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PubMed1993

The sensitivity and specificity of subjective and a semi-quantitative technique of amniotic fluid volume assessment in predicting intrapartum morbidity.

The aim of this study was to evaluate the ability of two techniques of amniotic fluid volume assessment to predict intrapartum morbidity in a high-risk population. A total of 213 pregnant women at the Grace Maternity Hospital, Vancouver, Canada were examined ultrasonically and the amniotic fluid volume was assessed subjectively and using the amniotic fluid index. Both techniques showed high specificity and negative predictive values for all outcome measures, but had an associated poor sensitivity and positive predictive value. Both techniques were similar in their ability to identify situations involving intrapartum morbidity. It is concluded that amniotic fluid assessment is a weak predictor of intrapartum morbidity but may be useful in certain conditions such as when the pregnancy is post-dates.

Journal Article↗

PubMed1994

[Determination catecholamines levels in amniotic fluid, maternal and umbilical blood].

Catecholamines (CA) levels of amniotic fluid, maternal and umbilical blood were determined by HPLC. The results showed that epinaphrine (E) and dopamine (DA) levels of pregnancy were significantly different as compared with non-pregnant women (P > 0.05), where as norepinephrine (NE) levels were significantly decreased (P < 0.05). In vaginal delivery, CA levels of pregnant women were significantly higher than those of non and late-pregnant women (P < 0.01). Plasma CA levels of umbilical artery were higher than those of umbilical vein (P < 0.001); NE of CA was 3.3 times, E 4.7 times and DA 2.1 times. NE and E levels of umbilical artery in cesarean section were significantly lower than those of in vaginal delivery. In fetal distress, plasma NE and E levels of umbilical artery were higher significantly than those of the normal fetus. CA levels of amniotic fluid increased with advance of gestational weeks, significantly in fetal distress, even more than the upper limit of 95%. The incidence of newborn asphyxia was about 60.0%.

Amniotic Fluid↗

PubMedDate not supplied

Third-trimester amniotic fluid metal levels associated with preeclampsia.

Studies of maternal amniotic fluid and serum at delivery have revealed the presence of toxic metals or deficiencies of essential metals associated with high-risk pregnancy. Essential and toxic metal levels were studied in 29 preeclamptic and 101 normal pregnancies. The authors grouped the samples according to the following gestation ages: 33-36 wk (48 normal and 10 preeclamptic) and 37-40 wk (53 normal and 19 preeclamptic). The metals studied were calcium, magnesium, zinc, selenium, copper, cadmium, and lead. Comparisons of the 33-36-wk gestation group showed significant differences between normal and preeclamptic amniotic fluid in levels of lead, calcium, magnesium, zinc, and selenium. There were also significant differences in levels of magnesium, copper, zinc, cadmium, and lead during the gestation period of 37-40 wk. The changes observed in calcium and lead levels were consistent with the results of animal studies in which investigators have found depressed calcium transport associated with subacute or chronic lead poisoning, resulting in a physical syndrome similar to preeclampsia.

Amniotic Fluid↗

PubMed1983

Vitamin D metabolites in amniotic fluid.

To provide further data on vitamin D metabolism in pregnancy, the concentrations of 25-hydroxyvitamin D (25OHD; n = 72), 24,25-dihydroxyvitamin D [24,25-(OH)2D; n = 70], and 1,25-(OH)2D (n = 59) were measured in amniotic fluid by competitive protein-binding radioassays. At term, the mean (+/- SE) concentrations of 25OHD and 24,25-(OH)2D in amniotic fluid (810 +/- 76 and 37.5 +/- 5.4 pg/ml, respectively) were significantly lower (P less than 0.01) than those at 16-18 weeks gestation (1707 +/- 2.67 and 149 +/- 3 pg/ml, respectively). Similarly, the concentrations of 25OHD in pooled amniotic fluid samples, as determined by high pressure liquid chromatography and UV absorbance detection at 254 nm, were 664 +/- 188 pg/ml at term and 1240 +/- 294 pg/ml at midgestation. In comparison, no difference could be found between the mean concentrations of 1,25-(OH)2D at term (4.3 +/- 0.8 pg/ml) and those at midgestation (3.3 +/- 0.4 pg/ml). However, in 14 of 39 amniotic fluid samples obtained at term (35.9%), the concentration of 24,25-(OH)2D was undetectable, while the level of 1,25-(OH)2D was increased. The reciprocal relationship between 24,25-(OH)2D and 1,25-(OH)2D found in more than a third of the amniotic fluid samples at term may be due to a regulatory mechanism responding to the increased fetal demand for calcium in the final stages of pregnancy.

25-Hydroxyvitamin D 2↗

PubMed1976

Surface properties of amniotic fluid and fetal lung maturity.

Surface activity of 75 amniotic fluid samples from pregnancies which ended before term or at term with small-for-date newborns was measured in the surface balance. The results were correlated with the clinical symptomatology and the birth weight of the newborn. The surface properties of the lungs of those infants who had died were assessed by the buble stability method (Pattle), by recording of pressure-volume diagram and by measurements of surface activity of lung extracts. The results indicate that gamma-min is the essential parameter in determining the degree of fetal lung maturity. In cases with gamma-min values of amniotic fluid above 27 dyn/cm, a 100% respiratory distress syndrome (RDS) incidence is to be expected; values between 23 and 27 dyn/cm have a 70% values between 17 and 23 dyn/cm have a 30% incidence of RDS and in all cases with values below 17 dyn/cm, RDS may be rules out. When induced delivery before term is considered, this method of determining the degree of fetal lung maturity is, therefore, of significant prognostic reliability.

Amniotic Fluid↗

PubMed1999

Amniotic fluid levels of dimeric inhibins, pro-alpha C inhibin, activin A and follistatin in Down's syndrome.

OBJECTIVE: In the second trimester of pregnancy, inhibin A is significantly increased in maternal serum and decreased in amniotic fluid in Down's syndrome pregnancies compared to normal. We wished to further evaluate the levels of inhibin A, inhibin B, pro-alpha C inhibin, activin A and the binding protein follistatin in amniotic fluid in Down's syndrome and control pregnancies. DESIGN: Case-matched control study. PATIENTS: 29 Down's syndrome and 290 chromosomally normal control pregnancies were identified from records and amniotic fluid, collected at second trimester amniocentesis, retrieved from routine storage for analysis. MEASUREMENTS: Inhibin A, inhibin B, pro-alpha C inhibin, total activin A and follistatin were measured using sensitive and specific enzyme linked immunosorbent assays. RESULTS: The median (10th-90th percentiles) amniotic fluid inhibin A level in the control pregnancies increased from 334 (122-553) ng/l at 14 weeks' to 695 (316-1475) ng/l at 19 weeks' gestation. The corresponding figures for inhibin B and the alpha-subunit precursor inhibin pro-alpha C were 632 (185-1354) and 2062 (1237-3381) ng/l, respectively at 14 weeks' and 2439 (748-5307) and 3115 (2021-6567) ng/l, respectively at 19 weeks' gestation. Total activin A increased from 3795 (1554-5296) at 14 weeks' to 5086 (3059-8224) at 18 weeks' gestation. Expressed as multiples of the median (MoM) the median (95% CI) amniotic fluid levels of inhibin A, inhibin B, pro-alpha C inhibin and acitivin A in the Down's syndrome samples were 0.77 (0.59-0.85), 0.94 (0.63-1.23), 0.77 (0.49-0.84) and 0.77 (0.53-0.87), respectively. Compared to controls the levels of inhibin A, pro-alpha C inhibin and activin A were significantly lower in Down's syndrome pregnancies (P < 0.01, Mann-Whitney U test). Follistatin levels in the controls declined slightly from 2106 (1421-3538) ng/l at 14 weeks' to 1600 (1281-2543) ng/l at 18 weeks' gestation. Levels in the Downs' syndrome pregnancies were similar to controls. CONCLUSIONS: The data suggest that the production, secretion or metabolism of the inhibin alpha- and beta A-subunits is altered in Down's syndrome pregnancies in the second trimester.

Activins↗

PubMed1999

Amniotic fluid concentrations of interleukin-1beta, interleukin-6 and TNF-alpha in chorioamnionitis before 32 weeks of gestation: histological associations and neonatal outcome.

OBJECTIVES: To test the association between cytokine levels in the amniotic fluid and (i) the vascular invasion phase of intrauterine infection, (ii) the occurrence of periventricular leukomalacia; to assess the correlation between C-reactive protein levels, a recognised biological marker of inflammation in maternal serum and cytokine levels in the amniotic fluid. DESIGN: Prospective clinical study. SETTING: Fetal medicine unit and neonatal intensive care unit, Antoine Beclere Hospital, Clamart, France. SAMPLE: Thirty-one pregnancies complicated by chorioamnionitis leading to birth before 32 weeks of gestation. METHODS: Interleukin 1-beta, Interleukin 6 and TNF-alpha prospectively measured in the amniotic fluid. Histological examination of the placenta. Ultrasound examination and magnetic resonance imaging of the brains of the newborn infants performed within the first week of life. MAIN OUTCOME MEASURES: The occurrence of periventricular leukomalacia was assessed by transfontanellar ultrasound and magnetic resonance imaging. RESULTS: There was a significant positive correlation between the occurrence of histological chorioamnionitis, vascular extension of infection of the membranes, maternal inflammatory syndrome and neonatal sepsis. A strong association was found between maternal serum C-reactive protein concentrations and cytokine levels in the amniotic fluid. Interleukin-1beta was the best predictor of vascular extension of chorioamnionitis, and TNF-alpha was the best predictor of the development of severe early neonatal infection. There was no association between the amniotic fluid levels of cytokines and the development of periventricular leukomalacia. CONCLUSIONS: These data suggest that IL-1beta, IL-6 and TNF-alpha are produced in relation to intrauterine inflammation and infection, but cannot be directly implicated in the development of fetal cerebral white matter lesions.

Amniotic Fluid↗

PubMed1976

Bacterial growth inhibition by amniotic fluid. V. Phosphate-to-zinc ratio as a predictor of bacterial growth-inhibitory activity.

Human amniotic fluid has been shown to contain an inorganic bacterial growth-inhibitory component, zinc. The average zinc concentration in amniotic fluid was 0.44 mug per milliliter. The phosphate concentration of amniotic fluid appears to determine the expression of zinc inhibitory activity. The average phosphate concentration was 92 mug per milliliter. For 22 fluid samples tested, a phosphate-to-zinc ratio of 100 or less predicted a bactericidal fluid. A ratio between 100 and 200 predicted a bacteriostatic fluid. A ratio of greater than 200 predicted a noninhibitory fluid. The possible clinical significance of the ratio is discussed.

Amniocentesis↗

PubMed1991

Identification of Treponema pallidum in amniotic fluid and fetal blood from pregnancies complicated by congenital syphilis.

Two pregnant women with secondary syphilis underwent amniocentesis and evaluation for fetal syphilis. In both cases, motile spirochetes, typical of Treponema pallidum, were observed during dark-field microscopic examination of the amniotic fluid. The presence of T pallidum was confirmed by antitreponemal monoclonal antibody immunofluorescence assays and by rabbit infectivity tests using the amniotic fluid. In the first case, an infant at 35 weeks' gestation delivered within 24 hours of amniocentesis had hepatosplenomegaly, osteochondritis, and neurosyphilis. In the second case, a fetus at 24 weeks' gestation was hydropic and a fetal blood sample showed anemia, thrombocytopenia, and elevated liver enzymes. Fetal syphilis was confirmed by rabbit infectivity testing using fetal blood obtained by funipuncture. This is the first report of the diagnosis of fetal syphilis by funipuncture and confirmation of the presence of virulent T pallidum in the blood of a human fetus. The mother was treated for secondary syphilis, but the infant had residual signs of congenital infection at birth 14 weeks later. Neonatal serum from the first case and fetal serum from the second case showed specific immunoglobulin M reactivity with the 47-kd antigen of T pallidum by Western blot assays. A new wild-type strain of T pallidum, designated DAL-1, was isolated from the amniotic fluid of the first case and is available for future studies. We conclude that the presence of T pallidum in amniotic fluid or fetal blood indicates fetal-placental infection. Further investigation is necessary to determine the pathogenesis of amniotic fluid infection and its role in the prenatal diagnosis of congenital syphilis.

Adult↗

PubMed1977

N-Acetyl-beta-hexosaminidase isoenzymes of amniotic fluid and maternal serum. Their relevance to prenatal diagnosis of the GM2 gangliosidoses.

The isoenzymes of N-acetyl-beta-hexosaminidase were quantitated in 30 amniotic fluid and 13 maternal serum samples collected between 11 and 40 weeks of gestation using DEAE-Sephadex A-25 chromatography. Isoenzymes A and B consitituted the major components of most amniotic fluids but seven samples characterized by high N-acetyl-beta-hexosaminidase activities contained high proportion of an isoenzyme apparently identical to isoenzyme P of maternal serum. This passage of maternal serum N-acetyl-beta-hexosaminidase into the amniotic cavity could lead to false negative diagnosis of type B and type O GM2 gangliosidoses if the diagnosis rely solely upon isoenzyme analysis in amniotic fluid. However, the release of maternal enzyme into amniotic fluid seems to be restricted to the third trimester of gestation and should not interfere with prenatal diagnosis of the GM2 gangliosidoses ususally performed at an earlier stage of gestation.

Amniotic Fluid↗

PubMed1991

Evidence that gonadal hormone levels in amniotic fluid are decreased in males born to alcohol users in humans.

Biochemical evaluation of amniotic fluid content is often used to monitor fetal secretory and excretory functions. It is known that alcohol freely passes through the placenta and enters the fetal tissues. The study was designed to investigate whether alcohol use during pregnancy affects amniotic fluid steroid and peptide hormone levels. Five alcohol users who drank between 40 and 45 drinks per month and consumed approximately 1 oz. of alcohol per day from beer drinking participated in the study. Thirteen controls with no history of alcohol use including essential and non-essential drugs were selected for the study. The final selection of participants was made among those who delivered male offsprings. Amniotic fluid was aspirated between 16 and 20 weeks of gestation by amniocentesis and an aliquot was used to assay steroid hormones (4-androstenedione [-4-AD], testosterone [T], estradiol [E2], dehydroepiandrosterone sulfate [DHEA-S]), and peptide hormones (FSH and LH). Birth weights, placental weights and gestation age were recorded at birth. The results showed that -4-AD, T and E2 levels were significantly decreased (P less than 0.01) in alcohol users; DHEA-S, FSH and LH levels were unaffected. Birth weights were significantly decreased (P less than 0.05) in alcohol users, the placental weights and gestation age were not affected. We conclude that alcohol passes through the placenta and affects fetal testes, capacity to synthesize steroids and the effect appears to be direct and not via the hypothalamic-hypophyseal axis.

Adult↗

PubMed1985

Clearance of 3H-dopamine from the amniotic fluid in the rhesus monkey.

Previous studies have suggested that dopamine is the major catecholamine in the amniotic fluid; however, there are few data available concerning the metabolism of this hormone in the amniotic fluid compartment. With the use of acute 3H-dopamine injection studies into the amniotic sac of pregnant rhesus monkeys, the dopamine half-life was observed to be 29 minutes, the amniotic fluid volume was 113 ml, the metabolic clearance rate was 164 ml/hr, and the calculated production rate was 436 ng/hr. The biphasic pattern of dopamine clearance from this compartment suggests that it is cleared from the amniotic sac by mechanisms similar to those used in the intravascular compartment.

Amniotic Fluid↗

PubMed1994

Proton magnetic resonance spectroscopy of human amniotic fluids sampled at 17-18 weeks of pregnancy in cases of decreased digestive enzyme activities and detected cystic fibrosis.

Low digestive enzyme activities in human amniotic fluid can be observed in normal and disease-affected pregnancies: cystic fibrosis, trisomy 21, intestinal atresia. Amniotic fluids were analyzed by proton nuclear magnetic resonance (NMR) spectroscopy in order to specify prenatally the etiology of low digestive enzyme activities observed at 17-18 weeks of amenorrhea. A total of 114 amniotic fluid samples were collected at 17-18 weeks of amenorrhea. Karyotyping and assays of digestive enzyme activities were performed in all cases. Samples were divided into six groups according to enzyme activities and pathology. Proton spectra were retrospectively recorded. Many compounds, such as amino acids and carboxylic acids, were detected by NMR. The same resonance intensities (normalized to creatinine) were observed in the six groups. Nevertheless, an unidentified resonance at 1.05 ppm was detected in seven out of 13 cases of cystic fibrosis affected fetuses. The NMR spectra demonstrated the stability of the amniotic fluid composition at 17-18 weeks of amenorrhea, even when the fetus was affected by a disease such as trisomy 21 or intestinal atresia. The resonance associated with most cases of cystic fibrosis should be further investigated.

Alkaline Phosphatase↗

PubMed1976

[Biomechanic examination of prenatal lung maturity. Testing of amniotic fluid specimens and lung homogenates on Wilhelmy's scale].

In all traditional methods of determining fetal lung maturity the content of phospholipids in the amniotic fluid is used as parameter. The function of the other parts of the surfactant is not taken into account. The dynamic surface tension measurements using the Wilhelmy balance simulate the interplay of the whole biological system. We have tested 76 specimens of amniotic fluid and 17 lung extracts from 25 weeks' gestation onwards using the biomechanical procedure. In addition, the L/S ratio in the amniotic fluid was determined. There was a correspondence between the values of the amniotic fluid and the lung measured in the same week of pregnancy. The results of the surface tension measurements show a good correlation with the standard method. The following are the advantages of the Wilhelmy balance: results show a small range of dispersion, procedure can be easily learned and carried out quickly and simply.

Amniotic Fluid↗

PubMed1998

B19 parvovirus induced fetal hydrops: rapid and simple diagnosis by detection of B19 antigens in amniotic fluids.

In our study we describe the direct detection of parvovirus B19 capsid antigens in amniotic fluid samples for the rapid and simple prenatal diagnosis of B19 induced fetal hydrops. The assay was performed on amniotic fluid specimens from fetal hydrops dotted on nylon membranes. The two capsid antigens, VP1 and VP2, which represent four per cent and 96 per cent of the capsid, respectively, were detected using a pool of monoclonal antibodies directed against these two proteins and the complex was visualized by immunoperoxidase staining. The assay could be performed in about four hours and positive results were revealed at the end of the reaction as dark blue spots on the nylon membrane. We analysed 26 amniotic fluid samples from 26 selected cases of non-immune hydrops for the presence of B19 antigens. Out of these 26 samples, 13 had previously proved positive for B19 DNA, detected by dot blot hybridization and/or in situ hybridization and/or nested PCR, and 13 had proved negative. The results obtained with our assay were compared with results obtained for the presence of B19 DNA and a close agreement was found. The method is simple and rapid to perform, does not require costly instruments, and all the reagents used in the assay are commercially available. The assay described can thus be useful for a prompt counselling and management of B19 fetal infection.

Amniotic Fluid↗

PubMed1990

[Intersexual differences in the levels of trace elements in amniotic fluid in the 2d trimester of pregnancy].

The authors assessed during comprehensive examination of amniotic fluid obtained by transabdominal amniocentesis on account of genetic indication during the second trimester of normal pregnancy between the 15th and 22nd week of gestation four selected trace elements - Zn, Cu, Pb and Cd, using the method of atomic absorption spectrometry. One of the criteria for evaluation of the results was also the relationship of the concentration of the selected trace elements and sex of the foetus. In 157 amniotic fluids collected during the 16th-19th week of gestation they recorded a significantly elevated lead level in male foetuses. During the 17th week normal pregnancy they found also a significantly increased zinc concentration in amniotic fluid of female foetuses. The authors are so far unable to interpret these interesting results which will be the subject of future investigation.

Amniotic Fluid↗

PubMed1983

Amniotic fluid human chorionic gonadotropin in late pregnancy: elevated levels in toxemia with intrauterine growth retardation.

Amniotic fluid human chorionic gonadotropin (hCG) was studied by radioimmunoassay in 88 normal pregnancies and in 48 pregnancies with toxemia either with or without intrauterine growth retardation, between 34 and 41 weeks. In normal pregnancy, no significant change in the hCG level was observed from 34 to 41 weeks, with the logarithmic mean value being 522 mU/ml. The hCG levels in amniotic fluid were markedly elevated in toxemia (logarithmic mean 1,079 mU/ml), especially when associated with intrauterine growth retardation (logarithmic mean 2,056 mU/ml). Since in intrauterine growth retardation without maternal disease the hCG levels were normal (logarithmic mean 657 mU/ml), toxemia itself may be the factor that causes elevated levels of hCG in amniotic fluid.

Amniotic Fluid↗

PubMed1995

Ingestion of amniotic fluid by postpartum rats enhances morphine antinociception without liability to maternal behavior.

Ingestion of amniotic fluid or placenta by rats has been shown to enhance opioid-mediated analgesia induced by morphine injection, foot shock, vaginal/cervical stimulation, or late pregnancy. The present study was designed to determine whether this mechanism might be a means of providing greater analgesia during the periparturitional period without contributing to the disruption of maternal behavior (measured primarily as retrieval) that can result from excessive opioid levels. Postpartum primiparous rats, injected with either 2 or 3 mg/kg morphine sulfate or vehicle and given orogastric infusions of either amniotic fluid or saline, were tested for maternal behavior. Pain threshold (determined by tail-flick latency test) in rats injected with 2 mg/kg morphine and infused with amniotic fluid was elevated to a level that did not differ significantly from that of a separate group of rats injected with 3 mg/kg morphine and infused with saline. This enhanced analgesia was not, however, accompanied by the significant disruption of maternal behavior found among the rats receiving the higher morphine dose.

Amniotic Fluid↗