Biochemical Composition of Fluids for Amnioinfusion during Fetoscopy

Abstract

Objective: To evaluate which of the commercially available solutions is best suited for amnioinfusion during fetoscopy, based on resemblance with the biochemical properties of amniotic fluid. Materials and Methods: Amniotic fluid samples from 10 pregnancies were studied. Specimens were obtained from 5 pathologic pregnancies (of which 3 were complicated by polyhydramnios) and 5 uncomplicated pregnancies. The concentrations of sodium, potassium, chloride, bicarbonate, calcium, glucose, osmolality, pH, total protein content and albumin were determined in each sample. A literature search (PubMed, Embase) was performed to identify commercially available fluids used for amnioinfusion in clinical practice. The composition of these infusion solutions was compared to the amniotic fluid samples mentioned above. Results: We identified two different electrolyte solutions used in clinical practice for amnioinfusion. We identified four additional commercially available solutions that could potentially be used for amnioinfusion. Most of these infusion solutions differ considerably from midtrimester amniotic fluid samples both in electrolyte composition and pH, with the most striking difference in the latter. Conclusion: Lactated Ringer’s solution approximates amniotic fluid the closest for both electrolyte composition and pH. This infusion solution seems to be the most suitable choice for amnioinfusion during fetoscopy.

Transcriptome Adaptation of Group B Streptococcus to Growth in Human Amniotic Fluid

“…AF is composed mostly of water, urea, small amounts of amino acids, keratin from shed host epithelial cells, and proteins [35], [36], [37]. Thus, AF is relatively poor in nutrients, which means that bacteria with complex nutritional requirements will not grow or grow poorly.…”

Mid-trimester preterm premature rupture of membranes (PPROM): etiology, diagnosis, classification, international recommendations of treatment options and outcome

“…Additional testings, such as nitrazine or the ferning tests, may be applied, if the diagnosis is uncertain; however, contaminating substances could produce a false-positive result in the presence of blood, semen after coitus, alkaline-based antiseptics or bacterial vaginosis. Normal vaginal pH varies between 4.4 and 6.0, whereas pH of amniotic fluid is 8.0 [18]. A manual vaginal examination should be contraindicated in the presence of PPROM because of its association with an increased risk of chorioamnionitis by ascending infection and reduction of the latency period by 9 days on average [21,73].…”

“…The amniotic membranes and the umbilical cord do not have an effective capillary net and the antibiotic from the maternal circulation does not reach the bacteria which is colonized on the surfaces in sufficient concentrations ( Figure 3). Unfortunately, fetal urine containing antibiotic leaves the amniotic cavity through membrane rupture too quickly and is therefore unable to eliminate the bacteria in the amniotic cavity (Figure 3) [14,16,18]. This seems redundant despite multiple studies showing a prolongation of pregnancy and reduction in neonatal morbidity, an analysis of children at age 7 years born to the 4148 women who had completed the ORACLE-1 trial after the prescription of erythromycin, with or without clavulanic acid, did not show any reduction in functional impairment and educational outcomes compared to the placebo group (38.3% vs. 40.4%) [109].…”

Association Analysis Between Maternal Neutrophil Ratio and the Risk of Histological Chorioamnionitis in Pregnant Women with Premature Rupture of Membranes in Late Pregnancy

“…The diagnosis of PROM was made based on the patient’s medical history and physical examination. The diagnostic criteria were as follows: 1 before labor, pregnant women complained of vaginal discharge or moistness in the external genitalia; examination with a speculum showed that fluid was flowing out of the cervical opening or there was a fluid pool in the posterior fornix; ultrasound examination displayed a decrease in amniotic fluid volume before membrane rupture; pH test strip underwent a color change (the normal vaginal pH varies between 4.4 and 6.0, while the pH of amniotic fluid is 8.0); 23 and test positive for insulin-like growth factor. No patients were treated with antibiotics before admission.…”