T.A. Doran

Composition of the amniotic fluid and maternal serum in pregnancy

Abstract The following parameters in maternal serum and amniotic fluid were simultaneously estimated at varying periods of gestation by manual and automated techniques in 252 samples: bilirubin, sodium, potassium, chloride, total CO 2 , urea nitrogen, glucose, uric acid, creatinine, total protein, albumin, osmolality, alkaline phosphatase, acid phosphatase, lactic dehydrogenase, hydroxybutyric dehydrogenase, and creatine kinase. Analysis of the results established norms for several parameters and indicated areas of difference from results of other workers. Emphasis is placed on the need for further biochemical studies of this nature.

Maternal serum α-fetoprotein and fetal autosomal trisomies

Abstract Maternal serum α-fetoprotein values in 61 patients with fetal autosomal trisomies diagnosed at 6581 genetic amniocenteses were significantly lower than those in an equal number of matched control subjects. The genetic risk of fetal autosomal trisomies for women

Genetic amniocentesis in seventy twin pregnancies

Genetic amniocenteses were performed in 70 twin pregnancies over an 11-year period. Both sacs were successfully sampled in 49 of 62 patients (79%). The success rate was decreased (68%) with two placentas (anterior and posterior) and was improved with gestational age greater than or equal to 17 weeks (88%) and with ultrasound visualization of the septum (86%). Of three spontaneous abortions, two were attributed to amniocentesis (chorioamnionitis). When twin pregnancy is diagnosed in a patient with an indication for genetic amniocentesis, a careful reevaluation and discussion of risk factors with the couple are recommended.

Amniotic fluid tests for fetal maturity in normal and abnormal pregnancies.

Amniotic fluid creatinine, percentage of lipid-positive cells, and L/S ratio were determined on 285 samples from normal pregnancies and 222 samples from abnormal pregnancy states (Rh isoimmunization, diabetes, hypertensive disorders, intrauterine growth retardation, and hydramnios). In normal pregnancy the coefficient of correlation between true gestational age and estimated period of gestation (EPG) based on the three parameters was 0.94, in Rh isoimmunization 0.77, in diabetes 0.67, and in hypertensive disorders 0.59. In intrauterine growth retardation both the L/S ratio and creatinine were depressed, the coefficient was 0.61, and the EPG was consistently less than the true gestational age. The mean L/S ratio in pre-eclampsia was slightly below the normal mean and in diabetes the mean L/S ratio was also depressed. In 150 samples taken within 48 hours of delivery L/S ratios were accurate in assessing fetal pulmonary maturity although there was a 20 per cent incidence over all of false-immature values. There were no false-mature values except in diabetes (2/9).

Amniotic fluid tests for fetal maturity

Abstract Eighteen biochemical parameters and one cytologic test (percentage of lipid-positive cells) in amniotic fluid were assessed for their value in establishing fetal maturity. Ten parameters showed a trend with gestation but the three best tests were percentage of lipid-positive cells, lecithin/sphingomyelin ratio (L/S), and creatinine. With the use of a graph containing the mean value of the three key parameters, an estimated period of gestation was produced which was 95 per cent accurate for any individual sample. With some minor deviations the three tests and the estimated period of gestation based on the three tests continued to be accurate in abnormal pregnancy states.

Infant outcome following mid-trimester amniocentesis: development and physical status at age six months.

Summary. Ninety‐one infants whose mothers had had amniocentesis, because age increased their risk for a fetal chromosome abnormality, were compared with 53 infants whose mothers chose not to have the test. Mental and motor development and temperament were studied to assess potential influence of amniocentesis on the brain. Physical growth was assessed and the infants were examined for orthopaedic abnormalities and needle injury. The results indicated that amniocentesis does not appear to influence infant mental and motor development, temperament, physical growth or the risk of orthopaedic abnormalities. However, amniocentesis is not entirely free of risk because several of the infants had needle marks. Reassessment of the cohort at age 4 and 7 years and will provide information on the potential longer term consequences of mid‐trimester amniocentesis.

Midtrimester amniocentesis: Obstetric outcome and neonatal neurobehavioral status

The possible effects of midtrimester genetic amniocentesis on neurobehavioral status were studied in newborn infants of women who had had the procedure (N = 100) and in newborn infants of women who had declined the test (N = 56). Brazeltons Neonatal Behavioral Assessment Scale was administered to newborn infants born at term and did not reveal consequences of amniocentesis on neonatal orientation, range of state, motor ability, autonomic regulation, regulation of state, response decrement, or reflexes. Information on obstetric complications also was obtained. The findings raised questions regarding the temporal relationship between amniocentesis and fetal loss and focused attention on preterm birth as a potential risk that warrants further investigation. This study provides the foundation for our prospective longitudinal follow-up in which the cohort will be reassessed later in infancy and in childhood.

The effect of maternal steroid administration on fetal platelet count in immunologic thrombocytopenic purpura: Management of pregnancy and mode of delivery

Eight pregnancies complicated by immunologic thrombocytopenic purpura are described and the literature is reviewed. We conclude that, while steroid treatment favorably influenced fetal platelet counts in our cases, overall experience with this disease indicates that such protection is incomplete in some cases and unnecessary in others. Antiplatelet antibody levels show promise as excellent indicators of fetal thrombocytopenia, and elevated levels may be an indication for steroid therapy for the improvement of fetal well-being in some cases.

Amniotic fluid lecithin/sphingomyelin ratio, palmitic acid, palmitic acid/stearic acid ratio, total cortisol, creatinine, and percentage of lipid-positive cells in assessment of fetal maturity and fetal pulmonary maturity: A comparison

Lecithin/sphingomyelin (L/S) ratio, creatinine, percentage of lipid-positive cells, palmitic acid, palmitic acid/stearic acid (P/S) ratio, and total cortisol were analyzed as tests for fetal maturity and fetal pulmonary maturity in 164 samples of amniotic fluid from 121 patients. Fifty samples were taken within 72 hours of delivery. The best tests for fetal maturity (37 weeks) with differential percentages were L/S ratio, palmitic acid, and P/S ratio. In the assessment of fetal pulmonary maturity, we studied an additional 174 samples in which only L/S ratio, creatinine, and lipid-positive cells were analyzed. All tests showed a high predictive value of an immature (positive) result was much less for all six parameters; the three best tests were total cortisol (33%), lipid-positive cells (26%) and L/S ratio (14%).

Prenatal diagnosis of fetal sex by amniotic fluid testosterone and FSH, and their potential use in detecting sex linked disorders

Amniotic fluid testosterone was assayed by radioimmunoassay in 971 samples at 16-18 weeks gestation. FSH assay was performed in 353 of these samples. Correct prediction of fetal sex (46%) was made in all samples with a testosterone level above 338 ng/L for all males, and below 162 ng/L for females. For 45% of samples with FSH levels below 7.6 IU/L for males and 10.9 IU/L for females the fetal sex was predicted correctly. By using a testosterone/FSH ratio, the diagnostic accuracy was 80%. The anmiotic fluid of ten Duchenne Muscular Dystrophy carrier mothers were studied and only the sex of one case could not be predicted. The amniotic fluid testosterone and FSH assays could be used as a rapid biochemical screening method for predicting fetal sex in X-linked disorders before birth.