Normal Amniotic Fluid Research Articles

Effect of Oral Hydration on External Cephalic Version at Term

ObjectiveTo evaluate the effect of oral hydration on the success rate of external cephalic version (ECV). DesignRandomized controlled and single-blind trial. SettingAcademic tertiary hospital with approximately 3,000 births annually. ParticipantsOne hundred sixty-four women at a gestational age of at least 37 weeks with breech-presenting fetuses and normal amniotic fluid indexes (AFIs). MethodsParticipants were randomly assigned to drink 2000 ml or no more than 100 ml of water in the 2 hours before undergoing ECV. The AFIs were assessed before and after treatment by the same sonographer, who was blinded to the treatment group. Data were collected on relevant maternal and fetal characteristics and ECV success. ResultsThe mean AFI after hydration was significantly greater than that in the control group (15.5 cm vs. 13.4 cm, p = .003). The ECV success rate was 53.7% in the hydration group and 46.3% in the control group (odds ratio: 1.34, 95% confidence interval [0.69, 2.59]; p = .349). Hydration was well tolerated and there were no serious adverse events. ConclusionOral hydration significantly increased the AFIs but did not affect the success rate of ECVs.

Ion-exchange chromatography purification of extracellular vesicles.

Despite numerous studies, isolating pure preparations of extracellular vesicles (EVs) has proven challenging. Here, we compared ion-exchange chromatography (IEC) to the widely used sucrose density gradient (SDG) centrifugation method for the purification of EVs. EVs in bulk were isolated from pooled normal human amniotic fluid (AF) by differential centrifugation followed by IEC or sucrose density gradient separation. The purity of the isolated EVs was evaluated by electrophoresis and lectin blotting/immuno blotting to monitor the distribution of total proteins, different EVs markers, and selected N-glycans. Our data showed efficient separation of negatively charged EVs from other differently charged molecules, while comparative profiling of EVs using SDG centrifugation confirmed anion-exchange chromatography is advantageous for EV purification. Finally, although this IEC-based method was validated using AF, the approach should be readily applicable to isolation of EVs from other sources as well.

Lower urinary tract obstruction: fetal intervention based on prenatal staging.

The authors present an overview of lower urinary tract obstruction (LUTO) in the fetus with a particular focus on the insult to the developing renal system. Diagnostic criteria along with the challenges in estimating long-term prognosis are reviewed. A proposed prenatal LUTO disease severity classification to guide management decisions with fetal intervention to maintain or salvage in utero and neonatal pulmonary and renal function is also discussed. Stage I LUTO (mild form) is characterized by normal amniotic fluid index after 18weeks, normal kidney echogenicity, no renal cortical cysts, no evidence of renal dysplasia, and favorable urinary biochemistries when sampled between 18 and 30weeks; prenatal surveillance is recommended. Stage II LUTO is characterized by oligohydramnios/anhydramnios, hyperechogenic kidneys but absent renal cortical cysts or apparent signs of renal dysplasia and favorable fetal urinary biochemistry; fetal vesicoamniotic shunting (VAS) or fetal cystoscopy is indicated to prevent pulmonary hypoplasia and renal failure. Stage III LUTO is oligohydramnios/anhydramnios, hyperechogenic kidneys with cortical cysts and renal dysplasia and unfavorable fetal urinary biochemistry after serial evaluation; fetal vesicoamniotic shunt may prevent severe pulmonary hypoplasia but not renal failure. Stage IV is characterized by intrauterine fetal renal failure, defined by anhydramnios and ultrasound (US) findings suggestive of severe renal dysplasia, and is associated with death in 24h of life or end-stage renal disease (ESRD) within the first week of life; fetal vesicoamniotic shunt and fetal cystoscopy are not indicated.

Natural History of Fetal Lower Urinary Tract Obstruction with Normal Amniotic Fluid Volume at Initial Diagnosis

Objective: The aim of this study was to define the natural history of lower urinary tract obstruction (LUTO) with normal midgestational amniotic fluid volumes. Materials and Methods: We performed a retrospective review of 32 consecutive patients with LUTO with normal midgestational amniotic fluid volume followed at 11 North American Fetal Therapy Network (NAFTNet) centers from August 2007 to May 2012. Normal amniotic fluid volume was defined as an amniotic fluid index (AFI) of ≥9 cm. Results: The mean gestational age (GA) and AFI at enrollment were 23.1 ± 2.1 weeks and 15.8 ± 3.9 cm, respectively. The mean GA at delivery was 37.3 ± 2.8 weeks. The mean creatinine level at discharge was 1.2 ± 0.8 mg/dL. Perinatal survival was 97%. Twenty-five patients returned for serial postnatal assessment. Renal replacement therapy (RRT) was required in 32%. Development of oligohydramnios and/or anhydramnios, development of cortical renal cysts, posterior urethral valves, prematurity, and prolonged neonatal intensive care unit stay were associated with need for RRT (p < 0.05) by univariate analysis. By multivariate analysis, preterm delivery remained predictive of need for RRT (p = 0.004). Conclusion: Prenatal diagnosis of LUTO with normal midgestational amniotic fluid volumes is associated with acceptable renal function in the majority of patients. Approximately one-third of these children require RRT. Surrogate markers of disease severity appear to be predictive of need for RRT.

Standard approach to ultrasound investigation of monochorionic twin pregnancy in centers of primary and secondary level of care

Introduction. Management of multiple pregnancy complicated by twin-to-twin transfusion syndrome (TTTS) is one of the most difficult parts of contemporary obstetrics. This syndrome develops only in presence of anastomoses in common placenta of monochorionic twins. Without intrauterine correction of severe TTTS in 80-100% of cases one or both twins die in utero.&#x0D; The aim of this study is to define the signs that can help in differentiation of monochorionic twins to low or high risk group that needs to be managed in centers of secondary level of care. We investigated 115 monochorionic twin pregnancies at gestational age weeks.&#x0D; Materials and methods. There was 214 ultrasound and Doppler studies in total.&#x0D; Results. We measured biometric parameters of both fetuses and PI in umbilical artery, ductus venosus and middle cerebral artery. We demonstrated that monochorionic twins with weight difference less than 15% and normal amniotic fluid can be managed in centers of primary level of care, whereas fetuses with weight difference more than 15% and olygohydramnion/polyhydramnion sequence need to be transfered to the special centers of secondary level of care. Appearance of reversed blood flow in umbilican artery of the donor twin or ductus venosus of the recipient twin is indicative for in utero laser coagulation of placental anastomoses.

Maternal and Perinatal Outcomes Among Pregnancies Complicated by Isolated Oligohydramnios Compared with Normal Amniotic Fluid Index

Aims: The study was aimed to compare the maternal and perinatal outcomes among pregnancies with isolated oligohydramnios compared to normal amniotic fluid volume between 37-42 weeks.Methods: It was a prospective cohort study done among the singleton pregnancies between 37-42 weeks with isolated oligohydramnios taken as cases (n=100) and pregnancies with normal levels of amniotic fluid matched to cases by gestational age and parity in 2:1 ratio fulfilling the inclusion criteria were taken as controls (n=200). Both the mother and baby were followed up till discharge for outcomes.Results: Majority of the patients (n=300) were of age group 20-30 years (79.0%). Most of them (n=300) were primigravida (74.0%). The overall caesarean section rate was 24.66% (n=300). In the oligohydramnios group, 43.0% had undergone induction of labour (p value&lt;0.05), 63.0% had undergone caesarean section (p value=0.001) and the most common indication for caesarean section was non-reassuring NST (44.44%) (p value&lt;0.05). 26.0% babies had low birth weight, 12% had birth defects, 10.0% were small for gestational age (p value&lt;0.05). There were significantly more ICU admission (13.0% vs 3.5%), early neonatal death (6.0% vs 1.5%), fetal distress (6.0% vs 1.5%) in the oligohydramnios compared to control group ( p value&lt;0.05).Conclusions: Patients with oligohydramnios have increased labour induction, increased operative interferences and increased neonatal mortality and morbidity compared to patients with normal fluid volume.

Does Polyhydramnios Predict Adverse Perinatal Outcome in Congenital Diaphragmatic Hernia? [10P

INTRODUCTION: To examine polyhydramnios as a predictor of adverse perinatal outcomes in prenatally diagnosed congenital diaphragmatic hernia (CDH). METHODS: A retrospective cohort study of CDH cases evaluated between 11/2008 and 6/2016. Perinatal outcomes including preterm birth and mode of delivery were compared between CDH cases with polyhydramnios (amniotic fluid index greater than 25 cm) and those with normal amniotic fluid index. Additional data compared between groups were fetal anatomic characteristics, intrauterine fetal demise (IUFD), gestational age at delivery, preterm birth, length of hospital stay, and neonatal death. Cases that resulted in termination were excluded. Chi square and Fischer's exact tests were used to compare proportions. RESULTS: 192 cases were identified, and 56 of these (29.2%) had polyhydramnios. No significant associations were observed in fetal anatomic characteristics between the polyhydramnios and normal amniotic fluid groups. Similarly, there were no differences in gestational age at delivery, preterm birth, vaginal delivery, or neonatal or infant death between these groups. However, cases with polyhydramnios demonstrated a trend toward a higher risk of IUFD (33.3% vs. 66.7%, p = 0.06), and were more likely to have a prolonged neonatal length of hospital stay (37 days versus 22 days, p= 0.03) compared to cases with normal amniotic fluid. CONCLUSION: Comparing CDH cases with polyhydramnios to those with normal amniotic fluid, similar rates of fetal anatomic characteristics, preterm birth, vaginal delivery, and neonatal or infant death were observed. There was a trend toward a higher risk of IUFD in the polyhydramnios group, suggesting that these cases may merit closer antepartum surveillance.

Obstetric Outcomes and Interventions Between Low Normal Amniotic Fluid Index Compared to True Oligohydramnios [38B

INTRODUCTION: Our goal was to assess obstetric outcomes and interventions in patients with low normal amniotic fluid index versus oligohydramnios. METHODS: This was a retrospective study of deliveries between 2010 and 2014. Oligohydramnios was defined as Amniotic Fluid Index less than 5 cm (AF-5) and low normal amniotic fluid of 5 to 8 cm (AF-LN) on ultrasound performed greater than 24 hours before delivery. Outcomes included cesarean section, preterm delivery, Apgars at 1 and 5 minutes, umbilical artery pH, birth weight (BW), and admission to neonatal intensive care unit (NICU). Statistics included chi-square and student t-test. RESULTS: 76 cases had AF-5 and 398 had AF-LN. Mean gestational age at delivery was 37.62 and 38.18 weeks (P=.005). Preterm birth rates were higher in AF-5 (P=.003), as well as both primary and all c-section delivery rates (P &lt; .05). Our institution’s overall reported primary cesarean section rate for low risk pregnancies was 24%. Neonatal Apgars and BW were significantly lower in AF-5. There was no significant difference in NICU admissions. One fetal death was observed in each group. CONCLUSION: As expected, patients with true oligohydramnios have a higher rate of perinatal morbidity than those with low but normal amniotic fluid, with increased interventions in the true oligohydramnios patients. More investigation is warranted to assess whether earlier intervention in the oligohydramnios group may be the cause of the increased perinatal morbidity.

Polyhydramnios in isolated oral cleft pregnancies: incidence and outcome in a retrospective study.

Polyhydramnios is suggested to be associated with oral clefts (OCs) due to swallowing problems. This study assessed incidence and outcome of idiopathic polyhydramnios in isolated OC pregnancies. This was a retrospective cohort study of prenatally diagnosed OC. The incidence of idiopathic polyhydramnios in isolated OC pregnancies was determined. Pregnancy outcome, neonatal and paediatric follow-up were compared between cases with polyhydramnios and those with normal amniotic fluid. Subgroup analysis was conducted to evaluate whether an association exists between polyhydramnios and presence of associated anomalies diagnosed after birth. In 230 cases of isolated OC, 15 developed polyhydramnios (6.5%). Involvement of the palate was significantly more common in the presence than in the absence of polyhydramnios (13/15 or 87% vs 125/215 or 58%, p = 0.03, odds ratio 4.7, 95% confidence interval 1.0-30.8). No significant differences were seen in pregnancy outcome or neonatal and paediatric follow-up between the two groups. In subgroup analysis, rate of polyhydramnios was not significantly different in associated cases that appeared isolated prenatally (1/27; 3.7%) compared with that in the isolated cases (15/230; 6.5%). The incidence of idiopathic polyhydramnios in isolated OC pregnancies is 6.5%. Polyhydramnios in isolated OC increases the risk of palate involvement. The presence of polyhydramnios is not associated with adverse perinatal or long-term outcome. If isolated at prenatal assessment, polyhydramnios does not increase the risk of associated anomalies postpartum. © 2016 John Wiley & Sons, Ltd.

Linking expression of aquaporin 3 to activation of JNK pathway.

Aquaporin 3 (AQP3) has been shown to be low in the amnion and chorion tissues of patients with oligohydramnios and that S. miltiorrhiza, a Chinese herbal medicine, results in increased AQP3 in human amniotic epithelial cells (hAECs). Here, we provide evidence for the involvement of the JNK pathway in AQP3 regulation in isolated oligohydramnios tissues in vitro, in hAECs derived from normal amniotic fluid and fluid from patients with isolated oligohydramnios. Phosphorylation of JNK was suppressed by pretreatment of cells with JNK-specific inhibitor (SP600125) and was up-regulated by S. miltiorrhiza; S. miltiorrhiza combined with SP600125 prevented SP600125-induced down-regulation of phospho-JNK both in normal amniotic fluid volume and in isolated oligohydramnios. In isolated oligohydramnios, AQP3 expression was significantly suppressed by SP600125 in a concentration- and time-dependent mannner, while its expression was up-regulated by S. miltiorrhiza. S. miltiorrhiza combined with SP600125 inhibited the increased expression of AQP3 relative to the S. miltiorrhiza treated group. Together, the data suggest that c-jun N-terminal kinase (JNK) pathway unerlies the regulation of AQP3 by S. miltiorrhiza amnion and chorion tissues.

Intrauterine Fetal Death with 24 Weeks of Gestation of One Fetus in Twin Gestation Due Parvovirus Infection and Other Remained Assymptomatic

Parvovirus B 19 fetal infection usually tends to be serious. The infection can cause nonimmune fetal hydrops culminating with death. A major problem is that one third of maternal infections have no symptoms. Apart from fetal hydropsy, spontaneous abortion, intrauterine growth retardation and meconium peritonitis are possible manifestations of fetal infection. Case report and literature review. A 32 year old woman with a twin pregnancy and no complications until 30 weeks and 2 days was diagnosed with fetal death in one of the twin, while the other one had normal movements, dopllerfluxometry, biometry, placenta and amniotic fluid. The dead fetus was hydropic with pronounced placental edema that suggested infection. Mother had no clinical disturbance. Serological analysis was positive for B19 Parvovirus. The living fetus was delivered through a cesarean incision at 34 weeks of gestation. He presented leucopenia and was discharged from hospital one week after birth. This case illustrates how B 19 Parvovirus can be aggressive; outcome depends of fetal immunological response. Unfortunately, such infections run silently in most mothers and there’s no way to prevent his occurrence.

Mode of delivery among women admitted with polyhydramnios

A retrospective matched case control study was conducted to examine the incidence of caesarean delivery (CD) among women admitted with polyhydramnios with and without a trial of labour compared to women with normal amniotic fluid index (AFI). Singleton pregnancies diagnosed with polyhydramnios upon admission to labour between 2003 and 2013 were included. A control group (normal AFI) matched at a ratio of 1:1 was randomly selected. Primary outcome was the incidence of CD. A total of 588 women were included. The overall incidence of CD was significantly higher among women with polyhydramnios (31.3%) compared to the controls (18.7%), (p < .001). The incidences of both non-labouring caesarean and intrapartum operative deliveries were significantly higher among women with polyhydramnios compared to the controls (p = .007 and p = .01, respectively). On a multiple logistic regression model, polyhydramnios was found to be an independent risk factor for delivery by a caesarean (p = .0015; OR 2.0; 95%CI 1.30–2.90).

Adverse perinatal outcomes in borderline amniotic fluid index

Normal amniotic fluid predicts normal placental function, fetal growth and fetal well-being. To determine adverse pregnancy outcomes in borderline amniotic fluid index (AFI). Pregnant women (37-40 wks) with diagnosis of borderline AFI between December 2012 and August 2014 were identified. Antepartum, intrapartum and neonatal data were collected and compared with those of pregnant women with normal AFI. An AFI less than 8 and more than 5 cm was defined for borderline AFI. Pregnancy outcomes included Cesarean section for non-reassuring fetal heart rate, meconium stained amniotic fluid, 5-min Apgar score <7, low birth weight, umbilical cord blood pH at term and NICU admission. Gestational age at delivery in pregnancies with borderline AFI was significantly lower than normal AFI. Cesarean section rate for non-reassuring fetal heart rate in women of borderline AFI was significantly higher and there was an increased incidence of birth weight less than 10th percentile for gestation age in borderline AFI group. Incidence of low Apgar score and low umbilical artery pH in pregnancies with borderline AFI was significantly higher than women with normal AFI. There were no significant difference in the rate of NICU admission and meconium staining in both groups. There are significant differences for adverse pregnancy outcomes , such as Cesarean section due to non-reassuring fetal heart rate, birth weight less than 10th percentile for gestation age, low 5 min Apgar score and low umbilical artery pH between pregnancies with borderline and normal AFI.

Prostaglandin E2 induction of labor and cervical ripening for term isolated oligohydramnios in pregnant women with Bishop score ≤ 5

BackgroundWe aimed to evaluate the efficacy and safety of dinoprostone for cervical ripening and labor induction in patients with term oligohydramnios and Bishop score ≤ 5. MethodsThis was a prospective case–control study, which included 104 consecutive women with a Bishop score≤5. Participants were divided into two groups. Women with term isolated oligohydramnios and Bishop score≤5 underwent induction of labor with a vaginal insert containing 10-mg timed-release dinoprostone (prostaglandin E2; Group A, n=40). The control group, Group B, consisted of 64 cases of pregnancy with normal amniotic fluid volume (amniotic fluid index≥5 cm) and Bishop score≤5, and was matched for patient's age and parity. The primary outcome was time from induction to delivery; the secondary outcomes were the caesarean section (CS) rate, uterine hyperstimulation, rate of failed induction, and neonatal complications. ResultsThe mean time interval from induction to delivery was not different between the two groups (p=0.849), but there was a statistically significant difference between the groups in terms of the CS rate (p=0.005). There were no differences between the groups in neonatal outcome or perinatal morbidity or mortality. ConclusionDinoprostone appears to be a safe alternative for induction of labor in pregnancies with oligohydramnios. Induction of labor with dinoprostone in term pregnancies with isolated oligohydramnios is associated with increased rate of CS but there is no higher risk of perinatal complications.

Does the presence of anhydramnios affect the duration of medical abortion?

The aim of the study was to determine whether anhydramnios affected the duration of medical abortion in cases with various indications as compared to cases with normal amniotic fluid volume. Patients who were admitted to our clinic because of medical abortion between January 2010-December 2013 were included in this retrospective study. A total of 32 pregnant women with anhydramnios (study group) and 67 pregnant women with normal amniotic fluid volume but with fetal abnormality (control group) were included in the study. Patient age, gravidity, parity, gestational age, previous delivery route, and duration of the abortion were recorded. Mean duration of the abortion in the study group was 71.93 ± 47.51 h as compared to 79.08 ± 52.62 h in the control group. There were no statistically significant differences between the two groups in terms of duration of the abortion (p = 0.516). Also, we found no statistically significant differences in duration of the abortion with regard to previous delivery route (p = 0.220). There were no statistically significant differences between the study group and controls in terms of duration of the abortion. In addition, neither parity nor previous delivery route affected the duration of the abortion.

Idiopathic polyhydramnios at term and pregnancy outcomes: a multicenter observational study

Aim: To assess pregnancy outcomes in pregnancies with idiopathic polyhydramnios at term.Methods: We conducted a retrospective cohort study of 106 225 term pregnancies from 37 hospitals in China. Maternal and fetal outcomes in pregnancies with idiopathic polyhydramnios were compared with pregnancies with normal amniotic fluid. The primary outcome was intra-uterine fetal death (IUFD).Results: In all, 307 out of 106 225 (0.3%) had idiopathic polyhydramnios at term, 276 of which were mild and 31 of which were moderate-severe. Compared to term pregnancies with normal amniotic fluid, pregnancies idiopathic polyhydramnios was associated with over 24-fold higher risk for IUFD (adjusted odds ratio [aOR] 24.4, 95% confidence interval (CI) 7.3–82.0), macrosomia (aOR 2.8, 95%CI 2.0–3.8), malpresentation (aOR 2.5, 95%CI 1.7–3.7), cesarean delivery (aOR 2.5, 95%CI 1.7–3.7) and low APGAR scores at 5 min (aOR 4.3, 95%CI 2.4–7.8), which increased with severity of idiopathic polyhydramnios.Conclusion: Term pregnancies with idiopathic polyhydramnios, especially moderate–severe ones are at a significantly increased rate for adverse pregnancy outcome. Increased antepartum surveillance of fetal well-being and timed delivery are warranted.

EP10.32: A case of fetal bilateral marked echogenic kidneys with normal amniotic fluid during pregnancy

EP10.32: A case of fetal bilateral marked echogenic kidneys with normal amniotic fluid during pregnancy

Ruptured Endometriotic Cyst Mimicking Acute Appendicitis During Pregnancy

A 21-year-old primigravid pregnant woman of 33 gestational weeks applied to our Perinatology Clinic with acute abdominal pain. The pain was spreading from the midline to the right lower quadrant of the abdomen. Guarding and rebound tenderness existed in the right lower quadrant. An ultrasonographic examination revealed a single alive fetus and normal amniotic fluid. A whole blood count revealed leukocytosis and there were no signs of preterm labor or placental abruption. Fetal heart rate decelerations in a non-stress test were observed, and a decision for cesarean section and abdominal exploration were made.A healthy male baby of 2,500 grams was delivered. In the abdominal exploration, all peritoneal surfaces were coated with a dark red- to brown-colored dense material, like mud. There were two endometriotic cysts in the left ovary; one had a 6-cm mean diameter and was ruptured, while the other was intact and had a mean diameter of 2–3 cm. Both cysts were excised and sent for pathologic examination. The patient had no postoperative problems over two days and was discharged. The final pathologic diagnosis was endometriotic cysts.

Prenatal second trimester ultrasound diagnosis of cloacal extrophy

Purpose: Bladder extrophy is rare and affects 1:30.000 – 50.000 live births, more often boys than girls. Prenatal diagnosis shows normal amniotic fluid with no visible bladder, but normal kidneys.

Reference Value of Normal Amniotic Fluid Index in Second and Third Trimester among Sudanese Pregnant Ladies

Reference Value of Normal Amniotic Fluid Index in Second and Third Trimester among Sudanese Pregnant Ladies