Ultrasound abnormalities of the amniotic fluid, membranes, umbilical cord, and placenta

Prenatal ultrasound has expanded the ability to assess the umbilical cord, fetal membranes, amniotic fluid volume, and placenta. Evaluation of these structures provides information regarding the intrauterine environment. Umbilical cord abnormalities may be associated with fetal aneuploidy, structural anomalies, and fetal compromise. Estimating the amniotic fluid volume has become an integral part of a sonogram and provides immense information regarding possible fetal anomalies and perinatal outcome. Likewise, placental location or abnormalities may significantly impact obstetric management and prognosis. Early detection of several of these conditions may lead to increased vigilance that may improve perinatal outcome.     

Lead and cadmium concentrations in maternal and umbilical cord blood, amniotic fluid, placenta, and amniotic membranes

The lead and cadmium concentrations in maternal and umbilical cord blood and amniotic fluid were determined in 19 parturient women at delivery. Six placental and amniotic membrane tissue specimens were also investigated. The mean lead concentrations (mean +/- SD) in maternal (40.4 +/- 18.2 ng/ml) and umbilical cord (37.1 +/- 13.5 ng/ml) blood were similar and correlated significantly with each other (r = 0.77, p less than 0.001). The lead concentration in amniotic fluid (59.6 +/- 8.3 ng/ml) was significantly higher than in maternal or umbilical cord blood. Cadmium concentrations in maternal blood (1.1 +/- 0.9 ng/ml) and amniotic fluid (1.0 +/- 0.2 ng/ml) were significantly higher (p less than 0.001) than in umbilical cord blood (0.4 +/- 0.2 ng/ml) and there was no significant correlation among these values. The highest concentrations of cadmium (35.1 +/- 24.2 ng/gm of wet weight) and lead (87.3 +/- 154.2 ng/gm of wet weight) were found in the amniotic membranes. Our results show that lead and cadmium accumulate in amniotic fluid and amniotic membranes and that the distribution of lead and cadmium is different in the human maternal-fetoplacental unit. The fetal exposure to lead is similar and that to cadmium, lower, compared with maternal exposure. The inability of the placenta to totally prevent the fetus from exposure to lead and cadmium suggests that pregnant women should avoid occupations where exposure to these toxic elements is possible.     

CA 125 antigen in human amniotic fluid and fetal membranes

The cancer antigen CA 125 is manifest by serous cystadenocarcinoma of the ovary and to a lesser extent by other gynecologic and nongynecologic tumors. Its presence was screened for in normal human fetal tissues and fluids. Appreciable quantities of CA 125 were discovered in amniotic fluid by both a dot blot assay and the commercially available immunoradiometric assay kit. The most likely source of this antigen was found not to be the developing fetus, since antigen was absent from cord blood and fetal urine, but rather the chorionic membrane, which contained significant quantities of the antigen. CA 125 was found in extracts of maternal decidua, but none was found in extracts of placenta or amnion. The CA 125 antigen was determined by gel filtration experiments to be in excess of 700,000 daltons and probably in the range of 2 to 3 X 10(6) daltons. Size heterogeneity based on gel filtration and anion heterogeneity based on anion exchange chromatography have both been demonstrated for the CA 125 molecule. The amniotic fluid antigen is composed of two subunits of approximately 240,000 and 180,000 daltons as detected by iodine 125-labeled OC 125 monoclonal antibody. The antigen may contain additional subunits not detected by the monoclonal antibody. Size and change heterogeneity as well as the poor definition of the subunit bands on polyacrylamide gels also suggest this molecule contains an appreciable carbohydrate component.     

The activities of cathepsin A in the placenta, fetal membranes and amniotic fluid in physiologic pregnancy and pregnancy complicated by EPH gestosis

Activity of cathepsin A was determined in placenta, fetal membranes and amniotic fluid as well in normal pregnancy as in complicated pregnancy by EPH-gestosis. Measurement of activity was done by N-CbZ-L-glutamyl-tyrosine with pH 5.5. Compared with normal pregnancy activity of cathepsin A was lower in the three materials of EPH-gestosis.     

Concentration of amoxicillin in maternal serum,cord blood,amniotic fluid and the placenta after vaginal administration

Objective: The aim of this study was to assess the amoxicillin concentration in maternal serum, cord blood, amniotic fluid and the placenta, 2?h following vaginal administration and the factors influencing the drug level.

Methods: Twenty-eight full-term pregnant women who qualified for elective cesarean delivery were included in the study. Vaginal suppositories containing 250?mg of amoxicillin were administered 2?h prior to the operation. Amoxicillin levels were determined using the diffusion microbial assay.

Results: The amoxicillin level in amniotic fluid was significantly higher in comparison to that of maternal serum, cord blood or the placenta. Maternal age positively and gestational weight gain negatively correlated with the amoxicillin concentration in maternal serum. The maternal serum hemoglobin level and red blood cell count were positively correlated with amoxicillin concentration in the amniotic fluid. Neonatal birth weight was positively correlated with maternal serum and cord blood amoxicillin levels. Hypertensive women had significantly higher amoxicillin concentrations in amniotic fluid, and women with thrombocytopenia presented significantly higher cord blood amoxicillin concentrations.

Conclusions: Amoxicillin presented poor concentration in maternal–fetal compartments after vaginal administration, but the factors influencing the drug level in different compartments require further investigation.     

Secretory component in human amniotic fluid and gestational tissues: a potential endogenous phospholipase A2 inhibitor

OBJECTIVES: Prostaglandins (PGs) are essential mediators of labor during human pregnancy. Phospholipase A2 (PLA2) provides the essential substrate for PG synthesis through the liberation of arachidonic acid from membrane phospholipid stores. Nonlaboring amniotic fluid (NL-AF) contains secretory component (SC)-like protein(s) that suppress in vitro PLA2 activity. This study characterizes the biologic activity, identity, and tissue distribution of these protein(s) in NL-AF and gestational tissues. METHODS: Third-trimester NL-AF was collected by amniocentesis, fractionated by ammonium sulfate precipitation, and submitted to an in vitro PLA2 assay. Identity of the PLA2 inhibitor in NL-AF was confirmed by Western blot and antibody neutralization studies. Secretory component-immunoreactive proteins were purified by immunoaffinity chromatography and visualized by sodium dodecyl sulfate-gel electrophoresis. Tissue distribution of SC in gestational tissues was determined by immunohistochemistry. RESULTS: The 100% pellet and supernatant fractions of NL-AF suppressed PLA2 activity, and this activity was neutralized by a polyclonal antibody to SC. Western blot studies revealed an SC-reactive protein in the 70-80-kD range in the 100% pellet fraction of NL-AF. Two SC-reactive proteins were detected in the 60-80-kD range in the eluate from the SC immunoaffinity column, along with minor proteins of 30 and greater than 100 kD. Immunohistochemical studies revealed SC in placental trophoblast, amniotic membranes, and decidual epithelium. CONCLUSIONS: These results demonstrate that proteins homologous to SC are present in human gestational tissues and possess anti-PLA2 activity. These proteins may contribute to the maintenance of pregnancy by suppressing local PG production.     

Microvillar enzyme assays in amniotic fluid and fetal tissues at different stages of development

A systematic study of microvillar enzyme activities in the amniotic fluid in correlation with their values in different fetal tissues during development has been undertaken. Microvillar enzymes appeared in the amniotic fluid at the time of disappearance of the anal membrane, 12-13 weeks, and declined from the 18th week until the 24th week. The study of fetal tissues and fluids has shown that gamma-glutamyltranspeptidase is mainly of liver origin. The significant decrease of the activities of these amniotic fluid enzymes has been the basis of prenatal diagnosis of cystic fibrosis. These assays may be useful for the diagnosis of certain digestive tract abnormalities at later stages of pregnancy.     

The fetal membranes as a possible source of amniotic fluid prostaglandins.

Biosynthesis and metabolism of prostaglandins was studied in human amniotic and chorionic membranes obtained at term. Using specific in vitro methods it was demonstrated that the fetal membranes contain an organization of enzymes regulating both synthesis and degradation of prostaglandins. Differentiation between amnion and chorion showed that virtually all of the biosynthesis and metabolism occurred in the chorion, whereas enzymatic activities in the amnion were negligible or low. The results suggest a high turnover of prostaglandins in the chorion, and its importance as a source of prostaglandins found in amniotic fluid is discussed.     

Krabbe's disease: first trimester diagnosis confirmed on cultured amniotic fluid cells and fetal tissues

Chorionic villi obtained during the first trimester from a pregnancy at risk for Krabbe's disease were shown to have reduced cerebroside-beta-galactosidase (E.C.3.2.1.46) activity using the artificial substrate trinitrophenylaminolauryl galactocerebroside (TNPAL-galactocerebroside). Assay of this enzyme in cultured amniotic fluid cells following amniocentesis, performed at the patient's request confirmed the diagnosis. Termination of pregnancy was performed and subsequent enzyme studies of the fetal tissues were consistent with the diagnosis of Krabbe's disease, thus confirming that chorionic villi can be used for first trimester diagnosis of this condition.     

The infrequent occurrence of mycoplasmas in amniotic fluid from women with intact fetal membranes

As human genital mycoplasmas have been associated with various forms of reproductive failure, the present study was undertaken to investigate whether M. hominis and U. urealyticum organisms (ureaplasmas) are capable of crossing intact fetal membranes. Nearly 300 women in Denmark and England were investigated. Most of them were seen at about the fourth month of gestation and the remainder towards or at the time of birth, all with unruptured membranes. A swab was taken from the uterine cervix or vagina and M. hominis was isolated from 9% of the women and ureaplasmas from half of them. The presence of these mycoplasmas was not associated with an abnormal outcome of pregnancy. In contrast to the frequent presence of mycoplasmas in the lower genital tract, amniotic fluids obtained by transabdominal amniocentesis or at cesarean section did not contain M. hominis and ureaplasmas were isolated from only one of them. This was associated with the same ureaplasmas serotype being recovered from the cervix and also from the blood of both infant and mother, whose case differed from the others as labor had already started when the amniotic fluid was obtained. Thus, in our populations, we have no evidence that mycoplasmal invasion of the amniotic fluid occurs before the onset of labor. During labor, despite intact membranes, it seems that genital mycoplasmas may occasionally invade the fetal--placental unit, probably by the hematogenous route after strong uterine contractions, or otherwise directly after membrane rupture. Since both these events are followed usually by immediate delivery, there would seem to be insufficient time for the genital mycoplasmas to cause fetal damage.     

Lysyl oxidases: expression in the fetal membranes and placenta

The cross-linking of the connective tissues in the fetal membranes and placenta is important for their tensile strength and elasticity. We have studied the expression of lysyl oxidase (LOX) because it is the classical enzyme responsible for the cross-linking of collagen and elastin. We have also studied the two recently described, genetically distinct lysyl oxidase-like genes and proteins, lysyl oxidase-like (LOXL) and lysyl oxidase-like 2 (LOXL2), of unknown functions.Specific antisera have been used for immunolocalization in fetal membranes and placentae from early pregnancy terminations and after caesarean section at both preterm and term, prior to labour. In addition, the steady state mRNA levels of the three genes has been quantitated in separated amnion, chorion, decidua and placentae collected at term before labour. The immunocytochemistry shows that the spatial expression of the three lysyl oxidases is similar in early pregnancy in both the fetal membranes and placentae. However, by preterm this pattern had diverged and becomes greatest at term. The expression of the genes found at term was similar to the results of protein expression obtained by immunocytochemistry, with the exception of LOXL which had high placental gene expression, but low levels of immunolocalized protein. Thus by term, LOX was expressed predominantly in the amniotic epithelium, with little expression in the placenta, while LOXL showed highest gene expression in the placenta and lowest expression in the amnion. LOXL2 expression was again different and was expressed predominantly in the chorionic cytotrophoblast of the membranes with low expression in both the amnion and placentae. These results suggest that these three members of the lysyl oxidase family may have similar roles in early pregnancy during the development of the placenta and fetal membranes, but their divergence as pregnancy advances to term, may reflect changes in substrate specificity and connective tissue composition.     

Intrapartum amniotic fluid volume at term. Association of ruptured membranes, oligohydramnios and increased fetal risk

The amniotic fluid index (AFI), a semiquantitative technique for assessing amniotic fluid volume, has been shown to be a useful adjunct in antepartum surveillance. We evaluated the usefulness of the AFI in the early intrapartum period as it relates to subsequent fetal morbidity and fetal heart rate patterns. Two hundred term gravidas presenting in the latent phase of labor with vertex-presenting fetuses were studied. An intrapartum AFI less than or equal to 5.0 cm was associated with a significant increase in the risk of cesarean section for fetal distress and of an Apgar score of less than 7 at one minute as well as abnormal fetal heart rate patterns in late labor. The majority (71.4%) of the patients with an intrapartum AFI less than or equal to 5.0 cm had ruptured membranes on entry; however, there was no significant difference in outcome when they were compared to patients with intact membranes and oligohydramnios. Variable decelerations on entry were associated with oligohydramnios in 43.8% of the patients. An AFI less than or equal to 5.0 cm in the early intrapartum period is a risk factor for perinatal morbidity and abnormal fetal heart rate patterns in subsequent labor, and ruptured membranes in early labor are a risk factor for oligohydramnios.