[The capillary method for assessing pulmonary maturity using amniotic fluid].

OBJECTIVE: To determine whether elevated concentrations of macrophage inflammatory protein-1 alpha (MIP-1 alpha) in amniotic fluid (AF) are related to term and preterm labor. METHODS: Amniotic fluid was obtained from women from five different clinical situations: 1) term cesarean delivery, no labor (n = 29); 2) normal term labor, no infection (n = 36); 3) preterm labor, delivery more than 1 week from sampling, no infection (n = 19); 4) preterm labor, delivery within 1 week from sampling, no infection (n = 18); and 5) preterm chorioamnionitis (n = 8). Amniotic fluid was collected aseptically at the time of amniocentesis, amniotomy, or hysterotomy. Concentrations of MIP-1 alpha were determined by enzyme-linked immunosorbent assay. Statistical analysis was by Wilcoxon rank-sum test, Kruskal-Wallis test, and unpaired t test. RESULTS: Women in normal term labor had significant elevations of AF MIP-1 alpha concentrations when compared with women at term undergoing repeat cesarean delivery (P < .001). In women with term gestation, AF MIP-1 alpha correlated well with cervical dilation (r2 = 0.479, P < .001). In women with preterm labor who later delivered within 1 week of presentation, AF MIP-1 alpha concentrations were higher than those from women who did not deliver within 1 week. Women who presented with clinically evident chorioamnionitis had the highest concentrations of AF MIP-1 alpha (P = .001). CONCLUSION: Women in labor have significantly elevated AF concentrations of MIP-1 alpha, particularly if labor is associated with intrauterine infection. We suggest that MIP-1 alpha is involved in the physiology of normal labor and in the pathogenesis of infection-associated preterm labor.

Amniotic Fluid↗

PubMed1996

Prognostic significance of unexplained elevated amniotic fluid alpha-fetoprotein.

OBJECTIVE: To compare the prognostic values of unexplained elevated amniotic fluid alpha-fetoprotein (AF AFP > or = 2.0 multiples of the median [MoM]) and unexplained elevated maternal serum alpha-fetoprotein (MSAFP > or = 2.5 MoM). METHODS: We accessed a data base containing the results of MSAFP screening tests, genetic amniocenteses, and pregnancy outcome data on all women undergoing second-trimester genetic amniocentesis from October 1988 through August 1994. After excluding all patients whose elevated AFP levels had any identifiable cause (positive AF acetylcholinesterase, AF blood contamination, fetal malformation or aneuploidy, multiple gestation, etc), 5743 cases were analyzed. Relative risks (RR) for selected pregnancy complications were determined. RESULTS: Elevated MSAFP, with any AF AFP, was associated with fetal growth restriction (RR 2.5, 95% confidence interval [CI] 1.4-4.4), stillbirth (RR 3.5, 95% CI 1.4-8.3), preeclampsia (RR 2.8, 95% CI 1.1-7.0), and preterm delivery (RR 2.8, 95% CI 2.3-3.4). Elevated AF AFP, with any MSAFP, was associated with preeclampsia (RR 4.4, 95% CI 2.0-10.0) and preterm delivery (RR 1.7, 95% CI 1.3-2.4). Elevation of both AF AFP and MSAFP was associated with preterm delivery (RR 4.0, 95% CI 2.8-5.7). When elevated AF AFP was found in association with a normal MSAFP, the RR to develop preeclampsia was 4.6 (95% CI 1.9-11.2). CONCLUSION: Maternal serum alpha-fetoprotein is a better predictor of late pregnancy complications than AF AFP. However, unexplained elevated AF AFP appears to be especially predictive of preeclampsia.

Amniotic Fluid↗

PubMed1996

The human prolactin receptor in the fetal membranes, decidua, and placenta.

Human PRL is synthesized and secreted by the maternal decidua, but not by the chorionic cytotrophoblast of the chorion laeve or the placenta. The sites of action for decidual PRL are currently unknown. Accordingly, Northern analysis and in situ hybridization histochemistry have been used respectively to quantitate and localize the expression of the PRL receptor (PRL-R) gene within the uterus during the peripartal period. Immunocytochemistry and Western blot analysis using an anti-PRL-R antibody (U5) localized the translated protein at the cellular level in the same tissues. As judged by the level of expression of the PRL-R gene and its translated products, the chorionic cytotrophoblast has been shown to be a primary site of action. Novel sites were also shown in the decidua, placental trophoblast, and amniotic epithelium. In situ hybridization was not obtained in the latter despite positive Northern analysis and immunostaining. Western analyses with an antibody (U5) to the extracellular domain of the rat PRL-R detected six major molecular species of 95, 85, 63, less than 63, more than 30, and 30 kDa in cytosol from separated amnion, chorion, and decidua. The two bands at 95 and 85 kDa were approximate values only and represent the mature glycosylated forms of the human PRL-R. The other four major bands were partial degradation products from the PRL-R, showing tissue-specific processing and patient to patient variation related to the spectrum of proteases present in these tissues. The 63- and 30-kDa PRL-R-related proteins were detected in both the cytosol and medium from amnion, chorion, and decidua and were also present in amniotic fluid. The 30-kDa species was equal in size to a recently reported PRL-binding protein in human milk. The release of these two PRL-R-related proteins into amniotic fluid suggests possible functions as binding and or/PRL transport proteins in these tissues. The more than 30-kDa species was detected in high amounts in both cytosol and medium from the decidua, but was absent from amniotic fluid. Further work is required to clarify the structural relationships and potential functions of these immunologically PRL-R-related proteins. This study shows that the PRL-R is widely expressed by both fetal and maternal tissues in late pregnancy. Its increased expression during labor and delivery in the chorion, decidua, and placenta supports an autocrine/paracrine role for decidual PRL in the peripartum.

Amniotic Fluid↗