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Inflammation and infection play a major role in preterm birth. The purpose of this study was to (i) determine the prevalence and clinical significance of sterile intra-amniotic inflammation and (ii) examine the relationship between amniotic fluid (AF) concentrations of high mobility group box-1 (HMGB1) and the interval from amniocentesis to delivery in patients with sterile intra-amniotic inflammation.AF samples obtained from 135 women with preterm labor and intact membranes were analyzed using cultivation techniques as well as broad-range PCR and mass spectrometry (PCR/ESI-MS). Sterile intra-amniotic inflammation was defined when patients with negative AF cultures and without evidence of microbial footprints had intra-amniotic inflammation (AF interleukin-6 ≥ 2.6 ng/mL).(i) The frequency of sterile intra-amniotic inflammation was significantly greater than that of microbial-associated intra-amniotic inflammation [26% (35/135) versus 11% (15/135); (P = 0.005)], (ii) patients with sterile intra-amniotic inflammation delivered at comparable gestational ages had similar rates of acute placental inflammation and adverse neonatal outcomes as patients with microbial-associated intra-amniotic inflammation, and (iii) patients with sterile intra-amniotic inflammation and high AF concentrations of HMGB1 (≥8.55 ng/mL) delivered earlier than those with low AF concentrations of HMGB1 (P = 0.02).(i) Sterile intra-amniotic inflammation is more frequent than microbial-associated intra-amniotic inflammation, and (ii) we propose that danger signals participate in sterile intra-amniotic inflammation in the setting of preterm labor.

Fourteen women admitted in early labor, with intact membranes, were studied. In each woman, two catheters were inserted transcervically; one catheter was inserted into the extraamniotic space before rupture of membranes, and the second catheter was inserted, after artificial rupture of membranes into the intraamniotic cavity. The contraction to contraction difference in active pressure (pressure above the baseline) recorded by the two catheters, as well as the cumulative total active pressure generated (calculated by adding the active pressure of all contractions) throughout labor by the two catheters were compared. Of the 606 contractions analysed, 43.2% showed pressure difference of 0-5 mmHg between the intra amniotic and extraamniotic catheter; 21.3% showed 6-10 mmHg difference, 12.2% showed a difference of 11-15 mmHg, and 23.3% showed a difference greater than 15 mmHg. When total active pressure generated by each catheter for individual patients was calculated, the percentage difference varied from 2.3% to 53.7%. Intrauterine pressure measurements in labour using transducer-tipped catheters inserted in the extraamniotic space may not provide comparable information to a similar catheter inserted intraamniotically when membranes are ruptured.

Three hundred and fifteen pregnancies in the second trimester were terminated by intra-amniotic administration of prostaglandin F2α-The method of administration, dosage, side effects and results are discussed.

In this study, pentraxin 3 (PTX3), C-reactive protein (CRP), and serum amyloid P component (SAP) concentrations in the amniotic fluid of women with preterm pre-labor rupture of membranes (PPROM) were evaluated based on evidence of microbial invasion of the amniotic cavity (MIAC), intra-amniotic inflammation (IAI), and microbial-associated IAI. A total of 149 women with PPROM were included in this study. Amniotic fluid samples were obtained by transabdominal amniocentesis. Amniotic fluid PTX3, SAP, and CRP concentrations were assessed using enzyme-linked immunosorbent assay. PTX3 and CRP concentrations were higher in women with MIAC, IAI, and microbial-associated IAI than in women without these conditions. SAP concentrations were only higher in the presence of IAI and microbial-associated IAI. Amniotic fluid PTX3 concentrations of 11 ng/mL were found to be the best value for identifying the presence of microbial-associated IAI and IAI in women with PPROM. To conclude, amniotic fluid pentraxins are involved in intra-amniotic inflammatory responses in pregnancies complicated by PPROM.

Objective: We developed an improved AFP kit for detecting AFP in leaked amniotic fluid. We studied the relationship between the results of the improved AFP kit and! those of the intra-amniotic PSP dye-injection test (PSP test), and compared the results of two tests with the prognosis for subsequent pregnancy outcome, in order to know the diagnostic value of the two tests for preterm PROM, especially in equivocal cases. Methods: We compared the results of the AFP kit test with those of the PSP test in 8 equivocal cases of preterm PROM (18th to 34th weeks of gestation). Results: The results of the AFP kit test coincided with those of the PSP test in all 8 equivocal cases of preterm PROM. The 4 cases that tested positive resulted in preterm deliveries; and the other 4 cases that tested negative resulted in full-term deliveries. Conclusion: The use of the AFP kit test is useful in assessing the prognosis for subsequent pregnancy in equivocal cases of preterm PROM. The rapid and accurate AFP kit test for diagnosing preterm PROM can be substituted for the PSP test in bedside and outpatient-clinic assessments.

Two premature triplet pregnancies underwent repeated treatment aimed at acceleration of individual fetal lung maturity while administering intravenous tocolytic treatment. From the early third trimester, repeated amniocenteses were used for intra-amniotic administration of thyroxine to each sac, while the individual fetal lung maturation rate was determined by surfactant microviscosity until lung maturity was achieved.

A case is described in which intra-amniotic debris was identified during an ultrasound scan in a woman with polyhydramnios at 33 weeks' gestation. At delivery neonate was found to have severe ichthyosis involving the whole of her head, trunk and limbs, with large plaques of hyperkeratotic skin on the palms of her hands and the soles of her feet. The finding of excessive debris in association with polyhydramnios should raise the possibility of an exfoliative skin disorder. Copyright © 1997 International Society of Ultrasound in Obstetrics and Gynecology

Serial estimations were made of plasma non-esterified fatty acids (NEFA) and glucose in 43 patients, and of plasma cortisol in 27 patients, during mid-trimester abortions induced with intra-amniotic prostaglandin F2alpha (PGF2alpha). The mean plasma concentrations of NEFA, cortisol and glucose showed rises after PGF2alpha. There was no relation betweeen these rises and the induction-delivery interval, signs of fetal distress or of intrauterine fetal death. The changes in plasma NEFA were related to the fasting level and there was an inverse relation between the changes and the patients' weight. A positive correlation existed between the change in plasma concentrations of cortisol and glucose.

The growth of total intrauterine, intra-amniotic and placental volume during the latter half of pregnancy was studied longitudinally with ultrasound in 115 healthy women with normal singleton pregnancies. A parallel planimetric area method was used. The range and distribution of normal values between 20 and 40 weeks was determined for a main study group of 103 primiparous women with which values from 12 parous women were compared. Total intrauterine volume increased from a median of 1006 ml to 4420 ml, intra-amniotic volume from 716 ml to 3406 ml and placental volume, calculated as the difference between total intrauterine and intra-amniotic volume, increased from 259 ml to 801 ml. Variation between individuals was wide at all stages of pregnancy. No significant difference was found between primiparous and parous women. Between successive 5-week periods from 20 to 40 weeks there was evidence that women tended to maintain their initial volume ranking. During the 30-35 week period, rate of growth of total intrauterine and intra-amniotic volume was somewhat faster than the near constant mean rate at other times, while the rate of growth of placental volume decreased after 30 weeks towards term.

Levels of unconjugated oestradiol-17 beta (E2) and testosterone (T) and total oestriol (E3) were measured hourly to 6 h after intra-amniotic (i.a.) (100--200 mg) or intravenous (i.v.) (100 mg) injection of dehydroepiandrosterone sulphate (DHEA-S) in a series of twenty-six women with mid-trimester abortion. Amniotic fluid E2 and T levels were elevated significantly 1--6 h after the i.a. injection of DHEA-S, while the E3 level in amniotic fluid did not change. The i.a. administration also induced significant rises in serum E2 and T levels between 1 and 6 h and in the serum E3 level between 2--6 h. The i.v. injection of DHEA-S was accompanied by significantly elevated serum levels of E2 and T, while the E3 concentration remained unchanged. It appears that following maternal i.v. administration or an amniotic fluid injection, DHEA-S is rapidly converted to E2 and T, and these accumulate in both the maternal circulation and the amniotic fluid. E3, however, is formed only after i.a. administration of DHEA-S, and is selectively transported to the maternal blood.

Summary A double blind trial of the effect of oestriol sulphate on myometrial contractility was performed on 20 post-mature primigravidae. One half were given oestriol sulphate by intra-amniotic injection and the others the solvent vehicle only. The effect of these injections on spontaneous uterine activity was observed for four hours. The membranes were then ruptured and recordings of uterine contractions were made for a further five hours in order to determine whether pre-treatment with oestriol affected the response of the uterus to rupture of the membranes. The oestrogen-treated group did not differ from the placebo group either in endogenous activity or in response to rupture of the membranes.

Summary A double-blind trial of the effect of oestriol sulphate on myometrial activity was performed on 20 women undergoing termination of pregnancy by hypertonic saline at 15 to 18 weeks. Intrauterine instillation of oestriol sulphate did not cause a significant increase in myometrial activity; nor did prior treatment with oestriol sulphate cause a stronger myometrial response to the hypertonic saline. On the average there were non-significant improvements in myometrial activity and the inductiondelivery interval was shorter in the treated group. None of the women given oestriol sulphate required an oxytocin drip while four of the placebo treated patients did so. It is concluded that such oestrogen treatment marginally improves the response of the uterus to intra-amniotic saline.

This report describes a new type of nylon catheter for intra-amniotic pressure measuring. We have monitored the fetal heart rate for some years and on occasions have experienced problems with insertion and blockage of open ended catheters used to measure intra-uterine pressure which is essential for the interpretation of the significance of fetal heart rate changes. Blockage occurs at the distal end of the catheter, due either to the design or to leakage at the point of attachment to the pressure transducer, thus allowing debris to enter and obstruct the distal orifice. The new catheter is designed to overcome these difficulties. The pressure transducer is a device mounted on or near the monitor which converts the pressure in the catheter to an electrical signal. It usually has a Luer fitting for attachment of the catheter.

Summary A patient who had a generalized epileptiform convulsion 25 minutes after the intraamniotic injection of prostaglandin E2 is described.