnoses performed on chorionic villi and cell-free amniotic fluid obtained simultaneously at 12-13 weeks of gestation. In addition, we report the result of 59 prenatal diagnoses performed at 12-13th week using amniotic fluid only. METHODS AND RESULTS: A total of one fetal loss (1/191) was observed when a sample of amniotic fluid was obtained at around 12-13 weeks, whereas three losses (3/82) were observed after midtrimester amniocentesis. We attribute this finding to the fact that only a very small volume of amniotic fluid was sampled using a very small needle. CONCLUSION: From these data it appears that when a couple is facing a high risk of recurrence of some metabolic diseases, the study of chorionic villus and amniotic fluid sampled simultaneously offers a safe and reliable method of early prenatal diagnosis.

Abortion, Spontaneous↗
PubMed1995

Outcome of amniotic fluid analysis and neonatal respiratory status in diabetic and nondiabetic pregnancies.

OBJECTIVE: To evaluate the likelihood of mature or immature amniotic fluid analysis and subsequent presence or absence of neonatal pulmonary disease in a large population of diabetic and nondiabetic pregnancies. STUDY DESIGN: Six hundred sixty-eight pregnancies that delivered within seven days of phosphatidylglycerol (PG) and lecithin/sphingomyelin ratio (L/S) testing were analyzed. (PG testing was by Amniostat-FLM and L/S testing by a modified Gluck technique.) Neonatal respiratory outcome and amniocentesis results were stratified by maternal diabetes status and gestational age for comparison. We determined the likelihood of finding correctly mature and correctly immature amniotic fluid analysis for each gestational age category. RESULTS: We found high rates of incorrectly immature results for PG (53%) and L/S (21%) preterm and for PG at term (20%). Diabetic and nondiabetic pregnancies did not differ. CONCLUSION: Population-based information on the a priori chances of amniotic fluid and neonatal pulmonary outcome in diabetic and nondiabetic pregnancies is given for use in determining the utility of amniotic fluid analysis in individual clinical settings.

Amniotic Fluid↗
PubMed2002

Amniotic fluid index in low-risk pregnancy as an admission test to the labor ward.

BACKGROUND: Oligohydramnios has been shown to be a predictor of intrapartal fetal distress. In a selected group of low-risk pregnancies, however, it has not yet been established that oligohydramnios contributes to intrapartal fetal distress. METHODS: Ultrasonically estimated four-quadrant amniotic fluid index as a test for admission to the labor ward was evaluated as a predictive factor for fetal distress during labor in a prospective "blind" study comprising 600 low-risk pregnancies. Oligohydramnios was defined as an amniotic fluid index < or = 50 mm. The parturients were divided into two groups according to the status of the fetal membranes. The amniotic fluid index results were correlated to fetal outcome: Apgar score at 1 and 5 min, pH of blood in umbilical artery and vein, operative delivery because of fetal distress, cesarean delivery because of fetal distress, and number of babies referred to the neonatal intensive care unit. RESULTS: Two-hundred and sixty-seven women had ruptured membranes. Among these a significant increase in operative delivery because of fetal distress was seen in cases of oligohydramnios compared with the normal amount of amniotic fluid (odds ratio 3.86, confidence interval = 1.25-11.9). No significant differences were seen regarding other variables of perinatal outcome. The group with intact membranes comprised 333 parturients. Among these, no significant differences in perinatal outcome could be seen in relationship to the amniotic fluid index, although a 50% increase in emergency operations for fetal distress was seen in women with oligohydramnios. A significant correlation might have been evident even in that group if a larger sample had been studied. CONCLUSION: The results indicate that measurement of the amniotic fluid index in low-risk pregnant women admitted for labor might identify parturients with an increased risk of intrapartal fetal distress.

Amniotic Fluid↗
PubMed1996

Amniotic fluid index and perinatal morbidity.

Our purpose was: (1) to determine whether assessment of amniotic fluid index in high risk patients with a reactive nonstress test (NST) allowed improved recognition of the fetus at risk for perinatal morbidity than a reactive NST alone; and (2) to determine the optimal low amniotic fluid index (AFI) which should prompt clinical concern. The last NST performed within a week of delivery and amniotic fluid index were retro-spectively compared with various indices of perinatal morbidity. In fetuses with a reactive NST, decreasing AFI was directly correlated with a risk of 5-minute Apgar score of less than 7 and delivery for fetal distress. When various subgroupings of AFI were compared, 7 cm or greater appeared to have a better inverse correlation with the indices of morbidity than lower cut-off values. The addition of AFI assessment to the standard NST allows better prediction of perinatal morbidity than the NSTs alone. Seven centimeters appears to be a reasonable cut-off for clinical concern.

Amniotic Fluid↗
PubMed1990

Glucose and insulin concentration in amniotic fluid and in maternal blood in early and in late pregnancy.

Glucose concentration in the amniotic fluid decreases towards the end of gestation, whereas the insulin concentration increases. The ratio between fetal (amniotic fluid) glucose to maternal glucose is reduced by about 50% at the end of pregnancy, whereas the ratio of C peptide is increased four times. The higher glucose concentration in amniotic fluid in early pregnancy could be explained by a lower fetal metabolic rate in the early stage of development and a low insulin activity of the fetus.

Adult↗
PubMed1984

Decidual, amniotic fluid, maternal and fetal prolactin in normal and abnormal pregnancies.

In the present studies, the content and the in vitro production of prolactin by decidua as well as the concentrations of prolactin in amniotic fluid, maternal and fetal serum in normal term pregnancies, induced abortions at various gestational ages, and in pregnancies complicated by diabetes mellitus, preeclampsia, chronic hypertension, and polyhydramnios were measured. Maternal and fetal prolactin levels varied considerably throughout gestation, but at term did not differ significantly between normal and abnormal pregnancies. Prolactin levels in amniotic fluid as well as decidual prolactin content and production were significantly lower only in pregnancies complicated by either hypertension or polyhydramnios. In both normal and abnormal pregnancies, decidual prolactin production correlated strongly with amniotic fluid concentrations. The present data suggest that 1) maternal and fetal prolactin levels do not differ significantly between normal and abnormal pregnancies, 2) the decidua is the principal source of amniotic fluid prolactin, and 3) the significantly lower levels of prolactin in amniotic fluid of pregnancies complicated by hypertension or polyhydramnios are probably due to adverse effects of these conditions on the synthesis and release of prolactin by decidua.

Amniotic Fluid↗
PubMed1997

Prenatal diagnosis of congenital toxoplasmosis: comparative value of fetal blood and amniotic fluid using serological techniques and cultures.

The prenatal diagnosis of congenital toxoplasmosis is mainly based on biological tests performed on fetal blood and amniotic fluid. We studied the performance of neonatal diagnosis procedures and the results of fetal blood and amniotic fluid analysis. Of 127 women who contracted toxoplasmosis and underwent prenatal diagnosis, the postnatal serological follow-up was long enough to definitively diagnose congenital toxoplasmosis in 19 cases and to exclude it in 27 cases. Prenatal diagnosis allowed the detection of 94.7 per cent (18/19) of the infected fetuses. The sensitivities of tests in amniotic fluid and fetal blood were equivalent, 88.2 per cent (15/17) and 87.5 per cent (14/16), respectively. In fetal blood, biological techniques were positive in 12/16 cases and in 2/16 cases, serological tests were the only positive sign. The specificities of tests in amniotic fluid and fetal blood were respectively 100 per cent (23/23) and 86.3 per cent (19/22) (three false-positive serological results). These results, added to the lower morbidity of amniocentesis compared with cordocentesis, might lead to cordocentesis being abandoned in the prenatal diagnosis of congenital toxoplasmosis.

Amniocentesis↗
PubMed1996

Blood contamination of amniotic fluid after amniocentesis in relation to placental location.

The aim of the present study was to evaluate blood contamination of the amniotic fluid collected in 20 patients undergoing a second amniocentesis performed 2 weeks after a first procedure that had failed due to Pseudomonas aeruginosa contamination of the cell cultures. Red blood cell and haemoglobin concentrations in the amniotic fluid were significantly higher in patients who had undergone a transplacental procedure compared with patients in whom the placenta was not traversed with the needle. For both groups, blood contamination of the amniotic fluid was significantly higher compared with a control group of 20 patients undergoing amniocentesis for the first time. Significant blood contamination of the amniotic fluid after amniocentesis occurs in every instance if evaluated at a "second-look' procedure; the blood contamination is higher when an anterior placenta is traversed with the needle. The clinical significance of these findings needs to be further evaluated.

Adult↗
PubMed1987

[Correlation between disaturated phosphatidylcholine in amniotic fluid and fetal lung maturation].

The concentrations of disaturated phosphatidylcholine (DSPC), the major component of pulmonary surfactant, were quantified on 528 amniotic fluid samples, which did not show the contamination of blood or meconium and were uncomplicated by polyhydramnios or severe congenital anomalies incompatible with life. 396 samples of amniotic fluid (29 RDS cases) obtained 72 hours before delivery were used to evaluate the reliability of DSPC as a specific indicator in pedicting fetal lung maturation. DSPCs were determined according to the method described by Mason et al. and lecithin/sphingomyelin (L/S) ratios were measured by using two dimensional thin-layer chromatography. The critical points of DSPC and L/S ratio were defined as 1.0mg/dl, 2.0 respectively. The results are as follows. There was a gradual increase in DSPC levels of amniotic fluid with increasing maturity until 35 weeks of gestational age and a rapid rise from 36 weeks to term. About 70% of the amniotic fluids having a significantly higher DSPC level greater than or equal to 5.0mg/dl within 35 weeks of gestation were found to be obtained from pregnant women whose pregnancy was complicated by PROM, threatened premature labor or cervical incompetency and who eventually underwent preterm labor. Out of 58 samples, in which DSPC and the L/S ratio were measured simultaneously, two markers agreed in 47 cases in an immature or a mature value for predicting fetal lung maturation. RDS was correctly predicted in 27 of 60 cases (false negative, 55.0%) with DSPC levels less than 1.0mg/dl. When DSPC levels were 1.0mg/dl or more, there were only two of 336 (0.6%), false positives.(ABSTRACT TRUNCATED AT 250 WORDS)

Amniotic Fluid↗
PubMed1996

Amniotic fluid alpha-fetoprotein determination at the time of genetic amniocentesis: has it outlived its usefulness?

The purpose of this retrospective study was to evaluate the utility of routine measurement of amniotic fluid alpha-fetoprotein levels at the time of second trimester genetic amniocentesis (mean gestational age, 17.3 weeks +/- 2.5 weeks standard deviation; median, 16.8 weeks; range, 15 to 22 weeks). During the study period 7174 patients underwent second trimester genetic amniocentesis. Outcome data were available in all cases. In 79 (1.1%) cases the amniotic fluid alpha-fetoprotein level was > or = 2.0 multiples of the median. Thirty-three of the 79 (42%) patients had normal ultrasonograms, and in 31 of 33 (94%) the amniotic fluid alpha-fetoprotein level was between 2.0 and 3.0 multiples of the median. Forty-six of the 79 (58%) patients had abnormal ultrasonographic findings, and of these, 82% were neural tube defects, abdominal wall defects, or cystic hygromas. Acetylcholinesterase was positive in 37 cases, all of which had abnormal ultrasonographic findings. None of the fetuses with negative findings on sonographic screening had detectable abnormalities at birth. In this study, with over 7000 patients, amniotic fluid alpha-fetoprotein and acetylcholinesterase levels did not increase the detection of fetal abnormalities. On the basis of these results, routine measurement of amniotic fluid alpha-fetoprotein level at the time of routine genetic amniocentesis (15 to 22 weeks) does not appear justified.

Abdominal Muscles↗
PubMed1983

Isolation of amniotic fluid erythrocytes and their possible use in prenatal diagnosis.

Many of the components of amniotic fluid have been found to be valuable in prenatal diagnosis; however, the presence of erythrocytes is usually considered undesirable. The authors have used buoyant density centrifugation on 96 amniotic fluid specimens from 70 subjects to isolate small numbers of erythrocytes from a majority of these specimens. Through immunofluorescence, these specimens were found to have higher levels of fetal hemoglobin-containing cells than the adult, indicating that the erythrocytes were at least in part fetal in origin. Thus, erythrocytes present in amniotic fluid could also be used in prenatal diagnosis.

Amniocentesis↗
PubMed2001

Amniotic fluid infection, cytokines, and adverse outcome among infants at 34 weeks' gestation or less.

OBJECTIVE: We examined the hypothesis that amniotic fluid (AF) infection and elevated cytokine concentrations may cause neonatal injury beyond that expected solely from prematurity. METHODS: The effects of exposure to AF infection and elevated cytokine concentrations were measured in 151 infants born to afebrile women in preterm labor with intact membranes at less than or equal to 34 weeks' gestation. Amniotic fluid was collected by amniocentesis for culture and determination of tumor necrosis factor-alpha and interleukin-6. Cytokine concentrations, stratified by AF infection, were compared for three gestational age groups. We then examined the associations between a positive AF culture or elevated AF tumor necrosis factor-alpha concentration and adverse neonatal outcomes, adjusted for birth weight. RESULTS: Amniotic fluid from 45 (30%) of 151 pregnancies had microorganisms, an elevated tumor necrosis factor-alpha concentration, or both. Amniotic fluid cytokine concentrations were significantly higher among women in preterm labor at less than or equal to 30 weeks, compared with 31-34 weeks. Nine of 11 infants who died at less than or equal to 24 hours of age had AF infection or elevated AF tumor necrosis factor-alpha. For the 140 surviving infants, AF infection and/or an elevated AF tumor necrosis factor-alpha was associated with respiratory distress syndrome (adjusted odds ratio [OR] 1.7), grade 3-4 intraventricular hemorrhage (adjusted OR 2.2), necrotizing enterocolitis (adjusted OR 1.8), and multiple organ dysfunction (adjusted OR 3.0). CONCLUSION: Among infants born at less than or equal to 34 weeks to women who have intact membranes and are initially afebrile, those exposed to AF bacteria or cytokines have more adverse neonatal outcomes than unexposed infants of similar birth weight.

Adolescent↗
PubMed1976

Amniotic fluid bilirubin and creatinine concentrations in Nigerian pregnant women.

Amniotic fluid bilirubin and creatinine levels were determined in 143 pregnant patients of known maturity. The bilirubin values did not bear any significant relationship with the gestational age. The creatinine levels however, showed a rise as pregnancy progressed. Amiotic fluid mean creatinine values were below 1 mg/100 ml before 30 weeks and around 2 mg/100 ml close to term. Eighty per cent of all creatinine values at 37 weeks gestation and over were 1.6 mg/100 ml or more. The mean level of creatinine in amniotic fluid correlated with gestational age. This test can therefore be applied antenatally along with other clinical data to distinguish between the premature and mature infants.

Amniotic Fluid↗
PubMed1992

Origin of macrophage colony-stimulating factor (M-CSF) and granulocyte colony-stimulating factor (G-CSF) in amniotic fluid.

A large amount of M-CSF and G-CSF exists in human amniotic fluid and both are considered to have some physiological affect on maintaining pregnancy. We therefore examined the source of M-CSF and G-CSF found in the amniotic fluid. The average level of M-CSF in the amniotic fluid of patients without complications was 17.3 +/- 8.5 ng/ml and that of G-CSF 1.85 +/- 1.72 ng/ml, both being high values. In neonatal urine, the average level of M-CSF was also very high, 144.3 +/- 97.0 ng/ml, but that of G-CSF was below the determination limit of 60 pg/ml. Immunohistochemical staining indicated that production of M-CSF and G-CSF was localized in the epithelial cells of fetal membrane. On the basis of the above observations, M-CSF was found to derive from neonatal urine and the epithelial cells of fetal membrane, and G-CSF from the epithelial cells of fetal membrane.

Amniotic Fluid↗
PubMed1989

Amniotic fluid concentrations of prostaglandin F2 alpha, 13,14-dihydro-15-keto-prostaglandin F2 alpha (PGFM) and 11-deoxy-13,14-dihydro-15-keto-11, 16-cyclo-prostaglandin E2 (PGEM-LL) in preterm labor.

Although prostaglandins (PGs) are considered the key mediators of human parturition at term, there is a paucity of data regarding their participation in the mechanisms responsible for preterm labor. The purpose of this study was to establish if preterm labor is associated with changes in the amniotic fluid concentrations of prostaglandins. PGF2 alpha, 13,14-dihydro-15-keto-prostaglandin F2 alpha (PGFM) and 11-deoxy-13,14-dihydro-15-keto-11,16-cyclo-prostaglandin E2 (PGEM-ll) were measured by using specific and sensitive radioimmunoassays. Amniotic fluid was retrieved by transabdominal amniocentesis from 55 women with preterm labor and intact membranes. Patients were divided into three groups according to the response to tocolysis and the presence or absence of an intra-amniotic infection. Amniotic fluid concentrations of PGFM and PGEM-ll were significantly greater in women with preterm labor and intra-amniotic infection than in women without infection. In addition, patients unresponsive to tocolysis without intra-amniotic infection also had a significantly greater concentration of PGFM and PGEM-ll in amniotic fluid than those responsive to tocolysis. Amniotic fluid concentrations of PGF2 alpha were greater in women with intra-amniotic infection than in women without intra-amniotic infection. In the absence of intra-amniotic infection, no difference in amniotic fluid PGF2 alpha concentrations could be found between women who responded to tocolytic treatment and those who did not.

Amnion↗