妊娠晚期特发性羊水量异常羊水的生化改变探讨

目的:探讨妊娠晚期特发性羊水量异常者的羊水生化改变.方法:对73例妊娠晚期特发性羊水异常患者(59例特发性羊水过少、14例特发性羊水过多)进行羊水10项生化指标检测和分析,与同期随机选取的50例无妊娠合并症和并发症的单胎足月孕妇羊水进行比较.结果:特发性羊水过少组羊水中钠浓度、钙浓度、葡萄糖及渗透压较正常组降低,肌酐浓度升高,其差异有统计学意义(P<0.05);特发性羊水过多组各项羊水生化参数与羊水量正常组差异无统计学意义(P>0.05).结论:妊娠晚期特发性羊水过少者羊水中的钠浓度、钙浓度、葡萄糖及渗透压有改变.     

病理学诊断在羊水栓塞诊断中的价值

目的:评价病理学诊断在羊水栓塞诊断中的价值.方法:健康孕晚期山羊12只,根据其股静脉中注入不同羊水性质随机分成3组:原羊水组、过滤羊水组、胎粪污染羊水组,每组4只.在羊水注入3小时后取心脏血和股静脉血查找羊水成分,同时将动物处死,取肺组织行病理学检查.结果:12只动物的中心血和外周血均找到羊水成分,肺组织均可见不同程度的肺水肿及炎性反应,原羊水组1只(25.0%)、胎粪组4只(100%)动物肺组织中找到了羊水成分,过滤羊水组无一例见羊水成分.结论:依靠病理学诊断羊水栓塞可能是不可靠的.     

The Role of Amniotic Fluid Analysis

Amniocentesis is a practical tool in daily obstetrics. The rapid and relatively safe procedure can enhance the clinician's judgement in important decisions concerning the fetal maturity, Rh iso-immunization, and genetic counseling and, to a lesser degree, in placenta localization and diagnoses of fetal well-being and congenital abnormalities. The indications and technique for amniotic fluid analysis me presented, and possible complications are discussed.     

The Determination of Peroxidase in Amniotic Fluid.

Analyzing total peroxidase activity in amniotic fluid is extremely simple, requiring only 1 1/2 minutes of incubation at room temperature and a spectrophotometer. Peroxidase, clearly detectable at as early as 17 weeks' gestation in the amniotic fluid, increases 100-fold by term. The increase follows a predictable rising curve and can be used to estimate the fetal age. Maturation of the fetal salivary gland is most probably the source of rising amniotic fluid peroxidase levels. Samples from complicated pregnancies are lower than normal, do not increase as rapidly, and probably can be bracketed into their own ranges for gestational age evaluation.     

Significance of Amniotic Fluid Glucose in Late Pregnancy

Glucose levels were estimated in over 150 amniotic fluid samples and were found to fall with advancing gestational age. Significantly lower levels were found in post-term pregnancies and in association with fetal growth retardation. Amniotic fluid glucose estimation was found to be superior to human placental lactogen in distinguishing between normal pregnancies and those complicated by fetal growth retardation. The role of the membranes in influencing the level of amniotic fluid glucose was investigated using in vitro perfusion experiments. The permeability of the membranes to glucose decreased with advancing gestational age.     

Possible Amniotic Fluid Embolism Associated with Amnioinfusion

Polyhydramnios and subsequent fetal distress are the only documented complications of amnioinfusion described in the literature. We report two possible cases of amniotic fluid embolism associated with amnioinfusion. Symptoms developed at the time of fluid bolus for amnioinfusion. Both patients recovered completely with extended supportive care.     

Alphafetoprotein by Radioimmunoassay in Maternal Serum and Amniotic Fluid

Summary: The use of a competitive inhibition radioimmunoassay allows the measurement of alphafetoprotein (AFP), a specific a-globulin produced by fetal and malignant liver cells, in serum and amniotic fluid at low concentrations of ng/ml. In normal pregnancy, mean AFP levels in maternal serum showed a slow rise, from undetectable levels (less than 20 ng/ml) before 12 weeks of gestation, to a maximum at 30 weeks. After that, there was a comparable decline in levels for the remainder of pregnancy, up to 42 weeks. From 14 weeks there was a wide variation in individual AFP values at all stages of gestation, but most of them fell within 2 standard deviations above the mean.
A correlation was found between AFP levels in samples of maternal serum and amniotic fluid taken simultaneously, with levels in amniotic fluid reading at least 50% higher. AFP levels in amniotic fluid in late pregnancy corresponded to the lecithin/sphingomyelin ratio in an inverse relationship.     

Pretreatment of Gastroschisis with Transabdominal Amniotic Fluid Exchange

Background: Intestinal thickening in gastroschisis results from prolonged exposure to amniotic fluid (AF). Experimental AF exchange has been shown to prevent intestinal thickening in gastroschisis.Case: A 25-year-old primigravida was referred at 24 weeks’ gestation with a prenatal diagnosis of gastroschisis. Transabdominal AF exchange was performed at 29 weeks. This pretreatment did not cause any complications and prevented intestinal thickening in our patient. Thus, we were able to perform primary fascial closure with an intra-abdominal pressure less than 5 mmHg. We began feeding the infant on the 5th day and discharged her on the 8th day.Conclusion: Evidence obtained from this initial case seems promising for the further application of the AF exchange for prevention of intestinal thickening in gastroschisis.     

Predictive Value of Amniotic Fluid Gram Stain in Postcesarean Endomyometritis

The objective of this prospective study was to determine the value of the amniotic fluid Gram stain in identifying patients at high risk for postcesarean endomyometritis. Intraoperative samples of amniotic fluid were obtained from 151 patients undergoing nonelective cesarean section. Gram stains were performed and analyzed for the presence of bacteria and white blood cells (WBCs). Endomyometritis occurred in 55/151 (36%) of patients. Positive Gram stain, defined as the presence of any bacteria in any high power field, occurred in 29/55 (53%) of patients with endomyometritis as compared to 4/96 (4.2%) of patients without endomyometritis (P < 0.001). The amniotic fluid Gram stain showed a sensitivity of 53%, specificity of 96%, a negative predictive value of 78%, and a positive predictive value of endomyometritis of 88%, which was higher than other clinical determinants evaluated. A positive test can therefore be used in clinical management by starting antibiotic treatment at the time of cesarean delivery. This may shorten the hospital course of endomyometritis and decrease maternal morbidity.     

Epidemiology of Meconium Staining of Amniotic Fluid in Hong Kong

The characteristics of 94 patients with meconium stained amniotic fluid diagnosed during labour in the Prince of Wales Hospital, Hong Kong, from July to August 1984, were analysed. The incidence was 21.4% of deliveries. These patients were compared to a group of non-meconium patients (349 cases) in demographic and obstetric aspects. Patients in low social class and patients with antenatal and medical complications did not have a higher incidence of meconium staining of amniotic fluid. However, a history of previous spontaneous or induced abortion was significantly more common in the meconium group. The labour performance of these patients and the perinatal outcome are discussed.     

Amniotic Fluid Squalene: A Useful Test in Prolonged Pregnancy

Summary: This study further investigates the predictive value of measurement of squalene in amniotic fluid in assessing the gestational age of the fetus in term and in prolonged pregnancies (>42 weeks). A preliminary finding that high squalene values were characteristic of prolonged pregnancies was confirmed. A retrospective search of medical records from patients whose pregnancies were thought to be prolonged demonstrated that a high percentage of these pregnancies indeed were not so. The availability of a test which is a good indicator of prolonged pregnancy may in fact lower the rate of unnecessary obstetric intervention in prolonged pregnancies     

Midgestational Amniotic Fluid Human Atrial Natriuretic Polypeptide (HANP): Possible Predictor of Third-Trimester Pregnancy-Induced Hypertension

Background. Hypertension in pregnancy in the developing world is largely underreported, misdiagnosed, and untreated, especially in rural settings, though it contributes significantly to maternal and perinatal morbidity and mortality. To reduce general global cardiovascular and cerebrovascular morbidity and mortality, the World Health Organization aims to develop and validate low-resource-use blood pressure devices for use in developing nations. Objective and methods. To describe how existing antenatal care systems provide a useful and relevant model through which to evaluate the potential for this initiative to be applied in low-resource settings and to offer opportunities for much needed further research.