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PubMed2003

Microbial invasion and cytokine response in amniotic fluid in a Swedish population of women with preterm prelabor rupture of membranes.

BACKGROUND: Previous studies have shown an association between intra-amniotic microbial invasion and/or inflammation and spontaneous preterm birth. The aim of this study was to investigate the occurrence of intra-amniotic microorganisms and cytokines [interleukin (IL)-6 and IL-8] in a Swedish population, with low incidence of preterm birth, of women with preterm prelabor rupture of membranes and their correlation to preterm birth. METHODS: Amniotic fluid was retrieved transabdominally from 58 patients with preterm prelabor rupture of membranes before 34 weeks of gestation. Polymerase chain reaction (PCR) analyses for Ureaplasma urealyticum and Mycoplasma hominis and culture for aerobic and anaerobic bacteria were performed. IL-6 and IL-8 were analyzed with enzyme-linked immunosorbent assay (ELISA). RESULTS: Microorganisms in amniotic fluid were detected in 13 patients (25%). Patients with bacteria detected in the amniotic fluid had significantly higher levels of IL-6 and IL-8. An amniotic fluid concentration of IL-6 >/= 0.80 ng/ml [relative risk 1.93, 95% confidence interval (CI) 1.13-3.29, sensitivity 63%, specificity 75%] was associated with an increased risk of delivery within 7 days. There was also an association between IL-8 and preterm birth (< 34 weeks). CONCLUSIONS: Intra-amniotic microbial invasion and inflammation in this population of Swedish women with preterm prelabor rupture of membranes were similar to data reported from populations with a higher incidence of preterm delivery. Amniotic IL-6 correlated to the presence of microorganisms and delivery within 7 days and IL-8 to delivery before 34 weeks.

Adult↗
PubMed1998

Effects of gestational age, maternal diabetes, and intrauterine growth retardation on markers of fetal bone turnover in amniotic fluid.

Little is known about the dynamics of bone formation and bone resorption in utero, particularly the normal changes that occur throughout gestation and in clinical situations that result in low bone mass at birth. The objectives of this study were to describe the effects of gestational age on markers of fetal bone turnover, and to investigate whether the reported low bone mass at birth in small-for-gestational-age (SGA) infants and infants of diabetic mothers (IDMs) was associated with biochemical markers of decreased bone formation or increased bone resorption in utero. Bone formation and resorption were assessed by measurement of carboxyterminal propeptide of type I procollagen (PICP) and cross-linked carboxyterminal telopeptide of type I collagen (ICTP), respectively, in 201 amniotic fluid samples. These markers are by-products of type I collagen formation and degradation, respectively, and have been used in the assessment of bone metabolism ex utero. Both PICP and ICTP concentrations in amniotic fluid were inversely associated with gestational age (P < 0.0001). Amniotic fluid concentrations of PICP increased exponentially in relation to infant birthweight (P = 0.008), and SGA infants had lower amniotic fluid PICP concentrations than controls (P = 0.07). The presence of diabetes in the mother was not associated with alterations in amniotic fluid PICP or ICTP concentrations. Although maturational effects on clearance of bone markers from amniotic fluid cannot be excluded, these data are consistent with a high turnover of bone matrix early in fetal life, and a reduction in bone formation when fetal growth is compromised.

Adolescent↗
PubMed1996

[Ultrasonographic density of amniotic fluid and its correlation with fetal pulmonary maturity].

In order to determine if the amniotic fluid density is correlated with fetal lung maturity, we carried out a prospective study in the Hospital de Gineco-Obstetricia del Centro Médico León del Instituto Mexicano del Seguro Social. One hundred and forty one patients with pregnancies between 13 and 41 gestation weeks were included. The amniotic fluid density was calculated by counting the level of echoes (free-floating particles) in the amniotic fluid. We found a significant correlation (P < 0.05) between the level of echoes and the gestation age, nevertheless, the correlation coefficient was very low (R = 0.28), therefore we concluded that this procedure is not a reliable predictor of fetal lung maturity.

Adolescent↗
PubMed2004

Maternal serum and amniotic fluid levels of macrophage inhibitory cytokine 1 in Down syndrome and chromosomally normal pregnancies.

OBJECTIVES: To measure maternal serum and amniotic fluid levels of macrophage inhibitory cytokine-1 (MIC-1) in Down syndrome and normal pregnancies, assessing the utility of MIC-1 as a prenatal marker of Down syndrome. METHODS: Stored serum from 64 Down syndrome and 399 control pregnancies, collected at 8 to 17 weeks of pregnancy, and stored amniotic fluid from 17 Down syndrome and 53 controls, collected at 15 to 19 weeks of pregnancy, were retrieved for analysis. MIC-1 was measured using an established in-house ELISA, blinded to sample type. RESULTS: In maternal serum, MIC-1 levels are not altered in Down syndrome in either the first or second trimester. Levels, expressed as median (95% CI) multiples of the median (MoM), in the Down syndrome cases and controls were 1.07 (0.9-1.1) MoM and 1.0 (0.95-1.03) MoM respectively. In amniotic fluid, MIC-1 levels were significantly decreased compared to controls, 0.52 (0.44-0.64) MoM versus 1.0 (0.85-1.08) MoM (p < 0.0001). CONCLUSION: MIC-1 is decreased in amniotic fluid but not in maternal serum in Down syndrome pregnancies. MIC-1 will not be useful as a prenatal marker of Down syndrome.

Amniotic Fluid↗
PubMed2002

Heparin-binding EGF-like growth factor is present in human amniotic fluid and breast milk.

BACKGROUND/PURPOSE: Heparin-binding EGF-like growth factor (HB-EGF) is a member of the epidermal growth factor (EGF) family that has been implicated in the healing of various organ injuries. Endogenous HB-EGF production is upregulated in response to injury to the kidney, liver, brain, skin, and intestine. Exogenous administration of HB-EGF protects against intestinal epithelial cell apoptosis and necrosis and intestinal ischemia/reperfusion (I/R) injury. This study examines the presence of endogenous HB-EGF in human amniotic fluid and breast milk, fluids that are in intimate contact with the developing and neonatal gastrointestinal tract. METHODS: Breast milk samples were collected from lactating women and amniotic fluid was gathered from full-term uteri (cesarian sections) or preterm uteri (amniocentesis). Crude and partially purified breast milk and amniotic fluid samples were analyzed for HB-EGF levels using an HB-EGF-specific enzyme-linked immunosorbent assay (ELISA). RESULTS: Analysis results showed detectable HB-EGF levels in human amniotic fluid and breast milk, ranging from 0.2 to 230 pg/mL. Breast milk and amniotic fluid subjected to heparin affinity or HB-EGF-affinity column chromatography showed bioactivity eluting at positions consistent with those known for native HB-EGF. CONCLUSIONS: This study represents the first report of detectable HB-EGF in human amniotic fluid and breast milk. The presence of HB-EGF in these fluids may serve a role in the development of the gastrointestinal tract in utero, and in protection against gut mucosal injury after birth.

Amniotic Fluid↗
PubMed1993

Deviation in amniotic fluid optical density at a wavelength of 450 nm in Rh-immunized pregnancies from 14 to 40 weeks' gestation: a proposal for clinical management.

OBJECTIVES: Our purpose was to study deviations in values of amniotic fluid optical density at 450 nm in Rh-immunized pregnancies in the second and third trimesters and to propose a clinical management plan. STUDY DESIGN: A total of 789 amniotic fluid single and serial values of deviations in optical density at 450 nm were performed on Rh-immunized pregnancies from 14 to 40 weeks' gestation. The relationship of the deviations in amniotic fluid values of optical density at 450 nm to varying degrees of fetal disease were examined. RESULTS: In Rh-negative fetuses (unaffected) amniotic fluid values rise until 22 to 26 weeks before decreasing to term. In fetuses at risk of dying in utero, values are higher and trends rise. A clinical management plan was devised on the basis of the amniotic fluid findings of deviations in optical density at 450 nm. CONCLUSIONS: A clinical management scheme consisting of four zones is outlined. Rh-negative fetuses have minimal invasive procedures. Fetuses at risk of death undergo early cordocentesis for evaluation and therapy. Values that fall in between can be separated into two zones on the basis of the degree of risk.

Amniotic Fluid↗
PubMed1981

Prenatal assessment of fetal outcome by amniotic fluid C-peptide levels in pregnant diabetic women.

Amniotic fluid C-peptide (AFCP), insulin, and glucose levels were measured in 33 diabetic and 126 nondiabetic pregnant women at greater than or equal to 36 weeks' gestation. Levels of AFCP distinguished diabetic from nondiabetic patients more reliably than amniotic fluid (AF) insulin or glucose. Levels of AFCP in diabetic patients correlated well with infant birth weight adjusted for gestational age (large for gestational age greater than adequate for gestational age), degree of diabetic control (fair to poor control greater than good control), or diabetogenic infant morbidity, but did not correlate with classes of diabetes within the limits of the population studied. We conclude that AFCP is a useful prognostic index for predicting fetal outcome in diabetic pregnancies. A level of AFCP of greater than or equal to 1.0 pmoles/ml is associated with an increased risk of macrosomia in infants of diabetic mothers.

Adult↗
PubMed1991

Relation between the birthweight and cord, maternal serum and amniotic fluid growth hormone levels.

Maternal and cord serum and amniotic fluid growth hormone (GH) levels were measured in 55 term pregnancies in order to evaluate the role of GH in prenatal fetal somatic growth. The study group consisted of patients who had small, large, and average for gestational age infants. The difference in mean maternal and cord serum and amniotic fluid GH levels between the three weight groups were found to be insignificant. It is concluded that GH does not influence fetal somatic growth.

Adolescent↗
PubMed1988

[Critical evaluation of various methods of determining markers of fetal maturity in amniotic fluid].

11 methods for investigation of fetal lung maturity, fetal skin maturity and common maturity signs were described. All investigations have been carried out on the base of 61 amniotic fluid samples. A certain declaration of fetal lung maturity is possible by: 1. The absorbance of native amniotic fluid at 650 nm 2. Shake-test (Clements) 3. Average quantities of the keratinocytes of the amniotic fluid cell population. Good results, a small amniotic fluid quantity and a simple procedure characterise these methods. They are usefull in clinical practice.

Amniotic Fluid↗
PubMed1995

Relaxin levels in amniotic fluid, extraembryonic coelomic fluid and maternal serum in early human pregnancy.

Separately identified samples of amniotic fluid and extraembryonic coelomic fluid together with maternal serum were collected from 22 women between 8 and 11 weeks of pregnancy and analysed for relaxin by immunoassay. Relaxin levels in maternal serum (median 1085 pg/ml; range 390-1259 pg/ml) were substantially higher than those in extraembryonic coelomic fluid (median 57.5 pg/ml; range 17-145 pg/ml; P < 0.0001; Mann-Whitney U-test). In turn, the levels of relaxin in coelomic fluid were higher than those in amniotic fluid (median 10 pg/ml; range 10-37 pg/ml; P < 0.0001; Mann-Whitney U-test). A linear correlation was found between relaxin levels in maternal serum and coelomic fluid (r = 0.68; P = 0.001) but there was no relation between levels in the other fluid compartments.

Amniotic Fluid↗
PubMed1990

The ferning test for detection of amniotic fluid contamination in umbilical blood samples.

There is currently no standard means of detecting amniotic fluid contamination in fetal blood obtained by percutaneous umbilical blood sampling. The ferning test is proposed for this purpose. An in vitro model, using centrifuged serial dilutions of neonatal cord blood and amniotic fluid, showed that ferning of the supernatant occurs in proportion to the degree of contamination. A system for grading ferning was devised, and tested in a blind trial. For the detection of amniotic fluid contamination of 10% or more, the method showed a sensitivity of 98% and a specificity of 81%. The method may be useful in percutaneous umbilical blood sampling, and in the diagnosis of spontaneous rupture of membranes with vaginal bleeding.

Amniotic Fluid↗
PubMed1987

Neuron specific enolase in amniotic fluid--a possible indicator for fetal distress and brain implication.

It can be suggested that a NSE concentration in body fluids above the normal range may indicate brain damage, because NSE is found in neurons and neuroendocrine cells only. In this paper the concentration of the neuron specific enolase (NSE) in the amniotic fluid of normal and high risk pregnancies was investigated. Sixty-three samples of amniotic fluid were collected from 55 pregnant women and women in labor between the 19th and the 42nd gestational week. In 24 normal pregnancies 1.02 +/- 0.31 microgram NSE/L (mean +/- SD) were found. A relationship of NSE concentration was not found for gestational age, uterine contractions, age and parity of the mother, infant's birth weight or 1 min Apgar score. Maternal diseases such as diabetes mellitus, hypertension and others do not result in any increase of NSE concentration in the amniotic fluid (N = 20; 1.06 +/- 0.24 microgram NSE/L). Fetal and birth related high risk factors such as meconium stained amniotic fluid, cord around the neck, severe decelerations of the fetal heart rate or combinations of these factors caused the NSE concentration to exceed significantly normal values (N = 17; 2.22 +/- 0.87 microgram NSE/L). Due to its high organ and cell specificity, NSE may be a possible parameter for brain damage due to hypoxia in the fetus and newborn; however, only subsequent neurological and psychological examinations of these children can indicate the prognostic value of an elevation of NSE concentration in amniotic fluid.

Amniotic Fluid↗
PubMed2004

Determination of choline containing phospholipids in serum, bile and amniotic fluids by the derivative enzymatic-spectrophotometric method.

A comparison was performed of the analytical results obtained by applying a well-known enzymatic-spectrophotometric method for the determination of choline containing phospholipids in biological human fluids (sera, bile and amniotic fluids) following the standard procedure method, or else using the first or second derivative methods. In terms of result reproducibility the comparison was extended to include also a biosensor-based method developed in recent years by the present authors. Some advantages are associated with using the first derivative method in the case of serum samples containing blood traces, especially via the 'Gran's plot' method.

Amniotic Fluid↗
PubMed2001

Immunologic studies in presumed amniotic fluid embolism.

OBJECTIVE: To evaluate the potential role of immunologic mechanisms that involve mast cell degranulation (anaphylaxis) or complement activation in the mechanism of amniotic fluid embolism. METHODS: This study was a case series of nine women with presumed amniotic fluid embolism and a control group of 22 women who had normal labor. Women were from community and tertiary referral hospitals in Japan and the United States. Main outcome measures were maternal peripartum complement levels (C3 and C4), serum levels of tryptase, urinary histamine concentrations, and serum levels of a fetal antigen (sialyl Tn). RESULTS: Serum tryptase and urinary histamine measurements were negative in women with amniotic fluid embolism; seven of nine had elevated levels of fetal antigen. All eight who had serum available for testing had abnormally low levels of complement. Mean C3 level of 44.0 mg/dL and C4 level of 10.7 mg/dL were significantly lower than corresponding postpartum control values of 117.3 mg/dL and 29.4 mg/dL (P =.018 for C3, P =.012 for C4). Postpartum C3 and C4 levels decreased by 8% and 5%, respectively, compared with intrapartum values (P =.003 for C3, P =.021 for C4) but were still within normal range. CONCLUSION: Serologic findings suggest a role for complement activation in the mechanism of amniotic fluid embolism. Laboratory data from this series did not implicate mast cell degranulation (anaphylaxis) in the pathophysiology of the disease.

Antigens, Tumor-Associated, Carbohydrate↗
PubMed2003

Are myo-inositol, glucose and zinc concentrations in amniotic fluid of fetuses with spina bifida different from controls?

OBJECTIVE: Associations are reported between myo-inositol, glucose, zinc and the occurrence of spina bifida. To gain more insight into the pathogenesis of spina bifida, the concentrations of myo-inositol, glucose and zinc were determined in amniotic fluids from pregnancies with a spina bifida or unaffected control fetus. METHODS: Amniotic fluids of 27 pregnancies complicated by spina bifida and 49 controls were collected at the Department of Obstetrics and Gynecology of the University Medical Center Nijmegen in the Netherlands. Myo-inositol, glucose and zinc concentrations were determined. By indication, the samples were taken at different gestational ages. Therefore, the data were evaluated using multiple linear regression analysis to adjust for gestational age. RESULTS: Amniocentesis was performed at a more advanced gestational age in the spina bifida group than in controls. In the spina bifida group, amniotic fluid myo-inositol, glucose and zinc concentrations gradually declined throughout pregnancy. At a gestational age of 15 weeks, the estimated mean amniotic fluid glucose and zinc concentrations in the spina bifida group were, respectively, significantly lower (p< or =0.5) and higher (p< or =0.5) compared with the control group. At the same gestational age, the estimated mean myo-inositol concentrations were comparable in both groups. At a gestational age of 38 weeks, the estimated mean myo-inositol, glucose and zinc concentrations were not significantly different in the spina bifida compared with the control group. CONCLUSION: This study may suggest that a derangement in zinc and glucose transfer or metabolism is associated with spina bifida. Since compounds in amniotic fluid are only a very crude marker of the actual fetal condition, studies that focus on the metabolism of these compounds on tissue or even cellular level should be performed to clarify their role in the pathogenesis and future prevention of spina bifida.

Adult↗
PubMed1977

Amniotic fluid neutrophils prior to Cesarean section and intrauterine infection.

Amniotic fluid from 35 patients delivered by cesarean section was examined by Wright's stain. Of the patients in labor and with rupture of the membranes, 32% had more than 1 polymorphonuclear neutrophil per oil field (PMN/OF) while 68% had less than 1 PMN/OF. In both groups, endometritis occurred frequently, and fever indexes were similar. With ruptured membranes prior to cesarean section, observing greater than 1 PMN/OF of amniotic fluid did not discriminate groups at high and low risk for intrauterine infection.

Amniotic Fluid↗
PubMed1983

An enzymic radiochemical method for determining phosphatidylglycerol in amniotic fluid.

We describe an enzymic quantification of phosphatidylglycerol in amniotic fluid. Phosphatidylglycerol is hydrolyzed in alkali and the resulting glycerol is then enzymatically phosphorylated with adenosine 5'-[gamma-32P]triphosphate to yield glycero[32P]phosphate. After removal of excess [gamma-32P]ATP by charcoal, the radioactivity of the glycerophosphate is measured in a liquid scintillation counter. Triglyceride in the amniotic fluid is hydrolyzed by lipase before extraction and thus does not interfere with the analysis. This method is specific for phosphatidylglycerol. Preliminary studies suggest that a phosphatidylglycerol value greater than or equal to 10 nmol/mL correlates with fetal lung maturity.

Amniotic Fluid↗
PubMed1989

[Maternal concentration of serum digoxin and concentration in the amniotic fluid and neonatal serum].

Digoxin was assayed in maternal and neonatal sera and in the amniotic fluid in 14 pregnant patients chronically digitalized for mitral stenosis. Neonatal serum levels of digoxin are linearly correlated with maternal concentrations of the drug, and all are inversely related to maternal creatinine clearance. Amniotic fluid levels of the drug are not related to serum levels, but relate to amniotic fluid creatinine concentration. Fetal serum levels are identical to maternal ones for all practical purposes, but bear no relation to amniotic digoxin concentration. Digoxin was assayed with a commercial kit showing very little cross-reactivity with endogenous digoxin-like cross-reacting compounds. Pitfalls in commercial digoxin assays and clinical implications are discussed.

Amniotic Fluid↗