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Journal of Obstetrics and Gynaecology... Jan 2017OUTCOMES: EVIDENCE: A MEDLINE and KFINDER search was used to identify relevant articles, with review of bibliography identified article including Cochrane reviews and...
OBJECTIVE
OUTCOMES: EVIDENCE: A MEDLINE and KFINDER search was used to identify relevant articles, with review of bibliography identified article including Cochrane reviews and recent review articles.
VALUES
The evidence collected was reviewed by the Diagnostic Imaging Committee of the Society of Obstetricians and Gynecologists of Canada. The recommendations were made according to the guidelines developed by The Canadian Task Force on Preventative Health Care (Table 1).
BENEFITS, HARMS AND COSTS
Amniotic fluid assessment by ultrasound has become an integral part of fetal assessment in modern obstetrics. Abnormalities of fluid volume result in obstetrical intervention and further investigations. In Canada, there are no standard definitions of fluid volume estimation, nor a standard approach to assessing fluid. Multiple randomized trials have suggested that using a Single Pocket Estimation technique (rather than the multi pocket assessment approach known as the amniotic fluid index), will result in fewer obstetrical interventions without any increase in adverse outcomes. Recent literature suggests that there are detectable, modest changes in amniotic fluid that can occur within an hour or two of normal physiological maneuvers. This may account for the variability and inconsistent results from repeated assessments within a short period of time which can lead to confusion and generate further testing. This article hopes to describe the limitations of amniotic fluid assessment, promote a standard method of amniotic fluid assessment, and propose a common set of definitions to be used to describe amniotic fluid volume.
SUMMARY STATEMENTS
RECOMMENDATION.
Topics: Amniotic Fluid; Female; Humans; Pregnancy; Ultrasonography, Prenatal
PubMed: 28062025
DOI: 10.1016/j.jogc.2016.09.012 -
Annals of Medicine 2023Interleukin (IL)-6 is a pro-inflammatory cytokine that plays an important role in preterm birth (PTB), Several meta-analyses investigated the association between IL-6... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Interleukin (IL)-6 is a pro-inflammatory cytokine that plays an important role in preterm birth (PTB), Several meta-analyses investigated the association between IL-6 and PTB, but definitive conclusion has not yet been achieved. This updated meta-analysis aimed to ascertain the association between IL-6 and PTB by examining IL-6 levels in both normal birth and PTB groups.
MATERIAL AND METHODS
Prospective cohort studies were retrieved in PubMed, Embase, and the Cochrane library from their inception until 18 February 2020. The primary outcome was the association between IL-6 and PTB, and secondary outcomes were the association between IL-6 and spontaneous PTB.
RESULTS
Nine studies involving 1904 patients were included. Overall, IL-6 from different sample types (maternal blood, amniotic fluid and cervicovaginal fluid) was associated with PTB (standard mean difference [SMD]: 0.86, 95% confidence interval [CI]: 0.32 to 1.39, < 0.001). Furthermore, the association was significant for IL-6 only in amniotic fluid (SMD: 1.87, 95%CI: 0.82 to 2.93, < 0.001) and cervicovaginal fluid (SMD: 0.46, 95%CI: 0.09 to 0.84, = 0.022), but not significant in maternal blood (SMD: -0.11, 95%CI: -0.57 to 0.34, = 0.623). In addition, IL-6 was also associated with spontaneous PTB (SMD: 1.57, 95% CI: 0.18 to 2.95, < 0.001).
CONCLUSIONS
Based on the available evidence, IL-6 in amniotic fluid and cervicovaginal fluid might be useful for predicting preterm birth.
Topics: Female; Humans; Infant, Newborn; Premature Birth; Interleukin-6; Prospective Studies; Cytokines; Amniotic Fluid
PubMed: 38010798
DOI: 10.1080/07853890.2023.2284384 -
Progress in Neuro-psychopharmacology &... Apr 2021Data regarding the ability of antidepressants to enter fetal, newborn and infant fluids have become gradually available, but mechanisms of antidepressant transfer remain... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
Data regarding the ability of antidepressants to enter fetal, newborn and infant fluids have become gradually available, but mechanisms of antidepressant transfer remain poorly understood. Here we calculated penetration ratios in an array of matrices from combined samples of pregnant/breastfeeding women taking antidepressants.
METHOD
We performed a systematic literature search of PubMed and EMBASE to identify studies with concentrations of antidepressants from maternal blood, amniotic fluid, umbilical cord blood and/or breast milk. Penetration ratios were calculated by dividing the concentrations in amniotic fluid, umbilical cord plasma or breast milk by the maternal plasma concentration. When data from multiple studies were available, we calculated combined penetration ratios, weighting the study mean by study size.
RESULTS
Eighty-five eligible studies were identified. For amniotic fluid, the highest penetration ratios were estimated for venlafaxine (mean 2.77, range 0.43-4.70 for the active moiety) and citalopram (mean 2.03, range 0.35-6.97), while the lowest ratios were for fluvoxamine (mean 0.10) and fluoxetine (mean 0.11, range 0.02-0.20 for the active moiety). For umbilical cord plasma, nortriptyline had the highest ratio (mean 2.97, range 0.25-26.43) followed by bupropion (mean 1.14, range 0.3-5.08). For breast milk, the highest ratios were observed for venlafaxine (mean 2.59, range 0.85-4.85), mianserin (mean 2.22, range 0.80-3.64) and escitalopram (mean 2.19, range 1.68-3.00).
CONCLUSION
We observed considerable variability across antidepressants regarding their ability to enter fetal, newborn and infant fluids. Measuring antidepressant concentrations in a maternal blood sample can provide a reliable estimate of fetal/infant exposure, although further evidence for concentration-dependent effects is required.
Topics: Amniotic Fluid; Antidepressive Agents; Breast Feeding; Female; Fetal Blood; Humans; Infant; Milk, Human; Pregnancy; Pregnancy Complications
PubMed: 33358964
DOI: 10.1016/j.pnpbp.2020.110228 -
Methods in Enzymology 2020Extracellular vesicles (EVs), specifically exosomes of 50-150nm, have emerged as important communication channels between cells and tissues and can be isolated from...
Extracellular vesicles (EVs), specifically exosomes of 50-150nm, have emerged as important communication channels between cells and tissues and can be isolated from multiple biofluids including blood, urine and amniotic fluid. No standardized approach for exosome isolation from these biofluids has been established. This chapter outlines an optimized approach for isolating exosomes from human amniotic fluid samples. Like plasma, amniotic fluid contains many protein and cellular contaminants that requires multiple steps for cleanup. Therefore, to ensure samples contain minimal contaminants, including larger EVs, we also outline multiple methods for characterization of isolated exosomes for size, morphology and protein markers.
Topics: Amniotic Fluid; Biomarkers; Exosomes; Extracellular Vesicles; Humans
PubMed: 33565971
DOI: 10.1016/bs.mie.2020.07.006 -
Best Practice & Research. Clinical... Feb 2016Regenerative medicine has recently been established as an emerging field focussing on repair, replacement or regeneration of cells, tissues and whole organs. The... (Review)
Review
Regenerative medicine has recently been established as an emerging field focussing on repair, replacement or regeneration of cells, tissues and whole organs. The significant recent advances in the field have intensified the search for novel sources of stem cells with potential for therapy. Recently, researchers have identified the amniotic fluid as an untapped source of stem cells that are multipotent, possess immunomodulatory properties and do not have the ethical and legal limitations of embryonic stem cells. Stem cells from the amniotic fluid have been shown to differentiate into cell lineages representing all three embryonic germ layers without generating tumours, which make them an ideal candidate for tissue engineering applications. In addition, their ability to engraft in injured organs and modulate immune and repair responses of host tissues suggest that transplantation of such cells may be useful for the treatment of various degenerative and inflammatory diseases affecting major tissues/organs. This review summarises the evidence on amniotic fluid cells over the past 15 years and explores the potential therapeutic applications of amniotic fluid stem cells and amniotic fluid mesenchymal stem cells.
Topics: Amniotic Fluid; Humans; Mesenchymal Stem Cell Transplantation; Mesenchymal Stem Cells; Multipotent Stem Cells; Regenerative Medicine; Stem Cell Transplantation; Stem Cells
PubMed: 26542929
DOI: 10.1016/j.bpobgyn.2015.08.009 -
Journal of Extracellular Vesicles May 2022Amniotic fluid surrounding the developing fetus is a complex biological fluid rich in metabolically active bio-factors. The presence of extracellular vesicles (EVs) in...
Amniotic fluid surrounding the developing fetus is a complex biological fluid rich in metabolically active bio-factors. The presence of extracellular vesicles (EVs) in amniotic fluid has been mainly related to foetal urine. We here characterized EVs from term amniotic fluid in terms of surface marker expression using different orthogonal techniques. EVs appeared to be a heterogeneous population expressing markers of renal, placental, epithelial and stem cells. Moreover, we compared amniotic fluid EVs from normal pregnancies with those of preeclampsia, a hypertensive disorder affecting up to 8% of pregnancies worldwide. An increase of CD105 (endoglin) expressing EVs was observed in preeclamptic amniotic fluid by bead-based cytofluorimetric analysis, and further confirmed using a chip-based analysis. HLA-G, a typical placental marker, was not co-expressed by the majority of CD105 EVs, in analogy with amniotic fluid stromal cell derived-EVs. At a functional level, preeclampsia-derived EVs, but not normal pregnancy EVs, showed an antiangiogenic effect, possibly due to the decoy effect of endoglin. Our results provide a characterization of term amniotic fluid-EVs, supporting their origin from foetal and placental cells. In preeclampsia, the observed antiangiogenic characteristics of amniotic fluid-EVs may reflect the hypoxic and antiangiogenic microenvironment and could possibly impact on the developing fetus or on the surrounding foetal membranes.
Topics: Amniotic Fluid; Biomarkers; Endoglin; Extracellular Vesicles; Female; Humans; Phenotype; Placenta; Pre-Eclampsia; Pregnancy
PubMed: 35582873
DOI: 10.1002/jev2.12217 -
Journal of Perinatal Medicine Sep 2023This study was conducted to determine whether bacteria, fungi, or archaea are detected in the amniotic fluid of patients who underwent midtrimester amniocentesis for...
OBJECTIVES
This study was conducted to determine whether bacteria, fungi, or archaea are detected in the amniotic fluid of patients who underwent midtrimester amniocentesis for clinical indications.
METHODS
Amniotic fluid samples from 692 pregnancies were tested by using a combination of culture and end-point polymerase chain reaction (PCR) techniques. Intra-amniotic inflammation was defined as an interleukin-6 concentration >2,935 pg/mL.
RESULTS
Microorganisms were detected in 0.3% (2/692) of cases based on cultivation, 1.73% (12/692) based on broad-range end-point PCR, and 2% (14/692) based on the combination of both methods. However, most (13/14) of these cases did not have evidence of intra-amniotic inflammation and delivered at term. Therefore, a positive culture or end-point PCR in most patients appears to have no apparent clinical significance.
CONCLUSIONS
Amniotic fluid in the midtrimester of pregnancy generally does not contain bacteria, fungi, or archaea. Interpretation of amniotic fluid culture and molecular microbiologic results is aided by the assessment of the inflammatory state of the amniotic cavity. The presence of microorganisms, as determined by culture or a microbial signal in the absence of intra-amniotic inflammation, appears to be a benign condition.
Topics: Pregnancy; Female; Humans; Amniotic Fluid; Pregnancy Trimester, Second; Chorioamnionitis; Archaea; Retrospective Studies; Bacteria; Inflammation; Fungi
PubMed: 37194083
DOI: 10.1515/jpm-2022-0604 -
PloS One 2020Amniotic fluid is clinically accessible via amniocentesis and its protein composition may correspond to birth timing. Early changes in the amniotic fluid proteome could...
BACKGROUND
Amniotic fluid is clinically accessible via amniocentesis and its protein composition may correspond to birth timing. Early changes in the amniotic fluid proteome could therefore be associated with the subsequent development of spontaneous preterm delivery.
OBJECTIVE
The main objective of this study was to perform unbiased proteomics analysis of the association between mid-trimester amniotic fluid proteome and spontaneous preterm delivery and gestational duration, respectively. A secondary objective was to validate and replicate the findings by enzyme-linked immunosorbent assay using a second independent cohort.
METHODS
Women undergoing a mid-trimester genetic amniocentesis at Sahlgrenska University Hospital/Östra between September 2008 and September 2011 were enrolled in this study, designed in three analytical stages; 1) an unbiased proteomic discovery phase using LC-MS analysis of 22 women with subsequent spontaneous preterm delivery (cases) and 37 women who delivered at term (controls), 2) a validation phase of proteins of interest identified in stage 1, and 3) a replication phase of the proteins that passed validation using a second independent cohort consisting of 20 cases and 40 matched controls.
RESULTS
Nine proteins were nominally significantly associated with both spontaneous preterm delivery and gestational duration, after adjustment for gestational age at sampling, but none of the proteins were significant after correction for multiple testing. Several of these proteins have previously been described as being associated with spontaneous PTD etiology and six of them were thus validated using enzyme linked immunosorbent assay. Two of the proteins passed validation; Neutrophil gelatinase-associated lipocalin and plasminogen activator inhibitor 1, but the results could not be replicated in a second cohort.
CONCLUSIONS
Neutrophil gelatinase-associated lipocalin and Plasminogen activator inhibitor 1 are potential biomarkers of spontaneous preterm delivery and gestational duration but the findings could not be replicated. The negative findings are supported by the fact that none of the nine proteins from the exploratory phase were significant after correction for multiple testing.
Topics: Adult; Amniocentesis; Amniotic Fluid; Cohort Studies; Female; Gestational Age; Humans; Male; Pregnancy; Pregnancy Trimester, Second; Premature Birth; Proteome
PubMed: 32379834
DOI: 10.1371/journal.pone.0232553 -
American Journal of Obstetrics and... Mar 2016Stem cells are undifferentiated cells with the capacity for differentiation. Amniotic fluid cells have emerged only recently as a possible source of stem cells for... (Review)
Review
Stem cells are undifferentiated cells with the capacity for differentiation. Amniotic fluid cells have emerged only recently as a possible source of stem cells for clinical purposes. There are no ethical or sampling constraints for the use of amniocentesis as a standard clinical procedure for obtaining an abundant supply of amniotic fluid cells. Amniotic fluid cells of human origin proliferate rapidly and are multipotent with the potential for expansion in vitro to multiple cell lines. Tissue engineering technologies that use amniotic fluid cells are being explored. Amniotic fluid cells may be of clinical benefit for fetal therapies, degenerative disease, and regenerative medicine applications. We present a comprehensive review of the evolution of human amniotic fluid cells as a possible modality for therapeutic use.
Topics: Amniocentesis; Amniotic Fluid; Fetal Therapies; Humans; Stem Cell Transplantation; Tissue Engineering
PubMed: 26767797
DOI: 10.1016/j.ajog.2015.12.061 -
The Journal of Maternal-fetal &... Dec 2023The aim of this review is to evaluate the relationship between the use of non-steroidal anti-inflammatory drugs (NSAIDs) during last trimesters of the pregnancy and the... (Review)
Review
OBJECTIVE
The aim of this review is to evaluate the relationship between the use of non-steroidal anti-inflammatory drugs (NSAIDs) during last trimesters of the pregnancy and the reduction of amniotic fluid.
METHODS
Electronic databases were searched (PubMed, Medline, and Scopus). Selection criteria included studies reporting the relationship between oligohydramnios and use of NSAID during pregnancy. We analyzed the median age of women, weeks of pregnancy at the beginning of the drug administration, kind of medication, period of exposure and dosage, deepest vertical pocket (DVP), and amniotic fluid index (AFI).
RESULTS
Of the 68 records identified, we analyzed 29 studies investigating the administration of NSAIDs, including 11 studies examined the administration of the Indomethacin, four articles have focused on the use of Nimesulide, and only two manuscripts considered the use of Diclofenac. We found a strict correlation between the development of oligohydramnios and the use of NSAIDs. The oligohydramnios is reversible, and the normal amount of amniotic fluid is restored after the interruption of the treatment.
CONCLUSIONS
The use of NSAIDs should be considered when maternal benefits outweigh the potential fetal risk, at the lowest effective dose for shortest duration. Beyond 48 h of NSAIDs treatment, we consider ultrasound monitoring of amniotic fluid, and we suggest stopping therapy if a decline AFI is present.
Topics: Pregnancy; Female; Humans; Oligohydramnios; Amniotic Fluid; Anti-Inflammatory Agents, Non-Steroidal; Pregnancy Trimester, Third; Ultrasonography; Pregnancy Outcome
PubMed: 38092425
DOI: 10.1080/14767058.2023.2253956