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PubMed2004

Dependence of fetal hairs and sebaceous glands on fetal adrenal cortex and possible control from adrenal medulla.

Human fetal adrenal development is characterized by rapid growth, high steroidogenic activity, and a distinct morphology, including a unique cortical compartment known as the fetal zone. For most of gestation, the predominant fetal zone accounts for 80-90% of the cortical volume and is the primary site of growth and steroidogenesis, producing 100-200 mg/day of the androgenic steroid, dehydroepiandrosterone sulfate (DHEA-S). The physiological role of this zone during intrauterine life is not well understood. While the glands appear to be capable of DHEA-S synthesis early in gestation (8-10 weeks), we noticed that this event precedes the differentiation of hairs and sebaceous glands. Hairs begin to develop between 9 and 12 weeks and sebaceous glands between 13 and 15 weeks of gestation. Sebaceous glands form an oily secretion - sebum that mixes with desquamated epidermal cells to form vernix caseosa. Vernix caseosa protects the developing skin from constant exposure to amniotic fluid, and hairs helps to hold the vernix caseosa on the skin. We suggest therefore that the human fetal adrenal cortex produces DHEA-S beginning at around 8-10 weeks of gestation in sufficient quantities to influence the growth of hairs and sebaceous glands. Soon after birth, the fetal zone atrophies, and adrenal androgen production decreases to minimal levels. As a consequence, in concordance with the rapid decrease in adrenal androgen levels and in consistent with our hypothesis, fetal hairs are shed and sebaceous glands shrink to small structures. The mechanism that regulates fetal adrenal androgen production is a key unanswered problem in human adrenal biology. Since there exists a close relationship between epinephrine and DHEA-S levels during adrenarche which shows modulatory interactions between adrenal androgen production and adrenomedullary function, we suggest again that adrenomedullary function might play a role in the control of fetal adrenal androgen secretion.

Adrenal Cortex↗
PubMed2005

Prenatal and newborn paternity testing with DNA analysis.

In rape against youthful girls which yields pregnancy after the abortion DNA examinations can be performed from the aborted foetal material to provide evidence of paternity of the suspect. In our present work we demonstrate six cases: four of them are rape cases and two where the mother abandoned her newborn baby. These cases proved that DNA-STR profiles can be determined from foetus after the abortion and perpetrator of a rape can be found. Due to our result we suggest that not only placenta but also bloody vernix caseosa is useful tissue for identifying the putative mother because vernix caseosa can be the carrier of the mother's blood.

Aborted Fetus↗
PubMed2003

Vernixuria: another sign of uterine rupture.

Uterine rupture complicates approximately 1% of trials of labor after cesarean. Classic signs and symptoms include loss of station, cessation of labor, vaginal bleeding, fetal distress, and abdominal pain. Other signs are also possible. We report a case of uterine rupture at VBAC trial that includes an unusual clinical sign of uterine rupture: vernix caseosa observed in the urine of the parturient. During labor, a bladder catheter was inserted to evaluate oliguria. Vernix caseosa and blood were found in the tubing. Prompt cesarean delivery followed. A tear extending from the original transverse scar into the bladder dome was found. Vernixuria is an additional sign of uterine rupture.

Adult↗
PubMed1978

[Measuring the turbidity of amniotic fluid, a possibility to assess fetal maturity before birth (author's transl)].

At the end of gestation, depending on maturation of the fetus and especially of its skin, vernix caseosa is detached into amniotic fluid. The changes of amniotic fluid turbidity can be quantitatively verified with a fotometer (filter for 578 nm, 10 mm disposable cuvettes). The turbidity of amniotic fluid was measured in 125 cases. No correlation was found between turbidity and length of gestation from day 261 to day 287 after last menstruation. In contrast, there is strong and significant contingency between turbidity of amniotic fluid and maturity of fetal skin (quantity of vernix caseosa) or clinical maturity assessed according to Farr et al. Finding a turbidity below 0.5 U on extinction scale of the fotometer, the fetus is not fully mature in 50% of these cases; placental dysfunction can be excluded with high probability. In contrast, two thirds of the children with high turbidity of amniotic fluid (more than 1.0 U on extinction scale) had clinical signs of placental dysfunction.

Amniotic Fluid↗
PubMed2006

Micelles of pulmonary surfactant in human amniotic fluid at term.

Studies using in vitro analysis have shown that the interaction between pulmonary surfactant and vernix caseosa could explain the appearance of amniotic fluid turbidity. That phenomenon is interpreted based on the "roll-up" hypothesis. We tested the roll-up hypothesis by examining the presence of micelles of pulmonary surfactant in human amniotic fluid at term. Amniotic fluid samples were collected from each of six healthy pregnant women at term and at 16 wk of gestation. These samples were stained negatively and analyzed using an electron microscope. Ultrastructures present in amniotic fluid were compared with the structure of micelles derived from suspended surfactant TA isolated from bovine lung. Surfactant TA formed spheroidal and rod-shaped micelles 10-70 nm in diameter above the critical micelle concentration. Identical micelle particles were described in human amniotic fluid at term. In addition, surfactant protein B was identified in the micelle fraction of amniotic fluid. However, no micelles were found in human amniotic fluid taken at 16 wk of gestation. Our results support the view that pulmonary surfactant could induce the detachment of vernix caseosa and increase the turbidity of the amniotic fluid.

Amniotic Fluid↗
PubMed1989

The effect of changes in the conductive medium on the fetal ECG throughout gestation.

The electrical conduction of the ECG from the fetal heart to the maternal abdomen has been modelled by using volume conductor models based on the measured actual geometry. The models have been verified by means of multi-lead recordings of the fetal ECG. The results show that early in pregnancy (less than 28 weeks) the conduction can successfully be described by an electrically homogeneous model. Based on this model, a description of the fetal ECG that is independent of the position of the fetus is derived. In late pregnancies, the conduction is dominated by the isolating effect of the vernix caseosa. As the distribution of the vernix over the fetal body is unknown, the shape of the fetal ECG is disturbed in an unintelligible way. As a consequence, caution has to be applied when using the shape of the fetal ECG for diagnostic means.

Electric Conductivity↗
PubMed1998

Clinical significance of echogenic amniotic fluid.

PURPOSE: This study aimed to determine the clinical significance of echogenic amniotic fluid. METHODS: We prospectively studied 19 twin pregnancies in which the amniotic fluid in 1 sac was anechoic and that in the other sac was echogenic. Morphologic characteristics of amniotic fluid were assessed from samples taken at amniocentesis or upon delivery within 48 hours after sonographic examination. RESULTS: In twins with echogenic amniotic fluid, assessment revealed clear fluid in 6 cases (32%), vernix caseosa in 12 (63%), and meconium in 1 (5%). In co-twins with anechoic amniotic fluid, assessment revealed clear fluid in 9 cases (47%), vernix caseosa in 6 (32%), and meconium in 4 (21%). CONCLUSIONS: Echogenic amniotic fluid on prenatal sonography is not predictive of meconium.

Adult↗
PubMed2002

The influence of fetoabdominal tissues on fetal ECGs and MCGs.

Both fetal electrocardiography and fetal magnetocardiography are influenced by the volume conduction within the abdomen of the pregnant woman. In this paper, various models are used to simulate this influence. Such models are helpful to determine where to attach electrodes at the maternal abdomen in case fetal ECGs are measured and where to position the magnetocardiograph in case fetal MCGs are measured. Another goal is to assess the influence of individual differences, such as the amount of amniotic fluid. Seven models based on MR-images have been created, four for the third trimester of gestation, with the fetus in left occiput position, and three for the second trimester. The models consist of four compartments; the fetus, the vernix caseosa, the amniotic fluid, and the remainder of the maternal abdomen. It turns out that individual differences have a large impact on the fetal MCG and that the best measurement positions are expected over the centre of the abdomen near the fetal heart. The fetal ECG is dependent on the vernix caseosa and when this layer is present, the fetal ECG is best measured by two electrodes, one over the fetal mouth and the other over the bottom of the fetus.

Abdomen↗
PubMed1986

Methods of prenatal determination of fetal maturity based on differentiation of the fetal skin during the last weeks of pregnancy.

During the process of 'maturation' of the fetal skin, detachment of the layer of vernix caseosa takes place from the fetal epidermis into the amniotic fluid, in the course of the last weeks of pregnancy. This results in: (a) a change of the cytological image of the amniotic fluid followed by a considerable increase in the proportion of the keratinized epidermic cells, (b) a simultaneous increase in the turbidity of the amniotic fluid and (c) a parallel increase in the quantity of sediment which remains after centrifugation of the amniotic fluid. The data presented in this paper, measured in 87 samples of amniotic fluid from normal, eutrophic, uncomplicated pregnancies, indicate the difference between the values of the various parameters before and after the main detachment of the vernix caseosa. Since the fetal skin is the organ reflecting most accurately the general status of the fetal maturity at the end of pregnancy, we consider that an overall examination of findings from the amniotic fluid indicating the condition of the fetal skin supplies us with reliable results for making a prenatal prediction of the maturity status of the fetus.

Amniotic Fluid↗
PubMed1986

Vernix in amniotic fluid: sonographic detection.

We investigated the possibility of using sonography to detect vernix caseosa, a complex fatty substance derived from desquamated epithelial cells and sebaceous material. In one of our cases, the sonographic appearance of vernix was dramatic, and its presence was confirmed at amniocentesis.

Adult↗
PubMed2000

Interaction between pulmonary surfactant and vernix: a potential mechanism for induction of amniotic fluid turbidity.

The development of amniotic fluid turbidity during the third trimester is a known marker of fetal lung maturity. We hypothesized that this turbidity results from detachment of vernix caseosa from the fetal skin secondary to interaction with pulmonary-derived phospholipids in the amniotic fluid. To test this hypothesis, we exposed vernix to bovine-derived pulmonary surfactant over a physiologically relevant concentration range. Ten milligrams of vernix was evenly applied to the interior walls of 1.5-mL polypropylene microfuge tubes. Surfactant phospholipids were added to the tubes followed by slow rotation at 37 degrees C overnight. The liquid was decanted and spectrophotometrically analyzed at 650 nm to detect solution turbidity due to vernix detachment and/or emulsification. Increasing concentrations of surfactant phospholipids produced a dose-dependent increase in solution turbidity. A phospholipid mixture closely approximating natural pulmonary surfactant but devoid of surfactant-associated proteins yielded no increase. In other studies, the flow properties of vernix were studied in a Haake flow rheometer at 23 degrees C and 37 degrees C. There was a marked temperature-dependent effect with lower stress required to elicit flow at 37 degrees C compared with 23 degrees C. This temperature dependence was also demonstrated in the turbidity assay with a 124% increase in turbidity at body temperature compared with room temperature. We conclude that under in vitro conditions, pulmonary surfactant interacts with vernix resulting in detachment from a solid phase support. We speculate that in utero, this phenomenon contributes to the increase in amniotic fluid turbidity that is observed near term.

Amniotic Fluid↗
PubMed1994

Very echogenic amniotic fluid: ultrasonography-amniocentesis correlation.

Very echogenic amniotic fluid has been variably attributed to meconium, blood, or vernix caseosa. However, most previous reports have been case reports, and most cases have not had proof by amniocentesis. In a larger series of patients with proof by amniocentesis, we sought to determine the relative frequency of these substances as causes of very echogenic amniotic fluid. We retrospectively identified obstetric sonograms in which the amniotic fluid was homogeneously filled with innumerable echogenic particles. The cause of the increased echogenicity was determined by fluid appearance at amniocentesis. Of 86 cases identified, immediate proof by amniocentesis was available in 19 patients for whom the gestational age ranged from 32.8 to 39.4 weeks. Vernix was present in 18 (95%) patients and meconium in one (5%) patient. Very echogenic amniotic fluid in the third trimester is most often due to vernix and infrequently due to meconium. This sonographic finding is not a reliable indicator of meconium or blood in amniotic fluid and should not typically alter antenatal management.

Amniocentesis↗