1
|
Sgayer I, Frank Wolf M, Mustafa Mikhail S, Lowenstein L, Odeh M. The Effect of Maternal Lower Limb Compression on Amniotic Fluid Index, Uteroplacental Perfusion, and Fetal Blood Flow in Isolated Oligohydramnios. Fetal Diagn Ther 2023; 51:85-91. [PMID: 37903468 PMCID: PMC10836746 DOI: 10.1159/000534816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 10/18/2023] [Indexed: 11/01/2023]
Abstract
INTRODUCTION The aim of this study was to examine the efficacy of pneumatic compression of the maternal lower extremities in increasing the amniotic fluid index (AFI) in pregnancies complicated by isolated oligohydramnios. METHODS Women with isolated oligohydramnios (AFI <5 cm) at 32-41 weeks of pregnancy were connected to a sequential compression device for 60 min. Prior and after the application, AFI and the pulsatility index (PI) of a number of arteries were measured. RESULTS The median (interquartile range) maternal age of the 21 women included was 29 years (26.50-32.00), the median parity was 1 (1-2), and the median gestational age at intervention was 37.60 weeks (37.00-39.40). The median AFI increased after the application from 4.00 (3.62-4.50) to 6.08 cm (4.90-7.03) (p < 0.001). The median PI of the fetal renal artery decreased from 2.30 (2.01-2.88) to 2.26 (1.68-2.71) (p = 0.01). The hourly fetal urine production did not increase. Changes were not significant in the PI of the umbilical artery, the middle cerebral artery, and the bilateral uterine arteries. CONCLUSION Short-term activation of pneumatic compression on maternal lower extremities could increase the AFI in women with isolated oligohydramnios.
Collapse
Affiliation(s)
- Inshirah Sgayer
- Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, Israel
- Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Maya Frank Wolf
- Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, Israel
- Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | | | - Lior Lowenstein
- Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, Israel
- Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Marwan Odeh
- Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, Israel
- Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| |
Collapse
|
2
|
Weiner E, Barrett J, Zaltz A, Ram M, Aviram A, Kibel M, Lipworth H, Asztalos E, Melamed N. Amniotic fluid volume at presentation with early preterm prelabor rupture of membranes and association with severe neonatal respiratory morbidity. Ultrasound Obstet Gynecol 2019; 54:767-773. [PMID: 30834608 DOI: 10.1002/uog.20257] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Revised: 02/23/2019] [Accepted: 02/27/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE Amniotic fluid volume (AFV) plays an important role in early fetal lung development, and oligohydramnios in early pregnancy is associated with pulmonary hypoplasia. The aim of this study was to evaluate the association between AFV at the time of presentation with early preterm prelabor rupture of membranes (PPROM) and severe neonatal respiratory morbidity and other adverse pregnancy outcomes. METHODS This was a retrospective study of all women with a singleton pregnancy, admitted to a single tertiary referral center between 2004 and 2014, for expectant management of PPROM at 20 + 0 to 28 + 6 weeks' gestation. The primary exposure was AFV at presentation, classified according to sonographic maximum vertical pocket (MVP) as: normal AFV (> 2 cm), oligohydramnios (≤ 2 cm and > 1 cm) or severe oligohydramnios (≤ 1 cm). The primary outcome was a composite variable of severe respiratory morbidity, defined as either of the following: (1) need for respiratory support in the form of mechanical ventilation using an endotracheal tube for ≥ 72 h and need for surfactant; or (2) bronchopulmonary dysplasia, defined as requirement for oxygen at postmenstrual age of 36 weeks or at the time of transfer to a Level-II facility. Adjusted odds ratios (aOR) and 95% CI for the primary and secondary outcomes were calculated for each AFV-at-presentation group (using normal AFV as the reference), adjusting for gestational age (GA) at PPROM, latency period, birth weight, mode of delivery and chorioamnionitis. RESULTS In total, 580 women were included, of whom 304 (52.4%) had normal AFV, 161 (27.8%) had oligohydramnios and 115 (19.8%) had severe oligohydramnios at presentation. The rates of severe respiratory morbidity were 16.1%, 26.7% and 45.2%, respectively. Compared with normal AFV at presentation, oligohydramnios (aOR, 3.27; 95% CI, 1.84-5.84) and severe oligohydramnios (aOR, 4.11; 95% CI, 2.26-7.56) at presentation were associated independently with severe respiratory morbidity. Other variables that were associated independently with the primary outcome were GA at PPROM (aOR, 0.54; 95% CI, 0.43-0.69), latency period (aOR, 0.94; 95% CI, 0.91-0.98) and Cesarean delivery (aOR, 2.01; 95% CI, 1.21-3.32). CONCLUSIONS In women with early PPROM, AFV at presentation, as assessed by the MVP on ultrasound examination, is associated independently with severe neonatal respiratory morbidity. This information may be taken into consideration when counseling women with early PPROM regarding neonatal outcome and management options. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
Collapse
Affiliation(s)
- E Weiner
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
- Department of Obstetrics and Gynecology, The Edith Wolfson Medical Center, Holon, Israel, affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - J Barrett
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - A Zaltz
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - M Ram
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
- Lis Maternity and Women's Hospital, Tel-Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - A Aviram
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
- Lis Maternity and Women's Hospital, Tel-Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - M Kibel
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - H Lipworth
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - E Asztalos
- Department of Newborn and Developmental Pediatrics, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - N Melamed
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
3
|
Bergh EP, Mann LK, Jain RR, Donepudi R, Moise KJ, Johnson A, Papanna R. Effect of intra-amniotic fluid pressure from polyhydramnios on cervical length in patients with twin-twin transfusion syndrome undergoing fetoscopic laser surgery. Ultrasound Obstet Gynecol 2019; 54:774-779. [PMID: 30693576 DOI: 10.1002/uog.20228] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 01/18/2019] [Accepted: 01/24/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVES To determine the relationship between intra-amniotic pressure and cervical length (CL) in patients with twin-twin transfusion syndrome (TTTS) undergoing fetoscopic laser photocoagulation (FLP), and to identify pre- or intraoperative factors associated with increased intra-amniotic pressure in this population. METHODS This was a prospective cohort study of patients undergoing FLP for TTTS. Exclusion criteria were triplet or higher-order gestation and prior cervical cerclage, amnioreduction or FLP procedure. CL was assessed using preprocedure transvaginal ultrasound. Intra-amniotic pressure measurements were obtained on initial placement of the trocar into the amniotic cavity, using a direct hydrostatic pressure gauge. The relationship between intra-amniotic pressure and CL was assessed using multivariate linear regression analysis, including relevant preoperative and intraoperative variables. RESULTS In total, 283 pregnancies met the inclusion criteria. Quintero stage of TTTS was I in 33 pregnancies, II in 88, III in 150 and IV in 12. Mean gestational age (GA) at FLP was 20.7 ± 3 weeks. Mean intra-amniotic pressure was 23.1 ± 9 mmHg. On unadjusted linear regression analysis, there was no significant association between intra-amniotic pressure and preoperative CL (P = 0.24) or GA at delivery (P = 0.22). On multivariate analysis, the factors associated significantly with intra-amniotic pressure were: number of prior term deliveries (P = 0.03), recipient maximum vertical pocket (P < 0.0001), Quintero stage IV (P = 0.01) and type of anesthesia (sedation vs general anesthesia; P = 0.01). CONCLUSION In pregnancies with TTTS, intra-amniotic pressure is not associated with CL or GA at delivery. This novel finding suggests that cervical shortening in this population is not mechanically driven. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
Collapse
Affiliation(s)
- E P Bergh
- The Texas Fetal Center, Department of Obstetrics, Gynecology and Reproductive Sciences, University of Texas Health Medical School, Houston, TX, USA
| | - L K Mann
- The Texas Fetal Center, Department of Obstetrics, Gynecology and Reproductive Sciences, University of Texas Health Medical School, Houston, TX, USA
| | - R R Jain
- Department of Anesthesiology, McGovern Medical School, Houston, TX, USA
| | - R Donepudi
- The Texas Fetal Center, Department of Obstetrics, Gynecology and Reproductive Sciences, University of Texas Health Medical School, Houston, TX, USA
| | - K J Moise
- The Texas Fetal Center, Department of Obstetrics, Gynecology and Reproductive Sciences, University of Texas Health Medical School, Houston, TX, USA
| | - A Johnson
- The Texas Fetal Center, Department of Obstetrics, Gynecology and Reproductive Sciences, University of Texas Health Medical School, Houston, TX, USA
| | - R Papanna
- The Texas Fetal Center, Department of Obstetrics, Gynecology and Reproductive Sciences, University of Texas Health Medical School, Houston, TX, USA
| |
Collapse
|
4
|
Zoukal S, Hassoune S. The effects of Ramadan fasting during pregnancy on fetal development: a general review. Tunis Med 2019; 97:1132-1138. [PMID: 31691940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND From a religious point of view, Ramadan fasting (RF) is not mandatory during pregnancy. However, some pregnant women insist to fast. Does this choice affect fetal development? AIM The objective of this general review was to determine the impact of RF on fetal development. METHODS The search was conducted via the following databases PubMed, Scopus, Web of Sciences and Google Scholar from January 1st 2009 to December 31th 2018, using the following query: (« Ramadan « OR « Ramadan month « OR « fasting «) AND (« fetal development « OR « fetal growth « OR « fetal programming «) AND (pregnanc* OR gestat* OR pregnant wom*n). Articles published in English or French were included, and comparative studies on the impact of RF on fetal development in the group of pregnant women who fasted and the group who did not fast, regardless of the stage of gestation. RESULTS Ten studies met the research criteria and all were case-control ones. Six studies were conducted in Turkey, two in Egypt, one in Iran and one in Pakistan. The RF coincided with the summer period in 8 studies. An obstetrical ultrasound with Doppler was performed on 1390 pregnant women at the beginning and end of Ramadan. Significant decreases in cephalic perimeter, biparietal diameter and femoral length were noted in a single study. A change in the amniotic fluid index was observed in two studies. CONCLUSION The RF practiced by healthy pregnant women has no negative impact on fetal development.
Collapse
|
5
|
Kulikova B, Kovac M, Bauer M, Tomkova M, Olexikova L, Vasicek J, Balazi A, Makarevich AV, Chrenek P. Survivability of rabbit amniotic fluid-derived mesenchymal stem cells post slow-freezing or vitrification. Acta Histochem 2019; 121:491-499. [PMID: 31005288 DOI: 10.1016/j.acthis.2019.03.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Revised: 03/03/2019] [Accepted: 03/25/2019] [Indexed: 12/20/2022]
Abstract
This work aimed to evaluate the effect of two distinct cryopreservation procedures - conventional slow-freezing and vitrification, on survivability and mesenchymal marker expression stability of rabbit amniotic fluid-derived mesenchymal stem cells (rAF-MSCs). Cells at passage 2 were slowly frozen, using 10% of dimethylsulfoxide, or vitrified, using 40% of ethylene glycol, 0.5 M sucrose and 18% Ficoll 70. After three months storage in liquid nitrogen, viability, chromosomal stability, ultrastructure, surface and intracellular marker expression and differentiation potential of cells were evaluated immediately post-thawing/warming and after additional culture for 48-72 h. Our results showed decreased (P ≤ 0.05) viability of cells post-thawing/warming. However, after additional culture, the viability was similar to those in fresh counterparts in both cryopreserved groups. Increase (P ≤ 0.05) in the population doubling time of vitrified cells was observed, while doubling time of slow-frozen cells remained similar to non-cryopreserved cells. No changes in karyotype (chromosomal numbers) were observed in frozen/vitrified AF-MSCs, and histological staining confirmed similar differentiation potential of fresh and frozen/vitrified cells. Analysis of mesenchymal marker expression by qPCR showed that both cryopreservation approaches significantly affected expression of CD73 and CD90 surface markers. These changes were not detected using flow cytometry. In summary, the conventional slow-freezing and vitrification are reliable and effective approaches for the cryopreservation of rabbit AF-MSCs. Nevertheless, our study confirmed affected expression of some mesenchymal markers following cryopreservation.
Collapse
Affiliation(s)
- Barbora Kulikova
- Research Institute for Animal Production in Nitra, NAFC, Hlohovecká 2, 951 41 Lužianky, Slovak Republic.
| | - Michal Kovac
- Faculty of Biotechnology and Food Science, Slovak University of Agriculture, Tr. A. Hlinku 2, 949 76 Nitra, Slovak Republic
| | - Miroslav Bauer
- Research Institute for Animal Production in Nitra, NAFC, Hlohovecká 2, 951 41 Lužianky, Slovak Republic; Faculty of Natural Sciences, Constantine the Philosopher University in Nitra, Nábrežie mládeže 91, 949 74 Nitra, Slovak Republic
| | - Maria Tomkova
- Faculty of Biotechnology and Food Science, Slovak University of Agriculture, Tr. A. Hlinku 2, 949 76 Nitra, Slovak Republic
| | - Lucia Olexikova
- Research Institute for Animal Production in Nitra, NAFC, Hlohovecká 2, 951 41 Lužianky, Slovak Republic
| | - Jaromir Vasicek
- Research Institute for Animal Production in Nitra, NAFC, Hlohovecká 2, 951 41 Lužianky, Slovak Republic; Faculty of Biotechnology and Food Science, Slovak University of Agriculture, Tr. A. Hlinku 2, 949 76 Nitra, Slovak Republic
| | - Andrej Balazi
- Research Institute for Animal Production in Nitra, NAFC, Hlohovecká 2, 951 41 Lužianky, Slovak Republic
| | - Alexander V Makarevich
- Research Institute for Animal Production in Nitra, NAFC, Hlohovecká 2, 951 41 Lužianky, Slovak Republic
| | - Peter Chrenek
- Research Institute for Animal Production in Nitra, NAFC, Hlohovecká 2, 951 41 Lužianky, Slovak Republic; Faculty of Biotechnology and Food Science, Slovak University of Agriculture, Tr. A. Hlinku 2, 949 76 Nitra, Slovak Republic; Faculty of Animal Breeding and Biology, University of Technology and Life Sciences, Al. prof. S. Kaliskiego 7, 85 796 Bydgoszcz, Poland
| |
Collapse
|
6
|
Van Opstal D, Diderich KE, Joosten M, Govaerts LC, Polak J, Boter M, Saris JJ, Cheung WY, van Veen S, van de Helm R, Go AT, Knapen MF, Papatsonis DN, Dijkman A, de Vries F, Galjaard RH, Hoefsloot LH, Srebniak MI. Unexpected finding of uniparental disomy mosaicism in term placentas: Is it a common feature in trisomic placentas? Prenat Diagn 2018; 38:911-919. [PMID: 30187503 PMCID: PMC6282787 DOI: 10.1002/pd.5354] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 08/22/2018] [Accepted: 08/26/2018] [Indexed: 11/16/2022]
Abstract
Objective Non‐invasive prenatal testing (NIPT) detects placental chromosome aberrations. When amniocentesis reveals a normal karyotype, confined placental mosaicism (CPM) may be assumed. In order to confirm this, placental cytogenetic studies were performed. Method NIPT was conducted in the course of the Dutch TRIDENT study. Placentas of 10 cases with NIPT results indicating an autosomal trisomy and showing a normal (N = 9) or low mosaic karyotype (N = 1) in amniotic fluid (AF) were investigated. The cytotrophoblast as well as the mesenchymal core of two to four placental chorionic villi biopsies were studied with single nucleotide polymorphism (SNP) array. Clinical outcome data were collected. Results In 10/10 cases, CPM was proven. In 3/10 cases trisomy/uniparental disomy (UPD)/biparental disomy (BPD) mosaicism was discovered. In 2/3 cases, all three cell lines were present in the placenta, whereas BPD was found in AF. In 1/3 cases trisomy 22/UPD22 was present in AF while trisomy 22/BPD22 mosaicism was found in the placenta. Five of 10 pregnancies were affected with pre‐eclampsia, low birth weight, preterm delivery, and/or congenital malformations. Conclusion The presence of trisomy/UPD/BPD mosaicism in 3/10 cases that we investigated proves that trisomic zygote rescue may involve multiple rescue events during early embryogenesis. UPD mosaicism, when present in crucial fetal tissues, may explain the abnormal phenotype in undiagnosed cases. What's already known about this topic?
Trisomic zygote rescue is the main mechanism for uniparental disomy (UPD) formation. Confined placental mosaicism (CPM) is the major source of discordant NIPT results. CPM is associated with a risk for adverse pregnancy outcome.
What does this study add?
Trisomic zygote rescue may involve multiple rescue events based on the co‐occurrence of a trisomy‐, UPD‐, and BPD‐cell line in half of the rescued cases as revealed by placental studies.
Collapse
Affiliation(s)
- Diane Van Opstal
- Department of Clinical GeneticsErasmus Medical CenterRotterdamThe Netherlands
| | - Karin E.M. Diderich
- Department of Clinical GeneticsErasmus Medical CenterRotterdamThe Netherlands
| | - Marieke Joosten
- Department of Clinical GeneticsErasmus Medical CenterRotterdamThe Netherlands
| | | | - Joke Polak
- Department of Clinical GeneticsErasmus Medical CenterRotterdamThe Netherlands
| | - Marjan Boter
- Department of Clinical GeneticsErasmus Medical CenterRotterdamThe Netherlands
| | - Jasper J. Saris
- Department of Clinical GeneticsErasmus Medical CenterRotterdamThe Netherlands
| | - Wai Yee Cheung
- Department of Clinical GeneticsErasmus Medical CenterRotterdamThe Netherlands
| | - Stefanie van Veen
- Department of Clinical GeneticsErasmus Medical CenterRotterdamThe Netherlands
| | - Robert van de Helm
- Department of Clinical GeneticsErasmus Medical CenterRotterdamThe Netherlands
| | - Attie T.J.I. Go
- Department of Obstetrics and Prenatal MedicineErasmus Medical CenterRotterdamThe Netherlands
| | - Maarten F.C.M. Knapen
- Department of Obstetrics and Prenatal MedicineErasmus Medical CenterRotterdamThe Netherlands
| | | | - Anneke Dijkman
- Department of Obstetrics and GynecologyReinier de Graaf GroepDelftThe Netherlands
| | - Femke de Vries
- Department of Clinical GeneticsErasmus Medical CenterRotterdamThe Netherlands
| | | | - Lies H. Hoefsloot
- Department of Clinical GeneticsErasmus Medical CenterRotterdamThe Netherlands
| | | |
Collapse
|
7
|
Abstract
BACKGROUND A hundred years ago, scientists believed that amniotic fluid is a yellowish hypotonic mixture of foetal urine and maternal transudate with peculiar odour. Current knowledge shows that it represents a dynamic, complex mixture of inorganic and organic compounds. OBJECTIVES Despite modern technological procedures, information is still lacking about the composition and properties of amniotic fluid. We focused on dynamics of selected physical and chemical properties of the amniotic fluid with the increasing gestational week. METHODS The physicochemical characteristics of 89 amniotic fluid samples were determined according to the week of pregnancy. The determination of pH, specific gravity, glucose and nitrites was performed immediately, at room temperature. RESULTS Our results show a significant negative correlation between week of pregnancy and semi-quantitative determined parameters of specific gravity (p < 0.001), pH (p < 0.01) and glucose (p < 0.001) values. Within the whole group of samples (n = 89), 29 % (n = 26) were nitrites positive (N+) and 71 % (n = 63) nitrites negative (N-). CONCLUSION In this study were determined basic parameters of amniotic fluid, which could be related to a wide range of pathological states (Tab. 2, Fig. 1, Ref. 27).
Collapse
|
8
|
Katsura D, Takahashi Y, Iwagaki S, Chiaki R, Asai K, Koike M, Nagai R, Yasumi S, Furuhashi M. Intra-Amniotic Pressure of Twin-to-Twin Transfusion Syndrome. Fetal Diagn Ther 2018; 44:160. [PMID: 30007973 DOI: 10.1159/000490893] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 06/06/2018] [Indexed: 11/19/2022]
|
9
|
Abstract
Background. Nutrition in early life is increasingly considered to be an important factor influencing later health. Food preferences are formed in infancy, are tracked into childhood and beyond, and complementary feeding practices are crucial to prevent obesity later in life. Methods. Through a literature search strategy, we have investigated the role of breastfeeding, of complementary feeding, and the parental and sociocultural factors which contribute to set food preferences early in life. Results. Children are predisposed to prefer high-energy, -sugar, and -salt foods, and in pre-school age to reject new foods (food neophobia). While genetically determined individual differences exist, repeated offering of foods can modify innate preferences. Conclusions. Starting in the prenatal period, a varied exposure through amniotic fluid and repeated experiences with novel flavors during breastfeeding and complementary feeding increase children’s willingness to try new foods within a positive social environment.
Collapse
Affiliation(s)
- Valentina De Cosmi
- Valentina De Cosmi Pediatric Intensive Care Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Branch of Medical Statistics, Biometry, and Epidemiology "G. A. Maccacaro", Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy.
| | - Silvia Scaglioni
- Silvia Scaglioni Fondazione De Marchi Department of Pediatrics, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy.
| | - Carlo Agostoni
- Carlo Agostoni Pediatric Intermediate Care Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy.
| |
Collapse
|
10
|
Peixoto AB, da Cunha Caldas TMR, Giannecchini CV, Rolo LC, Martins WP, Araujo Júnior E. Reference values for the single deepest vertical pocket to assess the amniotic fluid volume in the second and third trimesters of pregnancy. J Perinat Med 2016; 44:723-7. [PMID: 26495922 DOI: 10.1515/jpm-2015-0265] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Accepted: 09/29/2015] [Indexed: 11/15/2022]
Abstract
AIM To establish reference values for the single deepest vertical pocket to assess the amniotic fluid volume in the second and third trimesters of pregnancy. METHODS We performed a retrospective cross-sectional study with 3554 consecutive singleton low-risk pregnant women between 14 and 41 weeks of gestation. To perform the largest deepest vertical pocket measurement, the transabdominal convex probe was positioned vertical to the uterine contour of abdomen and parallel to the maternal sagittal plane. In order to obtain reference values for the largest deepest vertical pocket measurement and gestational age (GA), we have used a polynomial regression model. RESULTS The mean±standard deviation for the largest deepest vertical pocket measurement (cm) ranged from 3.1±1.1 (1.5-4.9) at 14-14+6 to 3.7±1.6 (0-6.7) at 41-41+6 weeks, respectively. A best-fit was a second-degree polynomial regression: largest deepest pocket=-1.478+0.197*GA-0.0030*GA2 (R2=0.014). CONCLUSION Reference values for the single deepest vertical pocket to assess the amniotic fluid volume in the second and third trimesters of pregnancy in a large heterogeneous population were established.
Collapse
|
11
|
Abstract
Recent observation of maternal voice recognition provides evidence of rudimentary memory and learning in healthy term fetuses. However, such higher order auditory processing has not been examined in the presence of maternal hypertension, which is associated with reduced and/or impaired uteroplacental blood flow. In this study, voice processing was examined in 40 fetuses (gestational ages of 33 to 41 weeks) of hypertensive and normotensive women. Fetuses received 2 min of no sound, 2 min of a tape-recorded story read by their mothers or by a female stranger, and 2 min of no sound while fetal heart rate was recorded. Results demonstrated that fetuses in the normotensive group had heart rate accelerations during the playing of their mother's voice, whereas the response occurred in the hypertensive group following maternal voice offset. Across all fetuses, a greater fetal heart rate change was observed when the amniotic fluid index was above compared to below the median (i.e., 150 mm), indicating that amniotic fluid volume may be an independent moderator of fetal auditory sensitivity. It was concluded that differential fetal responding to the mother's voice in pregnancies complicated by maternal hypertension may reflect functional elevation of sensorineural threshold or a delay in auditory system maturation, signifying functional differences during fetal life or subtle differences in the development of the central nervous system.
Collapse
Affiliation(s)
- C T Lee
- University of Toronto School of Nursing, Toronto, Canada
| | | | | | | |
Collapse
|
12
|
Bagci S, Brosens E, Tibboel D, De Klein A, Ijsselstijn H, Wijers CHW, Roeleveld N, de Blaauw I, Broens PM, van Rooij IALM, Hölscher A, Boemers TM, Pauly M, Münsterer OJ, Schmiedeke E, Schäfer M, Ure BE, Lacher M, Choinitzki V, Schumacher J, Zwink N, Jenetzky E, Katzer D, Arand J, Bartmann P, Reutter HM. More than fetal urine: enteral uptake of amniotic fluid as a major predictor for fetal growth during late gestation. Eur J Pediatr 2016; 175:825-31. [PMID: 26979529 DOI: 10.1007/s00431-016-2713-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Revised: 02/25/2016] [Accepted: 03/03/2016] [Indexed: 11/26/2022]
Abstract
UNLABELLED The purpose of our study was to investigate the importance of amniotic fluid (AF) for fetal growth during late gestation using esophageal atresia (EA) patients as a model. In this retrospective cohort study, we compared the z-scores adapted for birth weights (BW z-scores) for each of 517 European newborns with congenital pre-gastric intestinal atresia, i.e., EA, to a European reference population. To account for the influence of the intestinal atresia on fetal growth per se, we compared adapted birth weights for each of 504 European newborns with post colonic intestinal atresia (anorectal malformation (ARM) with atresia of the anus) to the same European reference population. Analysis of the complete cohort showed (i) a significantly higher rate of small for gestational age newborns among EA compared to ARM newborns (p < 0.001) and (ii) significantly lower BW z-scores among EA compared to ARM newborns (p < 0.001). BW z-scores of EA newborns were significantly lower in term compared to preterm newborns with an inverse correlation with gestational age (GA) (Spearman correlation coefficient, r = -0.185, p < 0.001). CONCLUSIONS Enteral uptake of AF seems to play a pivotal role in fetal growth during late gestation. WHAT IS KNOWN • Peak velocity of fetal weight gain occurs at 33 weeks of gestation and continues until birth. During this period, fetal growth is mainly characterized by cellular hypertrophy. • Amniotic fluid (AF) comprises large amounts of hormones and growth regulators. What is New: • A significantly higher rate of small for gestational age and lower birth weights and z-scores are observed among newborn infants with congenital pre-gastric intestinal atresia. • These findings suggest that enteral uptake of AF is a major predictor for fetal growth during late gestation.
Collapse
Affiliation(s)
- Soyhan Bagci
- Department of Neonatology and Pediatric Intensive Care, Children's Hospital, University of Bonn, Adenauerallee 119, 53113, Bonn, Germany.
| | - Erwin Brosens
- Department of Clinical Genetics, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Dick Tibboel
- Department of Pediatric Surgery and Intensive Care, Erasmus Medical Centre-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Annelies De Klein
- Department of Clinical Genetics, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Hanneke Ijsselstijn
- Department of Pediatric Surgery and Intensive Care, Erasmus Medical Centre-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Charlotte H W Wijers
- Department for Health Evidence, Radboud Institute for Health Sciences, Radboudumc, Nijmegen, The Netherlands
| | - Nel Roeleveld
- Department for Health Evidence, Radboud Institute for Health Sciences, Radboudumc, Nijmegen, The Netherlands
| | - Ivo de Blaauw
- Department of Surgery-Pediatric Surgery, Radboudumc Amalia Children's Hospital, Nijmegen, The Netherlands
| | - Paul M Broens
- Department of Surgery, Anorectal Physiology Laboratory, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Surgery, Division of Pediatric Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Iris A L M van Rooij
- Department for Health Evidence, Radboud Institute for Health Sciences, Radboudumc, Nijmegen, The Netherlands
| | - Alice Hölscher
- Department of Pediatric Surgery and Urology, University Hospital Cologne, Cologne, Germany
| | - Thomas M Boemers
- Department of Pediatric Surgery and Urology, University Hospital Cologne, Cologne, Germany
| | - Marcus Pauly
- Department of Pediatric Surgery, Asklepios Children's Hospital St. Augustin, St. Augustin, Germany
| | - Oliver J Münsterer
- Department of Pediatric Surgery, University Medicine of Mainz, Mainz, Germany
| | - Eberhard Schmiedeke
- Department of Pediatric Surgery and Urology, Center for Child and Youth Health, Klinikum Bremen-Mitte, Bremen, Germany
| | - Mattias Schäfer
- Department of Pediatric Surgery and Urology, Cnopf'sche Kinderklinik, Nürnberg, Germany
| | - Benno E Ure
- Center of Pediatric Surgery Hannover, Hannover Medical School and Bult Children's Hospital, Hannover, Germany
| | - Martin Lacher
- Center of Pediatric Surgery Hannover, Hannover Medical School and Bult Children's Hospital, Hannover, Germany
| | - Vera Choinitzki
- Institute of Human Genetics, University of Bonn, Bonn, Germany
| | | | - Nadine Zwink
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
| | - Ekkehart Jenetzky
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
- Department of Child and Adolescent Psychiatry and Psychotherapy, Johannes-Gutenberg University, Mainz, Germany
| | - David Katzer
- Department of Neonatology and Pediatric Intensive Care, Children's Hospital, University of Bonn, Adenauerallee 119, 53113, Bonn, Germany
| | - Joerg Arand
- Department of Neonatology, University Children's Hospital of Tübingen, University of Tübingen, Tübingen, Germany
| | - Peter Bartmann
- Department of Neonatology and Pediatric Intensive Care, Children's Hospital, University of Bonn, Adenauerallee 119, 53113, Bonn, Germany
| | - Heiko M Reutter
- Department of Neonatology and Pediatric Intensive Care, Children's Hospital, University of Bonn, Adenauerallee 119, 53113, Bonn, Germany
- Institute of Human Genetics, University of Bonn, Bonn, Germany
| |
Collapse
|
13
|
Olutoye OO, Gay AN, Sheikh F, Akinkuotu AC, Sundararajan M, Lazar DA, Zamora IJ, Naik-Mathuria BJ, Cass DL, Yu L. In-utero radiofrequency ablation in fetal piglets: Lessons learned. J Pediatr Surg 2016; 51:554-8. [PMID: 26309094 PMCID: PMC4728058 DOI: 10.1016/j.jpedsurg.2015.07.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2015] [Revised: 07/08/2015] [Accepted: 07/13/2015] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Radiofrequency ablation (RFA) is increasingly utilized in minimally invasive fetal intervention. However, the response of different fetal tissues to RFA is poorly characterized. We sought to determine the extent of RFA damage in a fetal environment. METHODS 90Day gestation Yorkshire piglets (term 115days) were subjected to RFA of the chest and abdominal viscera under various temperatures and wattages. The extent of tissue damage was determined by NADPH diaphorase histochemistry. RESULTS Tyne temperature was widely variable and displayed varying responses between lung and liver tissue. Tyne exposure to amniotic fluid resulted in an increase in amniotic fluid temperature. Collateral damage, even across the diaphragm, was readily seen, and ultrasonography did not always reflect this injury. CONCLUSIONS Utilization of extracorporeal tynes heats fluid at a greater rate than solid tissue and reliance on temperature sensitive probes may result in overheating. The extent of injury may extend beyond damage observed by ultrasound examination and varies for different tissues. Additional studies on the use of devices that regulate tyne temperature are needed to define optimal conditions and better define the extent of adjacent tissue injury.
Collapse
Affiliation(s)
- Oluyinka O Olutoye
- Texas Children's Fetal Center, Texas Children's Hospital, Houston, TX, USA; Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA.
| | - Andre N Gay
- Texas Children's Fetal Center, Texas Children's Hospital, Houston, TX, USA; Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Fariha Sheikh
- Texas Children's Fetal Center, Texas Children's Hospital, Houston, TX, USA; Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Adesola C Akinkuotu
- Texas Children's Fetal Center, Texas Children's Hospital, Houston, TX, USA; Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Miel Sundararajan
- Texas Children's Fetal Center, Texas Children's Hospital, Houston, TX, USA; Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - David A Lazar
- Texas Children's Fetal Center, Texas Children's Hospital, Houston, TX, USA; Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Irving J Zamora
- Texas Children's Fetal Center, Texas Children's Hospital, Houston, TX, USA; Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Bindi J Naik-Mathuria
- Texas Children's Fetal Center, Texas Children's Hospital, Houston, TX, USA; Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Darrell L Cass
- Texas Children's Fetal Center, Texas Children's Hospital, Houston, TX, USA; Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Ling Yu
- Texas Children's Fetal Center, Texas Children's Hospital, Houston, TX, USA; Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| |
Collapse
|
14
|
Quinto GG, Castro-Combs J, Li L, Gupta N, Campos M, Behrens A. Outcomes of different concentrations of human amniotic fluid in a keratoconjunctivitis sicca-induced mouse model. Int Ophthalmol 2016; 36:643-50. [PMID: 26767655 DOI: 10.1007/s10792-016-0180-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Accepted: 01/06/2016] [Indexed: 01/26/2023]
Abstract
To compare the effects of different concentrations of topical human amniotic fluid (HAF) in a mouse model of dry eye, forty C57BL/6 mice were divided into 4 treatment groups: 20 % HAF, 50 % HAF, 100 % HAF, and isotonic salt solution (control). Dry eye was induced by an injection of botulinum toxin B into the lacrimal gland. Tear production, ocular surface fluorescein staining, and blink rate were evaluated in each mouse at 5 time points during a 4-week period. Goblet cell density was assessed in stained histological sections. Regarding tear production, 20, 50, and 100 % HAF groups were all different from the control group (P < 0.001) at week 1. However, there were no statistically significant differences between the 20, 50, and 100 % HAF groups. At week 2, 20, 50, and 100 % HAF groups had significant improvement in staining score and were significantly different from the control group (P = 0.047, P = 0.005, and P = 0.001, respectively). No difference in spontaneous blink rate was observed between groups, at any time point. Goblet cell density was significantly decreased in the control group compared to the HAF treatment groups. All tested concentrations of topical HAF were effective and superior than the control in this keratoconjunctivitis sicca-induced mouse model. Further studies are needed to evaluate the effects of HAF on the human ocular surface.
Collapse
Affiliation(s)
- Guilherme G Quinto
- Department of Ophthalmology, The Wilmer Ophthalmological Institute, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Ophthalmology, Vision Institute, Federal University of São Paulo, São Paulo, Brazil
| | - Juan Castro-Combs
- Department of Ophthalmology, The Wilmer Ophthalmological Institute, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Li Li
- Department of Ophthalmology, The Wilmer Ophthalmological Institute, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Navin Gupta
- Department of Ophthalmology, The Wilmer Ophthalmological Institute, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mauro Campos
- Department of Ophthalmology, Vision Institute, Federal University of São Paulo, São Paulo, Brazil
| | - Ashley Behrens
- Department of Ophthalmology, The Wilmer Ophthalmological Institute, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
- The Wilmer Ophthalmological Institute, 400 N. Broadway Street, Smith Building Suite 455, Baltimore, MD, 21231, USA.
| |
Collapse
|
15
|
|
16
|
McCance RA. The development of osmolar, electrolyte and volume control. Contrib Nephrol 2015; 21:28-32. [PMID: 6771101 DOI: 10.1159/000385243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
|
17
|
Prior T, Mullins E, Bennett P, Kumar S. Influence of parity on fetal hemodynamics and amniotic fluid volume at term. Ultrasound Obstet Gynecol 2014; 44:688-692. [PMID: 24585483 DOI: 10.1002/uog.13332] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Revised: 01/22/2014] [Accepted: 01/31/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVES Pregnancy complications, particularly those associated with placental dysfunction, occur more frequently in nulliparous than in parous women. This difference may be a consequence of improved trophoblastic invasion and, as a result, improved placental function following previous pregnancy. Placental dysfunction in cases of fetal growth restriction may be identified by ultrasound assessment of fetoplacental hemodynamics and amniotic fluid volume. In this prospective observational study, we investigated whether differences in these measures of placental function exist between nulliparous and parous women, prior to active labor. METHODS Over a 2-year period, 456 nulliparous and 152 parous women with uncomplicated singleton pregnancies were recruited to this prospective observational study. Each participant underwent an ultrasound assessment prior to active labor, during which fetal biometry, umbilical artery, middle cerebral artery and umbilical venous Dopplers, as well as amniotic fluid volume, were assessed. All cases were followed up within 48 h of delivery. Ultrasound parameters and intrapartum outcomes were then compared between the nulliparous and parous groups. RESULTS Compared with nulliparous women, parous women had significantly higher fetal middle cerebral artery pulsatility index, cerebroplacental ratio and amniotic fluid volume. In nulliparous women, middle cerebral artery flow rate was also significantly higher and represented a greater percentage of umbilical venous flow than was observed in parous women. CONCLUSION Prior to the active phase of labor, ultrasound parameters indicative of placental function differ significantly between nulliparous and parous pregnancy, even amongst an uncomplicated, low-risk cohort.
Collapse
Affiliation(s)
- T Prior
- Centre for Fetal Care, Queen Charlotte's and Chelsea Hospital, London, UK; Institute for Reproductive and Developmental Biology, Imperial College London, London, UK
| | | | | | | |
Collapse
|
18
|
Cruz-Martínez R. Re: influence of parity on fetal hemodynamics and amniotic fluid volume at term. T. Prior, E. Mullins, P. Bennett and S. Kumar. Ultrasound Obstet Gynecol 2014; 44: 688-692. Ultrasound Obstet Gynecol 2014; 44:631. [PMID: 25449115 DOI: 10.1002/uog.14709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- R Cruz-Martínez
- Department of Fetal Medicine and Surgery,Children's and Women's Specialty Hospital of Queretaro, Unidad de Investigación en Neurodesarrollo, Instituto de Neurobiología, Universidad Nacional Autónoma de México (UNAM) Campus Juriquilla, Queretaro, Mexico.
| |
Collapse
|
19
|
Burns JS, Dominici M. A novel function for amniotic fluid: original or authentic? J Chin Med Assoc 2014; 77:601-2. [PMID: 25256749 DOI: 10.1016/j.jcma.2014.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2014] [Accepted: 04/30/2014] [Indexed: 11/28/2022] Open
Affiliation(s)
- Jorge S Burns
- Department of Medical and Surgical Sciences for Children and Adults, University Hospital of Modena and Reggio Emilia, Modena, Italy.
| | - Massimo Dominici
- Department of Medical and Surgical Sciences for Children and Adults, University Hospital of Modena and Reggio Emilia, Modena, Italy
| |
Collapse
|
20
|
Affiliation(s)
- Xinglong Tong
- Hebei Xinglong Institute of Pharmacological and Medical Science, 31, Southwest Second Loop Road, Shijiazhuang 050000, China.
| |
Collapse
|
21
|
Abstract
BACKGROUND Preterm premature rupture of membranes (PPROM) is a leading cause of perinatal morbidity and mortality. Amnioinfusion aims to restore amniotic fluid volume by infusing a solution into the uterine cavity. OBJECTIVES The objective of this review was to assess the effects of amnioinfusion for PPROM on perinatal and maternal morbidity and mortality. SEARCH METHODS We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (2 December 2013). SELECTION CRITERIA Randomised trials of amnioinfusion compared with no amnioinfusion in women with PPROM. DATA COLLECTION AND ANALYSIS Three review authors independently assessed trials for inclusion. Two review authors independently assessed trial quality and extracted data. Data were checked for accuracy. MAIN RESULTS We included five trials, of moderate quality, but we only analysed data from four studies (with a total of 241 participants). One trial did not contribute any data to the review.Transcervical amnioinfusion improved fetal umbilical artery pH at delivery (mean difference 0.11; 95% confidence interval (CI) 0.08 to 0.14; one trial, 61 participants) and reduced persistent variable decelerations during labour (risk ratio (RR) 0.52; 95% CI 0.30 to 0.91; one trial, 86 participants).Transabdominal amnioinfusion was associated with a reduction in neonatal death (RR 0.30; 95% CI 0.14 to 0.66; two trials, 94 participants), neonatal sepsis (RR 0.26; 95% CI 0.11 to 0.61; one trial, 60 participants), pulmonary hypoplasia (RR 0.22; 95% CI 0.06 to 0.88; one trial, 34 participants) and puerperal sepsis (RR 0.20; 95% CI 0.05 to 0.84; one trial, 60 participants). Women in the amnioinfusion group were also less likely to deliver within seven days of membrane rupture (RR 0.18; 95% CI 0.05 to 0.70; one trial, 34 participants). These results should be treated with circumspection as the positive findings were mainly due to one trial with unclear allocation concealment. AUTHORS' CONCLUSIONS These results are encouraging but are limited by the sparse data and unclear methodological robustness, therefore further evidence is required before amnioinfusion for PPROM can be recommended for routine clinical practice.
Collapse
Affiliation(s)
- G Justus Hofmeyr
- University of the Witwatersrand, University of Fort Hare, Eastern Cape Department of HealthDepartment of Obstetrics and Gynaecology, East London Hospital ComplexFrere and Cecilia Makiwane HospitalsPrivate Bag X 9047East LondonEastern CapeSouth Africa5200
| | - Ahizechukwu C Eke
- Michigan State University School of Medicine/Sparrow HospitalDepartment of Obstetrics and Gynecology1322 East Michigan AvenueSuite 220LansingMichiganUSA48912
| | - Theresa A Lawrie
- Royal United HospitalCochrane Gynaecological Cancer GroupEducation CentreBathUKBA13NG
| | | |
Collapse
|
22
|
Tchirikov M, Bapayeva G, Zhumadilov ZS, Dridi Y, Harnisch R, Herrmann A. Treatment of PPROM with anhydramnion in humans: first experience with different amniotic fluid substitutes for continuous amnioinfusion through a subcutaneously implanted port system. J Perinat Med 2013; 41:657-63. [PMID: 23774012 DOI: 10.1515/jpm-2012-0296] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Accepted: 05/13/2013] [Indexed: 11/15/2022]
Abstract
OBJECTIVE This study aims to treat patients with preterm premature rupture of the membranes (PPROM) and anhydramnion using continuous amnioinfusion through a subcutaneously implanted port system. METHODS An amniotic fluid replacement port system was implanted in seven patients with PPROM and anhydramnion starting at the 20th week of gestation (range, 14-26 weeks) for long-term amnioinfusion. Saline solutions (2 L/day; Jonosteril(®), Sterofundin(®), isotonic NaCl 0.9% solution, lactated Ringer's solution) and a hypotonic aqueous composition with reduced chloride content similar to the electrolyte concentration of human amniotic fluid were used for the continuous amnioinfusion. RESULTS The mean duration of the PPROM delivery interval continued for 49 days (range, 9-69 days), with 3 weeks of amnioinfusion via the port system (range, 4-49). The newborns showed no signs of lung hypoplasia. CONCLUSION Long-term lavage of the amniotic cavity via a subcutaneously implanted port system in patients with PPROM and anhydramnion may help prolong the pregnancy and avoid fetal lung hypoplasia. A hypotonic aqueous composition with reduced chloride content similar to human amniotic fluid can be safely used for amnioinfusion. Prospective randomized studies are ongoing.
Collapse
|
23
|
Tong X. Amniotic fluid may act as a transporting pathway for signaling molecules and stem cells during the embryonic development of amniotes. J Chin Med Assoc 2013; 76:606-10. [PMID: 23933344 DOI: 10.1016/j.jcma.2013.07.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Accepted: 03/11/2013] [Indexed: 10/26/2022] Open
Abstract
Amniotic fluid (AF) is formed at the very early stages of pregnancy, and is present throughout embryonic development of amniotes. It is well-known that AF provides a protective sac around the fetus that allows fetal movement and growth, and prevents mechanical and thermal shock. However, a growing body of evidence has shown that AF contains a number of proteins and peptides, including growth factors and cytokines, which potently affect cellular growth and proliferation. In addition, pluripotent stem cells have recently been identified in AF. Herein, this article reviews the biological properties of AF during embryonic development and speculates that AF may act as a transporting pathway for signaling molecules and stem cells during amniote embryonic development. Defining this novel function of AF is potentially significant for further understanding embryonic development and regenerative medicine, preventing genetic diseases, and developing therapeutic options for human malignancies.
Collapse
Affiliation(s)
- Xinglong Tong
- Hebei Xinglong Institute of Pharmacological and Medical Science, Shijiazhuang, China.
| |
Collapse
|
24
|
Ulker K, Temur I, Karaca M, Ersöz M, Volkan I, Gül A. Effects of maternal left lateral position and rest on amniotic fluid index: a prospective clinical study. J Reprod Med 2012; 57:270-276. [PMID: 22696825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To compare the effect of both maternal rest and activity on the amniotic fluid index (AFI). STUDY DESIGN Power analysis indicated that in order to achieve 20 mm of increase in AFI with 90% of power at one side alpha of 0.01, we needed at least 51 women in each group. The study group was comprised of pregnant women (n = 152) with a normal AFI and a singleton pregnancy at 26-40 weeks' gestation. Their AFI was determined by averaging the 2 repetitive measurements of the 4 amniotic fluid quadrants. The "rest" group (n = 77) was instructed to lie and rest in the left lateral position, and the "mild activity" group (n = 75) was instructed to sit and walk. RESULTS AFI increased significantly, from 151.25 +/- 37.40 mm to 173.79 +/- 39.76 mm, in the "rest" group (p = 0.00). However, the change from 153.69 +/- 37.94 to 152.34 +/- 36.62 mm was not significant in the "mild activity" group (p = 0.167). CONCLUSION Maternal rest in the left lateral position increases the AFI.
Collapse
Affiliation(s)
- Kahraman Ulker
- Department of Obstetrics and Gynecology, Kafkas University School of Medicine, Kars, Turkey.
| | | | | | | | | | | |
Collapse
|
25
|
Ulker K, Gül A, Ciçek M. Correlation between the duration of maternal rest in the left lateral decubitus position and the amniotic fluid volume increase. J Ultrasound Med 2012; 31:705-709. [PMID: 22535717 DOI: 10.7863/jum.2012.31.5.705] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVES The purpose of this study was to show the relationship between amniotic fluid volume changes and the duration of maternal rest in the left lateral decubitus position. METHODS Pregnant women (n = 34) with an amniotic fluid index between 6 and 24 cm and an uncomplicated singleton pregnancy at 35 to 40 weeks' gestation were included in the study. After the initial amniotic fluid index measurements, the women were instructed to rest in the left lateral position, and the measurements were repeated at 15, 30, 45, 60, 75, and 90 minutes. RESULTS The amniotic fluid index increased at each sequential interval. Although each amniotic fluid index value was higher than the preceding one, only the 15- and 30-minute values were significantly higher than the preceding measurements (P < .001; P < .01, respectively). At the beginning of maternal rest in the left lateral position, 15 minutes of rest was sufficient to create significant changes (P < .001). However, after 30 minutes of rest, an additional 45 minutes was needed to create a significant amniotic fluid index increase (P < .01). The curve describing the amniotic fluid index increases caused by maternal rest resembled a saturation curve, and the maximum increase in the amniotic fluid volume was projected to be achieved approximately at the end of the second hour of the rest period. CONCLUSIONS The correlation between the duration of maternal rest and amniotic fluid volume changes is not linear. However, maternal rest in the left lateral decubitus position significantly increases the amniotic fluid volume, particularly in the first 30 minutes (maximum increase in the first 15 minutes).
Collapse
Affiliation(s)
- Kahraman Ulker
- Department of Obstetrics and Gynecology, Kafkas University School of Medicine, Kars, Turkey.
| | | | | |
Collapse
|
26
|
Abstract
BACKGROUND Preterm premature rupture of membranes (PPROM) is a leading cause of perinatal morbidity and mortality. Amnioinfusion aims to restore amniotic fluid volume by infusing a solution into the uterine cavity. OBJECTIVES The objective of this review was to assess the effects of amnioinfusion for PPROM on perinatal and maternal morbidity and mortality. SEARCH METHODS We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 September 2011). SELECTION CRITERIA Randomised trials of amnioinfusion compared to no amnioinfusion in women with PPROM. DATA COLLECTION AND ANALYSIS Three review authors independently assessed trials for inclusion. Two review authors independently assessed trial quality and extracted data. Data were checked for accuracy. MAIN RESULTS We included five trials but we only analysed data from four studies (with a total of 241 participants). One trial did not contribute any data to the review.Transcervical amnioinfusion improved fetal umbilical artery pH at delivery (mean difference 0.11; 95% confidence interval (CI) 0.08 to 0.14; one trial, 61 participants) and reduced persistent variable decelerations during labour (risk ratio (RR) 0.52; 95% CI 0.30 to 0.91; one trial, 86 participants).Transabdominal amnioinfusion was associated with a reduction in neonatal death (RR 0.30; 95% CI 0.14 to 0.66; two trials, 94 participants), neonatal sepsis (RR 0.26, 95% CI 0.11 to 0.61; one trial, 60 participants), pulmonary hypoplasia (RR 0.22; 95% CI 0.06 to 0.88; one trial, 34 participants) and puerperal sepsis (RR 0.20; 95% CI 0.05 to 0.84; one trial, 60 participants). Women in the amnioinfusion group were also less likely to deliver within seven days of membrane rupture (RR 0.18; 95% CI 0.05 to 0.70; one trial, 34 participants). These results should be treated with circumspection as the positive findings were mainly due to one trial with unclear allocation concealment. AUTHORS' CONCLUSIONS These results are encouraging but are limited by the sparse data and unclear methodological robustness, therefore further evidence is required before amnioinfusion for PPROM can be recommended for routine clinical practice.
Collapse
Affiliation(s)
- G Justus Hofmeyr
- Department of Obstetrics and Gynaecology, East London Hospital Complex, University of the Witwatersrand, University of Fort Hare, Eastern Cape Department of Health, Frere and Cecilia Makiwane Hospitals, Private Bag X 9047, East London, Eastern Cape, South Africa, 5200
| | | | | |
Collapse
|
27
|
Baykal C, Kaya S, Takal MK, Yakupoğlu U. Successful management of a high-risk pregnancy with polyhydramnios, IUGR and recurrent pregnancy loss in a chronic renal failure patient: a case report. CLIN EXP OBSTET GYN 2011; 38:99-101. [PMID: 21485740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Pregnancy in patients with chronic renal failure occurs rarely but the incidence is increasing. The successful management of a 38-year-old woman suffering from chronic renal failure is discussed.
Collapse
Affiliation(s)
- C Baykal
- Department of Obstetrics and Gynecology, Istanbul, Turkey.
| | | | | | | |
Collapse
|
28
|
Abbasian B, Kazemini H, Esmaeili A, Adibi S. Effect of bovine amniotic fluid on intra-abdominal adhesion in diabetic male rats. J Diabetes Complications 2011; 25:39-43. [PMID: 19828333 DOI: 10.1016/j.jdiacomp.2009.09.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2009] [Accepted: 09/10/2009] [Indexed: 11/27/2022]
Abstract
BACKGROUND Postsurgical adhesion formation is a significant clinical problem within every surgical specialty. In type I diabetic patients, the problem is more severe and wound healing is slow. A wide variety of treatments have been proposed to deal with the problems that adhesion causes. One of the modalities that have not been studied extensively yet is the use of amniotic fluid. The purpose of the present study was to evaluate the clinical value of bovine amniotic fluid (BAF) efficacy in the treatment of postsurgical adhesion formation in diabetic male rats. MATERIALS AND METHODS Fifty male Wistar rats in five groups were used for our study, with animal identification being facilitated by a microchip implant system. Diabetes was induced in all groups except for the control group by intraperitoneal alloxan injection (120 mg/kg). Based upon blood glucose concentration, rats received either one third of the required insulin (two groups) or all the required insulin (remaining groups). After 2 weeks, a laparotomy was performed on each rat and adhesions were scaled. Bovine amniotic fluid was then applied to two groups, and, as a control, sterilized water was applied to the other groups. After 2 weeks, a laparotomy was again performed on each rat and adhesion was rescored. RESULTS AND CONCLUSION Significant reductions (P<.05) in adhesions were seen with BAF only in those diabetic rats that had received the required insulin. The results of our study suggest that BAF could be effective in the treatment of adhesion formation during diabetes.
Collapse
Affiliation(s)
- Behnam Abbasian
- Faculty of Veterinary Medicine, Shahrekord Azad University, Shahrekord, Iran
| | | | | | | |
Collapse
|
29
|
Pfeiffer S, Boyle J, Daly S, Dowd E, Haase J, McLaughlin D. Human amniocytes regulate serotonin levels by active uptake and express genes suggestive of a wider role in facilitating neurotransmitter regulation in the fetal environment. Stem Cells Dev 2010; 20:341-9. [PMID: 20528162 DOI: 10.1089/scd.2009.0500] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Fetal serotonin levels, which mediate multiple developmental processes, are highly regulated. However, an incomplete picture exists on the component parts of such regulation during fetal growth. Serotonin and its metabolite 5-hydroxyindoleacetic acid (5-HIAA) are found in the amniotic fluid, also containing significant numbers of amniocytes, previously thought to be the result of cell shedding as a byproduct of growth. The aim of the present study was to examine human amniocytes as a potentially active and dynamic component of serotonin regulation in the fetal environment. Using amniocytes derived from multiple donors of amniocentesis, we found all components necessary for serotonin metabolism. We identified a strong expression of the serotonin transporter and confirmed the high-affinity serotonin transporter-mediated uptake of serotonin (5-HT), along with uptake via the norepinephrine transporter, and an evidence of 5-HT breakdown due to the expression of the degradative enzymes monoamine oxidase A and B. Additionally, wider expression analysis for biogenic amine and cholinergic metabolism suggests a capability for cholinergic synthesis and release and for catecholamine storage. Our results shed new light on amniocytes, consistent with a role in the homeostasis of neurotransmitters during fetal development. Moreover, these results may provide clinical significance for amniocytes as new targets for uptake inhibitors such as tricyclic antidepressants, selective serotonin reuptake inhibitors, and drugs of abuse such as cocaine, with implications on their regulation during pregnancy. This work shows for the first time an inherent in vivo function of amniocytes and more broadly implicates them as a new and active component of the fetal-maternal regulatory system.
Collapse
Affiliation(s)
- Shona Pfeiffer
- Laboratory of Developmental Neurobiology, School of Biomolecular and Biomedical Sciences, University College Dublin, Conway Institute, Dublin, Ireland
| | | | | | | | | | | |
Collapse
|
30
|
Vaisbuch E, Romero R, Erez O, Kusanovic JP, Mazaki-Tovi S, Gotsch F, Romero V, Ward C, Chaiworapongsa T, Mittal P, Sorokin Y, Hassan SS. Clinical significance of early (< 20 weeks) vs. late (20-24 weeks) detection of sonographic short cervix in asymptomatic women in the mid-trimester. Ultrasound Obstet Gynecol 2010; 36:471-81. [PMID: 20503224 PMCID: PMC2937193 DOI: 10.1002/uog.7673] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
OBJECTIVE The aim of this study was to determine whether the risk of early spontaneous preterm delivery (PTD) in asymptomatic women with a sonographic cervical length of ≤ 15 mm in the mid-trimester changes as a function of gestational age at diagnosis. METHODS This cohort study included 109 asymptomatic patients with a sonographic cervical length of ≤ 15 mm diagnosed at 14-24 weeks of gestation. Women with a multifetal gestation, cerclage and a cervical dilatation of > 2 cm were excluded. The study population was stratified by gestational age at diagnosis (< 20 weeks vs. 20-24 weeks) and by cervical length (≤ 10 mm vs. 11-15 mm). The primary outcome variables were PTD at < 28 and < 32 weeks of gestation and the diagnosis-to-delivery interval. RESULTS The median gestational age at diagnosis of a short cervix before 20 weeks and at 20-24 weeks was 18.9 and 22.7 weeks, respectively. Women diagnosed before 20 weeks had a higher rate of PTD at < 28 weeks (76.9% vs. 30.9%; P < 0.001) and at < 32 weeks (80.8% vs. 48.1%; P = 0.004), and a shorter median diagnosis-to-delivery interval (21 vs. 61.5 days, P = 0.003) than those diagnosed at 20-24 weeks. The rate of amniotic fluid sludge was higher among patients diagnosed with a short cervix at < 20 weeks of gestation than in those in whom it was diagnosed between 20 and 24 weeks (92.3% vs. 48.2%; P < 0.001). CONCLUSIONS Asymptomatic women with a sonographic cervical length of ≤ 15 mm diagnosed before 20 weeks of gestation have a dramatic and significantly higher risk of early preterm delivery than women diagnosed at 20-24 weeks. These findings can be helpful to physicians in counseling these patients, and may suggest different mechanisms of disease leading to a sonographic short cervix before or after 20 weeks of gestation.
Collapse
Affiliation(s)
- Edi Vaisbuch
- Perinatology Research Branch, Intramural Division, NICHD/NIH/DHHS, Hutzel Women’s Hospital, Bethesda, MD, and Detroit, MI
- Department of Obstetrics and Gynecology, Wayne State University/Hutzel Women’s Hospital, Detroit, MI
| | - Roberto Romero
- Perinatology Research Branch, Intramural Division, NICHD/NIH/DHHS, Hutzel Women’s Hospital, Bethesda, MD, and Detroit, MI
- Center for Molecular Medicine and Genetics, Wayne State University, Detroit, MI
| | - Offer Erez
- Perinatology Research Branch, Intramural Division, NICHD/NIH/DHHS, Hutzel Women’s Hospital, Bethesda, MD, and Detroit, MI
- Department of Obstetrics and Gynecology, Wayne State University/Hutzel Women’s Hospital, Detroit, MI
| | - Juan Pedro Kusanovic
- Perinatology Research Branch, Intramural Division, NICHD/NIH/DHHS, Hutzel Women’s Hospital, Bethesda, MD, and Detroit, MI
- Department of Obstetrics and Gynecology, Wayne State University/Hutzel Women’s Hospital, Detroit, MI
| | - Shali Mazaki-Tovi
- Perinatology Research Branch, Intramural Division, NICHD/NIH/DHHS, Hutzel Women’s Hospital, Bethesda, MD, and Detroit, MI
- Department of Obstetrics and Gynecology, Wayne State University/Hutzel Women’s Hospital, Detroit, MI
| | - Francesca Gotsch
- Perinatology Research Branch, Intramural Division, NICHD/NIH/DHHS, Hutzel Women’s Hospital, Bethesda, MD, and Detroit, MI
| | - Vivian Romero
- Department of Obstetrics and Gynecology, Wayne State University/Hutzel Women’s Hospital, Detroit, MI
| | - Clara Ward
- Department of Obstetrics and Gynecology, Wayne State University/Hutzel Women’s Hospital, Detroit, MI
| | - Tinnakorn Chaiworapongsa
- Perinatology Research Branch, Intramural Division, NICHD/NIH/DHHS, Hutzel Women’s Hospital, Bethesda, MD, and Detroit, MI
- Department of Obstetrics and Gynecology, Wayne State University/Hutzel Women’s Hospital, Detroit, MI
| | - Pooja Mittal
- Perinatology Research Branch, Intramural Division, NICHD/NIH/DHHS, Hutzel Women’s Hospital, Bethesda, MD, and Detroit, MI
- Department of Obstetrics and Gynecology, Wayne State University/Hutzel Women’s Hospital, Detroit, MI
| | - Yoram Sorokin
- Department of Obstetrics and Gynecology, Wayne State University/Hutzel Women’s Hospital, Detroit, MI
| | - Sonia S. Hassan
- Perinatology Research Branch, Intramural Division, NICHD/NIH/DHHS, Hutzel Women’s Hospital, Bethesda, MD, and Detroit, MI
- Department of Obstetrics and Gynecology, Wayne State University/Hutzel Women’s Hospital, Detroit, MI
| |
Collapse
|
31
|
Gorski LA, Huang WH, Iriye BK, Hancock J. Clinical implication of intra-amniotic sludge on ultrasound in patients with cervical cerclage. Ultrasound Obstet Gynecol 2010; 36:482-485. [PMID: 20503233 DOI: 10.1002/uog.7675] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
OBJECTIVE The aim of this study was to determine whether intra-amniotic (IA) sludge, a sonographic finding of hyperechoic matter in the amniotic fluid close to the internal cervical os, is associated with preterm delivery in patients with cervical cerclage. METHODS A retrospective cohort study of patients who had undergone McDonald cerclage between January 1997 and December 2004 was conducted. Transvaginal ultrasound examinations had been performed at 14-28 weeks of gestation, and the ultrasound images were assessed by three reviewers (blinded to patient outcome) to determine the presence or absence of IA sludge. The primary outcome studied was the gestational age at delivery. RESULTS A total of 177 patients who had undergone cervical cerclage, and for whom adequate records were available, were identified. Sixty had sonographic evidence of IA sludge (Group 1) and 117 had absence of IA sludge (Group 2). There was no significant difference in the mean gestational age at delivery between the two groups (36.4 ± 4.0 vs. 36.8 ± 2.9 weeks, P = 0.53), and no statistical difference in the rate of preterm delivery at < 28 (6.7% vs. 1.7%, P = 0.18), < 30 (6.7% vs. 3.4%, P = 0.45), < 32 (8.3% vs. 6.8%, P = 0.77) or < 36 (16.7% vs. 19.7%, P = 0.69) weeks of gestation. CONCLUSION Intra-amniotic sludge on ultrasound is not associated with an increased risk of preterm delivery in patients with cervical cerclage.
Collapse
Affiliation(s)
- L A Gorski
- Center for Maternal-Fetal Medicine, Las Vegas, NV 89106, USA.
| | | | | | | |
Collapse
|
32
|
Shaikh EM, Mehmood S, Shaikh MA. Neonatal outcome in meconium stained amniotic fluid-one year experience. J PAK MED ASSOC 2010; 60:711-714. [PMID: 21381573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
OBJECTIVES To determine the effect of clear liquor and meconium stained liquor on mode of delivery, and to evaluate neonatal outcome. METHODS It was a Cross sectional analytical study, conducted in the department of Obstetrics and Gynaecology, Shaikh Zyed Federal Postgraduate Medical Institute/Hospital, Lahore and Shaikh Zaid Women Hospital Larkana, from April 2006 to March 2007. Two hundred and fifty patients from Larkana and 250 patients from Lahore in clear liquor group were included in the study. Similarly 125 patients from each city, that is 250 patients which had meconium stained liquor were included in group 2. The subjects with meconium stained amniotic fluid and clear amniotic fluid were registered as group 1 and 2. The socio demographic information, fertility history and gestational age of subjects were recorded. The investigations and information regarding mode of delivery and duration of labour were also noted. All babies delivered were attended by paediatricians. RESULTS In this study 500 cases with clear liquor and 250 cases of meconium stained liquor were selected from two cities, Lahore and Larkana. Out of these 55 (22%) patients had grade I meconium stained liquor, 140 (56%) patients and 55 (22%) patients had grade II and grade III meconium stained liquor respectively. The mode of delivery is significantly affected by meconium staining of liquor. The effect of meconium stained liquor was significant on time of delivery. There were 40 (16%) post date deliveries in meconium stained liquor as compared to 1% in subjects with clear liquor. The effect of meconium staining of liquor was significant on Apgar score, neonatal admission, meconium aspiration syndrome and neonatal deaths. CONCLUSION Meconium stained amniotic fluid (MSAF), is associated with increased neonatal morbidity and mortality. Caesarean sections were performed twice as frequently in women presenting with MSAF.
Collapse
|
33
|
Lee SM, Jun JK, Lee EJ, Lee JH, Park CW, Park JS, Syn HC. Measurement of fetal urine production to differentiate causes of increased amniotic fluid volume. Ultrasound Obstet Gynecol 2010; 36:191-195. [PMID: 20069667 DOI: 10.1002/uog.7519] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVES In polyhydramnios, amniotic fluid (AF) volume can be increased not only as a result of increased fetal urine production, but also due to several other factors, including impairment of both fetal swallowing and gastrointestinal (GI) absorption of AF. Our aim was to evaluate whether measurement of the fetal urine production rate (UPR) can be used to differentiate the causes of increased AF volume. METHODS This cross-sectional study included 54 pregnant women with an increased amniotic fluid index (AFI), defined as AFI > or = 18 cm, divided into two groups according to the presence of fetal anomalies that are associated with impairment of fetal swallowing or decreased GI absorption of AF (Group 1, n = 14) or the absence of fetal anomalies (Group 2, n = 40). The control group included 96 normal pregnancies with normal AFI (8 < or = AFI < 18 cm) (Group 3). Fetal UPR was obtained by serial bladder volume measurements (two to four times, with a median interval of 5 min between each) using the rotational method of Virtual Organ Computer-aided AnaLysis (VOCAL()) with three-dimensional ultrasound. To adjust for fetal weight (Wt) and gestational age (GA), UPR_Wt and UPR_SD were calculated using the following formulae: UPR_Wt = measured UPR/estimated fetal weight and UPR_SD = (measured UPR - mean UPR for each GA)/SD of UPR for each GA. RESULTS The AFI was increased significantly in Groups 1 and 2 compared with Group 3. However, the median fetal UPR in Group 1 did not differ from that of Group 3, in contrast to the higher median fetal UPR in Group 2 compared with Groups 1 and 3; this difference remained significant after adjusting for GA and estimated fetal weight in terms of UPR_SD and UPR_Wt. In Groups 2 and 3, AFI and UPR had a positive correlation in terms of UPR, UPR_SD and UPR_Wt. CONCLUSIONS Our findings that fetal UPR is significantly increased in cases with increased AFI without fetal anomalies, but not in those with increased AFI and fetal anomalies involving decreased GI absorption of AF, might be used to differentiate causes of increased AF volume. In the absence of fetal anomalies, AFI and fetal UPR correlate positively.
Collapse
Affiliation(s)
- S M Lee
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | | | | | | | | | | | | |
Collapse
|
34
|
Soucy JF, Lavoie J, Duncan AMV. Locus-specific dual color-probe for the enumeration of chromosome 18 in rapid FISH aneuploidy testing on uncultured amniocytes. Prenat Diagn 2010; 30:811-2. [PMID: 20661896 DOI: 10.1002/pd.2569] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
|
35
|
Skapinec P, Kacerovský M. [Aquaporins and the regulation of amniotic fluid circulation]. Ceska Gynekol 2010; 75:84-87. [PMID: 20518258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
OBJECTIVE The purpose of this study was to focuse on aquaporins and their role in the regulation of amniotic fluid circulation. DESIGN Review. SETTING Department of Obstetrics and Gynecology Medical Faculty Charles University Hradec Kralove. METHODS The summary about aquaporins which were first described as channels increased permeability of lipid membranes to water in response to osmotic and/or hydrostatic gradients. CONCLUSION The present review summarizes the results of clinical and experimental research on aquaporins and the regulation of amniotic fluid circulation.
Collapse
Affiliation(s)
- P Skapinec
- Lékarská fakulta Hradec Králové, Univerzita Karlova, Praha
| | | |
Collapse
|
36
|
Xiao YZ, Zhou QC, Zhang M. [Value of prenatal ultrasonography in the diagnosis of fetal urinary system anomalies]. Zhongguo Dang Dai Er Ke Za Zhi 2009; 11:593-595. [PMID: 19651000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
|
37
|
Tong XL, Wang L, Gao TB, Qin YG, Qi YQ, Xu YP. Potential function of amniotic fluid in fetal development---novel insights by comparing the composition of human amniotic fluid with umbilical cord and maternal serum at mid and late gestation. J Chin Med Assoc 2009; 72:368-73. [PMID: 19581143 DOI: 10.1016/s1726-4901(09)70389-2] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND Amniotic fluid (AF) is a dynamic and complex mixture. Up to now, little is known about the physiological functions of AF in the process of fetal development. We suppose that AF carries components such as proteins or peptides, which contribute to the regulation of fetal development. METHODS Compositions including biochemical components and tumor markers were determined in human AF, umbilical cord serum (UCS) and maternal serum (MS) from the same subject in the range of 15-42 weeks of gestation. RESULTS (1) The levels of primary electrolytes such as sodium, chloride, anion gap and osmotic pressure in AF was almost the same as in UCS and MS. (2) The levels of organic substances, including total protein, glucose, triglycerides, cholesterol and various enzymes, were markedly lower in AF than in UCS and MS, especially for total protein, which was 8- and 12.5-fold lower in AF than in UCS and MS, respectively. (3) The levels of tumor markers, including carcinoembryonic antigen, ferritin, cancer antigen 125 and 199, and alpha-fetoprotein in AF displayed different dynamic changes compared to UCS and MS as gestation advanced. CONCLUSION This study demonstrated that AF is not a result of simple filtration from the blood but an independent fluid. We speculate that proteins or peptides in the amniotic fluid modulate the process of fetus development since they possess potent bioactivity on cellular growth and proliferation. AF provides a pathway to transport these "regulators" to the fetus and thus plays a pivotal role in fetal development.
Collapse
Affiliation(s)
- Xing-Long Tong
- Hebei Xinglong Institute of Pharmacological and Medical Sciences, Shijiazhuang, China.
| | | | | | | | | | | |
Collapse
|
38
|
Gesteland KM, Anderson DF, Davis LE, Robertson P, Faber JJ, Brace RA. Intramembranous solute and water fluxes during high intramembranous absorption rates in fetal sheep with and without lung liquid diversion. Am J Obstet Gynecol 2009; 201:85.e1-6. [PMID: 19398093 DOI: 10.1016/j.ajog.2009.02.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2008] [Revised: 12/11/2008] [Accepted: 02/23/2009] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To examine mechanisms that mediate increased intramembranous solute and water absorption. STUDY DESIGN Intramembranous solute and water fluxes were measured in fetal sheep under basal conditions and after intraamniotic infusion of lactated Ringer's solution of 4 L/d for 3 days with and without lung liquid diversion. RESULTS Intramembranous sodium, potassium, chloride, calcium, glucose, and lactate fluxes increased 2.5- to 7.9-fold, were linearly related to volume fluxes (r = 0.83-0.99), and were unaffected by lung liquid. All clearance rates, except that of lactate, increased to equal the intramembranous volume absorption rate during infusion. CONCLUSION Under basal conditions, passive diffusion makes a minor and bulk flow a major contribution to intramembranous solute absorption. During high absorption rates, the increase in solute absorption above basal levels appears to be due entirely to bulk flow and is unaffected by lung liquid. The increased bulk flow is consistent with vesicular transcytosis.
Collapse
Affiliation(s)
- Katherine M Gesteland
- Departments of Obstetrics and Gynecology, Oregon Health and Science University, Portland, OR, USA
| | | | | | | | | | | |
Collapse
|
39
|
van de Beek C, van Goozen SHM, Buitelaar JK, Cohen-Kettenis PT. Prenatal sex hormones (maternal and amniotic fluid) and gender-related play behavior in 13-month-old Infants. Arch Sex Behav 2009; 38:6-15. [PMID: 18080735 DOI: 10.1007/s10508-007-9291-z] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2006] [Revised: 10/08/2007] [Accepted: 10/28/2007] [Indexed: 05/12/2023]
Abstract
Testosterone, estradiol, and progesterone levels were measured in the second trimester of pregnancy in maternal serum and amniotic fluid, and related to direct observations of gender-related play behavior in 63 male and 63 female offspring at age 13 months. During a structured play session, sex differences in toy preference were found: boys played more with masculine toys than girls (d = .53) and girls played more with feminine toys than boys (d = .35). Normal within-sex variation in prenatal testosterone and estradiol levels was not significantly related to preference for masculine or feminine toys. For progesterone, an unexpected significant positive relationship was found in boys between the level in amniotic fluid and masculine toy preference. The mechanism explaining this relationship is presently not clear, and the finding may be a spurious one. The results of this study may indicate that a hormonal basis for the development of sex-typed toy preferences may manifest itself only after toddlerhood. It may also be that the effect size of this relationship is so small that it should be investigated with more sensitive measures or in larger populations.
Collapse
Affiliation(s)
- Cornelieke van de Beek
- Department of Child and Adolescent Psychiatry, VU University Medical Center, Duivendrecht, Amsterdam, The Netherlands.
| | | | | | | |
Collapse
|
40
|
Abstract
BACKGROUND The incidence of meconium aspiration syndrome (MAS), associated perinatal factors, morbidity and deaths varies widely. This study aimed to assess the perinatal attributes and morbidity associated with MAS. METHODS Over a 2-year period, all neonates born through meconium-stained amniotic fluid (MSAF) were observed for respiratory distress (RD). Birth details, chest radiograph (CXR) and clinical course were documented. Neonates with consistent CXR findings whose RD could not otherwise be explained were defined as MAS. RESULTS Of 409 neonates born through MSAF, meconium was thick in 196 (47.9%). Fifty-five (13.4%) had RD and 45 (11.3%) were consistent with MAS. Six (1.5%) neonates died. Mean (SD) birthweight and gestation of MAS infants were 2721.9 (510.2) g and 38.67 (1.09) weeks, respectively. About one-third were of low birthweight and 28 were born by caesarean section. On univariate analysis, caesarean delivery, meconium in the trachea and thick meconium were the significant perinatal factors for the development of MAS. On multiple regression analysis, thick meconium was the only independent factor for MAS (OR 7.08, 95% CI 3.08-16.27, p<0.001). An Apgar score of <or=6 and blood gas abnormalities were found in 44.4% and 48.9%, respectively. Air leak syndrome was observed in 12 (26.7%), persistent pulmonary hypertension in seven and severe asphyxia and late sepsis in two each. Thirteen (28.9%) required mechanical ventilation and six (13.3%) died. CONCLUSION MAS occurred in 11.3% of neonates born through MSAF. Thick meconium was found to be an important causative factor. Nearly one-third of infants with MAS required mechanical ventilation and 13.3% died.
Collapse
Affiliation(s)
- R Y Bhat
- Department of Paediatrics, Kasturba Medical College, Manipal University, Manipal, Karnataka, India.
| | | |
Collapse
|
41
|
Abstract
BACKGROUND Amniotic fluid volume is an important parameter in the assessment of fetal well-being. Oligohydramnios occurs in many high-risk conditions and is associated with poor perinatal outcomes. Many caregivers practice planned delivery by induction of labor or caesarean section after diagnosis of decreased amniotic fluid volume at term. There is no clear consensus on the best method to assess amniotic fluid adequacy. OBJECTIVES To compare the use of the amniotic fluid index with the single deepest vertical pocket measurement as a screening tool for decreased amniotic fluid volume in preventing adverse pregnancy outcome. SEARCH STRATEGY We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (January 2008), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2007, Issue 2), MEDLINE (1966 to May 2007) and the metaRegister of Controlled Trials (May 2007). We handsearched the citation lists of relevant publications, review articles, and included studies. SELECTION CRITERIA Randomised controlled trials involving women with a singleton pregnancy, whether at low or high risk, undergoing ultrasound measurement of amniotic fluid volume as part of antepartum assessment of fetal well-being that compared the amniotic fluid index and the single deepest vertical pocket measurement. DATA COLLECTION AND ANALYSIS Both authors independently assessed eligibility and quality, and extracted the data. MAIN RESULTS Four trials (3125 women) met the inclusion criteria. There is no evidence that one method is superior to the other in the prevention of poor peripartum outcomes, including: admission to a neonatal intensive care unit; an umbilical artery pH of less than 7.1; the presence of meconium; an Apgar score of less than 7 at five minutes; or caesarean delivery. When the amniotic fluid index was used, significantly more cases of oligohydramnios were diagnosed (risk ratio (RR, random) 2.33, 95% CI 1.67 to 3.24), and more women had inductions of labor (RR (fixed) 2.10, 95% CI 1.60 to 2.76) and caesarean delivery for fetal distress (RR (fixed) 1.45, 95% CI 1.07 to 1.97). AUTHORS' CONCLUSIONS The single deepest vertical pocket measurement in the assessment of amniotic fluid volume during fetal surveillance seems a better choice since the use of the amniotic fluid index increases the rate of diagnosis of oligohydramnios and the rate of induction of labor without improvement in peripartum outcomes. A systematic review of the diagnostic accuracy of both methods in detecting decreased amniotic fluid volume is required.
Collapse
Affiliation(s)
- Ashraf F Nabhan
- Department of Obstetrics and Gynecology, Ain Shams University, 16 Ali Fahmi Kamel Street, Heliopolis, Cairo, Egypt, 11351.
| | | |
Collapse
|
42
|
Ferdaos N, Nathan S, Nordin N. Prospective full-term-derived pluripotent amniotic fluid stem (AFS) cells. Med J Malaysia 2008; 63 Suppl A:75-76. [PMID: 19024991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Amniotic fluid (AF) serves as an excellent alternative source of pluripotent stem cells, as they are not bound with ethical issues and the stem cells are more primitive than adult stem (AS) cells. Hence, they have higher potential. Here we aim to isolate and characterize pluripotent stem cells from mid-term and full-term pregnant rat amniotic fluid. The results demonstrate the evidence of heterogeneous population of cells in the amniotic fluid and some of the cells morphology shows similarity with ES cells.
Collapse
Affiliation(s)
- N Ferdaos
- Department of Obstetrics & Gynecology, Faculty of Medicine and Health Sciences, Universiti Putra, Malaysia
| | | | | |
Collapse
|
43
|
Velemínský M, Stránský P, Velemínský M, Tosner J. Relationship of IL-6, IL-8, TNF and sICAM-1 levels to PROM, pPROM, and the risk of early-onset neonatal sepsis. Neuro Endocrinol Lett 2008; 29:303-311. [PMID: 18580842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/21/2008] [Accepted: 06/09/2008] [Indexed: 05/26/2023]
Abstract
BACKGROUND Intraamniotic infections negatively affect the mortality and morbidity in parturients and newborns. The prognosis of the disease is associated with a timely diagnosis of these conditions. One of approaches to providing timely information on the risk of the initiation of intra-amniotic infection and early-onset neonatal sepsis is the examination of cytokine levels. OBJECTIVES The purpose of the work was to evaluate the importance of the cytokines, IL-6, IL-8, and TNF-alpha, and the adhesive molecule, sICAM-1, as risk factors for early-onset neonatal sepsis and intra-amniotic infections. METHODS In a group of 152 women we sampled the blood from the umbilical cord vein immediately after delivery for the determination of the cytokines IL-6, IL-8 and TNF-alpha, and the adhesive molecule, sICAM-1, in newborns. RESULTS The sensitivity and specificity results are as follows, respectively: IL-6, 0.800 and 0.972; TNF-alpha, 0.364 and 0.943; IL-8, 0.875 and 0.965; and sICAM-1, 0.833 and 0.952. CONCLUSIONS For screening purposes, it is suitable to determine levels of IL-8, IL-6, and sICAM-1. For the screening examination, one of the cytokines mentioned is sufficient, i.e., IL-8 or IL-6, or the level of the adhesive molecule, sICAM-1. It is unnecessary to combine these markers.
Collapse
Affiliation(s)
- Milos Velemínský
- Department of Obstetrics and Gynaecology, Hospital Ceske Budejovice, Czech Republic.
| | | | | | | |
Collapse
|
44
|
Buhimschi IA, Buhimschi CS. Proteomics of the amniotic fluid in assessment of the placenta. Relevance for preterm birth. Placenta 2008; 29 Suppl A:S95-101. [PMID: 18191197 DOI: 10.1016/j.placenta.2007.12.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2007] [Revised: 11/30/2007] [Accepted: 12/03/2007] [Indexed: 11/18/2022]
Abstract
Proteomics is the study of expressed proteins and has emerged as a complement to genomic research. The major advantage of proteomics over DNA-RNA based technologies is that it more closely relates to phenotypes and not the source code. Proteomics thus holds the promise of providing a direct insight into the true mechanisms of human diseases. Historically, examination of the placenta has been the first modality to subclassify pathogenetic entities responsible for preterm birth. Because placenta is a key pathophysiological participant in several major obstetrical syndromes (preterm birth, pre-eclampsia, intrauterine growth restriction) identification of relevant biomarkers of placental function can profoundly impact on the prediction of fetal outcome and treatment efficacy. Since proteomics is a young science and studies that associate proteomic patterns with long-term outcome require follow-up of children up to school age, using placental pathological footprints of cellular injury as intermediate outcomes can be useful in the interim. Furthermore, knowledge on the identity of the dysregulated proteins may provide the needed breakthrough insight into novel pathophysiological pathways and unravel possible targets for therapeutical intervention that could not have been envisioned through hypothesis-driven approaches.
Collapse
Affiliation(s)
- I A Buhimschi
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, 333 Cedar Street, LLCI 804, New Haven, CT 06520, USA.
| | | |
Collapse
|
45
|
Peister A, Porter BD, Kolambkar YM, Hutmacher DW, Guldberg RE. Osteogenic differentiation of amniotic fluid stem cells. Biomed Mater Eng 2008; 18:241-246. [PMID: 19065029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
|
46
|
Schmidt D, Achermann J, Odermatt B, Breymann C, Mol A, Genoni M, Zund G, Hoerstrup SP. Prenatally fabricated autologous human living heart valves based on amniotic fluid derived progenitor cells as single cell source. Circulation 2007; 116:I64-70. [PMID: 17846327 DOI: 10.1161/circulationaha.106.681494] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND A novel concept providing prenatally tissue engineered human autologous heart valves based on routinely obtained fetal amniotic fluid progenitors as single cell source is introduced. METHODS AND RESULTS Fetal human amniotic progenitors were isolated from routinely sampled amniotic fluid and sorted using CD133 magnetic beads. After expansion and differentiation, cell phenotypes of CD133- and CD133+ cells were analyzed by immunohistochemistry and flowcytometry. After characterization, CD133- derived cells were seeded onto heart valve leaflet scaffolds (n=18) fabricated from rapidly biodegradable polymers, conditioned in a pulse duplicator system, and subsequently coated with CD133+ derived cells. After in vitro maturation, opening and closing behavior of leaflets was investigated. Neo-tissues were analyzed by histology, immunohistochemistry, and scanning electron microscopy (SEM). Extracellular matrix (ECM) elements and cell numbers were quantified biochemically. Mechanical properties were assessed by tensile testing. CD133- derived cells demonstrated characteristics of mesenchymal progenitors expressing CD44 and CD105. Differentiated CD133+ cells showed features of functional endothelial cells by eNOS and CD141 expression. Engineered heart valve leaflets demonstrated endothelialized tissue formation with production of ECM elements (GAG 80%, HYP 5%, cell number 100% of native values). SEM showed intact endothelial surfaces. Opening and closing behavior was sufficient under half of systemic conditions. CONCLUSIONS The use of amniotic fluid as single cell source is a promising low-risk approach enabling the prenatal fabrication of heart valves ready to use at birth. These living replacements with the potential of growth, remodeling, and regeneration may realize the early repair of congenital malformations.
Collapse
Affiliation(s)
- Dörthe Schmidt
- Clinic for Cardiovascular Surgery and Department of Surgical Research, University and University Hospital Zurich, Raemistrasse 100, CH 8091 Zurich, Switzerland
| | | | | | | | | | | | | | | |
Collapse
|
47
|
Umber A, Chohan MA. Intravenous maternal hydration in third trimester oligohydramnios: effect on amniotic fluid volume. J Coll Physicians Surg Pak 2007; 17:336-9. [PMID: 17623581 DOI: 06.2007/jcpsp.336339] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/24/2006] [Accepted: 05/23/2007] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To determine the affect of acute intravenous maternal hydration on amniotic fluid volume in patients with third trimester oligohydramnios. STUDY DESIGN Quasi experimental study. PLACE AND DURATION OF STUDY Department of Obstetrics and Gynaecology Unit III, Sir Ganga Ram Hospital, Lahore, from May 2001 to April 2002. PATIENTS AND METHODS Twenty-five women with third trimester oligohydramnios (AFI < or = 5.0 cm) and 25 controls with normal amniotic fluid volume (AFI 8-24 cm) were prospectively recruited for this study. Study inclusion criteria were, singleton pregnancy, well-established gestational age, intact membranes, absence of maternal complication (anemia, cardiac disease, renal disease, pre-eclampsia, hypertension, or diabetes); absence of fetal structural malformation and/or distress. Maternal urinary specific gravity and amniotic fluid index were determined before and after intravenous hydration by infusing 2 liters of 5% dextrose water in 2 hours and recorded on printed proformas. Sample independent 't' test was used to compare the mean AFI and urine specific gravity before and after treatment, and the posttreatment AFI--pre-treatment AFI ( delta AFI). RESULTS Maternal hydration increased amniotic fluid volume (AFV) in women with oligohydramnios (mean change in amniotic fluid index 4.5 cm, 95% confidence interval 4.02 to 5.06; p-value<0.01); as well as in women with normal amniotic fluid volume (mean change in amniotic fluid index 2.7 cm, 95% confidence interval 2.23 to 3.21; p-value<0.01). The percentage increase in mean AFI was 58.6% in the oligohydramnios group, which was significantly greater (p<0.05) than the percentage increase of 28.4% in control group. Maternal hydration was associated with decrease in urinary specific gravity in both groups. CONCLUSION Under the conditions of this study, maternal (intravenous) hydration increased the AFV in women with oligohydramnios as well as in those with normal AFV and may be beneficial in the management of oligohydramnios.
Collapse
Affiliation(s)
- Aneela Umber
- Ministry of Population Welfare, Sir Gana Ram Hospital, Lahore, Pakistan.
| | | |
Collapse
|
48
|
Yan-Rosenberg L, Burt B, Bombard AT, Callado-Khoury F, Sharett L, Julliard K, Weiner Z. A randomized clinical trial comparing the effect of maternal intravenous hydration and placebo on the amniotic fluid index in oligohydramnios. J Matern Fetal Neonatal Med 2007; 20:715-8. [PMID: 17763271 DOI: 10.1080/14767050701516204] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To compare the treatment of acute intravenous hydration with placebo in term pregnant women manifesting oligohydramnios. METHODS All patients with oligohydramnios who met the inclusion criteria were offered participation in this randomized, double-blind, placebo-controlled study. After ruling out rupture of membranes and maternal and fetal complications, we recruited 44 women with third trimester singleton pregnancies having an amniotic fluid index (AFI) of less than 6. Patients were randomized into treatment or control groups. Patients in the treatment group received a continuous intravenous infusion of (1/2) normal saline (NS) at a rate of 1000 mL/h for two hours. Patients in the placebo group received an intravenous infusion of (1/2) NS at 10 mL/h for two hours. The AFI was re-assessed by the same sonographer one hour after the hydration was completed. Both the patient and the examiner were blinded to the study groups. RESULTS Maternal age, parity, gestational age, and birth weight were not significantly different between the two groups. The AFI increased significantly in both treatment (3.8 +/- 1.2 vs. 5.3 +/- 2.5, p < 0.05) and placebo (4 +/- 1.3 vs. 5.5 +/- 2.4, p < 0.05) groups. Moreover, the changes in AFI did not significantly differ between the treatment and the placebo groups (1.2 +/- 2.1 vs. 1.5 +/- 2.1, respectively; p > 0.05). CONCLUSIONS There are statistically significant short-term increases in the AFI in patients with oligohydramnios whether the patients are treated with intravenous fluids or not. The short-term increase in AFI may reflect physiologic diurnal variations in the amniotic fluid.
Collapse
Affiliation(s)
- Linli Yan-Rosenberg
- Department of Obstetrics and Gynecology, Lutheran Medical Center, Brooklyn, NY 11220, USA
| | | | | | | | | | | | | |
Collapse
|
49
|
Deering SH, Patel N, Spong CY, Pezzullo JC, Ghidini A. Fetal growth after preterm premature rupture of membranes: is it related to amniotic fluid volume? J Matern Fetal Neonatal Med 2007; 20:397-400. [PMID: 17674244 DOI: 10.1080/14767050701280249] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Preterm premature rupture of membranes (PPROM) has been associated with an increased rate of fetal growth restriction (FGR). It is unknown whether impairment of fetal growth is mediated through external compression from decreased amniotic fluid volume or (an)other mechanism(s). METHODS Over a three-year period all patients with singleton pregnancies experiencing PPROM at <37 weeks lasting greater than 10 days, and who underwent serial sonograms to assess fetal biometry after PPROM, were included in the study. Patients were excluded for congenital anomalies or other inherent risk factors for abnormal fetal growth. Fetal abdominal circumference (AC) percentiles were compared between the first sonographic exam after PPROM and the last exam before delivery. The median amniotic fluid index between PPROM and delivery was correlated with the change in AC percentiles while controlling for the duration of PPROM. Statistical analysis utilized one-way analysis of variance and correlation; a p value of <0.05 was considered significant. RESULTS Twenty-two patients met our inclusion criteria with a mean duration (+/-SD) of PPROM of 58 days (+/-46). The median AFI during the PPROM period was not correlated with the change in AC percentiles after controlling for duration of PPROM (p = 0.49). CONCLUSIONS The residual amniotic fluid volume after PPROM does not appear to correlate with fetal growth suggesting that the increased rate of FGR in PPROM is not secondary to oligohydramnios. We hypothesize that the intrauterine pathologic processes responsible for membrane rupture may also interfere with fetal growth.
Collapse
Affiliation(s)
- Shad H Deering
- Department of Obstetrics and Gynecology, Georgetown University Hospital, Washington, DC, USA.
| | | | | | | | | |
Collapse
|
50
|
Wibbens B, Bennet L, Westgate JA, De Haan HH, Wassink G, Gunn AJ. Preexisting hypoxia is associated with a delayed but more sustained rise in T/QRS ratio during prolonged umbilical cord occlusion in near-term fetal sheep. Am J Physiol Regul Integr Comp Physiol 2007; 293:R1287-93. [PMID: 17652358 DOI: 10.1152/ajpregu.00373.2007] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
There is limited information about whether preexisting fetal hypoxia alters hemodynamic responses and changes in T/QRS ratio and ST waveform shape during subsequent severe asphyxia. Chronically instrumented near-term sheep fetuses (124 +/- 1 days) were identified as either normoxic Pa(O(2)) > 17 mmHg (n = 9) or hypoxic Pa(O(2)) < or = 17 mmHg (n = 5); then they received complete occlusion of the umbilical cord for 15 min. Umbilical cord occlusion led to sustained bradycardia, severe acidosis, and transient hypertension followed by profound hypotension in both groups. Preexisting hypoxia did not affect changes in mean arterial blood pressure but was associated with a more rapid initial fall in femoral blood flow and vascular conductance and with transiently higher fetal heart rate at 2 min and from 9 to 11 min of occlusion compared with previously normoxic fetuses. Occlusion was associated with a significant but transient rise in T/QRS ratio; preexisting hypoxia was associated with a significant delay in this rise (maxima 3.7 +/- 0.4 vs. 6.2 +/- 0.5 min), but a slower rate of fall. There was a similar elevation in troponin-T levels 6 h after occlusion in the two groups [median (range) 0.43 (0.08, 1.32) vs. 0.55 (0.16, 2.32) microg/l, not significant]. In conclusion, mild preexisting hypoxia in normally grown singleton fetal sheep is associated with more rapid centralization of circulation after umbilical cord occlusion and delayed elevation of the ST waveform and slower fall, suggesting that chronic hypoxia alters myocardial dynamics during asphyxia.
Collapse
Affiliation(s)
- Bert Wibbens
- Department of Physiology, The University of Auckland, Auckland, New Zealand
| | | | | | | | | | | |
Collapse
|