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R e l a t i o n s h i p b e t w e e n the p r o c o a g u l a t o r y a c t i v i t y a n d t h e l u n g m a t u r i t y i n a m n i o t i c f l u i d " ^
W. R a t h , A . W . B e h b e h a n i * , R . U l b r i c h , R . H i l g e r s , A . W e i ß * ( D e p t . o f P e d i a t r i c s , U n i v . o f G o e t t i n g e n )
I n a d d i t i o n t o t h e i n c r e a s e i n s u r f a c t a n t i n a m n i o t i c f l u i d d u r i n g t h e c o u r s e o f p r e g n a n c y t h e r e i s a l s o a n i n c r e a s e i n t h e p r o c o a g u l a t o r y a c t i v i t y o f t h e a m n i o t i c f l u i d . T h i s p r o c o a g u l a t o r y a c t i v i t y i n c r e a s e i s d e r i v e d f r o m a p h o s p h o l i p i d - d e p e n d e n t a c t i v a t i o n of f a c t o r X
( 2 , 4 ) .
The aim of t h i s s t u d y was to d e t e r m i n e the c o u r s e of the d e v e l o p m e n t o f t h i s a c t i v i t y , i t s r e l a t i o n t o t h e f e t a l l u n g m a t u r i t y a s w e l l a s t h e c l i n i c a l s t a t e o f t h e n e w - b o r n . As a p r e r e q u i s i t e for t h i s s t u d y reported m e t h o d s f o r t h e d e t e r m i n a t i o n o f c o a g u - l a t i o n tests i n a m n i o t i c f l u i d were e v a l u a t e d a n d , w h e r e n e c e s - s a r y , m o d i f i e d . - A t o t a l of 146 s a m p l e s o f a m n i o t i c f l u i d f r o m the 1 5 t h to 43rd w e e k s of p r e g - n a n c y were taken by e i t h e r t r a n s - a b d o m i n a l a m n i o c e n t e s i s o r a m n i o tomy d u r i n g b i r t h . I n a d d i t i o n t o t h e P / S r a t i o t h e f o l l o w i n g c o a g u l a t i o n tests were d e t e r - m i n e d a f t e r c e n t r i f u g a t i o n : c l o t t i n g t i m e , m o d i f i e d p r o t h r o m b i n t i m e ( Q u i c k ) , P T T
( 3 7 ° C ) , P T T ( 5 6 ° C ) , r e c a l c i f i c a t i o n t i m e a n d , i n s e l e c - t e d s a m p l e s , t h r o m b e l a s t o g r a m s ( T E G ) . Al.l s a m p l e s c o n - t a m i n a t e d w i t h b l o o d o r m e c o n i u m were d i s c a r d e d .
In the c o u r s e of p r e g n a n c y t h e r e is a s i g n i f i c a n t s h o r t e n i n g o f a l l c o a g u l a t i o n tests m e a s u r e d ( W i l c o x o n test < 0 . 0 0 1 ) . T h i s w a s p a r t i c u l a r l y e v i d e n t i n t h e m o d i - f i e d Q u i c k ( F i g . 1 ) a n d t h e r - t i m e i n t h e T E G ( F i g . 2 ) . C o m p a r i n g t-he v a l u e s o b t a i n e d i n t h e 1 5 t h t o 1 7 t h a n d t h e 37th to 43rd w e e k s of g e s t a t i o n and l i t e r a t u r e r e s u l t s t h e f o l l o w i n g v a l u e s m a y i n d i c a t e f e t a l m a t u r i t y : c l o t t i n g t i m e < 1 0 0 s e c , m o d i f i e d Q u i c k < 8 0 s e c , PTT ( 3 7 ° C ) < 3 0 s e c , P T T ( 5 6 ° C ) < 2 9 s e c and r e c a l c i f i c a t i o n t i m e ^ 8 0 s e c . T h e l o w e r l i m i t f o r P / S r a t i o i n n o r m a l p r e g n a n c y i s 5 , 0 ( 3 )
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m?s t 24 h o u r s b e f o r e d e l i v e r y . T h e r e was no case of KDS i n t h i s g r o u p . T h e r e s u l t s o f a m n i o t i c f l u i d i n v e s t i - g a t i o n s were c o r r e l a t e d w i t h f e t a l o u t c o m e . E l i m i n a t i n g
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i n t e r m e d i a t e P/S v a l u e s of 4,5 to 5,0 a f a l s e n e g a t i v e rate o f 1 , 7 % f o r t h e p r e d i c t i o n o f f e t a l l u n g m a t u r i t y w a s s e e n . T h e c o r r e s p o n d i n g r a t e f o r t h e m o d i f i e d Q u i c k w a s 3 , 4 % a n d f o r t h e c l o t t i n g t i m e 6 , 4 % .
In the 30th to 36th weeks of g e s t a t i o n 18 c h i l d r e n were b o r n w i t h i n 2 4 h o u r s o f s a m p l i n g o f a m n i o t i c f l u i d , o f t h e s e , 7 s u f f e r e d f r o m RDS of v a r i o u s d e g r e e s . In t h e s e 7 RDS cases all cases c o u l d be p r o p e r l y p r e d i c t e d f r o m t h e r e c a l c i f i c a t i o n t i m e a n d t h e PIT ( 3 7 ° C ) ( F i g . 3 ) . T h e
u s u a l l i m i t o f 5 , 0 f o r t h e P / S r a t i o i n n o r m a l p r e g n a n c y m a y n o t a l w a y s b e s t r i c t l y v a l i d , e s p e c i a l l y i n cases o f m a t e r n a l i n s u l i n - d e p e n d e n t d i a b e t e s
m e l l i t u s ( 1 ) . T h e f a l s e n e g a t i v e r a t e i n t h i s g r o u p f o r a l l c o a - g u l a t i o n tests t a k e n t o g e t h e r was a b o u t 5 0 % ; on the o t h e r
h a n d , t h e P / S r a t i o showed i n t h i s g r o u p n o f a l s e n e g a t i v e s .- T h e p r e s e n t r e s u l t s c o n f i r m t h e i n c r e a s e i n t h e p r o c o a g u l a t o r y a c t i v i t y i n a m n i o t i c f l u i d i n t h e c o u r s e o f p r e g n a n c y . T h e r e c a l c i f i c a t i o n t i m e a n d t h e P T T ( 3 7 ° C ) s u c c e e d e d i n p r e d i c t i n g t h e p u l m o n a r y s t a t u s of the n e w b o r n in the 7 RDS c a s e s . The f e t a l l u n g m a t u r i t y may be e v a l u a t e d by m e a n s of s i m p l e and r a p i d c o a g u l a t i o n tests a n d t h i s m a y b e u s e f u l i n t h e j u d g i n g of the n e e d for RDS p r o p h y l a c t i c t h e r a p y . The use of more t h a n one test may e n h a n c e the degree of c o n f i d e n c e in p r e d i c t i n g t h e p u l m o n a r y s t a t u s . T h e d e t e r m i n a t i o n o f t h e L / S o r P / S r a t i o s , h o w e v e r , c a n n o t y e t b e d i s p e n s e d w i t h . F u r t h e r i n v e s t i g a t i o n s a r e n e c e s s a r y t o e s t a b l i s h the r e l i a b i l i t y o f c o a g u l a t i o n tests i n t h e p r e d i c t i o n o f f e - t a l l u n g m a t u r i t y .
R e f e r e n c e s :
1 . O ' N e i l , G . J . , I . J . D a v i e s , J . S i u : P a l m i t i c / s t e a r i c r a t i o o f a m n i o t i c f l u i d i n d i a b e t i c a n d n o n d i a b e t i c p r e g n a n c i e s a n d i t s r e l a t i o n s h i p t o d e v e l o p m e n t o f r e s p i r a t o r y d i s t r e s s s y n d r o m e .
Am. J . O b s t e t . G y n e c o l . 1 3 2 ( 1 9 7 8 ) 5 1 9
2 . P h i l l i p s , L . L . , E . C . D a v i d s o n : P r o c o a g u l a n t p r o p e r t i e s o f a m n i o t i c f l u i d . A m . J . O b s t e t . G y n e c o l . 1 1 3 ( 1 9 7 2 ) 9 1 1 3 . S c h i r a r . , Α . , J . P . V i e l h , L . G . A l c i n d o r , J . P . G a u t r a y : A m n i o t i c f l u i d p h o s p h o l i p i d s a n d f a t t y a c i d s i n n o r m a l
p r e g n a n c i e s . A m . J . O b s t e t . G y n e c o l . 1 2 1 ( 1 9 7 5 ) 6 5 3 4 . Y a f f e , H . , A . E l d o r , E . H o r n s h t e i n , E . S a d o v s k y : T h r o m b o p l a s t i c a c t i v i t y i n a m n i o t i c f l u i d d u r i n g p r e g - n a n c y . O b s t e t . G y n e c o l . 5 0 ( 1 9 7 7 ) 4 5 4
D r . W . R a t h , U n i v e r s i t t s - F r a u e n k l i n i k G t t i n g e n , H u m b o l d t a l l e e 3, D - 3 4 0 0 G t t i n g e n
