Fibrinolytic components in fetal membranes and amniotic fluid

OBJECTIVE: We evaluated fibrinolytic components in plasma and amniotic fluid of pregnant women and in postpartum fetal membranes. STUDY DESIGN: Fibrinolytic parameters in amniotic fluid and plasma were measured by means of enzyme-linked immunosorbent assays. Fetal membranes collected after spontaneous labor at term were analyzed by immunohistochemical methods with immunospecific antibodies against fibrinolytic components. RESULTS: Amniotic fluid contained high plasminogen activator inhibitor-1 concentrations but had low activity. Strong staining for plasminogen activator inhibitor-1 and vitronectin was observed in chorionic trophoblasts and moderate staining in decidual connective tissue. Strong staining for plasminogen activator inhibitor-2 was seen in decidual cells. Although prominent staining of plasminogen activators and plasminogen were observed in the amniotic epithelium, virtually no plasminogen activator inhibitor-1, plasminogen activator inhibitor-2, or alpha 2-plasmin inhibitor staining was detected. CONCLUSION: The delicate balance of fibrinolytic activators and inhibitors in fetal membranes and amniotic fluid may contribute to the triggering of membrane rupture at term.     

Changes in the amniotic fluid volume in fetal structural anomalies]

Phathalate esters, which are commonly used as plasticizers for polyvinyl chloride, are also well known to disturb Sertoli cells. This study aims to show the effect of prenatally administered phthalate on testicular descent in pre- and postnatal rats. Pregnant rats were exposed to mono-n-butyl phthalate (MBP) by gavage from the 15th to the 18th gestational days. Rats administered with solvent only were used as controls. In 20-day-old fetuses (n = 15), the degree of transabdominal testicular ascent in relation to the bladder neck was thus found to be significantly higher in MBP-treated rats than that of the controls (n = 19). In addition, in MBP-treated male offspring (n = 26), 22 rats showed either bilateral or unilateral cryptorchidism at the age of 30 to 40 days old, and the occurrence of cryptorchidism was 84.6%. By contrast, the occurrence of cryptorchidism was 0% in the control rats (n = 15, P < .001). It is therefore suggested that prenatal exposure to MBP may disturb the Sertoli cells and elevate the fetal testes relative to the bladder neck while also inducing cryptorchidism postnatally. Sertoli cells may thus play an important role in the transabdominal descent of the testis by secreting Müllerian-inhibiting substance (MIS), which is known to act as a putative mediator of the transabdominal phase.     

Prediction of fetal lung maturity from near-infrared spectra of amniotic fluid

A total of 189 infants of 24-29 weeks' gestation were born in a regional perinatal centre during a 2-year period. They were divided into groups according to the primary cause of preterm delivery: antepartum haemorrhage (n = 37, 20%), preeclampsia (n = 27), 14%), preterm premature rupture of membranes (n = 64, 34%), preterm labour (n = 27, 14%), chorioamnionitis (n = 16, 8%), other complications (n = 18, 10%). The perinatal mortality rate (PMR) was 286/1,000 of whom 44% were stillbirths. The 'other complication' group had the highest PMR due to a large number of intrauterine deaths, with no differences in neonatal mortality between the groups. Preeclampsia was associated with an increased risk of necrotizing enterocolitis and chorioamnionitis was associated with an increased risk of periventricular haemorrhage. Follow-up to at least 2 years was performed in 122 (97%) of survivors. Cerebral palsy occurred in 7%, while 18% had neurodevelopmental disability. No relationship was found between primary cause of preterm delivery and outcome. This information should be of value in counselling parents when preterm delivery is imminent.     

Effect of fetal movement on the amniotic fluid index in diamniotic twin gestations

Fetal movement changes the size and location of amniotic fluid pockets during measurement of the amniotic fluid index. In singleton gestations, the effect of redistributing the fixed intrauterine fluid volume on the amniotic fluid index is clinically insignificant. In this study, we tested the hypothesis that the index in twin pregnancies is unaffected by fetal movement. A single examiner prospectively determined the amniotic fluid index before and after three discrete episodes of movement by both fetuses of 82 diamniotic twin pregnancies referred for obstetric sonograms between 20 and 38 weeks' menstrual age. A reliable blinded examiner provided a second post-movement measurement as a control. Data were analyzed by the paired t-test. The mean change in the amniotic fluid index after fetal movement was 2.1 +/- 0.2 cm and 3.7 +/- 0.3 cm for post-movement determinations by the same and blinded examiners, respectively (p < .001). Interobserver variation was 3.5 cm. Intraobserver variation was 1.8 cm for the first examiner and 2.2 cm for the second examiner. Therefore, interobserver and intraobserver variation can account for the observed change in the amniotic fluid index following movement of both diamniotic twins.     

Low-level mosaicism for both trisomy 15 and monosomy-X in amniotic fluid cells confirmed in fetal tissues

We report here a case of true fetal mosaicism for both trisomy 15 and monosomy-X; the aberrant cell lines were initially detected at amniocentesis as low-level mosaicism (trisomy 15) and multiple-cell pseudo-mosaicism (monosomy-X). In the fetal lymphocytes, only metaphases with a normal chromosome complement were observed. After termination of the pregnancy, various fetal biopsies revealed both trisomy 15 and monosomy-X mosaicism, whereas, at autopsy, no external or internal abnormalities could be detected in the fetus. The karyotype can be described as 45,X[15]/47,XY,+15[3]/46,XY[27]. Our results implicate that an additional amniocentesis could be more helpful than fetal blood sampling in predicting the fetal karyotype after diagnosis of chromosome mosaicism at amniocentesis.     

Presence of immunoassayable beta-endorphin in human amniotic fluid: elevation in cases of fetal distress

Immunoassayable beta-endorphin is present in samples of amniotic fluid obtained in the last two weeks of pregnancy. Average concentration is approximately 300 pg. per milliliter. In all cases of suspected or recognized fetal distress, striking elevations of the beta-endorphin concentrations (twofold to 20-fold) were observed. The degree of elevation correlated with the degree of fetal distress.     

Cocaine and its metabolites constrict cerebral arterioles in newborn pigs

We examined the effect of cocaine and several of its metabolites on cerebral arterioles in newborn pigs and evaluated the sympathomimetic properties of each of the compounds as a vasoactive mechanism. After piglets were equipped with closed cranial windows, compounds were suffused over the brain surface and pial arteriolar diameter (base line, approximately 100 microns) was recorded. Cocaine, cocaethylene, norcocaine, ecogonine, benzoylecgonine and ecgonine methylester each caused a dose-dependent (10(-8) M to 10(-4) M) decrease in pial arteriolar diameter: maximum percent reductions in diameter induced by each compound (10(-4) M) were, respectively, 12 +/- 1, 12 +/- 2, 11 +/- 1, 7 +/- 1, 7 +/- 2 and 5 +/- 1. In analyzing the dose-response curves, cocaethylene was the most potent vasoconstrictor, followed by cocaine, norcocaine and then ecogonine, benzoylecgonine and ecgonine methylester. Cerebral vasoconstriction induced by topically applied norepinephrine was enhanced by cocaine, norcocaine and cocaethylene, but not by the other three metabolites. Topical application of phentolamine failed to block vasoconstriction elicited by cocaine or its metabolites, although it did block vasoconstriction elicited by norepinephrine. These observations indicate that cocaine and its metabolites constrict the immature cerebrovasculature by a non-sympathomimetic mechanism.     

Prognostic value of amniotic fluid index estimated during labor during chronic fetal acidosis]

There were performed measurements of AFI in 32 women during labour and they were referred to pH of neonatal umbilical vein. It was proved by significant statistic relation p = 0.034 (r = 0.375) between AFI and pH of umbilical vein blood. In anticipation of fetal acidosis with AFI < or = 5 cm with pH < or = 7.25 it was determined that: sensitivity 66.7%, specificity 58.6%, positive predictive value 14.3%, negative predictive value 94.4%, false positive 85.7%, false negative 5.6%, accuracy 59.4%. Obtained data do not differ from those given in literature. Measurements of AFI < or = 5 cm help in identification of the risk group (fetus in danger, of acidosis during labour) but due to low specificity and low positive predictive value (66.7% and 14.3% respectively). Clinical decisions should be made after consideration the result of the other tests of fetal well-being.     

In vivo transfer of gene and oligodeoxynucleotides into skin of fetal rats by incubation in amniotic fluid

One of the tools to test an in vitro hypothesis in vivo is transgenic/gene targeting technology. Transgenic technology provides many advantages such as: (1) the study of specific gene function as systemic and developmental effects; and (2) testing of specific gene function chronically. nevertheless, one disadvantage of this technology is the difficulty in tissue-specific targeting of the transgenic expression. Another useful tool is the in vivo gene transfer approach. Therefore, we tested a potential novel model for the study of transgene expression and knock-out using antisense technology. Here, we have demonstrated that incubation of hemagglutinating virus of Japan (HVJ)-liposome complex containing FITC-labeled oligonucleotides in the amniotic fluid of fetal rats resulted in the nuclear localization of fluorescence in the skin (epidermis and dermis). Similarly, transfection of beta-galactosidase gene resulted in positive staining in several surface layers of the skin. Thus, local gene or antisense oligonucleotide transfer approach into the skin may be useful for studying the role of autocrine/paracrine mediators and treating diseases.     

Collagen degradation products in amniotic fluid

It was found that amniotic fluid (38-42 Hbd) contains hydroxyproline in concentration about 10 micrograms/ml. Gel filtration and dialysis demonstrated that most of hydroxyproline exists in a form of low molecular weight products. Furthermore, it was found that amniotic fluid contains a protein which eluates during gel filtration in void volume of the column. It gives a positive reaction for hydroxyproline but the absorption spectrum of such product is not characteristic for this amino acid. Furthermore, it is not digested by bacterial collagenase. It allows to conclude that amniotic fluid (38-42 Hbd) does not contain collagenous proteins. Only low molecular weight degradation products were found. Only part of them is susceptible on the action of bacterial collagenase.     

Cocaine and metabolites in the hair of ancient Peruvian coca leaf chewers

Cocaine and its metabolites, benzoylecgonine (BZE) and ecgonine methylester (EME), were found in hair samples from ancient Peruvian coca-leaf chewers dating back to AD 1000. Hair was analyzed by gas chromatography/mass spectrometry (GC/MS) to quantitate the concentrations. The two metabolites were found in higher concentration than the parent drug. The metabolite levels appear to be below that of modern cocaine abusers. Gender does not appear to be a factor in the incorporation of drug into hair.     

Decreased amniotic fluid volume at < 32 weeks of gestation is associated with decreased fetal movements

The objective of this study was to assess the relationship between amniotic fluid volume (AFV) and fetal movements at < 32 weeks gestation as assessed by routine biophysical profile (BPP). From a database of 465 consecutive nonhypertensive, nondiabetic patients delivering at < 32 weeks gestation, patients with singleton, nonanomalous fetuses with AFV and fetal movements determined as part of a BPP assessment within 24 hours of delivery were studied. Amniotic fluid volume was scored 0 to 2, according to the following criteria: largest pocket in vertical diameter < 1 cm = 0; < 2 but > 1 cm = 1; > or = 2 cm = 2. Fetal movements (FM) were scored over 30 minutes: 0 if absent, 1 if 1 to 2 movements, 2 if > or = 3 gross (limb/trunk) movements. Variables assessed included fetal presentation, gestational age (GA), premature rupture of membranes (PROM) as a principal indication for delivery, clinical chorioamnionitis (diagnosed by previously published criteria), histologic parameters of infection (in amnion and umbilical cord assessed by a single pathologist blinded to clinical data), and neonatal outcome. Statistical analyses included contingency tables and analysis of variance with p < 0.05 considered significant. Three hundred and fifty-two patients met the inclusion criteria. One hundred and sixty-seven patients (47%) had PROM as a primary indication for delivery. Infrequently, decreased fetal well-being manifested by a BPP < 7 of 10 points was an indication for delivery despite prematurity (n = 7). Of the 352 patients, 80 (23%) had AFV = 0, 60 (17%) had AFV = 1, and 212 (60%) had AFV = 2; and 12 (3%) had FM = 0, 30 (9%) FM = 1, and 310 (88%) FM = 2. There was a significant correlation between decreased AFV and decreased fetal movements (p < 0.0001). Fetal presentation and GA were not significantly different between patients based on score of fetal movements. The incidence of clinical chorioamnionitis was significantly greater in patients with FM = 0 (p < 0.005). We conclude that decreased AFV is associated with decreased fetal movements irrespective of fetal presentation or gestational age. Neonatal outcome (umbilical vasculitis, sepsis, intraventricular hemorrhage) is affected only in unusual cases in which otherwise uncompromised (nonhypoxic, nonacidotic) fetuses have low scores on both these antepartum ultrasonographic parameters.     

Cocaine exposure causes long-term increases in impulsive choice.

In this study, the authors examined the long-term effects of prior exposure to cocaine on a delay-discounting task commonly used to measure impulsive choice. Male Long-Evans rats received daily intraperitoneal injections of 30 mg/kg cocaine HCl or saline for 14 days. Following 3 weeks of withdrawal, rats began training. On each trial, rats were given a choice between 2 levers. A press on 1 lever resulted in immediate delivery of a single 45-mg food pellet, and a press on the other resulted in delivery of 4 pellets after a delay period. Impulsive choice was defined as preference for the small immediate over the large delayed reward. Three months after treatment, cocaine-exposed rats displayed increased impulsive choice behavior. They also showed less anticipatory responding (entries into the food trough) during the delays prior to reward delivery, indicating that the enhanced impulsive choice in these rats may be related to deficits in bridging the delay between response and reward. These data demonstrate that cocaine exposure can cause enduring increases in impulsive choice behavior, consistent with observations in human subjects with drug addictions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Second-trimester echogenic bowel and intraamniotic bleeding: association between fetal bowel echogenicity and amniotic fluid spectrophotometry at 410 nm

OBJECTIVE: Our purpose was to determine whether the presence of heme pigments in amniotic fluid is associated with the ultrasonographic findings of increased fetal bowel echogenicity in the second trimester. STUDY DESIGN: Spectrophotometric analysis of amniotic fluid for optical density at 410 nm was prospectively performed to study the presence of heme pigments in (1) 104 pregnancies undergoing second-trimester amniocentesis for routine cytogenetic indications and (2) in 14 pregnancies undergoing amniocentesis for prenatal karyotyping because of fetal strongly echogenic bowel. In the routine amniocentesis group the fetal small bowel echogenicity was assessed immediately before amniocentesis and classified as nonechogenic (n = 64), mildly echogenic (n = 36), or hyperechogenic (n = 4) with the fetal iliac wing and liver used as references. Only amniotic fluid specimens that were obtained at the first attempt and that were not blood-stained were included in this study, with the first milliliter being discarded in all samples. RESULTS: In the routine amniocentesis group abnormal amniotic fluid optical density readings were significantly more frequent in fetuses with increased bowel echogenicity compared with those with nonechogenic bowel (8/40 [20%] vs 3/64 [5%], respectively; p < 0.001). In the hyperchogenic bowel group abnormal amniotic fluid optical density readings were found in four samples (29%). Overall, 12 of 54 fetuses (22%) with increased bowel echogenicity had a detectable peak at 410 nm. Three of the 12 (25%) fetuses with echogenic bowel and positive readings for hemoglobin were chromosomally abnormal. CONCLUSIONS: Fetal small bowel echogenicity is associated with the presence of heme pigments in amniotic fluid as determined by amniotic fluid optical density at 410 nm. Swallowing of amniotic fluid after intraamniotic bleeding seems implicated in the etiology of second-trimester echogenic bowel in both euploid and aneuploid fetuses.     

Prenatal diagnosis of congenital toxoplasmosis: comparative value of fetal blood and amniotic fluid using serological techniques and cultures

The management of patients with acute, severe ulcerative colitis requires careful in-hospital assessment of the patient and the coordinated treatment of a team of experienced gastroenterologists and surgeons. Complete understanding of the potential complications and their management, especially toxic megacolon, is essential. We review the current medical arsenal and advocate a standardized approach to management that includes continuous, high dose intravenous hydrocortisone, more aggressive use of topical steroids as well as feeding the patients and continuing (but not initiating) oral 5-aminosalicylic acid (5-ASA) agents. For those patients whose disease proves refractory to intravenous steroids, intravenous cyclosporin (with an acute response rate of 82%) is an essential component in the medical management of these patients. Antibiotics should be used only when specifically indicated. Total parenteral nutrition has not been shown to be helpful in the acute setting. Air contrast barium enema and colonoscopy have been used to predict response but may be dangerous diagnostic modalities in these acutely ill patients and are no better than good clinical judgement. We review and advocate long-term management of acute response using 6-mercaptopurine or azathioprine. The surgical experience and the postoperative complications of the ileal pouch anal anastomosis, which include acute pouchitis in 50-60%, chronic pouchitis in 5-10% and recent reports of dysplasia among patients with chronic pouchitis, must be considered before colectomy is advised. Over 80% of patients with acute severe colitis can be spared colectomy using our current arsenal of medical therapies.     

Evaluation of fetal condition in pregnancy complicated by hypertension--biochemical assessment of amniotic fluid. III. Acid-base balance]

Sixty two samples of amniotic fluid, collected by ultrasound guided amniocentesis, were submitted to biochemical investigation including 31 samples from women with pregnancy complicated by hypertension (studied group) and 31 samples deriving from healthy pregnant women (control group with). The following parameters of acid-base balance were measured in amniotic fluids of both groups: pH, pCO2, base deficiency, standard HCO3 and total CO2. Corning device type 168 was used. Distinct metabolic-respiratory acidosis was present in amniotic fluids of studied group showing the decrease of a pH, pO2, standard HCO3 values and an increase of CO2 values and base deficiency. Authors believe in pregnancy complicated by hypertension biochemical environment of intrauterine fetal development with regard to acid-base balance is highly unfavourable.     

Amniotic fluid and fetal maturity

The lecithin/sphingomyelin ratio in amniotic fluid is a method of predicting fetal lung maturity. The L/H ratios in certain high risk pregnancies are poorly correlated with the shake test. The L/S ratios in drug addiction methadone pregnancies and diabetic pregnancies do not have a high degree of correlation with normal L/S ratios after 36 weeks of gestation and are often low.