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Martin MM, Chan M, Antoine C, Bar-El L, Bornstein E, Young BK. Clinical potential of human amniotic fluid stem cells. J Perinat Med 2023; 51:117-124. [PMID: 35985014 DOI: 10.1515/jpm-2022-0309] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 08/06/2022] [Indexed: 01/17/2023]
Abstract
OBJECTIVES To determine whether amniotic fluid derived stem cells maintain their stem cell characteristics (a) after processing by a licensed cell therapy center and (b) after the cells undergo simulated clinical application. METHODS Amniotic fluid was collected by laparotomy - a small uterine incision was made at proposed site for delivery and a sterile catheter inserted to collect fluid into a sterile bag. After flow stopped the catheter was withdrawn, the cesarean completed and the collected fluid delivered to the cell therapy center for processing and cryostorage. A clinical setting was simulated where amniotic fluid cells received from cell therapy center were thawed at room temperature for a maximum of 3 h and passed through a clinical cell delivery device to monitor cell viability. The cells were examined for viability, stability, growth, differentiation, and markers of stemness. RESULTS Amniotic fluid stem cells processed from a clinical cell therapy center behave similarly to amniotic fluid stem cells processed in a research laboratory with respects to viability, stability, growth, differentiation and maintain markers of stemness. There were differences due to heterogeneity of samples which were not methodological. Growth in cell culture and differentiation were satisfactory. Simulation of treating the cells in a clinical environment show a general stability in viability of amniotic fluid cells at room temperature for 3 h minimum and when passed through a clinically approved delivery device. CONCLUSIONS The data indicate human amniotic fluid processed in a clinical facility could be used therapeutically if proven to be safe.
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Affiliation(s)
- Monique M Martin
- Department of Obstetrics and Gynecology, New York University Langone Health, New York, NY, USA
| | - Michael Chan
- Department of Obstetrics and Gynecology, New York University Langone Health, New York, NY, USA
| | - Clarel Antoine
- Department of Obstetrics and Gynecology, New York University Langone Health, New York, NY, USA
| | - Liron Bar-El
- Department of Obstetrics and Gynecology, Lenox Hill Hospital, Northwell Health, New York, NY, USA
| | - Eran Bornstein
- Department of Obstetrics and Gynecology, Lenox Hill Hospital, Northwell Health, New York, NY, USA
| | - Bruce K Young
- Department of Obstetrics and Gynecology, New York University Langone Health, New York, NY, USA
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Subhan BS, Kwong J, Kuhn JF, Monas A, Sharma S, Rabbani PS. Amniotic fluid-derived multipotent stromal cells drive diabetic wound healing through modulation of macrophages. J Transl Med 2021; 19:16. [PMID: 33407615 PMCID: PMC7789548 DOI: 10.1186/s12967-020-02674-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 12/11/2020] [Indexed: 01/13/2023] Open
Abstract
Background Cutaneous wounds in patients with diabetes exhibit impaired healing due to physiological impediments and conventional care options are severely limited. Multipotent stromal cells (MSCs) have been touted as a powerful new therapy for diabetic tissue repair owing to their trophic activity and low immunogenicity. However, variations in sources and access are limiting factors for broader adaptation and study of MSC-based therapies. Amniotic fluid presents a relatively unexplored source of MSCs and one with wide availability. Here, we investigate the potential of amniotic fluid-derived multipotent stromal cells (AFMSCs) to restore molecular integrity to diabetic wounds, amend pathology and promote wound healing. Method We obtained third trimester amniotic fluid from term cesarean delivery and isolated and expanded MSCs in vitro. We then generated 10 mm wounds in Leprdb/db diabetic mouse skin, and splinted them open to allow for humanized wound modeling. Immediately after wounding, we applied AFMSCs topically to the sites of injuries on diabetic mice, while media application only, defined as vehicle, served as controls. Post-treatment, we compared healing time and molecular and cellular events of AFMSC-treated, vehicle-treated, untreated diabetic, and non-diabetic wounds. A priori statistical analyses measures determined significance of the data. Result Average time to wound closure was approximately 19 days in AFMSC-treated diabetic wounds. This was significantly lower than the vehicle-treated diabetic wounds, which required on average 27.5 days to heal (p < 0.01), and most similar to time of closure in wild type untreated wounds (an average of around 18 days). In addition, AFMSC treatment induced changes in the profiles of macrophage polarizing cytokines, resulting in a change in macrophage composition in the diabetic wound bed. We found no evidence of AFMSC engraftment or biotherapy induced immune response. Conclusion Treatment of diabetic wounds using amniotic fluid-derived MSCs encourages cutaneous tissue repair through affecting inflammatory cell behavior in the wound site. Since vehicle-treated diabetic wounds did not demonstrate accelerated healing, we determined that AFMSCs were therapeutic through their paracrine activities. Future studies should be aimed towards validating our observations through further examination of the paracrine potential of AFMSCs. In addition, investigations concerning safety and efficacy of this therapy in clinical trials should be pursued.
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Affiliation(s)
- Bibi S Subhan
- Hansjörg Wyss Department of Plastic Surgery, New York University School of Medicine, 540 First Avenue, New York, 10016, USA
| | - Jennifer Kwong
- Hansjörg Wyss Department of Plastic Surgery, New York University School of Medicine, 540 First Avenue, New York, 10016, USA
| | - Joseph F Kuhn
- Hansjörg Wyss Department of Plastic Surgery, New York University School of Medicine, 540 First Avenue, New York, 10016, USA
| | - Arie Monas
- Hansjörg Wyss Department of Plastic Surgery, New York University School of Medicine, 540 First Avenue, New York, 10016, USA
| | - Sonali Sharma
- Hansjörg Wyss Department of Plastic Surgery, New York University School of Medicine, 540 First Avenue, New York, 10016, USA
| | - Piul S Rabbani
- Hansjörg Wyss Department of Plastic Surgery, New York University School of Medicine, 540 First Avenue, New York, 10016, USA.
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Varrey A, Romero R, Panaitescu B, Miller D, Chaiworapongsa T, Patwardhan M, Faro J, Pacora P, Hassan SS, Hsu CD, Gomez-Lopez N. Human β-defensin-1: A natural antimicrobial peptide present in amniotic fluid that is increased in spontaneous preterm labor with intra-amniotic infection. Am J Reprod Immunol 2018; 80:e13031. [PMID: 30101464 DOI: 10.1111/aji.13031] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 07/16/2018] [Indexed: 12/11/2022] Open
Abstract
PROBLEM Human β-defensins (HBDs) are antimicrobial peptides that participate in the soluble innate immune mechanisms against infection. Herein, we determined whether HBD-1 was present in amniotic fluid during normal pregnancy and whether its concentrations change with intra-amniotic inflammation and/or infection. METHOD OF STUDY Amniotic fluid was collected from 219 women in the following groups: (a) midtrimester who delivered at term (n = 35); (b) term with (n = 33) or without (n = 17) labor; (c) preterm labor with intact membranes who delivered at term (n = 29) or who delivered preterm with (n = 19) and without (n = 29) intra-amniotic inflammation and infection or with intra-amniotic inflammation but without infection (n = 21); and (d) preterm prelabor rupture of membranes (pPROM) with (n = 19) and without (n = 17) intra-amniotic inflammation/infection. Amniotic fluid HBD-1 concentrations were determined using a sensitive and specific ELISA kit. RESULTS (a) HBD-1 was detectable in all amniotic fluid samples; (b) amniotic fluid concentrations of HBD-1 were changed with gestational age (midtrimester vs term no labor), being higher in midtrimester; (c) amniotic fluid concentrations of HBD-1 were similar between women with and without spontaneous labor at term; (d) among patients with spontaneous preterm labor, amniotic fluid concentrations of HBD-1 in women with intra-amniotic inflammation/infection and in those with intra-amniotic inflammation without infection were greater than in women without intra-amniotic inflammation or infection who delivered preterm or at term; and (e) the presence of intra-amniotic inflammation and infection in patients with pPROM did not change amniotic fluid concentrations of HBD-1. CONCLUSION HBD-1 is a physiological constituent of amniotic fluid that is increased in midtrimester during normal pregnancy and in the presence of culturable microorganisms in the amniotic cavity. These findings provide insight into the soluble host defense mechanisms against intra-amniotic infection.
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Affiliation(s)
- Aneesha Varrey
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U. S. Department of Health and Human Services, Bethesda, Maryland, and Detroit, Michigan.,Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan
| | - Roberto Romero
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U. S. Department of Health and Human Services, Bethesda, Maryland, and Detroit, Michigan.,Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan.,Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, Michigan.,Center for Molecular Medicine and Genetics, Wayne State University, Detroit, Michigan
| | - Bogdan Panaitescu
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U. S. Department of Health and Human Services, Bethesda, Maryland, and Detroit, Michigan.,Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan
| | - Derek Miller
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U. S. Department of Health and Human Services, Bethesda, Maryland, and Detroit, Michigan.,Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan
| | - Tinnakorn Chaiworapongsa
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U. S. Department of Health and Human Services, Bethesda, Maryland, and Detroit, Michigan.,Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan
| | - Manasi Patwardhan
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan
| | - Jonathan Faro
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U. S. Department of Health and Human Services, Bethesda, Maryland, and Detroit, Michigan.,Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan
| | - Percy Pacora
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U. S. Department of Health and Human Services, Bethesda, Maryland, and Detroit, Michigan.,Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan
| | - Sonia S Hassan
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U. S. Department of Health and Human Services, Bethesda, Maryland, and Detroit, Michigan.,Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan.,Department of Physiology, Wayne State University School of Medicine, Detroit, Michigan
| | - Chaur-Dong Hsu
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan
| | - Nardhy Gomez-Lopez
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U. S. Department of Health and Human Services, Bethesda, Maryland, and Detroit, Michigan.,Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan.,Department of Immunology, Microbiology and Biochemistry, Wayne State University School of Medicine, Detroit, Michigan
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4
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Pei W, Lu T, Wang K, Ji M, Zhang S, Chen F, Li L, Li X, Guan W. Biological characterization and pluripotent identification of ovine amniotic fluid stem cells. Cytotechnology 2018; 70:1009-1021. [PMID: 29502286 DOI: 10.1007/s10616-017-0115-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Accepted: 03/21/2017] [Indexed: 01/03/2023] Open
Abstract
Mesenchymal stem cells derived from amniotic fluid have become one of the most potential stem cell source for cell-based therapy for the reason they can be harvested at low cost and without ethical problems. Here, we obtained amniotic fluid stem cells (AFSCs) from ovine amniotic fluid and studied the expansion capacity, cell markers expression, karyotype, and multilineage differentiation ability. In our work, AFSCs were subcultured to passage 62. The cell markers, CD29, CD44, CD73 and OCT4 which analyzed by RT-PCR were positive; CD44, CD73, CD90, CD105, NANOG, OCT4 analyzed by immunofluorescence and flow cytometry were also positive. The growth curves of different passages were all typically sigmoidal. The different passages cells took on a normal karyotype. In addition, AFSCs were successfully induced to differentiate into adipocytes, osteoblasts and chondrocytes. The results suggested that the AFSCs isolated from ovine maintained normal biological characteristics and their multilineage differentiation potential provides many potential applications in cell-based therapies and tissue engineering.
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Affiliation(s)
- Wenhua Pei
- Institute of Animal Science, Chinese Academy of Agricultural Sciences, Yuanmingyuan West road, haidian district, Beijing, 100193, China
| | - Tengfei Lu
- Institute of Animal Science, Chinese Academy of Agricultural Sciences, Yuanmingyuan West road, haidian district, Beijing, 100193, China
| | - Kunfu Wang
- College of Wildlife Resources, Northeast Forestry University, Harbin, 150040, China
| | - Meng Ji
- Institute of Animal Science, Chinese Academy of Agricultural Sciences, Yuanmingyuan West road, haidian district, Beijing, 100193, China
| | - Shuang Zhang
- Research Center for Sports Scientific Experiment, Harbin Sport University, Harbin, People's Republic of China
| | - Fenghao Chen
- College of Human Movement Science, Harbin Sport University, Harbin, 150040, China
| | - Lu Li
- College of Animal Science and Technology, Agricultural University of Hebei, Baoding, 071000, China
| | - Xiangchen Li
- Institute of Animal Science, Chinese Academy of Agricultural Sciences, Yuanmingyuan West road, haidian district, Beijing, 100193, China.
| | - Weijun Guan
- Institute of Animal Science, Chinese Academy of Agricultural Sciences, Yuanmingyuan West road, haidian district, Beijing, 100193, China.
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Highly Sensitive and Specific Detection of SRY Gene for Non–invasive Prenatal Diagnosis. CHINESE JOURNAL OF ANALYTICAL CHEMISTRY 2017. [DOI: 10.1016/s1872-2040(17)61043-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Effects of Pharmacological Agents on Human Amniotic Fluid-Derived Stem Cells in Culture. Stem Cells Dev 2016; 25:1570-1579. [DOI: 10.1089/scd.2016.0141] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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7
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Pietropolli A, Capogna MV, Cascella R, Germani C, Bruno V, Strafella C, Sarta S, Ticconi C, Marmo G, Gallaro S, Longo G, Marsella LT, Novelli A, Novelli G, Piccione E, Giardina E. Three-hour analysis of non-invasive foetal sex determination: application of Plexor chemistry. Hum Genomics 2016; 10:9. [PMID: 27044517 PMCID: PMC4820952 DOI: 10.1186/s40246-016-0066-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 03/28/2016] [Indexed: 11/26/2022] Open
Abstract
Background The knowledge of the individual genetic “status” in the prenatal era is particularly relevant in the case of positive family history for genetic diseases, in advanced maternal age and in the general screening for foetal abnormalities. In this context, here, we report an innovative molecular assay which utilizes the cell-free foetal DNA (cffDNA) as a source for the early and fast detection of the foetal sex. The study involved 132 pregnant women in their first 3 months of pregnancy, who agreed to give a blood sample. All the collected samples were immediately subjected to the separation of the plasma, which was utilized for the extraction of the cffDNA. Successively, the extracted cffDNA was analysed by a quantitative PCR (qPCR) method based on Plexor-HY chemistry, which is able to simultaneously identify, quantify and discriminate the autosomal DNA from the sex-linked DNA. Results Overall, the Plexor-HY assay demonstrated to be sensitive and specific for the determination of low-template DNA, such as the cffDNA. In fact, the Plexor-HY assay has been successfully performed in all the samples, identifying 70 males and 62 females. As the foetal sex can be provided in 120 min just by utilizing a maternal blood sample as cffDNA source, the assay represents a very fast, safe and non-invasive prenatal method. Conclusions The possibility of determining the foetal sex in the early prenatal life consents the application of our assay as a helpful screening test for subjects and families at risk of sex-linked disorders. Moreover, the early knowledge of the foetal sex may be of great help even for the specialist, who might promptly advise the patients concerning the foetal risk of inheriting sex-linked disorders and the clinical utility of performing an invasive prenatal diagnosis. Electronic supplementary material The online version of this article (doi:10.1186/s40246-016-0066-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Adalgisa Pietropolli
- Section of Gynecology and Obstetrics, Academic Department of Biomedicine and Prevention, "Tor Vergata" University Hospital, Oxford Street, 81, 00133, Rome, Italy.,Clinical Department of Surgery, "Tor Vergata" University Hospital, Oxford Street, 81, 00133, Rome, Italy
| | - Maria Vittoria Capogna
- Section of Gynecology and Obstetrics, Academic Department of Biomedicine and Prevention, "Tor Vergata" University Hospital, Oxford Street, 81, 00133, Rome, Italy.,Clinical Department of Surgery, "Tor Vergata" University Hospital, Oxford Street, 81, 00133, Rome, Italy
| | - Raffaella Cascella
- Department of Biomedicine and Prevention, School of Medicine, University of Rome "Tor Vergata", Montpelier Street, 1, 00133, Rome, Italy. .,Emotest Laboratory, M. Licola Patria Street, 60, 80078, Pozzuoli, NA, Italy.
| | - Chiara Germani
- Molecular Genetics Laboratory UILDM, Santa Lucia Foundation, Ardeatina Street, 306, 00142, Rome, Italy
| | - Valentina Bruno
- Section of Gynecology and Obstetrics, Academic Department of Biomedicine and Prevention, "Tor Vergata" University Hospital, Oxford Street, 81, 00133, Rome, Italy.,Clinical Department of Surgery, "Tor Vergata" University Hospital, Oxford Street, 81, 00133, Rome, Italy
| | - Claudia Strafella
- Department of Biomedicine and Prevention, School of Medicine, University of Rome "Tor Vergata", Montpelier Street, 1, 00133, Rome, Italy
| | - Simona Sarta
- Section of Gynecology and Obstetrics, Academic Department of Biomedicine and Prevention, "Tor Vergata" University Hospital, Oxford Street, 81, 00133, Rome, Italy.,Clinical Department of Surgery, "Tor Vergata" University Hospital, Oxford Street, 81, 00133, Rome, Italy
| | - Carlo Ticconi
- Section of Gynecology and Obstetrics, Academic Department of Biomedicine and Prevention, "Tor Vergata" University Hospital, Oxford Street, 81, 00133, Rome, Italy.,Clinical Department of Surgery, "Tor Vergata" University Hospital, Oxford Street, 81, 00133, Rome, Italy
| | - Giusy Marmo
- Department of Biomedicine and Prevention, School of Medicine, University of Rome "Tor Vergata", Montpelier Street, 1, 00133, Rome, Italy
| | - Sara Gallaro
- Department of Biomedicine and Prevention, School of Medicine, University of Rome "Tor Vergata", Montpelier Street, 1, 00133, Rome, Italy
| | - Giuliana Longo
- Department of Biomedicine and Prevention, School of Medicine, University of Rome "Tor Vergata", Montpelier Street, 1, 00133, Rome, Italy
| | - Luigi Tonino Marsella
- Department of Biomedicine and Prevention, School of Medicine, University of Rome "Tor Vergata", Montpelier Street, 1, 00133, Rome, Italy
| | - Antonio Novelli
- Bambino Gesù Children's Hospital, IRCCS, Sant'Onofrio Square, 4, Rome, Italy
| | - Giuseppe Novelli
- Department of Biomedicine and Prevention, School of Medicine, University of Rome "Tor Vergata", Montpelier Street, 1, 00133, Rome, Italy
| | - Emilio Piccione
- Section of Gynecology and Obstetrics, Academic Department of Biomedicine and Prevention, "Tor Vergata" University Hospital, Oxford Street, 81, 00133, Rome, Italy.,Clinical Department of Surgery, "Tor Vergata" University Hospital, Oxford Street, 81, 00133, Rome, Italy
| | - Emiliano Giardina
- Department of Biomedicine and Prevention, School of Medicine, University of Rome "Tor Vergata", Montpelier Street, 1, 00133, Rome, Italy.,Molecular Genetics Laboratory UILDM, Santa Lucia Foundation, Ardeatina Street, 306, 00142, Rome, Italy
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Connolly KA, Eddleman KA. Amniocentesis: A contemporary review. World J Obstet Gynecol 2016; 5:58-65. [DOI: 10.5317/wjog.v5.i1.58] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2015] [Revised: 10/27/2015] [Accepted: 12/15/2015] [Indexed: 02/05/2023] Open
Abstract
Amniocentesis is an essential tool in obstetrics. Invasive testing remains the only modality for diagnostic genetic testing and the only way to provide comprehensive testing for chromosomal abnormalities. Despite increasing use of cell free fetal deoxyribonucleic acid (DNA) testing, amniocentesis should still be offered to all women who desire more complete and accurate genetic testing. Counseling patients on the limitations of screening tests is of the upmost importance and amniocentesis should continue to be recommended to confirm positive results from cell free fetal DNA testing or in the case of failed cell free fetal DNA test. As cell free fetal DNA screening has not adequately been studied in multiple gestations, its use is not recommended in this population and invasive testing should be offered. Amniocentesis is also very useful in providing additional information in settings other than genetic testing the second and third trimester. If intraamniotic infection is suspected, but the clinical findings are not enough to guide management, amniocentesis can provide testing that can both immediately clarify the picture (interleukin-6, gram stain, glucose levels) and finally confirm the presence of infection (culture). It can also be used to detect the presence of intrauterine viral infections. Additionally, amniocentesis may be used to test for markers of fetal lung maturity. The American Congress of Obstetricians and Gynecologists recommends that amniocentesis for this indication not be used in cases where late preterm delivery is indicated. It may be useful in guiding decision-making, however, when late preterm delivery is indicated, but when exact timing is unclear. Regardless of the indication, amniocentesis appears to be a relatively low risk procedure with minimal risk to the patient. Additional randomized controlled trials are not likely, as they are not feasible to due extremely high number of participants that would be needed to detect a difference in loss rates. Based on current literature, however, the risk of pregnancy loss from second trimester amniocentesis is low in both singleton and twin gestations. We counsel patients that technique has changed since the original studies in the 1970s and feel comfortable quoting a loss rate of 1/500-1/1000 based on contemporary data.
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