Amniotic Fluid Values Research Articles

Anatomical and physiological aspects of the mutual influence of circulatory hypoxia of the myometrium and non-progressive labour

Non-progressive labour occurs in almost 10% of deliveries and is a main reason for unplanned cesarean sections and operative vaginal births using obstetric forceps or vacuum extraction. This article describes the morphological transformation of the myometrium and uterine blood vessels that occurs during pregnancy. It is shown that the myometrium inevitably experiences hypoxia at the microstructural level during each normal or pathological labour. We analyzed recent studies of the mutual influence of myometrial hypoxia and labour dystocia. Experimental and clinical studies showed relationship between the pH values and lactate levels determined in the myometrium on its contractility. Further research is justified, including the study of the pH and lactate values in amniotic fluid in patients with non-progressive labor. Finally, that will allow for clarifying the conditions and timing of labour stimulation with oxytocin and identifying a group of patients for whom oxytocin administration is contraindicated or hopeless.

Real-time and high-sensitive colorimetric sensor based on photonic crystal for amniotic fluid identification

In this study, we proposed a pH-responsive photonic crystal hydrogel sensor (PCHs) to conveniently and accurately recognize the amniotic fluid from urine of parturient women, which was constituted by three-dimensional polymethyl acrylamide (PMMA) array and optimized hydrogel. PMMA array was self-assembled by 180 nm monodispersed nanoparticles with vertical sedimentation method. The functional hydrogel containing N-acryloyl phenylalanine (APA), acrylamide (AM) and N, N'-methylene bis(acrylamide) (BIS) as co-monomer and crosslinking agent respectively, was photo-polymerized by the precursor under 365 nm UV light. This hydrogel significantly shrank or swelled corresponding to the acidity and alkalinity of the aqueous solution, which resulted in both the reflection peak position (λmax) of the prepared sensor and its structural color changing with the pH value. The λmax of PCHs redshifted from 514 nm to 606 nm in 60 s while the pH value of testing solution increased from 4.5 to 8.0, which exactly covered the pH value of amniotic fluid and urine. Correspondingly, its structure color gradually changed from pale-green to red ensuring their naked-eye determination. Furthermore, an extremely high sensitivity as 26.3 nm/pH of Δλmax was obtained which was linearly related to pH value. The prepared sensor possessed steady accuracy and extraordinary sensitivity compared with the pH test strip which was generally used in amniorrhexis diagnosis nowadays besides the advantages of the low cost, simple operation, rapid response and visual detection mode. The reliability of this PCHs was further confirmed by the real sample detection which relative standard deviation was below 5.0 %, suggesting its potential clinical applications.

The physicochemical features of eggshell, thick albumen, amniotic fluid, and yolk during chicken embryogenesis

The study aimed to analyze the hatching egg and physiochemical features of eggshells, thick albumen, amniotic fluid, and yolk during the incubation of Ross 308 chicken eggs. Eggs (n=755) were incubated for 21 d. Quality analysis of fresh eggs was performed. Eggshells, albumen, and yolk were collected from fresh eggs and incubation d 1, 7, and 14. Eggshell thickness and strength, pH, vitelline membrane strength, fatty acid (FA) in the yolk, pH, viscosity, lysozyme activity, and crude protein content in thick albumen and amniotic fluid were analyzed. Hatching parameters were calculated. Egg weight loss was constant (8.04% overall). Lower egg surface temperature was found on d 7 compared to d 4, 14, and 18. A lower thickness of posthatch eggshells was found. The strength of the vitelline membrane significantly decreased within 24 h (by over 58%). During incubation, there was a decrease in thick albumen/amniotic fluid pH; an opposite trend was found in yolk pH. The vitelline membrane strength was negatively correlated with the albumen pH. Lysozyme activity was higher in fresh thick albumen and up to 2 wk of incubation. On d 7, the lowest activity was found in the amniotic fluid. On d 14, lysozyme activity increased in amniotic fluid. The higher viscosity of the thick albumen was demonstrated on d 7 and 14 of incubation. The lowest viscosity in amniotic fluid was found on the same days. Crude protein content was higher in thick albumen (d 7 and 14) and lowest in amniotic fluid on d 7. The FA content changed between d 0 and 14. The results indicate different use of FA, where PUFA decreased. Eggshell is used in the last week of incubation. The thick albumen is reduced, while the biological value of amniotic fluid is increasing. Lysozyme activity, viscosity, and crude protein content may be interdependent. It may indicate the flow of substances and the transfer of functions from the thick albumen to the amniotic fluid during chicken embryogenesis.

Predictive Value of New Onset Versus Primary Meconium-Stained Amniotic Fluid

(Abstracted from Birth 2022;49:805–811 Meconium-stained amniotic fluid (MSAF) occurs in up to 52% of postterm pregnancies, 25% of term pregnancies, and 5% of pregnancies <37 weeks of gestation. As a sign of fetal maturity, MFAS may also help signal fetal distress.

Predictive value of new onset versus primary meconium-stained amniotic fluid.

Transition of clear amniotic fluid to meconium-stained fluid is a relatively common occurrence during labor. However, data regarding the clinical significance and the prognostic value of the presence of meconium-stained amnionic fluid (MSAF) are scarce. This study aimed to investigate delivery and neonatal outcomes according to the presence of MSAF and the timing of the meconium passage. We used an historical cohort study at a single tertiary medical center in Israel between the years 2011 and 2018. Women were divided into two groups according to timing of meconium passage: primary MSAF (MSAF present at membrane rupture) and secondary MSAF (clear amnionic fluid that transitioned to MSAF during labor). Neonatal complication rates were compared between groups. Composite adverse neonatal outcome was defined as arterial cord blood pH <7.1, 5 min Apgar score ≤7, and/or neonatal intensive care unit admission. The study cohort included 56 863 singleton term births. Of these, 9043 (15.9%) were to women who had primary MSAF, and 1484 (2.6%) to those with secondary MSAF. Secondary MSAF compared with primary MSAF increased the risks of cesarean birth and operative vaginal delivery, increased the risks of low one- and five-minute Apgar scores and low arterial cord blood pH, and increased hospital stay duration. Multivariate analysis revealed that secondary MSAF was independently associated with an increased risk of composite adverse neonatal outcome (OR1.68, 95% CI 1.25-2.24, p< 0.001) compared with primary MSAF. In this sample, secondary MSAF was associated with more adverse neonatal outcomes than primary MSAF. Closer monitoring of fetal well-being may be prudent in these cases.

РОЛЬ МИКРОЭЛЕМЕНТОВ В ТЕЧЕНИИ БЕРЕМЕННОСТИ

Trace elements take part in the implementation of the most important metabolic processes of the body. Violation of trace element homeostasis during pregnancy leads to the formation of various pathologies. Deficiency of zinc, manganese, selenium and cobalt, high or low copper content in the blood of a pregnant woman increases the risk of developing preeclampsia, anemia and miscarriages. А low boron content is observed with gestational diabetes mellitus and chronic arterial hypertension in pregnant women. Cobalt deficiency is associated with an increased risk of premature birth, the development of iron deficiency anemia, and arterial hypertension during gestation. A sufficient amount of molybdenum is necessary for the onset of pregnancy, its lack leads to a change in carbohydrate metabolism, the formation of xanthine stones, the occurrence of nausea, anemia and caries in pregnant women. Nickel deficiency leads to the development of iron deficiency anemia and impairment of reproductive function, and its excess can contribute to the formation of gestational diabetes mellitus. The addition of trivalent chromium to the diet of women with polycystic ovary syndrome increases the likelihood of pregnancy, and an excess of its hexavalent form positively correlates with the risk of developing preeclampsia and premature rupture of membranes. The increased consumption of Ni, Cr6+ and F has an adverse effect on the health of the pregnant woman. To fully understand the role of trace elements in ensuring maternal health and the proper development of the fetus, further studies of their concentrations and control values in amniotic fluid, maternal serum and umbilical cord blood during pregnancy are needed to determine the optimal level of supplementation and to quickly diagnose maternal and embryonic mineral metabolic disorders.

Sonographic Estimation of Amniotic Fluid Volume Using the Amniotic Fluid Index and the Single Deepest Pocket in a Resource-Limited Setting.

Objective:To determine the normal value of amniotic fluid (AF) volume among pregnant women in a Northern Nigerian population and to determine if there is a relationship between AF index (AFI) and single deepest pocket (SDP) with anthropometric variables.Materials and Methods:A prospective cross-sectional study was conducted among singleton pregnant women at late second and third trimester attending the antenatal clinic in Abubakar Tafawa Balewa Teaching Hospital, Bauchi, from December 2016 to April 2017. The mean AFI and SDP were measured by sonography. Ethical approval was obtained from the institution and informed consent was sought for from all the participants. Descriptive statistics, i.e. mean, standard deviation, and correlation coefficient, were used for the analysis.Results:A total of 206 women, aged between 18 and 40 years, with fetal gestational ages between 22 and 39 weeks were included in the study. The values for AFI in the study ranged from 12 to 28.7 cm, with a mean value of 19.84 ± 3.64 cm, and SDP ranged from 3.7 to 9.1 cm with a mean value of 6.04 ± 1.12 cm. This study found a weak relationship between the anthropometric variables and AFI and SDP and a strong relationship between AFI and SDP with a correlation coefficient of R = 0.901 and P = 0.014.Conclusion:This study found the mean values for AF volume using AFI and SDP in the studied population to be 19.84 ± 3.64 cm and 6.04 ± 1.12 cm, respectively; a strong positive relationship between AFI and SDP; and a negative relationship between body mass index with AFI and SDP.

Biochemical evaluation of amniotic and allantoic fluids of the Red Sokoto goat in the second term of pregnancy—a preliminary study

The amnion and allantois contain fluids and serve as cushion to protect the foetus against mechanical shock. Biochemical studies of the amniotic and allantoic fluids are important in understanding foetal metabolism and possible pathologic condition which may occur during gestation. This study evaluated the biochemical profile of the allantoic and amniotic fluids of pregnant Red Sokoto goats in their second term of pregnancy. Aliquots of each of the allantoic and amniotic fluids were aspirated and placed into separate clean sample bottles. These foetal membrane fluids samples were preserved at −20° and used for the biochemical evaluations. The foetuses were exteriorized, and the sexes of the foetuses were noted, while their crown-rump lengths (CRL) were measured. The CRL was used for gestational age determination. Allantoic and amniotic fluids from does of gestational age between 50 and 100 days were selected for the study. Gestational age between days 50 and 75 was considered early stage of the second term of pregnancy, while gestational age between days 76 and 100 was considered late stage. Standard procedures were followed in the determination of foetal fluid alanine aminotransferase (ALT), aspartate aminotransferase (AST) activities, and urea nitrogen, creatinine, calcium, sodium, and chloride ion levels. No significant (p > 0.05) variation was recorded in the mean allantoic and amniotic fluids values of AST, ALT, and sodium and chloride ions. Mean allantoic fluid values of urea nitrogen, creatinine, calcium, and potassium ions were significantly (p < 0.05) higher than those of amniotic fluid. In the early stage of the second term of pregnancy, mean allantoic fluid values of urea nitrogen, creatinine, calcium, chloride, and potassium ions were significantly lower (p < 0.05) when compared to the values obtained at the late stage. In the late stage of the second term of pregnancy, mean ALT, urea nitrogen, creatinine, and calcium amniotic fluid values were higher than the values obtained at the early stage. As the gestational age increases, allantoic and amniotic fluid levels of urea nitrogen, creatinine, and calcium ion increases.

The Early Prognosis Value of Activin A in Premature Infants’ Brain Injury

The purpose of this research is to explore the predictive value of amniotic fluid, umbilical cord blood and neonatal blood activin A in early brain injury in preterm neonates. 98 cases of premature infants were divided into brain injury group and control group according to the cranial imaging examination, and the brain injury group was further divided into mild brain injury group and severe brain injury group. The activin A level was measured in both preterm brain injury group and control group with enzyme-linked immunosorbent assay (ELISA) kit, then the comparisons of activin A levels between brain injury group and control group, mild and severe brain injury group were implemented to find out their differences. The results demonstrated that activin A levels of umbilical cord blood, amniotic fluid and 3-day-old premature infant peripheral blood in brain injury group were significantly higher than the control group (P&lt;0.05), activin A levels of amniotic fluid, umbilical cord blood and 3-day-old infant blood in the severe brain injury group were significantly higher than the mild brain injury group (P&lt;0.05), intragroup comparison among the brain injury group showed amniotic fluid and 3-day-old premature infant serum activin A levels were significantly higher than umbilical cord blood (P&lt;0.05), activin A has a certain value in early prediction and severity assessment of preterm brain injury. Keywords - Activin A , severity levels, preterm neonates, intraventricular hemorrhage

The early prognosis value of activin A in premature infants’ brain injury

The purpose of this research is to explore the predictive value of amniotic fluid, umbilical cord blood and neonatal blood activin A in early brain injury in preterm neonates. 98 cases of premature infants were divided into brain injury group and control group according to the cranial imaging examination, and the brain injury group was further divided into mild brain injury group and severe brain injury group. The activin A level was measured in both preterm brain injury group and control group with enzyme-linked immunosorbent assay (ELISA) kit, then the comparisons of activin A levels between brain injury group and control group, mild and severe brain injury group were implemented to find out their differences. The results demonstrated that activin A levels of umbilical cord blood, amniotic fluid and 3-day-old premature infant peripheral blood in brain injury group were significantly higher than the control group (P<0.05), activin A levels of amniotic fluid, umbilical cord blood and 3-day-old infant blood in the severe brain injury group were significantly higher than the mild brain injury group (P<0.05), intragroup comparison among the brain injury group showed amniotic fluid and 3-day-old premature infant serum activin A levels were significantly higher than umbilical cord blood (P<0.05), activin A has a certain value in early prediction and severity assessment of preterm brain injury. Keywords - Activin A , severity levels, preterm neonates, intraventricular hemorrhage

Lactate in Amniotic Fluid: Predictor of Labor Outcome in Oxytocin-Augmented Primiparas' Deliveries.

BackgroundOne of the major complications related to delivery is labor dystocia, or an arrested labor progress. Many dystocic deliveries end vaginally after administration of oxytocin, but a large numbers of women with labor dystocia will undergo a long and unsafe parturition. As a result of the exertion required in labor, the uterus produces lactate. The uterine production of lactate is mirrored by the level of lactate in amniotic fluid (AFL).ObjectivesTo evaluate whether the level of AFL, analysed in a sample of amniotic fluid collected vaginally at arrested labor when oxytocin was needed, could predict labor outcome in nulliparous deliveries.MethodsA prospective multicentre study including 3000 healthy primiparous women all with a singleton pregnancy, gestational age 37 to 42 weeks and no maternal /fetal chronic and/or pregnancy-related conditions. A spontaneous onset of labor, regular contractions and cervical dilation ≥ 3 cm were required before the women were invited to take part in the study.ResultsAFL, analysed within 30 minutes before augmentation, provides information about delivery outcome. Sensitivity for an acute cesarean section according to high (≥10.1mmol/l) or low (< 10.1mmol/l) AFL values was 39.0% (95% CI; 27–50), specificity 90.3% (95% CI; 87–93) PPV 37.3% (95% CI; 27–48) and NPV was 91.0% (95% CI; 88–93). The overall percentage of correct predictions of delivery outcome when the AFL level was used was 83.7%. Deliveries with a high AFL-level correlated with delivery time >12h (p = 0.04), post-partum fever (>38°C, p = 0.01) and post-partum haemorrhage >1.5L (p = 0.04).ConclusionThe AFL is a good predictor of delivery outcome in arrested nulliparous deliveries. Low levels of AFL may support the decision to continue a prolonged vaginal labor by augmentation with oxytocin. A high level of AFL correlates with operative interventions and post-partum complications.

Normal amino-terminal pro-brain natriuretic peptide (NT-proBNP) values in amniotic fluid

IntroductionBrain natriuretic peptide (BNP) is synthesized by human fetal membranes, both the amnion and chorion. This locally produced BNP inhibits the contraction of the human myometrium, contributing to the maintenance of myometrial quiescence during pregnancy. Reference values for NT-proBNP concentrations in amniotic fluid at different gestational ages have not been completely defined. We aimed to investigate the range of fetal NT-proBNP values in amniotic fluid in normal pregnancy between 17 and 41weeks of gestation. MethodsSamples of amniotic fluid were obtained from women meeting the following inclusion criteria: gestational age defined by early ultrasound, singleton gestation and not in labor. The exclusion criteria were as follows: multiple gestation, clinically evident chorioamnionitis, laboratory signs of infection in the amniotic fluid sample and fetal conditions that may alter NT Pro-BNP levels (anemia, hydrops, etc.). NT-proBNP concentrations in amniotic fluid were measured using the automated Elecsys® proBNP assay. ResultsWe analyzed 218 samples of amniotic fluid at various gestational ages. Half of the samples were obtained by amniocentesis (118 samples), and the other half (100 samples) were obtained by direct puncture at the time of cesarean section. We found a significant decline in NT-proBNP concentrations with advancing gestational age. DiscussionGestational age has to be taken into consideration in the assessment of NT-proBNP values. Our data may be used as reference values in fetal medicine, as a possible predictor of preterm delivery risk using the inferior limit (0.5 multiples of the median (MoM)) of our normal curve.

Feasibility of predicting the outcome of fetal infection with cytomegalovirus at the time of prenatal diagnosis

Congenital cytomegalovirus infection occurs in 0.7% of live births with 15-20% of infected children developing long-term disability including hearing loss and cognitive deficit. Fetal cytomegalovirus infection is established by viral DNA amplification by polymerase chain reaction in amniotic fluid obtained by amniocentesis following maternal seroconversion or after the diagnosis of ultrasound features suggestive of fetal infection. Severe brain ultrasound anomalies are associated with a poor prognosis. The prognosis of an infected fetus showing either no ultrasound features or nonsevere ultrasound anomalies is difficult to establish up until late in the second or third trimester of pregnancy. We sought to evaluate the prognostic value of fetal ultrasound, amniotic fluid, and fetal blood analysis at the time of prenatal diagnosis of fetal infection. We reviewed all cases of fetal cytomegalovirus infection with a sample of amniotic fluid positive for viral DNA and/or fetal blood analyzed in our laboratory from 2008 through 2013. Prenatal ultrasound features along with cytomegalovirus DNA loads in amniotic fluid and in fetal blood and fetal platelet counts were reviewed in relation to gestational age at maternal infection, neonatal examination, and postnatal follow-up or postmortem examination. In all, 82 fetuses were infected following maternal infection mainly in the first trimester. At the time of prenatal diagnosis at a median of23 weeks, 19, 22, and 41 fetuses showed severe brain ultrasound abnormalities, nonsevere ultrasound features, and normal ultrasound examination, respectively. Nonsevere ultrasound features, higher DNA load in amniotic fluid, fetal platelet count ≤114,000/mm(3), and DNA load ≥4.93 log10 IU/mL in fetal blood were associated with a symptomatic status at birth in univariate analysis (P < .001, P= .001, and P= .018, respectively). Bivariate analysis combining ultrasound results and either adjusted viral load in amniotic fluid or fetal blood profile showed that these were independent prognostic factors of a symptomatic status at birth. Both fetal blood parameters were better predictors than amniotic fluid viral load. At the time of prenatal diagnosis, the ultrasound negative predictive valuefor symptoms at birth or at termination of pregnancy was 93%. The combined negative predictive values of ultrasound and viral load in amniotic fluid and that of ultrasound and fetal blood parameters were 95% and 100%, respectively. In fetuses presenting with nonsevere ultrasound features, the positive predictive values of ultrasound alone and in combination with amniotic fluid viral load or with fetal blood parameters were 60%, 78%, and 79%, respectively. Risk assessment of infected fetuses for being symptomatic at birth is possible as early as the time of diagnosis by using a combination of targeted ultrasound examination along with viral load in amniotic fluid and in fetal blood together with platelet count. The advantage of using amniotic fluid is that it is available at prenatal diagnosis. One may wonder if increasing the negative predictive value of the overall assessment of an infected fetus from 95-100% is worth the additional risk of cordocentesis for fetal blood sampling. This can only be an individual decision made by well-informed women and it seems therefore appropriate to use the figures presented here and their confidence intervals for counseling.

Duration of the Development of Twin-Twin Transfusion Syndrome

Background: It is generally recommended that monochorionic diamniotic (MD) twin pregnancies be followed by ultrasound examination at least every 2 weeks in order to be able to promptly diagnose twin-twin transfusion syndrome (TTTS). In this study, we retrospectively investigated the clinical significance of TTTS developing at < 2 weeks (n = 9) and ≥ 2 weeks (n = 13). Methods: We examined the following potential factors associated with TTTS development: discordance of the crown-rump length at 8 - 11 weeks, the gestational age at the last confirmation of concordant amniotic fluid (AF), the gestational age at TTTS diagnosis, the estimated fetal weight discordance, and AF values at ≤ 3 - 7 days before TTTS diagnosis. Results: There were no significant differences in these variables between the two groups. Conclusion: There were no significant differences in the clinical histories of TTTS developing at < 2 weeks and ≥ 2 weeks in MD twin pregnancy. J Clin Gynecol Obstet. 2014;3(3):93-96 doi: http://dx.doi.org/10.14740/jcgo270w

Association between fetal weight and amniotic fluid index in women of Central India

Background:The placenta is important for fetal growth and well-being. Defective placentation and impaired placental circulation may result in anomalies in fetal growth. Placental volume in the second trimester appears to be closely related to the neonatal weight. The association of body weight with urine output has been observed in human neonates. Our goal is to assess the association of the amniotic fluid index (AFI) with the estimated fetal weight (EFW).Materials and Methods:Thirteen hundred and ninety-three pregnant women were prospectively studied by means of an ultrasound over a 12–month period. The fetal weight (FW) was estimated using a combination of fetal parameters – bi-parietal diameter, fetal trunk cross-sectional area, and femur length. AFI was assessed using the four quadrant method. The level of statistical significance was set at P ≤ 0.05.Results:There was no statistically significant association between AFI and EFW (P > 0.05; r = 0.413). We also did not find a significant association between AFI and EFW for all subdivisions of gestation age, except in the 24 – 28 weeks and 29 – 32 weeks’ groups.Conclusion:The FW calculations and amniotic index show a variation in values in late pregnancy. There does not appear to be a linear association between the ultrasound estimate of FW and the amniotic index. The implication of this is that the fetal size need not be taken into cognizance when alterations in amniotic fluid values are noted.

Biochemical Profile of Amniotic and Allantoic Fluid During Different Gestational Phases in Mares

Fetal fluids have different vital functions that sustain both pregnancy and normal parturition. The biochemical composition of amniotic fluid during gestation is not well established; thus the purpose of the present study was to determine the biochemical profile of both amniotic and allantoic fluids from mares during initial, mid, and latter third phases of pregnancy. Samples were collected after slaughter, using allantocentesis and amniocentesis. Sixty samples of fetal fluids were analyzed. Alkaline phosphatase (AP), glucose, total protein (TP), urea, creatinine, Ca, chloride (Cl), Na, and K concentrations were measured using commercially available kits. The AP concentration in amniotic fluid was higher than that in allantoic fluid during the three gestational phases (P < .05). There were no differences between glucose mean values of allantoic and those of amniotic fluids (P < .05). However, glucose values were higher in the allantoic fluid in the last trimester of pregnancy. TP was higher in the amniotic fluid than in allantoic fluid (P < .05). Urea values varied among the phases; however, there were no differences between the amniotic and allantoic fluid values (P > .05). Creatinine values were higher in allantoic fluid (P < .05). Na and Cl concentrations were higher in amniotic fluid (P < .05). However, Ca and K concentrations were higher in the allantoic fluid.

Relationship Between Amniotic Fluid Index and Ultrasound Estimated Fetal Weight in Healthy Pregnant African Women

Introduction:Fetal weight (FW) estimation in late pregnancy is an important guide in obstetric care. Amniotic fluid protects the fetus against traumatic and infective insults. There possibly exists a relationship between FW and amniotic fluid index (AFI) that can be estimated by ultrasonography.Materials and Methods:Two hundred and fifty-eight low-risk pregnancies were prospectively studied by means of ultrasound over a 12-month period. FW was estimated using a combination of fetal parameters; bi-parietal diameter, fetal trunk cross sectional area, and femur length. AFI was assessed using the 4-quadrant method. Spearman's correlation was used to test possible relationship between amniotic fluid indices and estimated FW pairs. The level of statistical significance was set at P ≤ 0.05.Results:The mean AF1 and estimated fetal weight (EFW) pairs were as follows: at 27-29 weeks the values were 172.1 mm and 1,250.2 g; at 30-32 weeks AF1 and EFW values were 170.3 mm and 1,648.0 g; at 33-35 weeks values were 162.3 mm and 2,273.5 g; at 36-38 weeks values were 144.09 mm and 2,906.1 g; at 39-40 weeks AF1 and EFW values were 125.0 mm and 3,222.6 g. Overall, there was no statistically significant relationship between AFI and EFW (P > 0.05; r = 0.241).Conclusion:While FW calculations and amniotic index showed variations in value in late pregnancy, there does not appear to be a linear relationship between ultrasound estimate of FW and amniotic index. The implication of this is that fetal size need not be taken into cognizance when alterations in amniotic fluid values are noted.

Intrapartum Fever at Term

Intrauterine infection is a serious complication during labor at term and is associated with adverse neonatal outcome. Early and accurate diagnosis is of great concern for both obstetrician and pediatrician with the use of current diagnostics. Clinical symptoms are often regarded as the main sign of intrauterine infection but this approach is highly unreliable and leads to both under- and overtreatment. Currently, no distinct fetal heart rate (FHR) patterns have been found that reliably identify neonates with intrauterine infection. Using a systematic literature search, this article reviews possible markers for the early detection of intrauterine or neonatal infection in maternal serum, amniotic fluid, and umbilical cord blood during labor at term. Maternal serum markers, with the possible exception of interleukin (IL)-8, are unreliable for the detection of intrauterine infection. In contrast, amniotic fluid levels of especially IL-6 and IL-8 are significantly associated with intrauterine infection. Umbilical cord blood IL-6 has been extensively investigated and is usually elevated in case of intrauterine or neonatal infection but shows only modest positive and negative predictive values (NPVs) for clinical use. Umbilical cord IL-8 concentration could be a valuable addition in the diagnostic process, as it has shown to have an NPV of 84% to 92% in the detection of neonatal infection and histological chorioamnionitis. Future research is essential and should focus on the combination of different markers and on the development of a prediction model, to improve the positive and NPVs of our arsenal to detect intrauterine and neonatal infections. Amniotic fluid and umbilical cord values of IL-6 and IL-8 levels are likely candidates for such a prediction model. Obstetricians & Gynecologists and Family Physicians After the completing the CME activity, physicians should be better able to evaluate the use of clinical chorioamnionitis with regard to histological evidence and as a diagnostic tool in early diagnosis of intra-amniotic infection. Asses the use of amniotic fluid IL-6 and IL-8 as diagnostic tools to detect early intra-amniotic infection and assess umbilical cord blood IL-8 in case of intrauterine- or neonatal infection using positive (PPV) and negative predictive values (NPV).

Effect of bovine amniotic fluid on intra-abdominal adhesion in diabetic male rats

Background Postsurgical adhesion formation is a significant clinical problem within every surgical specialty. In type I diabetic patients, the problem is more severe and wound healing is slow. A wide variety of treatments have been proposed to deal with the problems that adhesion causes. One of the modalities that have not been studied extensively yet is the use of amniotic fluid. The purpose of the present study was to evaluate the clinical value of bovine amniotic fluid (BAF) efficacy in the treatment of postsurgical adhesion formation in diabetic male rats. Materials and Methods Fifty male Wistar rats in five groups were used for our study, with animal identification being facilitated by a microchip implant system. Diabetes was induced in all groups except for the control group by intraperitoneal alloxan injection (120 mg/kg). Based upon blood glucose concentration, rats received either one third of the required insulin (two groups) or all the required insulin (remaining groups). After 2 weeks, a laparotomy was performed on each rat and adhesions were scaled. Bovine amniotic fluid was then applied to two groups, and, as a control, sterilized water was applied to the other groups. After 2 weeks, a laparotomy was again performed on each rat and adhesion was rescored. Results and Conclusion Significant reductions ( P<.05) in adhesions were seen with BAF only in those diabetic rats that had received the required insulin. The results of our study suggest that BAF could be effective in the treatment of adhesion formation during diabetes.

Reference values for γ‐glutamyl‐transferase in amniotic fluid in normal pregnancies

Nonvisualization of the fetal gallbladder by ultrasound poses a diagnostic dilemma. The aim of the study was to establish reference values for the hepatobiliary enzyme gamma-glutamyl-transferase (GGT) in amniotic fluid in normal pregnancies, and to determine the maximal week of gestation in which reference values can be determined. A cross-sectional design was used. The study group consisted of pregnant women at 16 gestational weeks or more referred to our ultrasound unit for amniocentesis. Amniotic fluid was assayed for levels of GGT and other hepatobiliary enzymes using the Integra 800 device. The 5th and 95th percentiles for each gestational week were calculated. A total of 263 samples were analyzed. After conversion to log units, enzyme levels showed a good correlation with gestational week (Pearson). The mean values and the 5th and 95th percentiles were calculated for gestational weeks 16 to 22. Beyond 22 weeks, the number of examinations was insufficient for analysis. On multiple regression analysis, log values of alkaline phosphatase, maternal age, and gestational age independently affected log GGT values. Levels of alkaline phosphatase, aspartate aminotransferase, and alanine aminotransferase were too low, and their correlation with gestational week too poor for calculation of reference values. GGT reference values in amniotic fluid in normal pregnancies were defined for gestational weeks 16 to 22. These data may be useful for differentiating isolated absence of fetal gallbladder from extrahepatic biliary atresia.