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Pison U, Gono E, Joka T, Obertacke U, Obladen M. High-performance liquid chromatography of adult human bronchoalveolar lavage: assay for phospholipid lung profile. JOURNAL OF CHROMATOGRAPHY 1986; 377:79-89. [PMID: 3711247 DOI: 10.1016/s0378-4347(00)80763-x] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
High-performance liquid chromatography has been used to separate pulmonary phospholipids from adult human bronchoalveolar lavage. A solvent system consisting of acetonitrile-water (80:20) as solvent A and pure acetonitrile as solvent B was used with a silica column (Bio-Sil HP 10) coupled to an Si-100 Polyol precolumn. A linear gradient from 87.5 to 25% of solvent B was found to separate all biologically relevant surfactant phospholipids in the following sequence and composition: phosphatidic acid (1.1%), phosphatidylglycerol (10.6%), phosphatidylinositol (9.9%), phosphatidylethanolamine (3.6%), phosphatidylserine (4.5%), phosphatidylcholine (60.8%), sphingomyelin (8.1%) and lysophosphatidylcholine (1.6%). These results were very similar to the phospholipid pattern obtained by two-dimensional thin-layer chromatography. It is concluded that high-performance liquid chromatography is a useful and rapid method for the separation of phospholipids in biological fluids containing pulmonary surfactant.
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Abstract
Diabetes mellitus is a high risk complication of pregnancy and this is particularly true whenever long standing diabetes is complicated by diabetic nephropathy. Five cases are reported of diabetic pregnancy complicated by nephropathy. Four women delivered healthy babies, and one patient aborted spontaneously in the 9th week of gestation. It is suggested that first and foremost in complicated diabetic pregnancy strict normoglycemia should be adhered to prior and all through pregnancy. Our findings based on these cases also suggest that: Pregnancy does not adversely affect the renal status of a diabetic woman or vice versa. Creatinine clearance is not worsened by the course of pregnancy in the majority of these patients and proteinuria per se does not add additional risks to pregnancy or outcome. Hypertension is a separate risk factor affecting the pregnancy despite normoglycemia. Motivation of these patients to maintain normoglycemia as well as bed rest for prolonged periods, intensive use of fetal monitoring, evaluation of fetal lung maturity and improved neonatal care may contribute to improved perinatal outcome.
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53
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Review. Clin Chem Lab Med 1986. [DOI: 10.1515/cclm.1986.24.10.705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Abstract
During the past decade, our major objective in the management of pregnancies complicated by diabetes mellitus has become normalization of maternal and, therefore, fetal glucose levels. For most women with insulin-dependent diabetes, this goal may be achieved through the use of multiple insulin injections combined with an appropriate dietary intake. The results of such therapy can now be accurately assessed by means of home glucose monitoring. Patients with gestational diabetes can be properly treated only if they are first identified. Therefore, all pregnant women should be tested for this disorder because screening based on past obstetric history or clinical criteria alone may miss up to 50% of patients with gestational diabetes. Between 1980 and 1984, the perinatal mortality rate reported in the American literature for more than 800 insulin-dependent patients was 21 per 1000, with more than 50% of these deaths resulting from major malformations. Such data emphasize the need to achieve maternal euglycemia before conception, as poor maternal control has been associated with teratogenesis. Prepregnancy assessment should also include a thorough evaluation of maternal vasculopathy.
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55
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Halvorsen PR, Gross TL. Laboratory and clinical evaluation of a rapid slide agglutination test for phosphatidylglycerol. Am J Obstet Gynecol 1985; 151:1061-6. [PMID: 3838619 DOI: 10.1016/0002-9378(85)90381-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Amniostat-FLM is a recently developed rapid slide agglutination test for amniotic fluid phosphatidylglycerol. We compared phosphatidylglycerol quantitated by two-dimensional thin-layer chromatography with phosphatidylglycerol determined by Amniostat-FLM in 180 amniotic fluid samples. If any level of phosphatidylglycerol by thin-layer chromatography, including a trace, was considered positive, then phosphatidylglycerol by thin-layer chromatography and Amniostat-FLM were concordant in 171 of 180 samples (95%). Both were positive in 123 and both negative in 48 samples. The nine amniotic fluid samples with discrepant results were as follows: Five negative Amniostat-FLM results were associated with trace phosphatidylglycerol by thin-layer chromatography (1% to 2% of total phospholipids), one negative Amniostat-FLM result was associated with 3% phosphatidylglycerol by thin-layer chromatography, and three positive Amniostat-FLM results were associated with negative phosphatidylglycerol by thin-layer chromatography results. There were 14 samples with trace phosphatidylglycerol by thin-layer chromatography; of these, there were nine positive and five negative Amniostat-FLM results. If greater than 2% phosphatidylglycerol by thin-layer chromatography was considered positive, concordance between the two tests was 93% (167 of 180). From these samples, 119 infants were delivered within 72 hours of amniocentesis. There were 100 positive Amniostat-FLM results and all were associated with the absence of respiratory distress syndrome; of the 19 negative Amniostat-FLM results, five were associated with infants who developed respiratory distress syndrome. The present study confirms that Amniostat-FLM is a simple, rapid, and accurate test for determining the presence of phosphatidylglycerol in amniotic fluid.
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Ferroni KM, Gross TL, Sokol RJ, Chik L. What affects fetal pulmonary maturation during diabetic pregnancy? Am J Obstet Gynecol 1984; 150:270-4. [PMID: 6385716 DOI: 10.1016/s0002-9378(84)90364-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Previous studies differ as to whether the fetus of the woman with diabetes mellitus has altered formation of lung surfactant. The factors responsible for these differences remain unclear. In this study, measures of blood glucose control, including birth weight percentile and the presence of factors potentially influencing fetal pulmonary maturation, such as diabetic class, maternal chronic hypertension, and preeclampsia, were compared with the amniotic fluid lecithin/sphingomyelin ratio, phosphatidylglycerol, and phosphatidylinositol within a group of 90 diabetic pregnancies. The factors were evaluated in combination with the techniques of canonical correlation and multiple regression analysis. Gestational age had the strongest effect in determining levels of amniotic fluid phospholipids, and hypertension was found to significantly accelerate the appearance of phosphatidylgycerol (p less than 0.05). The effect of hypertension was one third as important as that of gestational age. Neither diabetic blood glucose control, White classification, nor the remaining explanatory variables were found to play a significant role in determining the amniotic fluid phospholipid levels. This study suggests that, in the clinical management of diabetes, gestational duration remains the single most important determinant of amniotic fluid phospholipid levels.
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58
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Mattox HE, MacKenna J, Hodson CA, Wimmer JE, Brame RG. Comparison of pharyngeal aspirate and amniotic fluid surfactant composition. Am J Obstet Gynecol 1984; 150:132-5. [PMID: 6548085 DOI: 10.1016/s0002-9378(84)80003-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Amniotic fluid and oropharyngeal aspirate lung maturity profiles obtained simultaneously at delivery in 16 patients are compared. The lecithin/sphingomyelin ratio was greater in oropharyngeal aspirates than in amniotic fluid (p less than 0.02). The percent phosphatidylinositol was greater in oropharyngeal aspirates than in amniotic fluid (p less than 0.03). The mean differences between percent phosphatidylglycerol were not significant. These findings were uninfluenced by the time interval between amniotic fluid and oropharyngeal sampling, gestational age, or neonatal weight. These data could explain the lack of sensitivity of the amniotic fluid lung maturity profile.
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Feijen HW, Dony JM, Martin CB. The L/S ratio in vaginally collected amniotic fluid: a misleading result in a breech presentation. Eur J Obstet Gynecol Reprod Biol 1984; 18:77-80. [PMID: 6500150 DOI: 10.1016/0028-2243(84)90038-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
A case is reported in which serial L/S ratios, determined from fluid samples collected vaginally after premature rupture of the membranes, led to a grossly erroneous conclusion of fetal pulmonary immaturity. The fetus was in breech presentation, and in retrospect several 'amniotic fluid' samples consisted largely of fetal urine. Determination of the creatinine concentration of suspect samples should permit distinction to be made between mixed amniotic fluid and fluid containing a disproportionately large amount of fetal urine when the possibility of this error exists.
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60
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Tsai MY, Shultz EK, Nelson JA. Amniotic fluid phosphatidylglycerol in diabetic and control pregnant patients at different gestational lengths. Am J Obstet Gynecol 1984; 149:388-92. [PMID: 6731516 DOI: 10.1016/0002-9378(84)90150-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Phosphatidylglycerol (PG) and lecithin/sphingomyelin (L/S) ratios were simultaneously determined in 1770 samples of amniotic fluid. PG was defined as "present" when it appeared in at least 2% of the total phospholipids. Comparison of the appearance of PG in samples of amniotic fluid obtained from diabetic and nondiabetic pregnant patients according to L/S ratios showed that samples from diabetic patients were less likely to have PG present than those from nondiabetic patients, particularly at L/S ratios between 3.1 and 4.0. Because of that, further studies compared the appearance of PG according to gestation in 186 diabetic patients with that in a group of 238 control patients that was composed only of those who underwent repeat cesarean section. Rh-sensitized patients were not included in the control group, since they had delayed appearance of PG. The results showed that the appearance of PG was delayed in patients with Classes B, C, and D-F-R diabetes. In patients with Class A diabetes, the appearance of PG was not significantly different from that in control patients over the entire gestational period, although the appearance of PG may be delayed during early gestation. In contrast, there were no significant differences in L/S ratios in various classes of diabetic pregnant patients and control patients at different gestations.
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Leveno KJ, Quirk JG, Whalley PJ, Herbert WN, Trubey R. Fetal lung maturation in twin gestation. Am J Obstet Gynecol 1984; 148:405-11. [PMID: 6695997 DOI: 10.1016/0002-9378(84)90716-6] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Clear amnionic fluid was collected at cesarean section and the lecithin/sphingomyelin (L/S) ratio was used to evaluate fetal lung maturation in 42 twin gestations. The L/S ratios of twin pairs were usually similar in both numerical value and predictive accuracy except when the greater L/S ratio from one member of a pair indicated borderline lung maturity. Twin fetal lung maturation was found to be independent of sex, zygosity, and birth weight discordance. Comparison of mean L/S ratios in twins to those of uncomplicated singleton pregnancies revealed that fetal lung maturation occurred several weeks earlier in twins.
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62
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Lehmann CA, McClure GL. Isclation of Lecithin and Sphingomyelin from Lipid Mixtures for Quantitation by Infrared Spectroscopy. ANAL LETT 1984. [DOI: 10.1080/00032718408066493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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63
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Tydén O, Berne C, Eriksson UJ, Hansson U, Stangenberg M, Persson B. Amniotic fluid C-peptide and phosphatidyl glycerol in diabetic pregnancy. J Perinat Med 1984; 12:69-73. [PMID: 6470915 DOI: 10.1515/jpme.1984.12.2.69] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
The concentrations of C-peptide and phosphatidylglycerol in the amniotic fluid were determined in 36 pregnant diabetic women. Twenty-one patients who were being treated with insulin for gestational diabetes as well as 15 patients who were insulin dependent were studied. All patients were subjected to a program of strict metabolic control, and amniocentesis was performed at gestational week 36-37. Phosphatidyl glycerol was present in the amniotic fluid in 15 cases and absent in 21. The mean concentration of C-peptide did not differ whether phosphatidyl glycerol was present or absent. (C-peptide: 0.56 +/- 0.06 and 0.43 +/- 0.05 nmol/l respectively). Although the mean value for amniotic fluid C-peptide in both groups was close to that in diabetic pregnancies with an uneventful neonatal outcome, it was significantly higher than that in non-diabetic pregnancies, indicating minor fetal hyperinsulinemia. The level of C-peptide in the amniotic fluid showed a correlation to the subsequent birthweight of the infant (r = 0.50; p less than 0.01). It is concluded that with rigorous metabolic control of the pregnant diabetic patient, the presence or absence of phosphatidyl glycerol, as an index of fetal lung maturity, is apparently not related to the level of C-peptide in the amniotic fluid.
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64
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Grundy H, Wiltjer SL. One-dimensional versus two-dimensional phosphatidylglycerol. Am J Obstet Gynecol 1983; 147:718-9. [PMID: 6638118 DOI: 10.1016/0002-9378(83)90458-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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65
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Nelson RL. Diabetes and Pregnancy. Prim Care 1983. [DOI: 10.1016/s0095-4543(21)01115-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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66
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67
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Brame RG, MacKenna J. Vaginal pool phospholipids in the management of premature rupture of membranes. Am J Obstet Gynecol 1983; 145:992-1000. [PMID: 6404175 DOI: 10.1016/0002-9378(83)90854-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Clinical utility of vaginal pool amniotic fluid assessment in premature rupture of the membranes was prospectively studied in 214 patients between July 1, 1978, and June 30, 1981. We used a policy of nonintervention in patients with premature rupture of the membranes prior to 36 weeks' gestation. Vaginal samples collected on admission and daily thereafter were analyzed for phospholipids. Patients underwent delivery for any one of these conditions: (1) presence of phosphatidylglycerol, (2) spontaneous labor, or (3) sepsis. One hundred sixty-seven patients had no phosphatidylglycerol initially. Thirty-six of these acquired phosphatidylglycerol, and none had respiratory distress syndrome. Eight patients underwent delivery because of signs of sepsis in the mother, but all infants of septic mothers survived. The newborn infants of 49 patients developed the respiratory distress syndrome, and among these there were six deaths, with no maternal deaths. We believe that these results confirm the value of phosphatidylglycerol in patients with premature rupture of the membranes, and that delay in patients from premature rupture of the membranes results in few infections and a significant decrease in the respiratory distress syndrome.
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68
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Whittle MJ, Wilson AI, Whitfield CR. Amniotic fluid phosphatidylglycerol: an early indicator of fetal lung maturity. BRITISH JOURNAL OF OBSTETRICS AND GYNAECOLOGY 1983; 90:134-8. [PMID: 6824613 DOI: 10.1111/j.1471-0528.1983.tb08897.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
In a study of 766 amniotic fluids, collected from pregnancies between 26 weeks and term, phosphatidylglycerol (PG) was identified in a greater proportion than was a mature lecithin/sphingomyelin (L/S) ratio at all gestational ages between 28 and 38 weeks regardless of the underlying pregnancy complication. The early appearance of PG was particularly striking in amniotic fluids obtained after preterm rupture of membranes. Since PG has been previously shown to be a useful indicator of the risk of neonatal respiratory distress syndrome, its appearance before a mature L/S ratio suggests that its detection offers a considerable advantage in the management of high-risk obstetric problems in which the earliest possible indication that the fetal lungs are mature is required.
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69
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Norman RJ, Joubert SM, Marivate M. Amniotic fluid phospholipids and glucocorticoids in multiple pregnancy. BRITISH JOURNAL OF OBSTETRICS AND GYNAECOLOGY 1983; 90:51-5. [PMID: 6821671 DOI: 10.1111/j.1471-0528.1983.tb06746.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The phospholipid composition of amniotic fluid has been examined in 30 twin pregnancies with a mean gestation of 37.7 weeks. Before the onset of labour there was no difference in ratios of lecithin (L), phosphatidylinositol (PI), phosphatidylethanolamine (PE) and phosphatidylglycerol (PG) to sphingomyelin (S) between the first and second twin. With the start of contractions (6 patients) there was a significant increase in the L/S and PE/S ratios in the first twin (L/S ratio twin I 10.8 +/- 5.2, twin II 7.0 +/- 3.8; PE/S ratio twin I 0.7 +/- 0.2, twin II 0.4 +/- 0.1). Growth retardation of one fetus did not alter the phospholipid profile in the amniotic fluid. Amniotic fluid concentrations of glucocorticoids, measured before and during labour in both twins by specific immunoassay, were the same in both sacs before labour. During labour concentrations of unconjugated and conjugated glucocorticoids were significantly increased in the first sac (twin I unconjugated 113.2 +/- 16.6, conjugated 505.1 +/- 115.9; twin II unconjugated 69.5 +/- 41.4, conjugated 284.3 +/- 124 nmol/l). Amniotic fluid from growth retarded fetuses did not show higher glucocorticoid levels. In subsequent studies the glucocorticoids were separated by chromatography and only cortisol reacted significantly with the antibody used under the conditions of the assay.
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70
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Knippel E, Stark KH, Meyer HW, Thomaneck U, Schütt W, Kyank H. Fetal pulmonary maturity as determined by particle electrophoresis. J Perinat Med 1983; 11:149-54. [PMID: 6875787 DOI: 10.1515/jpme.1983.11.3.149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Particle electrophoresis has been used to investigate particles obtained from amniotic fluid. These particles are defined mainly as unilamellar and multilamellar liposomes by electron microscopy. A total of 172 samples of amniotic fluids from 132 pregnancies were included in this study. The electrophoretic results were compared to the total phospholipids and to neonatal outcomes in 42 cases. At least two kinds of particles from amniotic fluids with different electrophoretic mobilities (EPM) are evident. With a ratio of F greater than 1.0, the presence of electrophoretically faster particles was found to be associated with apparent fetal lung maturity. On the other hand when the ratio was F less than 1.0, this seems to indicate an immature fetal lung. Seventy-seven per cent of F values correspond to the total phospholipid content P regarding the prediction of fetal pulmonary maturity resp. immaturity. The correct prediction of fetal lung maturity was demonstrated in 42 patients delivered within 48 hours of amniotic fluid sampling. In 28 cases with a mature F value (greater than 1.0) the correct prediction of respiratory distress syndrome (RDS) was 100 per cent. Eight out of 14 patients with immature F values (less than 1.0) developed RDS. The F values were found to increase as pregnancy progressed. The electrophoretically differentiated amniotic fluid particles behave differently at low pH. Selection and electrophoretic measurement of particles were made in a subjective manner. This preliminary investigation suggests that the results correspond to those obtained by objective cell electrophoretic measurements.
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Abstract
The lecithin/sphingomyelin (L/S) ratio has been reported to be inadequate as a predictor of fetal surfactant maturity in many complicated obstetric cases, particularly in patients with diabetes. L/S ratios are also unreliable when the sample contains blood or meconium. Phosphatidylglycerol (PG) is present only in amniotic fluid and respiratory tract effluent. PG may characterize surfactant maturity in samples of amniotic fluid contaminated with blood or meconium as well as specimens collected from the vagina in cases of premature rupture of membranes. Three hundred eleven samples of amniotic fluid collected from January, 1980, to June, 1981, were analyzed for L/S ratio and PG. This report analyses the ability of these tests to predict neonatal maturity in normal and complicated obstetric cases.
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Whittle MJ, Wilson AI, Whitfield CR, Paton RD, Logan RW. Amniotic fluid phosphatidylglycerol and the lecithin/sphingomyelin ratio in the assessment of fetal lung maturity. BRITISH JOURNAL OF OBSTETRICS AND GYNAECOLOGY 1982; 89:727-32. [PMID: 7115636 DOI: 10.1111/j.1471-0528.1982.tb05099.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Based on the analysis of 561 amniotic fluid samples obtained within 72 h of delivery, including 288 samples collected from the vagina, the detection of phosphatidylglycerol (PG) in the fluid together with the determination of the lecithin/sphingomyelin (L/S) ratio gave an accurate prediction of the risk of the newborn infant developing respiratory distress syndrome (RDS). In the presence of PG, regardless of the L/S ratio, only 0.6% of the babies developed RDS, while absent PG was associated with an 82.8% incidence of RDS. The predictive ability was improved by knowing the L/S ratio since in the presence of both PG and a mature L/S ratio (greater than 2.0), no baby developed RDS whereas 3.4% of them did when the ratio was immature despite the presence of PG. The test appears to be a useful determinant of the risk of RDS in babies born to diabetic mothers and it seems particularly effective in assessing amniotic fluid collected vaginally. It is recommended that laboratories dealing with amniotic fluid from high-risk pregnancies should detect PG as well as measuring the L/S ratio.
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Hallman M, Wermer D, Epstein BL, Gluck L. Effects of maternal insulin or glucose infusion on the fetus: study on lung surfactant phospholipids, plasma myoinositol, and fetal growth in the rabbit. Am J Obstet Gynecol 1982; 142:877-82. [PMID: 7039322 DOI: 10.1016/s0002-9378(16)32535-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Pregnant rabbits were given continuous intravenous insulin between days 26.7 and 28.7 after conception. The treatment decreased fetal serum glucose, insulin, and myoinositol. Furthermore, maternal insulin decreased fetal growth slightly, and improved the survival of the prematurely delivered fetuses. Analysis of phospholipids recovered by alveolar lavage revealed that the lung surfactant was quantitatively and qualitatively superior to the surfactant from the fetuses of the saline-glucose control animals. This effect on the lung was more striking than that of glucocorticoid. Another group of pregnant rabbits received continuous intravenous glucose between days 27.0 and 29.0 after conception. The hyperinsulinemic fetuses of the glucose-infused does weighed more and had higher serum glucose and myoinositol than did those of the control animals. There was no detectable difference in alveolar lavage phospholipids between hyperinsulinemic and normoinsulinemic fetuses of glucose-infused does. The possible importance of these findings in understanding the mechanism of acceleration of lung maturation is discussed.
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Bent AE, Gray JH, Luther ER, Oulton M, Peddle LJ. Assessment of fetal lung maturity: relationship of gestational age and pregnancy complications to phosphatidylglycerol levels. Am J Obstet Gynecol 1982; 142:664-9. [PMID: 7065041 DOI: 10.1016/s0002-9378(16)32438-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Phosphatidylglycerol (PG) was measured in the pellet fraction of 863 amniotic fluid samples, and charts were reviewed for maternal disease, duration of gestation at collection, and outcome of pregnancy. PG was present at 32 to 34 weeks' gestation in 24.1% of samples; at 35 to 36 weeks, in 52.3%; and at 37 weeks, in 85.4%. Pre-eclamptic toxemia/hypertension, diabetes, premature rupture of membranes, and preterm labor all had earlier appearance of PG than a comparison group. There was no delay in lung maturity in gestational diabetics or Rh isoimmunization. Infants of patients with overt diabetes with PG greater than or equal to 0.5% did not develop respiratory distress syndrome. This value appeared in 30% of diabetic patients by 35 to 36 weeks and in 76.9% by 37 weeks' gestation.
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77
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Bleasdale JE, Johnston JM. CMP-dependent incorporation of [14C]Glycerol 3-phosphate into phosphatidylglycerol and phosphatidylglycerol phosphate by rabbit lung microsomes. BIOCHIMICA ET BIOPHYSICA ACTA 1982; 710:377-90. [PMID: 7074121 DOI: 10.1016/0005-2760(82)90121-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Rabbit lung microsomes were found to catalyze CMP-dependent incorporation of [14C]glycerol 3-phosphate into a total lipid extract. The radioactively labeled products in the lipid extract were identified as phosphatidylglycerol and phosphatidylglycerol phosphate. CMP-dependent incorporation of [14C]glycerol 3-phosphate by lung microsomes proceeded optimally at pH 7.4 and required Mn2+. The apparent Km value for CMP in this reaction was calculated to be 0.19 mM. No other cytidine nucleotide could substitute completely for CMP in supporting [14C]glycerol 3-phosphate incorporation into lipid. Cytosine-beta-D-arabinofuranoside-5'-monophosphate-dependent incorporation of [14C]glycerol 3-phosphate was observed at pH 8.5 but not at pH 6.8 CMP-dependent incorporation of [14C]glycerol 3-phosphate by microsomes was inhibited by inositol. The optimal in vitro rates of CMP-dependent and CDP diacylglycerol-dependent incorporation of [14C]glycerol 3-phosphate into lipid were similar (approximately 1 nmol . mg-1 protein . h-1) and were not additive. Both CMP -dependent and CDP diacylglycerol-dependent incorporation of [14C]glycerol 3-phosphate by lung microsomes appeared to involve CDPdiacylglycerol:glycerol-3-phosphate phosphatidyltransferase. However, the specific activity of this enzyme in a particular subcellular fraction did not relate directly in the extent of CMP-dependent [14C]glycerol 3-phosphate incorporation in that fraction. Preincubation of lung microsomes with 5 mM CMP plus 3 mM phosphatidylinositol increased CMP-dependent incorporation of [14C]glycerol 3-phosphate. When lung microsomes were depleted specifically of phosphatidylinositol by incubating with a phosphatidylinositol-specific phospholipase C, CMP-dependent incorporation was diminished. The Mn2+ requirement for CMP-dependent incorporation of [14C] glycerol 3-phosphate, its phosphatidylinositol requirement and its inhibition by Triton X-100 (0.2%) were not features shared by CDPdiacylglycerol-dependent incorporation of [14C]glycerol 3-phosphate but were characteristics of the reverse reaction catalyzed by CDPdiacylglycerol: inositol phosphatidyltransferase. Together with the previous finding of a developmental increase in the CMP content of fetal rabbit lung, these observations are consistent with a role for CMP in the regulation of the phosphatidylinositol and phosphatidylglycerol content of lung surfactant during lung maturation.
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Schmidt-Sommerfeld E, Litmeyer H, Penn D. A rapid qualitative method for detecting phosphatidylglycerol in amniotic fluid. Clin Chim Acta 1982; 119:243-7. [PMID: 7067122 DOI: 10.1016/0009-8981(82)90336-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
A fast, reliable and inexpensive procedure of the qualitative determination of phosphatidylglycerol (PG) in amniotic fluid, using one-dimensional thin layer chromatography and a phosphorus-specific spray, is described. The method detects amounts of PG exceeding 1 microgram or 1.7% of total phospholipids in amniotic fluid. Contamination with serum does not influence the results. Excessive amounts of meconium interfere with the chromatography. The presence of PG was always associated with a mature L/S ratio (greater than 2), whereas its absence did not necessarily exclude lung maturity.
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79
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Cunningham MD, McKean HE, Gillispie DH, Greene JW. Improved prediction of fetal lung maturity in diabetic pregnancies: a comparison of chromatographic methods. Am J Obstet Gynecol 1982; 142:197-204. [PMID: 7055185 DOI: 10.1016/s0002-9378(16)32336-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Following planned termination of pregnancy, infants of diabetic mothers have shown a continued vulnerability to the respiratory distress syndrome (RDS), suggesting false positive results on fetal lung maturity testing. We studied the adequacy of the standard one-dimensional chromatographic lecithin/sphingomyelin (L/S) ratio for predicting RDS in 56 diabetic and 50 nondiabetic pregnancies. An exceptionally low incidence of RDS was noted for the study (0.95%) as well as for diabetic pregnancies alone (1.85%). The clinical results were further compared to a new method for determining L/S ratios and identifying other pulmonary phospholipids by two-dimensional chromatography. Values for two-dimensional L/S ratios were significantly lower from 36 through 38 weeks' gestation (P less than 0.01), suggesting improved accuracy and a lessened risk for false positive results in preterm deliveries. Positive identification of amniotic fluid phosphatidylglycerol (PG) was related to increasing L/S ratios (P = 0.001), but only 50% of nondiabetic and 16.7% of diabetic amniotic fluid samples contained PG when the L/S was 2:1 or greater (P = 0.02). The identification of PG serves to confirm fetal lung maturity, but the L/S ratio remains the best available indicator of fetal lung maturity for all high-risk pregnancies.
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80
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Tsao FH, Zachman RD. Determination of phosphatidylglycerol in amniotic fluid by a simple one-dimensional thin-layer chromatography method. Clin Chim Acta 1982; 118:109-20. [PMID: 7053902 DOI: 10.1016/0009-8981(82)90232-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Phosphatidylglycerol (PG) in amniotic fluid is the second important component of lung surfactant phospholipids and may be clinically useful in assessing fetal lung maturity in utero. Although methods for PG determination are available, there are shortcomings in clinical application. We developed an alternative reliable one-dimensional thin-layer chromatography(TLC) method for separating and quantitating PG in amniotic fluid. A mini-TLC plate (8 X 10 cm) was prepared from silica gel H containing 5% ammonium sulfate. The plate was first developed in tetrahydrofuron/dimethoxymethane/methanol/2N ammonium hydroxide (30.0:20.6:5.6:3.0 v/v) and then in chloroform/methanol (60.9, v/v) in the same direction. PG was clearly separated from other phospholipids and neutral lipids, even when large amounts of other phospholipids were present on the TLC plate. The density of the charred PG was directly proportional to the amount of PG up to 8 nmol. The content of PG in nmol in the specimen can be quantitated by comparing with a standard PG. Up to 10% of blood serum or 3% meconium showed no detectable PG, nor did these substances affect PG quantitation in amniotic fluid. This method is sensitive and accurate. It is also time-saving and economical.
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81
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Beneditti TJ, Benedetti JK, Stenchever MA. Severe preeclampsia - maternal and fetal outcome. CLINICAL AND EXPERIMENTAL HYPERTENSION. PART B, HYPERTENSION IN PREGNANCY 1982; 1:401-16. [PMID: 7139978 DOI: 10.3109/10641958209139862] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Ninety patients with severe preeclampsia were reviewed. There was one maternal mortality and two patients who developed pulmonary edema. The corrected perinatal mortality rate was 143/100. Epidural anesthesia did not adversely affect fetal outcome. Perinatal morbidity and mortality was mainly related to the development of neonatal respiratory distress syndrome (RDS). Twenty-three neonates developed respiratory distress syndrome (RDS). RDS was strongly associated (P less than .001) with gestational age. RDS was not associated with mode of delivery, sex and perinatal asphyxia.
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82
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Abstract
Respiratory distress syndrome occurs in infants born with immature lungs. The immature fetal lung lacks an adequate supply of surfactant, a phospholipid-rich substance which is produced in the type II cells of the alveolar epithelium. In the fetus, surfactant is secreted into the potential air spaces of the lung and passes into the amniotic fluid as gestation proceeds. It is now clear that most methods currently in use for assessing fetal lung maturity depend on the detection of a sudden release of surfactant into the amniotic fluid as the lung reaches a critical stage of maturity. These methods, which include the lecithin/sphingomyelin ratio, the lung profile, total phospholipid or lecithin concentration, fluorescence depolarization, lamellar body phospholipid concentration, and the "shake" test, are reviewed in the light of recent understanding of the nature of surfactant. In assessing each method, we have examined possible sources of error in performing the test in the laboratory, factors which could theoretically limit its ability to reflect the state of fetal lung maturity and current information regarding its reliability, in terms of clinical performance. Guidelines for future research in this area are also suggested.
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83
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Abstract
A systematic study of amniotic fluid phospholipids including phosphatidylcholine (PC, lecithin), saturated phosphatidylcholine, and phosphatidylglycerol was undertaken to evaluate the stability of these surfactant indices as a function of temperature and time. The purpose of the study was to determine optimum conditions for storage and for transport of specimens to centralized laboratories performing comprehensive analyses of amniotic fluid phospholipids for improved assessment of fetal lung development. Remarkable stability was found for the above phospholipids, as well as for the more commonly employed ratio of lecithin to sphingomyelin. We determined that room temperature more commonly employed ratio of lecithin to sphingomyelin. We determined that room temperature storage is acceptable for periods up to 24 hours; however, when longer delays before lipid extraction are anticipated, it is essential that specimens be frozen or that refrigeration or wet-ice storage (4 degrees C) be employed. Results of this study indicate that when amniotic fluid samples are stored frozen and strict quality control is maintained in analytic procedures, only minimal changes occur in phospholipid concentrations over 12 months.
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84
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Jouanel P, Motta C, Brun J, Molina C, Dastugue B. Phospholipids and microviscosity study in broncho-alveolar lavage fluids from control subjects and from patients with extrinsic allergic alveolitis. Clin Chim Acta 1981; 115:211-21. [PMID: 7285366 DOI: 10.1016/0009-8981(81)90077-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Bronchoalveolar lavages were studied in control subjects and patients with extrinsic allergic alveolitis. Phospholipids, fatty acid composition of the different phospholipid species found and cholesterol were investigated. In allergic alveolitis, the phosphatidylcholine was absent, whereas two usually minor components in lung surfactant, phosphatidylethanolamine and phosphatidylinositol, were considerably enhanced. The tensio-active properties of the phospholipids present in fluids were investigated by a fluorescence polarization technique. Microviscosity of the phospholipids was studied, using 1,6-diphenyl-1,3,5-hexatriene. High values for the microviscosity were encountered in samples from patients. Phosphatidylethanolamine present at a high level exhibits the highest microviscosity. Saturated fatty acids in phospholipids and cholesterol are rigidifying factors contributing to the high microviscosity values found in allergic alveolitis. Moreover, one very important point microviscosity values found in allergic alveolitis. Moreover, one very important point brought out by the this technique is its full independence from the fluid volume recovery.
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85
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Abstract
The highly pulmonary concentration of 1,2-dipalmitoyl-sn-glycerol-3-phosphorylcholine (dipalmitoyllecithin) and its implication as an important component of lung surfactant have promoted investigation of phospholipid metabolism in the lung. This review will set the contents including recent informations for better understanding of phospholipid metabolism of the lung in normal state (physiological significances of lung phospholipids, characteristics of phospholipids in lung tissue and alveolar washing, biosynthetic pathways of dipalmitoyllecithin, etc.) as well as in toxic states (pulmonary oxygen toxicity, etc.) and in diseased states (idiopathic respiratory distress syndrome, pulmonary alveolar proteinosis, etc.) Since our main concern has been to clarify the most important route for supplying dipalmitoyllecithin, this review will be focused upon the various biosynthetic pathways leading to the formation of different molecular species of lecithin and their potential significance in the normal, toxic, and diseased lungs.
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86
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Hallman M, Teramo K. Measurement of the lecithin/sphingomyelin ratio and phosphatidylglycerol in aminotic fluid: an accurate method for the assessment of fetal lung maturity. BRITISH JOURNAL OF OBSTETRICS AND GYNAECOLOGY 1981; 88:806-13. [PMID: 7260001 DOI: 10.1111/j.1471-0528.1981.tb01307.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
A total of 506 amniotic fluid samples from 337 pregnancies was analysed for lecithin/sphingomyelin (L/S) ratio and phosphatidylglycerol. Two-dimensional chromatography on either laboratory-made or commercial thin-layer silica gel plates was required for proper resolution of the phospholipids. The predictive accuracy of the L/S ratio and the phosphatidylglycerol analysis was assessed in 225 patients, 187 of whom had an L/S ratio of 2 or more. In addition to predicting respiratory distress syndrome of the newborn, the phospholipid results predicted the risk of transient tachypnoea, symptomatic pneumothorax and the persistence of fetal circulation. The phosphatidylglycerol results improved the predictive value of both the mature L/S ratio (2 or more) and the non-mature L/S ratio (below 2).
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87
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Wenk RE. Respiratory Distress Syndrome, Fetal Pulmonary Surfactant, and Amniotic Fluid Phospholipid Analysis. Clin Lab Med 1981. [DOI: 10.1016/s0272-2712(18)31098-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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88
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Abstract
The past decade has seen a remarkable improvement in the prognosis for the pregnancy complicated by diabetes mellitus. Perinatal survival has become as common in these pregnancies as in normal ones. This improved outcome has been achieved through a better understanding of maternal metabolism and the needs to regulate maternal glycemia carefully as well as through reliable techniques for the surveillance of fetal well-being and advances in neonatal care. Significant perinatal morbidity still occurs, and congenital malformations--the leading cause of perinatal mortality today--remain an unresolved problem. Maternal outcome must also be considered. Uncertainty remains regarding the course of retinopathy in pregnancy, and the small group of diabetic women with coronary artery disease do appear to be at increased risk for mortality during gestation. A systematic screening program for gestational diabetes must now be adopted.
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89
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Salzer H, Husslein P, Nezbeda J, Simbruner G. The effect of premature rupture of the membranes on the surface activity of amniotic fluid and on the pulmonary function of the newborn. ARCHIVES OF GYNECOLOGY 1980; 230:149-57. [PMID: 6893907 DOI: 10.1007/bf02108270] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
In 30 patients with rupture of the membranes at 29 to 37 weeks gestation amniotic fluid was collected immediately and within 72 h. The concentration of lung surfactant was estimated by surface tension measurements in the Wilhelmy-balance. In 19 cases the results of the first surface tension measurement predicted lung immaturity, in 17 of these surfactant concentration increased, the last surface tension measurement being consistent with complete pulmonary maturation. None of these infants developed RDS. However, the two newborn infants, in whom serial surface tension measurements had shown no increase of surfactant concentration developed symptoms of RDS. In 11 patients with apparently mature surfactant values immediately after membrane rupture, further amniotic fluid surface tension measurements showed an increase in the concentration of surface active material. The respiratory compliance was measured in 11 healthy neonates and in the two newborn with RDS. The results reflected those of surfactant concentration obtained in amniotic fluid. Premature rupture of the membranes would seem to constitute a stimulus for fetal lung maturation.
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90
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Strassner HT, Golde SH, Mosley GH, Platt LD. Effect of blood in amniotic fluid on the detection of phosphatidylglycerol. Am J Obstet Gynecol 1980; 138:697-702. [PMID: 7435535 DOI: 10.1016/0002-9378(80)90091-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Samples of amniotic fluid were mixed with serum or red blood cells (RBC) in order to determine the effect of blood contamination on the detection of phosphatidylglycerol (PG). Samples of amniotic fluid was obtained from patients in the second trimester of pregnancy and at term, PG standard was added to half of the aliquots of the second-trimester fluid. The samples of fluid were tested before and after the addition of maternal or fetal serum or RBC in concentrations up to 20%. Two-dimensional thin-layer chromatographic procedures were performed to determine the presence or absence of PG. The results obtained showed that serum of RBC contamination of amniotic fluid without PG did not result in the appearance of a PG spot on the chromatographic plate. Neither serum nor RBC contamination interfered with the detection of PG in those fluids in which it was present. Maternal and fetal blood were similar in their failure to affect the detection of PG. These data suggest that PG determination for fetal lung maturity is a reliable test in the presence of bloody amniotic fluid.
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91
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Fonseca ME, Forsbach G, Canales ES, Zárate A. Correlation of optical density, lecithin and lecithin/sphingomyelin ratio in amniotic fluid. Int J Gynaecol Obstet 1980; 18:61-2. [PMID: 6106604 DOI: 10.1002/j.1879-3479.1980.tb00243.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
The correlation between optical density at 650 nm, lecithin and lecithin/sphingomyelin ration was investigated in 94 amniotic fluid samples obtained from 90 patients between 28 and 40 weeks of pregnancy. All samples were processed immediately and those contaminated with blood or meconium were discarded. The correlation coefficient between lecithin and absorbance was high (0.926). The lecithin/sphingomyelin ratio also had a good correlation coefficient with the optical density (0.768). We conclude that absorbance at 650 nm is a reliable test for assessing fetal lung maturation.
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92
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Iams JD, Semchyshyn S, O'Shaughnessy R, Moynihan V, Zuspan FP. Blood pressure response in hypertensive pregnancies treated with cortisol. Clin Exp Hypertens 1980; 2:923-32. [PMID: 7428568 DOI: 10.3109/10641968009037150] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Thirty-two hypertensive gravidas were treated in the third trimester of pregnancy with intravenous cortisol to enhance fetal lung maturity before premature delivery. Blood pressure was measured throughout 24 hours of steroid therapy. No significant increase in maternal blood pressure occurred. Complications and precautions are discussed. Fear of steroid induced exacerbation of maternal hypertension is not a valid reason to withhold steroid therapy in hypertensive pregnancy.
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93
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Jacob J, Gluck L, DiSessa T, Edwards D, Kulovich M, Kurlinski J, Merritt TA, Friedman WF. The contribution of PDA in the neonate with severe RDS. J Pediatr 1980; 96:79-87. [PMID: 6892514 DOI: 10.1016/s0022-3476(80)80336-2] [Citation(s) in RCA: 135] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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94
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Obladen M, Merritt TA, Gluck L. Acceleration of pulmonary surfactant maturation in stresses pregnancies: a study of neonatal lung effluent. Am J Obstet Gynecol 1979; 135:1079-85. [PMID: 583203 DOI: 10.1016/0002-9378(79)90741-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
To determine the maturation of pulmonary surfactant at birth, phospholipid patterns in tracheal or pharyngeal aspirates of 54 newborn infants were analyzed by two-dimensional thin-layer chromatography. The compositions of phospholipids and their surface tension-lowering abilities were assessed after gestations with various complications. Preterm infants with respiratory distress syndrome (RDS) lacked phosphatidylglycerol and had lower lecithin/sphingomyelin ratios than infants without RDS. An acceleration of both phosphatidylcholine (lecithin) and phosphatidylglycerol concentrations was observed in 21 preterm infants born after prolonged rupture of the membranes and treatment with isoxuprine. In these infants, the phospholipid pattern of lung effluent was similar to that of term infants even at gestational ages less than or equal to 30 weeks. Biochemical lung maturation was delayed in aneccephalic infants, infants of diabetic mothers, and one infant of a mother with hypothyroidism.
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95
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96
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