Withdrawal Of Amniotic Fluid Research Articles

INFLUENCE OF DIFFUSE NON-TOXIC GOITER ON THE PROBABILITY OF INCREASING THE CHANCES OF COMPLICATIONS DURING PREGNANCY AND CHILDBIRTH

Diffuse nontoxic goiter is the most common form of thyroid pathology among women, which is often found during pregnancy.The aim of the study. Evaluate the probability increase the chances of complications during pregnancy and childbirth in women with diffuse non-toxic goiter.Materials and methods. A retrospective analysis of the history of labor was conducted to assess the relationship between the presence of diffuse non-toxic goiter and the occurrence of complications during pregnancy and childbirth. The estimated probability of complications in women with diffuse nontoxic goiter without disturbance functions of the thyroid gland and hypothyroidism of the thyroid gland.Results of the research. In women with diffuse non-toxic goiter, compared with persons without goiter, statistically significantly more often, there are complications during pregnancy and childbirth, accordingly, increases the chance of threat spontaneous abortion (2.77; 95% CI 2.02-3.79) and threat of preterm labor (3.44; 95% CI 2.02-5.85), occurrence of placental dysfunction (6.51; 95% CI 4.80-8.84), growth retardation of the fetus (4.65; 95% CI 2.51-8.61), preeclampsia (1.65; 95% CI 1.05-2.58), iron deficiency anemia (2.55; 95% CI 1.85-3.52), preterm labor (3.71; 95% CI 1.93-7.12), untimely discharge of amniotic fluid (1.84; 95% CI 1.36-2.49) and anomalies of labor activity (3.16; 95% CI 2.15-4.66). In women with diffuse nontoxic goiter without thyroid disturbance, in comparison with women without goiter, the chance of occurrence of placental dysfunction (4.83; 95% CI 3.45-6.77), fetal growth retardation (3.09; 95% CI 1.55-6.15), iron deficiency anemia (1.82; 95% CI 1.26-2.63), anomalies of labor activity (2.13; 95% CI 1.37-3.31), untimely discharge of amniotic fluid (1.64; 95% CI 1.16-2.31). In women with diffuse nontoxic goiter and subclinical hypothyroidism the chance of a threat of abortion (6.78; 95% CI 4.56-10.08) and preterm labor (6.53 95% CI 3.66-11.63), premature delivery (6.88; 95% CI 3.43-13.81), placental dysfunction (11.17; 95% CI 7.30-17.11), growth retardation (7.39; 95% CI 3.79-14.41), preeclampsia (2.20; 95% CI 1.29-3.74), anemia (4.10; 95% CI 2.77 -6.08),untimely withdrawal of amniotic fluid (2.20; 95% CI 1.50-3.23), anomalies of labor (5.24; 95% CI 3.35-8.19) and caesarean section (1.93; 95% CI 1.20-3.12).Conclusion. The presence of diffuse non-toxic goiter in pregnant women increases the chance of complications during pregnancy and in childbirth. The most probable chance of occurrence of complications during pregnancy and childbirth is the presence of diffuse non-toxic goiter on the background of subclinical hypothyroidism.

Metabolic profile of amniotic fluid as a biochemical tool to screen for inborn errors of metabolism and fetal anomalies

Physiologic concentration in amniotic fluid (AF) of several metabolites has not been established with certainty. In this study, we initially assayed purines, pyrimidines, and amino compounds in 1,257 AF withdrawn between the 15th and the 20th week of gestation from actually normal pregnancies (normal gestations, normal offspring). Results allowed to determine physiologic reference intervals for 45 compounds. In these AF, not all purines and pyrimidines were detectable and uric acid (238.35±76.31 μmol/l) had the highest concentration. All amino compounds were measurable, with alanine having the highest concentration (401.10±88.47 μmol/l). In the second part of the study, we performed a blind metabolic screening of AF to evaluate the utility of this biochemical analysis as an additional test in amniocenteses. In 1,295 additional AF from normal pregnancies, all metabolites fell within the confidence intervals determined in the first part of the study. In 24 additional AF from women carrying Down's syndrome-affected fetuses, glutamate, glutamine, glycine, taurine, valine, isoleucine, leucine, ornithine, and lysine were different from physiologic reference values. One AF sample showed phenylalanine level of 375.54 μmol/l (mean value in normal AF=65.07 μmol/l) and was from a woman with unreported phenylketonuria with mild hyperphenylalaninemia (serum phenylalanine=360.88 μmol/l), carrying the IVS 4+5 G-T and D394A mutations. The fetus was heterozygote for the maternal D394A mutation. An appropriate diet maintained the mother phenylalanine in the range of normality during pregnancy, avoiding serious damage in fetal and neonatal development. These results suggest that the metabolic screening of AF might be considered as an additional biochemical test in amniocenteses useful to highlight anomalies potentially related to IEM.

Audit of amniocentesis from a district general hospital: is it worth it?

To audit all mid-trimester amniocenteses performed by obstetricians at a district general hospital to see whether experience improved the outcome. Retrospective review of medical records. Royal Gwent Hospital, south Wales. All 469 amniocenteses carried out in 1985-7. Number of attempts at withdrawal of amniotic fluid; number with bloodstained liquor; and number of subsequent miscarriages, terminations, and congenital abnormalities. Of the 469 amniocenteses, 411 were performed by one obstetrician, and initial comparisons with those performed by the rest of the hospital team showed no significant differences in outcome of pregnancy. The main difference between the two groups was in the number of attempts at withdrawal of amniotic fluid and the number with bloodstained liquor. The single obstetrician failed to obtain amniotic fluid on 1% of occasions compared with 10% for the other operators by the end of the second attempt. The costs of carrying out the audit were considerable. The review of fewer than 500 case records cost the equivalent of 2000 pounds in staff time and took over 200 hours to complete, equivalent to 63 sessions of one person's time. The audit was useful in that it provided information on complication rates, which could be compared with published data, and comparisons between obstetricians who perform large and small numbers of procedures. For an individual's practice the monitoring of amniocentesis should not be continuously carried out and subsequent audits should tackle other common procedures. When an audit is attempted the health service should provide adequate support to clinicians for this purpose.

The effect of amniocentesis and drainage of amniotic fluid on lung development in Macaca fascicularis.

Amniocentesis and withdrawal of amniotic fluid was performed on pregnant monkeys (Macaca fascicularis) at two stages in development, either between 47 and 64, or between 85 and 95 days gestation. After birth the lungs of each infant monkey were studied using precise morphometric techniques, and compared with those in a control group of animals. The lungs after amniocentesis had alveoli of normal maturity but reduced in number and increased in size, features which both reduce the relative area for gas exchange. There was also a reduction in the number of respiratory airways. These changes occurred regardless of the time of amniocentesis, the amount of fluid removed and even if the membranes were simply punctured with no fluid removal. There is some evidence to suggest that similar sublethal effects may be present in human infants after maternal amniocentesis.

False elevation of amniotic fluid enzymes of relevance for prenatal diagnosis: creatine kinase measurement in relation to Duchenne muscular dystrophy.

The creatine kinase activity of amniotic fluid was measured in samples collected at fetoscopy. In our first study, the control sample range was 0.25 IU/l, although four samples had activities of 35-85 IU/l. Elevated values did not correlate with the activities in the fetal or maternal circulations. Electrophoresis revealed the presence of the BB isozyme of creatine kinase rather than just the MM form as expected. This suggested that the source of the elevated enzyme activity was from the myometrium, damaged by insertion of the trocar and cannula. In a further series the first 2 ml of amniotic fluid withdrawn yielded a much higher creatine kinase activity than a second aliquot. A control series of such second samples (first 2 ml discarded) gave an activity range of 0-7 IU/l with no spuriously high values. This compares favourably with a series from single samplings taken by amniocentesis. Normal creatine kinase activities were found in the amniotic fluids from 20 pregnancies at risk of Duchenne muscular dystrophy. We conclude that for accurate measurement of amniotic fluid enzyme activity the first portion withdrawn should be discarded. Amniotic fluid creatine kinase activity is of no value for the prenatal diagnosis of Duchenne muscular dystrophy.

Limb reduction anomalies and early in utero limb compression

Seven instances of limb reduction defects are reported with a presumed common underlying etiologic theme of early in utero limb compression, deduced as being due to a bicornuate uterus in four instances, a large fibroid in one instance, and early amnion rupture with transient amniotic fluid loss in two instances. Similar types of limb reduction defects have been experimentally produced as a consequence of early withdrawal of amniotic fluid with resultant compression of the developing limbs, leading to vascular disruption. A similar mechanism is hypothesized to have caused these seven instances of limb reduction defects.

Oligohydramnios and cortisone-induced cleft palate in the mouse.

A HIGH frequency of congenital cleft palate has been demonstrated in mouse embryos after puncture of the amniotic sac shortly before the normal time of palate closure1,2. The treated embryos were obviously constricted, and it was postulated that the cleft palates resulted from flexion of the neck pressing the lower jaw against the chest and thus jamming the tongue between the palatal shelves and preventing their closure. Kreshover3 confirmed these observations in rats. Further experiments demonstrated that cleft palate occurred if the embryos were freed from the uterus after withdrawal of amniotic fluid, but did not occur in such embryos if no fluid was removed4. Embryos observed at the normal time of palate closure after puncture of the amniotic sac do indeed have their lower jaws compressed and their tongues placed unduly high in the space between the shelves (unpublished work of Humphreys, Rosenbaum and Fraser), and it seems clear that in these circumstances cleft palate does result from the oligohydramnios.

MULTIPLE INTRAUTERINE TRANSFUSIONS FOR ERYTHROBLASTOSIS FETALIS.

SELECTIVE preterm delivery and postdelivery exchange tranfusions have been shown to be extremely effective in the management of infants with erythroblastosis fetalis. Spectrophotometric analysis of amniotic fluid has also been helpful in determining the onset of deterioration from erythroblastosis fetalis in the fetus. This has afforded an effective means of selection of fetuses for preterm delivery. In certain instances, unfortunately, the erythroblastosis fetalis is so severe that the fetus begins to deteriorate at a stage too early to survive outside the uterus from the standpoint of maturity alone. It is in this instance that the intrauterine transfusion is crucial. In September 1963, Liley1reported the first successful intrauterine transfusion. Following the withdrawal of amniotic fluid, a radiopaque substance was instilled into the amniotic cavity. In addition to delineating the fetal outline, the radiopaque medium was swallowed by the fetus resulting in a demonstration of the small intestine. Using the

Etiology of hypertension in toxemia of pregnancy

Summary 1. A pressor substance (hysterotonin) has been demonstrated in the decidua obtained from patients with hydatid mole with superimposed toxemia. No hysterotonin has been observed in decidua from normotensive patients with hydatid mole. 2. Vasopressor substances have been demonstrated in the maternal plasma of patients with toxemia. In eclampsia there seem to be two pressor substances, one is heat-stabile and has many of the same pharmacologic properties of hysterotonin, and the other is heat-labile and has many characteristics of the renin-like pressor system. To date, only one pressor substance (heat-stabile) has been demonstrated in pre-eclampsia. 3. The reduction of an elevated intrauterine pressure by withdrawal of amniotic fluid in toxemic individuals results in a marked fall in the maternal blood pressure. 4. Hypoxia is the underlying common denominator responsible for the release of hysterotonin in the uterus in toxemia. The hypertension of toxemia of pregnancy is due to these pressor substances in the maternal circulation.

The trend of modern obstetrics

Among the foregoing are included some advances in treatment whose place of permanence is already guaranteed. One of these is the treatment of central (and some marginal) placenta praevia by Caesarean section, and another is the treatment of acute hydramnios by the withdrawal of amniotic fluid through the abdominal wall. An ideal treatment of other conditions—I mention the toxaemias of pregnancy—has not yet been found. I must mention one condition in which patients are lost: I refer to post-partum haemorrhage. Grave as this condition is, its gravity is often increased manifold by the ill-advised, ill-directed attempts at Crede; ignorance of its many pitfalls is one of the main causes, potential or actual, of death in the third stage of labour or soon afterwards. I do not wish to be disrespectful to the memory of its author, but, instead of being taught as Crede’s manoeuvre, far better to call it Crede’s attack or Crede’s assault, when its potential seriousness and incidentally its many limitations will be better understood. The third stage of labour needs to be thoroughly understood in detail by every doctor practising midwifery. I invariably demand an accurate and detailed knowledge of the third stage from every postgraduate who seeks his L.M. diploma.