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Extracellular 70-kd heat shock protein in mid-trimester amniotic fluid and its effect on cytokine production by ex vivo-cultured amniotic fluid cells.

OBJECTIVE: The 70-kd heat shock protein is released from cells in response to stress and functions as a regulator of innate immunity. We hypothesized that 70-kd heat shock protein in mid-trimester amniotic fluid might regulate local immune system activation. STUDY DESIGN: Amniotic fluid that was obtained from 200 women who underwent amniocentesis at 15 to 19 weeks of gestation was tested by enzyme-linked immunosorbent assay for 70-kd heat shock protein, tumor necrosis factor-alpha, and interleukin-1beta and -6. The amniotic fluid cellular fraction also was evaluated for Mycoplasma hominis by gene amplification. Whole amniotic fluids were incubated ex vivo in medium alone or medium that contained peptidoglycan, a TLR2 ligand, or lipopolysaccharide, a TLR4 ligand. After 24 hours, the supernatants were collected and assayed for 70-kd heat shock protein. The influence of exogenous 70-kd heat shock protein on tumor necrosis factor-alpha and interleukin-1beta and -6 production by whole amniotic fluid was assessed similarly. RESULTS: The 70-kd heat shock protein was detected in all amniotic fluids with a median (range) of 11.5 ng/mL (1.2-76.7). The intra-amniotic 70-kd heat shock protein concentration was correlated positively only with amniotic fluid tumor necrosis factor-alpha levels (P = .0002). Detection of M hominis was associated with an increased 70-kd heat shock protein concentration (median, 17.2 ng/mL; P = .01). The addition of peptidoglycan resulted in a stimulation of 70-kd heat shock protein production, and exogenous 70-kd heat shock protein stimulated the release of tumor necrosis factor-alpha by amniotic fluid cells. CONCLUSION: The 70-kd heat shock protein is released from cells in mid-trimester amniotic fluid as a consequence of TLR2 stimulation and potentiates tumor necrosis factor-alpha production.

Amniotic Fluid↗

In vitro culture of mouse embryos in human amniotic fluid.

Human amniotic fluid was compared with Ham's F-10 culture medium as a possible alternative for use in in vitro fertilisation. The cleavage success of mouse embryos in human amniotic fluid (experimental group) was 92% compared with 86% in Ham's F-10 medium. It is concluded that human amniotic fluid is a viable alternative culture medium for mouse embryos.

Amniotic Fluid↗

Effect of smoking on cadmium and lead concentrations in human amniotic fluid.

The amniotic fluids of 155 pregnant women, non-smokers (n = 128) and smokers (n = 27), were investigated on their cadmium (Cd) and lead (Pb) concentrations. The mean +/- s range of Cd in the amniotic fluid of non-smokers amounted to 2.58 +/- 1.36 ng/l, that of smokers to 7.29 +/- 2.39 micrograms/l. Moreover, there was a correlation between the extent of daily cigarette consumption and Cd levels. With Pb, higher concentrations were found ranging between 23.98 +/- 9.41 ng/l for non-smokers and 21.53 +/- 7.16 micrograms/l for smokers. No correlations were seen between age, week of pregnancy, blood pressure, disorders of pregnancy and the amniotic Cd or Pb concentrations. Thus, the maternal and fetal risks of the higher Cd levels in the amniotic fluid of smoking women remain unanswered.

Amniotic Fluid↗

Amniotic fluid interleukin-6 levels correlate with histologic chorioamnionitis and amniotic fluid cultures in patients in premature labor with intact membranes.

OBJECTIVES: Our purpose was (1) to determine the frequency of intraamniotic and extraamniotic intrauterine infection in patients with premature labor and intact membranes and (2) to determine if intrauterine infection is associated with elevated amniotic fluid interleukin-6 levels. STUDY DESIGN: Amniocentesis was performed on 57 patients in preterm labor and 201 controls at various gestational ages without labor and at term with labor. The amniotic fluid was evaluated with gram stain, cultures, and an enzyme-linked immunosorbent assay specific for interleukin-6. Placentas from study patients (n = 52) and term controls (n = 120) were analyzed. RESULTS: The frequency of positive amniotic fluid cultures (intraamniotic intrauterine infection) was 10 of 57 (18%) in the preterm labor group and zero of 201 for controls. Histologic chorioamnionitis (extraamniotic intrauterine infection) was present in 21 of 24 (88%) of patients in preterm labor that failed tocolysis and 28 of 120 (23%) of term laboring controls. An amniotic fluid interleukin-6 level of > or = 600 pg/ml was 100% sensitive and 89% specific (positive predictive value 85%, negative predictive value 100%) for the identification of intrauterine infection. CONCLUSION: Interleukin-6 is a sensitive and specific marker for the identification of both intraamniotic and extraamniotic intrauterine infection in patients in preterm labor with intact membranes.

Adult↗

Amniotic fluid embolism.

Amniotic fluid embolism occurs rarely but is one of the leading causes of maternal mortality in the United States. The risk of death associated with this syndrome is 60% to 80% with half of survivors suffering long-term neurologic disability. The pathophysiology of amniotic fluid embolism is poorly understood. A review of the largest case series to date concluded that the physiologic and hematologic manifestations bear a greater resemblance to septic and anaphylactic shock than to any embolic phenomenon. Care of the patient who suffers amniotic fluid embolism is supportive. To date, no therapeutic interventions have been found to improve survival.

Animals↗

Occlusions of branch retinal arterioles following amniotic fluid embolism.

Amniotic fluid embolism is a serious complication of pregnancy with a high mortality. We present a 28-year-old healthy woman who underwent dilatation and curettage for an elective abortion, followed by the sudden loss of vision in her left eye. Occlusion of one branch retinal arteriole was the initial finding of her left fundus, and two occlusions developed consecutively on the color fundus photographs. Fluorescein angiography demonstrated occlusions in three retinal arterioles among seven retinal arterioles originating from the optic disc. These findings suggest that possible mechanisms of amniotic fluid embolism are the unusual cause in retinal arteriolar occlusions. Here clinical course and ophthalmic findings are reviewed, and the relationship between amniotic fluid embolism and retinal arteriolar occlusions is discussed.

Abortion, Legal↗

Amniotic fluid cell culture II. Evaluation of a red blood cell lysis procedure for culture of cells from blood-contaminated amniotic fluid.

Second trimester amniotic fluid samples obtained transabdominally for genetic analysis not infrequently are contaminated with blood. There has been disagreement as to whether blood contamination interferes with the efficiency of culture of amniotic fluid cells for genetic diagnosis. A procedure using ammonium chloride to lyse contaminating red blood cells has been recommended to increase culture success. In this report we document that cultures derived from blood-contaminated amniotic fluids form fewer cell colonies than cultures from clear amniotic fluids. We also show that a recommended procedure using ammonium chloride to lyse red blood cells is ineffectual in improving the efficiency of cell culture, and may be detrimental to successful culturing of cells from bloody amniotic fluids. A hypothesis concerning the mechanism of interference with culture of amniotic fluid cells by contaminating blood is presented and a means of preventing this complication is suggested.

Ammonium Chloride↗

[Fulminant course of amniotic fluid embolism].

Amniotic fluid embolism is an obstetric complication that can present during pregnancy or labor and is associated with high rates of morbidity and mortality. The incidence is low but the mortality rates for both mother and fetus are high. A 34-year-old woman in the 41st week of gestation was admitted for induction of labor. While still in the labor room, she complained of pruritus around the mouth and tongue. Tonic-clonic convulsions, hypotension, and loss of consciousness followed. Cardiopulmonary resuscitation maneuvers were started and an immediate cesarean section under general anesthesia was performed to deliver a live infant boy. The Apgar score at 5 minutes was 8. The mother was transferred for recovery to the intensive care unit (ICU), where rapid cardiocirculatory and pulmonary decline continued. After 2 episodes of electromechanical dissociation, exitus occurred 2 hours after ICU admission. The autopsy confirmed the diagnosis of amniotic fluid embolism. Keratin squames were found in the capillaries of both lungs and polymorphonuclear cells and proteinaceous material were observed in alveoli. Mechanical obstruction is not the only cause of amniotic fluid embolism. Circulating substances that affect myocardial contractility and coagulation are also implicated and the cause may even be an allergic reaction. The usual signs are acute respiratory failure, cardiovascular collapse, and occasionally convulsions and coagulopathy. Cardiac arrest occurs in 80% of the cases. Treatment is symptomatic to provide life-sustaining measures in response to the clinical picture as it develops.

Adult↗

[Effect of the vernix caseosa content in the amniotic fluid on the actual pH-value of the amniotic fluid].

To determine the eventual influence of the vernix caseosa on the actual pH-value of the amniotic fluid we compared the pH-value of 50 samples of non-filtered amniotic fluid and the pH-values of filtered portions of the same samples. The samples were taken after delivery of the fetus. We found a distinct shift of the pH-values of the filtered portions to alkaline values. It is recommended that these results should be taken into consideration in laboratory analysis of amniotic fluid.

Amniotic Fluid↗

Origin of prostanoids in human amniotic fluid: the fetal kidney as a source of amniotic fluid prostanoids.

The present study was designed to investigate the origin of prostanoids that are present in amniotic fluid. We evaluated the concentration of prostaglandins in fetal urine that was obtained from newborn infants immediately after delivery either before or after the onset of spontaneous labor or after oxytocin-induced labor. We found that the levels of prostaglandin (PG) E2, PGF2 alpha, 6-keto-PGF1 alpha, and 13, 14-dihydro-15-keto-PGF2 alpha in the fetal urine of newborn infants delivered after the spontaneous onset of labor and after oxytocin-induced labor were significantly greater than the levels in the fetal urine of newborn infants delivered before the spontaneous onset of labor. We conclude that one source of the prostanoids present in amniotic fluid is fetal urine, and, thence, fetal kidneys, and that labor, whether spontaneous or induced, caused increased excretion of prostanoids in fetal urine.

Amniotic Fluid↗

[Meconium-stained amniotic fluid and intra-amniotic infection].

OBJECTIVE: To explore the relationship between meconium-stained amniotic fluid and Fifty-six women of cesarean section with intact membrane and intra-amniotic infection. METHODS: without parturient were divided into 3 groups according to the property of amniotic fluid (no meconium, I to approximately II degree meconium stainedness, and III degree mecomium stainedness). The content of interleukin-6 in amniotic fluid was measured with ELISA. The infiltration of inflammatory cells in the placenta and its membrane was determined by the pathological diagnosis. The neonatal Apgar score and puerperial infection after the surgery were analyzed. RESULTS: There were no significant differences in the content of IL-6 in amniotic fluid and in the infiltration of inflammatory cells among the 3 groups. But the rate of neonatal asphyxia in the meconium-stained cases was significantly higher than that without meconium. CONCLUSION: Meconium-stained amniotic fluid is a marker of fetal distress, but it is not related to intra-amniotic infection.

Adult↗

HPLC of phospholipids in biological fluids -- application to amniotic fluid for the prediction of fetal lung maturity.

Because of both the advantage of speed compared with thin layer chromatography (TLC) and the dearth of high pressure liquid chromatography (HPLC) methods for phospholipid separation, it was decided to investigate the use of HPLC with a differential refractometer as detector for the separation and quantitation of amniotic fluid phospholipids required for the prediction of fetal lung maturity. A method was devised which gave results which compared well with those from TLC both in terms of quantitation and predictive value. Despite this, the method was found to lack sufficient reliability for application to the routine clinical assessment of fetal lung maturity. The method does, however, offer a good alternative to two dimensional TLC with phosphate analysis in research work involving quantitation of phosphatidyl inositol, phosphatidyl glycerol and particularly lecithin.

Amniotic Fluid↗

Amniotic fluid embolism and isolated coagulopathy: atypical presentation of amniotic fluid embolism.

A 41-year-old multigravida presented at 32 weeks of gestation with polyhydramnios and an anencephalic fetus. Abnormal bleeding as a result of disseminated intravascular coagulation complicated an emergency Caesarean section for severe abdominal pain thought to be due to uterine rupture. Massive transfusion with blood products was necessary and the abdomen packed to control bleeding. The patient was transferred to the intensive care unit where she made a slow but complete recovery. Amniotic fluid embolism with atypical presentation of isolated coagulopathy is the likely diagnosis in this case. The case serves to demonstrate that amniotic fluid embolism may present with symptoms and signs other than the classical pattern of dyspnoea, cyanosis and hypotension.

Adult↗

[Procoagulant properties of the amniotic fluid. IV. The acceleration time of thromboplastin in the amniotic fluid in pathologic pregnancy].

With the purpose of know the behaviour of the thromboplastic acceleration time in amniotic fluid, there were analized 390 amniotic fluids, 241 from normal pregnancies and 149 from abnormal pregnancies, of these, 52 from diabetic women, and 97 from hypertensive women. It was found an important increase in T.A.T. with the progress of pregnancy and their usefulness as fetal lung maturity test. It was concluded, that this method is easy, cheap, and highly specific, so it can be the first election test for determination of fetal lung maturity in low resources Obstetric Centers.

Amniotic Fluid↗

Current concepts of amniotic fluid dynamics.

Amniotic fluid at term in the human is the product of numerous exchanges with the fetal and indirectly, the maternal compartments. Our current information on the formation, circulation, and removal of this fluid is limited but provides an interesting concept of the steady-state regulation of this space. Further confirmation of this model comes from data describing drug exchange between mother, fetus, and amniotic fluid.

Amniotic Fluid↗

Amniotic pressure in disorders of amniotic fluid volume.

Amniotic pressure was measured in 49 pregnancies with abnormal quantities of amniotic fluid. Among 17 with polyhydramnios, the pressure was always above the normal mean for gestation and exceeded the upper limit of normal in nine. In polyhydramnios, amniotic pressure correlated positively with the depth of the deepest pool (r = 0.65, P = .04) and negatively with fetal PO2 (r = -0.57, P = .03) and pH (r = -0.56, P = .04). Amniotic pressure was raised in all those with a deepest pool of greater than 15 cm, and was normal in all with a deepest pool less than 15 cm. Amniotic pressure fell significantly with drainage of amniotic fluid in those with raised pressure (mean 12.7 mmHg, 95% confidence interval 7.0-18.3; P = .002) but not in those with normal pressure (mean 0.3, 95% confidence interval -3.2 to +3.9; P = .82). Restoration of normal amniotic pressure in one pregnancy was accompanied by marked improvement in fetal acid-base status. Among 24 pregnancies with severe oligohydramnios, amniotic pressure was always below the normal mean, falling below the lower limit of normal in eight; whereas in another eight pregnancies with mild/moderate oligohydramnios, amniotic pressure was scattered evenly within the normal range. Amnioinfusion of 55-500 mL of normal saline in cases of severe oligohydramnios led to a significant rise in pressure (4.7 mmHg, 95% confidence interval 3.5-5.9; P less than .0001). We conclude that amniotic pressure is high in polyhydramnios and low in oligohydramnios. Pressure monitoring may be beneficial during amnioinfusion and therapeutic amniocentesis.

Acid-Base Equilibrium↗