Exhaled nitric oxide concentration and amniotic fluid nitrite concentration during pregnancy

Abstract. We have assessed fetal and maternal nitric oxide (NO) production in pregnancy. Exhaled NO and amniotic fluid nitrite concentrations were measured by chemiluminescence between 10 and 42 weeks of pregnancy. Exhaled NO concentrations did not alter significantly during gestation. In contrast, there was a significant change in mean amniotic fluid nitrite concentration in late pregnancy ( P < 0.001). The finding of decreased amniotic nitrite concentrations after 37 weeks of gestation support the hypothesis that reduced NO production may contribute to increased uterine activity in late pregnancy.     

Cardiolipin antibodies in pregnancy of high risk]

Cardiolipin IgG and IgM antibodies (CAb) were studied in 116 cases of high-risk pregnancy. All the women were undergoing examination or treatment in regional perinatal center. CAb occurred more frequently in antenatal fetal death (50%). In blood hypertension, habitual abortions, history of infertility, gestational gestosis, CAb were encountered in 21.4, 20, 20 and 15.2% of cases, respectively. Intrauterine growth retardation was associated with CAb in 33.3% of cases. CAb occurred in pregnant women of different groups who had high uterine vascular resistance. The above findings indicate CAb contribution to genesis of gestational complications in high risk pregnancy.     

Identification of vasopressor constituents of amniotic fluid in pregnancy toxaemia

Summary The vasopressor activity of human amniotic fluid was assessed in 46 primigravidas during the third trimester of pregnancy. The subjects included 20 normal and 26 cases of pregnancy toxaemia. For identification of the vasoptessor activity of the amniotic fluid, blood pressure measurements were made in the intact rat, and the smooth muscle contraction of the rat ascending colon preparation was determinedin vitro. The samples of amniotic fluid showing vasoptessor activity were lyophilized and subjected to gel filtration using Sephadex G-100. The various fractions thus obtained were monitored at 280 nm and the pressor activity was re-estimated. It was observed that most of the pressor activity of the amniotic fluid of the toxaemic patients was capable of causing contraction of the rat colon as well as a significant rise in the systolic blood pressure of the intact rat. Furthermore, this activity was found to be heat-labile and was completely blocked by cinnarizine. Fractionation of the amniotic fluid showing vasopressor activity by gel filtration further substantiated the findings reported above. On the basis of these results it was concluded that the pressor activity of the amniotic fluid was due to the presence of an angiotensin II-like substance. Its concentration was found to be higher in the toxaemic group than in normotensive subjects.     

Sonographic measurement of amniotic fluid volume in the first trimester of pregnancy.

The sonographic estimate of amniotic fluid volume from 7 to 13 weeks of gestation in 95 pregnancies was calculated. Amniotic fluid volume increased from 1.5 ml at 7 weeks to 25 ml at 10 weeks and 100 ml at 13 weeks. The nomograms constructed may be used in the objective evaluation of the fetal condition in the first trimester.     

水通道蛋白1在羊水量异常产妇中的表达及意义

目的:研究水通道蛋白1在产妇胎盘、胎膜中的分布及表达,探讨水通道蛋白1在异常羊水量调节中的作用。方法:采用实时荧光定量PCR和免疫组化SP法,检测30例羊水量正常,30例羊水过少,21例羊水过多产妇胎盘、胎膜组织中水通道蛋白1的分布及表达。结果:水通道蛋白1在羊水过少产妇羊膜组织上的表达较羊水量正常组明显下调,在羊水过多产妇羊膜组织上的表达明显上调,均P<0.05。而水通道蛋白1在3组的胎盘和绒毛膜上的分布及表达强度差异无显著性。结论:水通道蛋白1在胎盘、胎膜组织表达,其在羊膜上的表达与羊水量异常的发生发展相关。     

Clinical significance of the presence of amniotic fluid 'sludge' in asymptomatic patients at high risk for spontaneous preterm delivery.

OBJECTIVES: To determine the clinical significance of the presence of amniotic fluid (AF) 'sludge' among asymptomatic patients at high risk for spontaneous preterm delivery. METHODS: This retrospective case-control study included 281 patients with (n = 66) or without (n = 215) AF 'sludge', who underwent transvaginal ultrasound examination between 13 and 29 completed weeks of gestation. Patients with threatened preterm labor, multiple gestation, fetal anomalies, placenta previa or uterine contractions were excluded. RESULTS: The prevalence of AF 'sludge' in the study population was 23.5% (66/281). The rates of spontaneous preterm delivery at < 28 weeks, < 32 weeks, < 35 weeks and < 37 weeks of gestation were 14.7% (29/197), 21.3% (46/216), 28.7% (62/216) and 42.1% (91/216), respectively. Patients with 'sludge' had: (1) a higher rate of spontaneous preterm delivery at < 28 weeks (46.5% (20/43) vs. 5.8% (9/154); P < 0.001), < 32 weeks (55.6% (25/45) vs. 12.3% (21/171); P < 0.001) and < 35 weeks (62.2% (28/45) vs. 19.9% (34/171); P < 0.001); (2) a higher frequency of clinical chorioamnionitis (15.2% (10/66) vs. 5.1% (11/215); P = 0.007), histologic chorioamnionitis (61.5% (40/65) vs. 28% (54/193); P < 0.001) and funisitis (32.3% (21/65) vs. 19.2% (37/193); P = 0.03); (3) a higher frequency of preterm prelabor rupture of membranes (PROM) (39.4% (26/66) vs. 13.5% (29/215); P < 0.001), lower gestational age at preterm PROM (median 24.7 (interquartile range (IQR), 22.3-28.1) weeks vs. 32.3 (IQR, 27.7-34.8) weeks; P < 0.001); and (4) shorter median ultrasound-to-delivery interval ('sludge' positive 127 days (95% CI, 120-134 days) vs. 'sludge' negative 161 days (95% CI, 153-169 days); P < 0.001) and ultrasound-to-preterm PROM interval ('sludge' positive 23 days (95% CI, 7-39 days) vs. 'sludge' negative 57 days (95% CI, 38-77 days); P = 0.003) than those without 'sludge'. AF 'sludge' was an independent explanatory variable for the occurrence of spontaneous preterm delivery at < 28 weeks, < 32 weeks and < 35 weeks, preterm PROM, microbial invasion of the amniotic cavity (MIAC) and histologic chorioamnionitis. Moreover, the combination of a cervical length < 25 mm and 'sludge' conferred an odds ratio of 14.8 and 9.9 for spontaneous preterm delivery at < 28 weeks and < 32 weeks, respectively. CONCLUSIONS: AF 'sludge' is an independent risk factor for spontaneous preterm delivery, preterm PROM, MIAC and histologic chorioamnionitis in asymptomatic patients at high risk for spontaneous preterm delivery. Furthermore, the combination of 'sludge' and a short cervix confers a higher risk for spontaneous preterm delivery at < 28 weeks and < 32 weeks than a short cervix alone.     

Amino acid composition of amniotic fluid during physiological and complicated pregnancy

An ion exchange chromatographic technique was used to study the content of 18 free amino acids in the amniotic fluid of women with physiological and complicated pregnancy. The amino acid spectrum of amniotic fluid in placental insufficiency was found to be characterized by the lower content of arginine, serine, glycine, alanine, cysteine, tyrosine, phenylalanine, and glutamine, which are involved in many metabolic processes required to maintain biochemical homeostasis during gestation. There was an opposite tendency for dicarboxylic amino acids and histidine, the levels of which increased, by enhancing nitrogen imbalance. The degree of the found impairments of a number of amino acids considerably increased in case of birth of babies with brain lesions, which permits use of their amniotic fluid determination to predict the neonatal status.     

Paediatric CPB: bypass in a high risk group

Children and particularly neonates present unique challenges during CPB. Patient age, size, underlying anatomy and surgical strategy influence the perfusion techniques and the construction of the CPB circuit. The normal changes in physiology in the first weeks of life impact upon surgical technique and outcome of repair. Limited surgical access necessitates alternative cannulation strategies. Deep hypothermia, low flow CPB and circulatory arrest are frequently used. An understanding of the related pathophysiology is therefore required to make the correct choices and to optimise patient outcome.     

The monitoring of pregnancy in rhesus-sensitized women by a quantitative determination of bilirubin in amniotic fluid (author's transl)]

The prognostic accuracy of spectro photometric examination of the amniotic fluid and of a specific method for the determination of free bilirubin in the amniotic fluid are compared. Amniocentesis was carried out 166 times in 85 sensitized rhesus-negative pregnant women. Spectro photometric examination gave a misleading assessment in 28% of the cases. This applied particularly to Liley's Zone II, in which the presence or absence of haemolytic disease of the newborn was incorrectly predicted in up to 70% of the cases. By contrast, on evaluation of the cases using specific determination of free bilirubin, not a single value obtained after the 34th week of pregnancy led to false assessment of the fetal condition. There is a stong correlation between the extent of fetal damage and the bilirubin content of the amniotic fluid.     

A simple method for the quantitation of amniotic fluid alpha-fetoprotein throughout pregnancy.

A simple method of Amicon membrane cone concentration followed by radial immunodiffusion is described and evaluated for the detection of amniotic fluid α-fetoprotein from 13–40 weeks gestation.     

Elevated pleural fluid glucose: a risk for tension hydrothorax

We have presented a case of tension hydrothorax that developed after hyperosmolar hyperalimentation fluids were infused into the pleural space through a misplaced jugular venous line. The hyperosmolar state of the pleural fluid appears to have played a prominent role in the development of the tension hydrothorax. We believe there is a risk of tension hydrothorax in any clinical situation in which the pleural fluid glucose concentration is significantly higher than the serum concentration.     

Acid hydrolases in amniotic fluid and chorionic villi at various stages of pregnancy

A study was made at various stages of pregnancy of five acid hydrolases which occur in amniotic fluid and chorionic villi and which are relevant to serious storage disorders.In amniotic fluid β-galactosidase and α-mannosidase decreased moderately towards term, while β-glucosidase decreased markedly. N-Acetyl-β-glucosaminidase and β-glucuronidase were relatively unchanged.In chorionic villi N-acetyl-β-glucosaminidase, β-galactosidase, and α-mannosidase were substantially decreased towards term, while β-glucosidase was unchanged and β-glucuronidase markedly increased.In both amniotic fluid and chorionic villi the enzyme pattern was approximately the same as that found in liver in a previous study.The findings suggest that these enzyme assays might be useful in the diagnosis of inborn errors prenatally by using amniotic fluid, and early postnatally by using chorionic villi.     

Determination of amniotic fluid palmitic acid concentration for the estimation of fetal lung maturity

Palmitic acid concentrations in amniotic fluid (AF) were determined in 135 patients with normal and pathological pregnancies between the 27th and 42nd week of gestation. There was a sharp rise in the mean palmitic acid concentration after the 34th weeks of gestation from 2.7 μg/ml to 9.9 μg/ml at term. This increase is almost identical with the rise of AF-lecithin. It was found that between 70% and 100% of AF-palmitic acid originates from lecithin. 65 patients were delivered within 24 h after amniotic fluid sampling. 7 infants of these patients developed a respiratory distress syndrome (RDS). In all cases with RDS AF-palmitic acid concentration was far below 5 μg/ml. Assuming an AF-palmitic acid concentration > 5 μg/ml for characterising fetal lung maturity (= no RDS), there were no false negative results, but 16% false positive results. However, the determination of AF-palmitic acid concentration seems to be a most reliable method for the assessment of fetal lung maturity.     

胎膜早破残余羊水量与妊娠结局的相关性研究

目的探讨胎膜早破残余羊水量与妊娠结局的相关性。方法选择胎膜早破、头位、无其他剖宫产指征、拟行经阴道分娩的孕妇156例,临产前B超监测残余羊水量。其中羊水池深度≤3.0cm者83例,>3.0cm者73例。观察并记录两组产妇的分娩方式及新生儿情况。结果羊水池深度≤3.0cm组手术产率比羊水池深度>3.0cm组升高,差异有显著性意义(P<0.05),新生儿窒息率也明显升高(6.0%)。结论胎膜早破残余羊水量与分娩方式和新生儿窒息密切相关,应合理干预,选择正确的分娩方式,提高产科分娩质量。     

New dimensions in the care of high risk pregnancy

In June 1989, the past president of the Philippine Nurses Association spoke at the annual convention of the Maternal Child Nurses Association at the Children's Medical Center in Quezon City. She addressed maternal health and high risk pregnancies in the Philippines. The maternal mortality rate was 90/100,000 live births each year. It was 4-5 times higher among remote tribes such as the Muslims of Sulu than the national rate. 54% of maternal deaths were attributed to pregnancy complications especially eclampsia (28%). About 2 million women experienced pregnancy annually and almost 1 million had anemia or were malnourished. 20% of these 1 million women gave birth to low birth weight infants who were at high risk of death from infections. About 574,000 out of 1.4 million infants born annually were unwanted. 63% of pregnant women each year did not want any children. Nurses can play an important role to reduce suffering and death among mothers and infants if they practice good health teaching. For example, they can inform mothers about child spacing and birth limiting. They can also identify high risk pregnancies and refer them to other health professionals to manage them. In September 1987, the Philippines Department of Health sponsored a conference on maternal health. Participants made 6 resolutions. The 1st resolution was to consider maternal mortality an indicator of Health for All by year 2000. They also resolved to declare 1988-97 the Decade of Safe Motherhood which included the creation of a multisectoral task force under the Department of Health. The speaker concluded by encouraging Philippine nurses to resist the temptation to work abroad to make more money and instead stay in the Philippines to care for their own people.