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Whittington JR, Chauhan SP, Wendel MP, Ghahremani TL, Pagan ME, Carter MM, Magann EF. Historical Assessment, Practical Management, and Future Recommendations for Abnormal Amniotic Fluid Volumes. J Clin Med 2024; 13:4702. [PMID: 39200844 PMCID: PMC11355879 DOI: 10.3390/jcm13164702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2024] [Revised: 08/07/2024] [Accepted: 08/08/2024] [Indexed: 09/02/2024] Open
Abstract
Objective: The purpose of this review is to examine the evidence that defines normal and abnormal amniotic fluid volumes (AFVs) and current recommendations on the management of abnormalities of AFV. Methods: The studies establishing normal actual AFVs and the ultrasound estimates used to identify normal and abnormal AFVs were evaluated. Recommendations from national and international organizations were reviewed for guidance on the definitions and management of abnormal AFVs. Results: A timeline of the development of the thresholds that define abnormal AFVs was created. Recommendations from 13 national and international guidelines were identified, but the definitions and management recommendations for abnormal AFVs varied considerably between groups. An algorithm for the management of oligohydramnios and polyhydramnios was developed. Knowledge gaps and the structure of future studies were examined. Conclusions: Assessment of AFV is performed multiple times per day in antenatal clinics and hospitals. Current recommendations on defining and managing abnormal AFVs differ between national and international organizations. We have proposed algorithms to assist in the management of abnormal AFVs until further studies can be undertaken.
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Affiliation(s)
- Julie R. Whittington
- Department of Obstetrics and Gynecology, Navy Medicine Readiness and Training Command Portsmouth, Portsmouth, VA 23708, USA; (J.R.W.)
| | - Suneet P. Chauhan
- Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX 77030, USA
| | - Michael P. Wendel
- Department of Obstetrics & Gynecology, University of Arkansas for Medical Sciences, 4301 W. Markham St. Slot 518, Little Rock, AR 72205, USA
| | - Taylor L. Ghahremani
- Department of Obstetrics & Gynecology, University of Arkansas for Medical Sciences, 4301 W. Markham St. Slot 518, Little Rock, AR 72205, USA
| | - Megan E. Pagan
- Department of Obstetrics and Gynecology, Darnall Army Medical Center, Fort Hood, TX 76500, USA
| | - Meagen M. Carter
- Department of Obstetrics and Gynecology, Navy Medicine Readiness and Training Command Portsmouth, Portsmouth, VA 23708, USA; (J.R.W.)
| | - Everett F. Magann
- Department of Obstetrics & Gynecology, University of Arkansas for Medical Sciences, 4301 W. Markham St. Slot 518, Little Rock, AR 72205, USA
- Department of Obstetrics and Gynecology, Virginia Tech Carillion, Roanoke, VA 24016, USA
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2
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Atukorala I, Hannan N, Hui L. Immersed in a reservoir of potential: amniotic fluid-derived extracellular vesicles. J Transl Med 2024; 22:348. [PMID: 38609955 PMCID: PMC11010396 DOI: 10.1186/s12967-024-05154-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 04/02/2024] [Indexed: 04/14/2024] Open
Abstract
This review aims to encapsulate the current knowledge in extracellular vesicles extracted from amniotic fluid and amniotic fluid derived stem/stromal cells. Amniotic fluid (AF) bathes the developing fetus, providing nutrients and protection from biological and mechanical dangers. In addition to containing a myriad of proteins, immunoglobulins and growth factors, AF is a rich source of extracellular vesicles (EVs). These vesicles originate from cells in the fetoplacental unit. They are biological messengers carrying an active cargo enveloped within the lipid bilayer. EVs in reproduction are known to play key roles in all stages of pregnancy, starting from fertilisation through to parturition. The intriguing biology of AF-derived EVs (AF-EVs) in pregnancy and their untapped potential as biomarkers is currently gaining attention. EV studies in numerous animal and human disease models have raised expectations of their utility as therapeutics. Amniotic fluid stem cell and mesenchymal stromal cell-derived EVs (AFSC-EVs) provide an established supply of laboratory-made EVs. This cell-free mode of therapy is popular as an alternative to stem cell therapy, revealing similar, if not better therapeutic outcomes. Research has demonstrated the successful application of AF-EVs and AFSC-EVs in therapy, harnessing their anti-inflammatory, angiogenic and regenerative properties. This review provides an overview of such studies and discusses concerns in this emerging field of research.
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Affiliation(s)
- Ishara Atukorala
- Department of Obstetrics, Gynaecology & Newborn Health, Melbourne Medical School, The University of Melbourne, Mercy Hospital for Women, 163 Studley Road, Heidelberg, VIC, 3084, Australia.
- Department of Obstetrics, Gynaecology & Newborn Health, The Northern Centre for Health Education and Research, Northern Health, Epping, VIC, Australia.
| | - Natalie Hannan
- Department of Obstetrics, Gynaecology & Newborn Health, Melbourne Medical School, The University of Melbourne, Mercy Hospital for Women, 163 Studley Road, Heidelberg, VIC, 3084, Australia
- Department of Obstetrics, Gynaecology & Newborn Health, The Northern Centre for Health Education and Research, Northern Health, Epping, VIC, Australia
| | - Lisa Hui
- Department of Obstetrics, Gynaecology & Newborn Health, Melbourne Medical School, The University of Melbourne, Mercy Hospital for Women, 163 Studley Road, Heidelberg, VIC, 3084, Australia
- Department of Obstetrics, Gynaecology & Newborn Health, The Northern Centre for Health Education and Research, Northern Health, Epping, VIC, Australia
- Department of Perinatal Medicine, Mercy Hospital for Women, Mercy Health, Heidelberg, VIC, Australia
- Reproductive Epidemiology Group, Murdoch Children's Research Institute, Parkville, VIC, Australia
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de Kroon RR, de Baat T, Senger S, van Weissenbruch MM. Amniotic Fluid: A Perspective on Promising Advances in the Prevention and Treatment of Necrotizing Enterocolitis. Front Pediatr 2022; 10:859805. [PMID: 35359891 PMCID: PMC8964040 DOI: 10.3389/fped.2022.859805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 02/15/2022] [Indexed: 12/09/2022] Open
Abstract
Necrotizing enterocolitis (NEC) is a common and potentially fatal disease that typically affects preterm (PIs) and very low birth weight infants (VLBWIs). Although NEC has been extensively studied, the current therapeutic approaches are unsatisfactory. Due to the similarities in the composition between human amniotic fluid (AF) and human breast milk (BM), which plays a protective role in the development of NEC in PIs and VLBWIs, it has been postulated that AF has similar effects on the outcome of NEC and potential therapeutic implications. AF has been long used for its diagnostic purposes and is often discarded after birth as "biological waste". However, researchers have started to elucidate its therapeutic potential. Experimental studies in animal models have shown that diseases of various organ systems can possibly benefit from AF-based therapy. Hence, we have identified three approaches which show promising results for future clinical application in the prevention and/or treatment of NEC: (1) administration of processed AF (PAF) isolated from donor mothers, (2) administration of AF stem cells (AFSCs), and (3) administration of simulated AF (SAF) formulated to mimic the composition of physiological AF. We have highlighted the most important aspects that should be taken into account to guide further research on the clinical application of AF-based therapy. We hope that this review can provide a framework to identify the challenges of AF-based therapy and help to design future studies to better evaluate AF-based approaches for the treatment and/or prevention of NEC in PIs and VLBWIs.
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Affiliation(s)
- Rimke Romee de Kroon
- Department of Neonatology, Amsterdam University Medical Center, Amsterdam, Netherlands
| | - Tessa de Baat
- Department of Neonatology, Amsterdam University Medical Center, Amsterdam, Netherlands
| | - Stefania Senger
- Department of Mucosal Immunology and Biology Research Center, Massachusetts General Hospital for Children, Boston, MA, United States
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Choi AY, Lee JY, Sohn IS, Kwon HS, Seo YS, Kim MH, Yang SW, Hwang HS. Does the Summer Season Affect the Amniotic Fluid Volume during Pregnancy? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18189483. [PMID: 34574404 PMCID: PMC8467933 DOI: 10.3390/ijerph18189483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 09/02/2021] [Accepted: 09/07/2021] [Indexed: 11/28/2022]
Abstract
Amniotic fluid is crucial for the well-being of the fetus. Recent studies suggest that dehydration in a pregnant woman leads to oligohydramnios. We assessed the variation in the amniotic fluid index (AFI) during the summer and non-summer seasons and evaluated neonatal outcomes. We retrospectively reviewed electrical medical records of pregnant women who visited the Konkuk University Medical Center for antenatal care, between July 2005 and July 2019. A total of 19,724 cases from 6438 singleton pregnant women were included after excluding unsuitable cases. All AFI values were classified as 2nd and 3rd trimester values. Additionally, borderline oligohydramnios (AFI, 5–8) and normal AFI (AFI, 8–24) were assessed according to the seasons. The average AFI between the summer and non-summer season was statistically different only in the 3rd trimester; but the results were not clinically significant. In the 3rd trimester, the summer season influenced the increased incidence of borderline oligohydramnios. The borderline oligohydramnios group showed an increased small-for-gestational-age (SGA) rate and NICU admission rate. In the summer season, the incidence of borderline oligohydramnios was seen to increase. This result would be significant for both physicians and pregnant women.
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Affiliation(s)
- Ah-Young Choi
- Division of Maternal and Fetal Medicine, Department of Obstetrics and Gynecology, Research Institute of Medical Science, Konkuk University School of Medicine, Seoul 05030, Korea; (A.-Y.C.); (I.-S.S.); (H.-S.K.)
| | - Jun-Yi Lee
- Department of Obstetrics and Gynecology, Korea University Guro Hospital, Korea University School of Medicine, Seoul 08308, Korea;
| | - In-Sook Sohn
- Division of Maternal and Fetal Medicine, Department of Obstetrics and Gynecology, Research Institute of Medical Science, Konkuk University School of Medicine, Seoul 05030, Korea; (A.-Y.C.); (I.-S.S.); (H.-S.K.)
| | - Han-Sung Kwon
- Division of Maternal and Fetal Medicine, Department of Obstetrics and Gynecology, Research Institute of Medical Science, Konkuk University School of Medicine, Seoul 05030, Korea; (A.-Y.C.); (I.-S.S.); (H.-S.K.)
| | - Yong-Soo Seo
- Department of Obstetrics and Gynecology, Sang-Gye Paik Hospital, Inje University School of Medicine, Seoul 01757, Korea; (Y.-S.S.); (M.-H.K.)
| | - Myoung-Hwan Kim
- Department of Obstetrics and Gynecology, Sang-Gye Paik Hospital, Inje University School of Medicine, Seoul 01757, Korea; (Y.-S.S.); (M.-H.K.)
| | - Seung-Woo Yang
- Department of Obstetrics and Gynecology, Sang-Gye Paik Hospital, Inje University School of Medicine, Seoul 01757, Korea; (Y.-S.S.); (M.-H.K.)
- Correspondence: (S.-W.Y.); (H.-S.H.)
| | - Han-Sung Hwang
- Division of Maternal and Fetal Medicine, Department of Obstetrics and Gynecology, Research Institute of Medical Science, Konkuk University School of Medicine, Seoul 05030, Korea; (A.-Y.C.); (I.-S.S.); (H.-S.K.)
- Correspondence: (S.-W.Y.); (H.-S.H.)
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Abstract
This study aimed to assess the association between maternal-isolated oligohydramnios (IO) and offspring long-term neurological complications. A population-based retrospective cohort study was conducted, including all births at a single tertiary medical center in Israel between the years 1991 and 2014. Multiple pregnancies and potential pregnancy complications associated with oligohydramnios were excluded. The computerized obstetrical database was linked with the computerized dataset of all pediatric hospitalizations of the same medical center. Evaluation of cumulative neurological-associated hospitalizations rate over time was compared using a Kaplan-Meier survival curve. The Weibull survival parametric model was conducted to assess the neurological-associated hospitalization risk in the presence of IO, while accounting for potential confounders. A total of 190,259 pregnancies were included in the study, of which 4063 (2.13%) pregnancies were complicated with IO. Total neurological-related hospitalizations were significantly more common in the IO group (3.7% in the IO group and 3.0% in the comparison group, p = 0.005). Pervasive developmental disorder, movement disorders, developmental disorders, and degenerative and demyelization disorders were all specific neurological diagnoses significantly more common in the exposed group. The survival curve demonstrated a significantly higher cumulative hospitalization rate in the exposed group (log-rank p = 0.001). Using a multivariate model adjusting for gestational age, maternal age, and labor induction, an independent association between IO and long-term neurological morbidity of the offspring was observed (adjusted hazard ratio 1.203; 95% CI 1.02-1.42). In summary, a significant association was found between pregnancies complicated by IO and long-term neurological morbidity of the offspring.
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Zamłyński M, Zamłyński J, Horzelska E, Maruniak-Chudek I, Bablok R, Szukiewicz D, Herman-Sucharska I, Kluczewska E, Olejek A. The Use of Indomethacin with Complete Amniotic Fluid Replacement and Classic Hysterotomy for the Reduction of Perinatal Complications of Intrauterine Myelomeningocele Repair. Fetal Diagn Ther 2019; 46:415-424. [PMID: 31085918 DOI: 10.1159/000496811] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 01/09/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVE This study presented outcomes of classical hysterotomy with modified antiprostaglandin therapy for intrauterine repair of foetal myelomeningocele (fMMC) performed in a single perinatal centre. STUDY DESIGN Forty-nine pregnant women diagnosed with fMMC underwent classic hysterotomy with anti-prostaglandin management, complete amniotic fluid replacement and high dose indomethacin application. RESULTS The average gestational age (GA) at delivery was 34.4 ± 3.4 weeks, with no births before 30 weeks GA. There were 2 foetal deaths. Complete reversal of hindbrain herniation (HH), assessed in magnetic resonance imaging at 30-31 weeks GA was found in 72% of foetuses (mostly with HH grade I prior to fMMC repair). Our protocol resulted in rare use of magnesium sulphate (6%), low incidence of chorioamniotic membrane separation - chorioamniotic membrane separation (6%), preterm premature rupture of membranes - preterm premature rupture of membranes (pPROM; 15%) and preterm labour - preterm labour (PTL; 17%). The postoperative wound continuity of the uterus was usually stable (in 72% of patients), with low frequency of scar thinning (23%). CONCLUSION Our protocol results in rare use of tocolytics, and the low occurrences of CMS, pPROM and PTL in relation to other study cohorts: Management of Myelomeningocele Study, Children's Hospital of Philadelphia, and Vanderbilt University Medical Centre.
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Affiliation(s)
- Mateusz Zamłyński
- Department of Gynecology, Obstetrics and Gynecologic Oncology Medical University of Silesia in Katowice, Bytom, Poland,
| | - Jacek Zamłyński
- Department of Gynecology, Obstetrics and Gynecologic Oncology Medical University of Silesia in Katowice, Bytom, Poland
| | - Ewa Horzelska
- Department of Gynecology, Obstetrics and Gynecologic Oncology Medical University of Silesia in Katowice, Bytom, Poland
| | - Iwona Maruniak-Chudek
- Department of Intensive Care and Neonatal Pathology Medical University of Silesia Upper Silesian Centre of Child's Health, Katowice, Poland
| | - Rafał Bablok
- Department of Gynecology, Obstetrics and Gynecologic Oncology Medical University of Silesia in Katowice, Bytom, Poland
| | - Dariusz Szukiewicz
- Department of General and Experimental Pathology with Centre for Preclinical Research and Technology (CEPT), Medical University of Warsaw, Warsaw, Poland
| | - Izabela Herman-Sucharska
- Electroradiology Department, Faculty of Health Sciences, Collegium Medicum, Jagiellonian University, Krakow, Poland
| | - Ewa Kluczewska
- Department of Radiology and Radiodiagnostics School of Medicine with the Division of Dentistry in Zabrze Medical University of Silesia in Katowice, Zabrze, Poland
| | - Anita Olejek
- Department of Gynecology, Obstetrics and Gynecologic Oncology Medical University of Silesia in Katowice, Bytom, Poland
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Jalali LM, Koski KG. Amniotic fluid minerals, trace elements, and prenatal supplement use in humans emerge as determinants of fetal growth. J Trace Elem Med Biol 2018; 50:139-145. [PMID: 30262271 DOI: 10.1016/j.jtemb.2018.06.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 06/04/2018] [Accepted: 06/15/2018] [Indexed: 01/23/2023]
Abstract
Amniotic fluid (AF), which is swallowed by the developing fetus, contains minerals and trace elements, but their association with fetal growth has not been explored. Our objectives were to assess (1) whether concentrations of AF minerals and trace elements were associated with changes in 5 fetal ultrasound measurements (estimated weight, bi-parietal diameter, head circumference, abdominal circumference, femur length) between 16-20 and 32-36 wks gestation and (2) whether a prenatal supplement was associated with concentrations of AF minerals and trace elements or the 5 fetal ultrasound measurements. We measured, using inductively coupled plasma-mass spectrometry (ICP-MS), 15 minerals and trace elements (aluminum, arsenic, calcium, chromium, copper, iron, lead, magnesium, nickel, potassium, rubidium, selenium, silver strontium, zinc) in amniotic fluid collected from 176 pregnant women undergoing age-related amniocentesis for genetic testing (15.7 ± 1.1 wks). AF mineral concentrations, prenatal supplement use, and determinants of ultrasound measurements during early and late pregnancy were used in models to assess their impact on change in fetal ultrasound measurements. Positive associations were identified for change in bi-parietal diameter with AF calcium, for change in head circumference with AF copper and nickel, and for change in femur length with AF selenium. Arsenic was negatively associated with estimated fetal weight, and this relationship was modified by prenatal supplement use. Additionally, AF chromium concentrations were lower in women taking prenatal supplements. In conclusion, AF minerals were associated with fetal ultrasound indices, supporting a biological role for calcium, copper, nickel and selenium in promoting in-utero fetal growth. Evidence of a mineral-vitamin interaction between arsenic and folic acid in prenatal supplements and mineral-mineral interaction between iron and chromium would suggest that attention be paid to mineral and trace element formulation of prenatal supplements.
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Affiliation(s)
- Lauren M Jalali
- School of Human Nutrition, Macdonald Stewart Building, McGill University, 21111 Lakeshore Road, Ste-Anne de Bellevue, QC, H9X 3V9, Canada.
| | - Kristine G Koski
- School of Human Nutrition, Macdonald Stewart Building, McGill University, 21111 Lakeshore Road, Ste-Anne de Bellevue, QC, H9X 3V9, Canada.
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PROM and Labour Effects on Urinary Metabolome: A Pilot Study. DISEASE MARKERS 2018; 2018:1042479. [PMID: 29511388 PMCID: PMC5817378 DOI: 10.1155/2018/1042479] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 12/24/2017] [Indexed: 01/22/2023]
Abstract
Since pathologies and complications occurring during pregnancy and/or during labour may cause adverse outcomes for both newborns and mothers, there is a growing interest in metabolomic applications on pregnancy investigation. In fact, metabolomics has proved to be an efficient strategy for the description of several perinatal conditions. In particular, this study focuses on premature rupture of membranes (PROM) in pregnancy at term. For this project, urine samples were collected at three different clinical conditions: out of labour before PROM occurrence (Ph1), out of labour with PROM (Ph2), and during labour with PROM (Ph3). GC-MS analysis, followed by univariate and multivariate statistical analysis, was able to discriminate among the different classes, highlighting the metabolites most involved in the discrimination.
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Uguz F, Gezginc K, Korucu DG, Sayal B, Turgut K. Are Major Depression and Generalized Anxiety Disorder Associated With Oligohydramnios in Pregnant Women? A Case-Control Study. Perspect Psychiatr Care 2017; 53:275-279. [PMID: 27357862 DOI: 10.1111/ppc.12174] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Revised: 04/11/2016] [Accepted: 06/02/2016] [Indexed: 11/28/2022] Open
Abstract
PURPOSE This study examined the prevalence of major depression and generalized anxiety disorder (GAD) in pregnant women with and without a diagnosis of oligohydramnios. DESIGN AND METHODS The study sample included 53 pregnant women with a diagnosis of oligohydramnios and 80 healthy pregnant women subjects. Major depression and GAD were diagnosed with the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (SCID-I). FINDINGS Pregnant women with oligohydramnios had higher scores of depressive and anxiety symptom, and a higher prevalence rate of major depression (24.5% vs. 6.2%) and GAD (30.2% vs. 3.2%). PRACTICE IMPLICATIONS The results of the present study suggest that oligohydramnios appears to be associated with both major depression and GAD in pregnant women.
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Affiliation(s)
- Faruk Uguz
- Associate Professor, Department of Psychiatry, University of Necmettin Erbakan, Meram Faculty of Medicine, Konya, Turkey
| | - Kazim Gezginc
- Associate Professor, Department of Obstetrics and Gynecology, University of Necmettin Erbakan, Meram Faculty of Medicine, Konya, Turkey
| | - Dilay Gok Korucu
- Research Assistant, Department of Obstetrics and Gynecology, University of Necmettin Erbakan, Meram Faculty of Medicine, Konya, Turkey
| | - Berkan Sayal
- Research Fellow, Department of Obstetrics and Gynecology, University of Necmettin Erbakan, Meram Faculty of Medicine, Konya, Turkey
| | - Keziban Turgut
- Research Assistant, Department of Psychiatry, University of Necmettin Erbakan, Meram Faculty of Medicine, Konya, Turkey
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Aminotic Fluid Index and its Correlation with Fetal Growth and Perinatal Outcome. JOURNAL OF FETAL MEDICINE 2015. [DOI: 10.1007/s40556-015-0049-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Marella D, Prefumo F, Valcamonico A, Donzelli CM, Frusca T, Fichera A. Polyhydramnios in sac of parasitic twin: atypical manifestation of twin reversed arterial perfusion sequence. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2015; 45:752-753. [PMID: 25510847 DOI: 10.1002/uog.14766] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Accepted: 12/10/2014] [Indexed: 06/04/2023]
Affiliation(s)
- D Marella
- Department of Obstetrics and Gynaecology, University of Brescia, Piazzale Spedali Civili 1, Brescia, 25123, Italy
| | - F Prefumo
- Department of Obstetrics and Gynaecology, University of Brescia, Piazzale Spedali Civili 1, Brescia, 25123, Italy
| | - A Valcamonico
- Department of Obstetrics and Gynaecology, University of Brescia, Piazzale Spedali Civili 1, Brescia, 25123, Italy
| | - C M Donzelli
- Department of Pathology, Spedali Civili di Brescia, Brescia, Italy
| | - T Frusca
- Department of Obstetrics and Gynaecology, University of Brescia, Piazzale Spedali Civili 1, Brescia, 25123, Italy
| | - A Fichera
- Department of Obstetrics and Gynaecology, University of Brescia, Piazzale Spedali Civili 1, Brescia, 25123, Italy
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12
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Cho GJ, Hong HR, Kim SW, Hong SC, Oh MJ, Kim HJ. Decreased umbilical orexin-A level is associated with idiopathic polyhydramnios. Acta Obstet Gynecol Scand 2015; 94:295-300. [DOI: 10.1111/aogs.12559] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Accepted: 12/08/2014] [Indexed: 11/26/2022]
Affiliation(s)
- Geum Joon Cho
- Department of Obstetrics and Gynecology; College of Medicine; Korea University; Seoul Korea
| | - Hye-Ri Hong
- Department of Obstetrics and Gynecology; School of Medicine; Kyung Hee University; Seoul Korea
| | - Suhng Wook Kim
- Department of Biomedical Science; College of Health Sciences; Korea University; Seoul Korea
| | - Soon Cheol Hong
- Department of Obstetrics and Gynecology; College of Medicine; Korea University; Seoul Korea
| | - Min-Jeong Oh
- Department of Obstetrics and Gynecology; College of Medicine; Korea University; Seoul Korea
| | - Hai Joon Kim
- Department of Obstetrics and Gynecology; College of Medicine; Korea University; Seoul Korea
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Benzer N, Tazegül Pekin A, Yılmaz SA, Seçilmiş Kerimoğlu Ö, Doğan NU, Çelik Ç. Predictive value of second and third trimester fetal renal artery Doppler indices in idiopathic oligohydramnios and polyhydramnios in low-risk pregnancies: A longitudinal study. J Obstet Gynaecol Res 2014; 41:523-8. [DOI: 10.1111/jog.12601] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Accepted: 08/16/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Nilgün Benzer
- Department of Obstetrics and Gynecology; Faculty of Medicine; Selçuk University; Konya Turkey
| | - Aybike Tazegül Pekin
- Department of Obstetrics and Gynecology; Faculty of Medicine; Selçuk University; Konya Turkey
| | - Setenay Arzu Yılmaz
- Department of Obstetrics and Gynecology; Faculty of Medicine; Selçuk University; Konya Turkey
| | | | - Nasuh Utku Doğan
- Department of Obstetrics and Gynecology; Faculty of Medicine; Akdeniz University; Antalya Turkey
| | - Çetin Çelik
- Department of Obstetrics and Gynecology; Faculty of Medicine; Selçuk University; Konya Turkey
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15
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Jelsema R. In the measurement of amniotic fluid vertical pockets, are all pockets of similar depth the same? JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2012; 31:666; author reply 666. [PMID: 22441929 DOI: 10.7863/jum.2012.31.4.666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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16
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Guin G, Punekar S, Lele A, Khare S. A prospective clinical study of feto-maternal outcome in pregnancies with abnormal liquor volume. J Obstet Gynaecol India 2012. [PMID: 23204684 DOI: 10.1007/s13224-011-0116-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
UNLABELLED AIMS AND OBJECTIVE(S): Evaluating feto-maternal outcome in pregnancies with abnormal liquor volume. MATERIAL AND METHOD(S) 200 pregnant subjects between 20 and 42 weeks of gestation, who were clinically suspected to have an abnormal amniotic fluid volume (oligohydramnios or polyhydramnios) were subjected to ultrasonographic (USG) assessment of amniotic fluid index. The subjects were closely monitored through pregnancy, labour and puerperium. OBSERVATION(S) Ultrasonically, abnormal liquor volume was confirmed in 90-93% clinically suspected patients. Post term pregnancy (38.5%), PROM (30%) and prolonged pregnancy (23.5%) were associated with oligohydramnios. Fetal congenital anomalies (31.1%), diabetes mellitus (20%), PIH (17.7%), twin pregnancy (6.6%) and Rh incompatibility (4.4%) were associated with polyhydramnios. The incidence of labour induction, fetal labour intolerance, CS for fetal distress and 1 min Apgar of <7 was high in oligohydramnios subjects. Premature labour complicated 40% of polyhydramnios pregnancies. The overall incidence of congenital anomalies (14%) and perinatal mortality (20%) in subjects with abnormal liquor volume was significantly higher (P < 0.001) than in women with normal liquor volume (0.3, 2.3% respectively). CONCLUSION(S) A good clinical examination can pick up most subjects of abnormal liquor volume. Abnormal liquor volumes are associated with increased maternal morbidity and adverse perinatal outcome.
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Affiliation(s)
- Gita Guin
- Department of Obstetrics & Gynaecology, N.S.C.B. Medical College, Gwalior, India ; 436, Kamla Nehru Nagar, Garha Road, Jabalpur, Madhya Pradesh 482 002 India
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Quiñones JN, Odibo AO, Stringer M, Rochon ML, Macones GA. Determining a threshold for amniotic fluid as a predictor of perinatal outcome at term. J Matern Fetal Neonatal Med 2011; 25:1319-23. [PMID: 22010941 DOI: 10.3109/14767058.2011.632453] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To determine a threshold level of amniotic fluid in low-risk term pregnancies predictive of adverse perinatal outcome. METHODS Prospective cohort study of low-risk patients at term undergoing amniotic fluid volume measurement. Amniotic fluid index (AFI) remained blinded unless ≤ 1 cm or ≥ 25 cm. Primary outcome was a positive fetal vulnerability index (FVI). The last AFI was evaluated as predictor of a +FVI. We estimated that we needed to perform ultrasounds on 620 women. RESULTS Patients were enrolled through 2004-2008. There were 24 (7.8%) patients delivering a neonate with +FVI. An AFI < 8 cm increased the risk of a +FVI (risk ratio 2.70 [95% CI 1.2, 6.0]; p = 0.01); however, the area under the receiver operating characteristics curve was 0.60. Enrollment was stopped at 308 patients due to enrollment challenges. CONCLUSIONS An AFI cutoff <8 cm was associated with an increase in FVI outcomes but had a low positive predictive value for a +FVI. Isolated incidentally found low fluid in uncomplicated pregnancies may not be an indication for immediate intervention.
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Affiliation(s)
- Joanne N Quiñones
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Lehigh Valley Health Network, Allentown, PA 18105, USA.
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Magann EF, Sandlin AT, Ounpraseuth ST. Amniotic fluid and the clinical relevance of the sonographically estimated amniotic fluid volume: oligohydramnios. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2011; 30:1573-1585. [PMID: 22039031 DOI: 10.7863/jum.2011.30.11.1573] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The amniotic fluid volume (AFV) is regulated by several systems, including the in-tramembranous pathway, fetal production (fetal urine and lung fluid) and uptake (fetal swallowing), and the balance of fluid movement via osmotic gradients. The normal AFV across gestation has not been clearly defined; consequently, abnormal volumes are also poorly defined. Actual AFVs can be measured by dye dilution techniques and directly measured at cesarean delivery; however, these techniques are time-consuming, are invasive, and require laboratory support, and direct measurement can only be done at cesarean delivery. As a result of these limitations, the AFV is estimated by the amniotic fluid index (AFI), the single deepest pocket, and subjective assessment of the AFV. Unfortunately, sonographic estimates of the AFV correlate poorly with dye-determined or directly measured amniotic fluid. The recent use of color Doppler sonography has not improved the diagnostic accuracy of sonographic estimates of the AFV but instead has led to overdiagnosis of oligohydramnios. The relationship between the fixed cutoffs of an AFI of 5 cm or less and a single deepest pocket of 2 cm or less for identifying adverse pregnancy outcomes is uncertain. The use of the single deepest pocket compared to the AFI to identify oligohydramnios in at-risk pregnancies seems to be a better choice because the use of the AFI leads to an increase in the diagnosis of oligohydramnios, resulting in more labor inductions and cesarean deliveries without any improvement in peripartum outcomes.
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Affiliation(s)
- Everett F Magann
- Department of Obstetrics and Gynecology, University of Arkansas for the Medical Sciences, Little Rock, AR 72205 USA.
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Yehuda I, Nagtalon‐Ramos J, Trout K. Fetal Growth Scans and Amniotic Fluid Assessments in Pregestational and Gestational Diabetes. J Obstet Gynecol Neonatal Nurs 2011; 40:603-14; quiz 614-6. [DOI: 10.1111/j.1552-6909.2011.01283.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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