Changes in appearance of amniotic fluid during pregnancy - the macroscore. 1976

M J Verpoest, and J C Seelen, and C F Westerman

During the first two trimesters of pregnancy the amniotic fluid is clear and yellow; during the third trimester the amniotic fluid becomes colourless; then, approximately from the 33rd-34rd week on, cloudiness and flocculation occur, at first very slowly, after the 36th-37th week steadily faster (Tab. I). At term, the amniotic fluid is moderately cloudy and contains a moderate number of flakes of vernix. The appearance of the amniotic fluid depending on the degree of cloudiness and on the number of flakes, has been expressed by means of a score system, the socalled macroscore (Tab. II). Relationships were observed: a) between the disappearance of the yellow colour (bilirubin) and the initial occurrence of cloudiness and flocculation; b) between the duration of pregnancy and the macroscore; from the 32nd-36th week of pregnancy the mean macroscore increases until the second half of the 40th week; then in the 41 st week there is a drop in the mean macroscore, after which a new increase occurs (Fig. 1,2 and 3). c) between the total gestation period at birth and the progression of the macroscore (Fig. 5); when birth takes place earlier (later), the macroscore will increase earlier (later). d) between the total duration of gestation at birth and the macroscore at the end of pregnancy; with an earlier (later) birth, the macroscore is lower (higher) (Fig. 5 and 6). With the macroscore it is possible to determine the duration of pregnancy (b) and the time before birth even more accurately (c). The fairly large standard deviation of the macroscore per pregnancy week (Fig. 1) also in case of a given duration of gestation at birth (Fig. 7) points to a fairly large interindividual variation in the appearance of the amniotic fluid at a certain duration of pregnancy. The macroscore is determined by elements originating from the fetal skin; the cloudiness and flocculation are caused by release of vernix and the flaking off of cells from the stratum corneum. Hence the macroscore reflects changes in the function of the fetal skin and is an indicator of the functional maturation of the fetal skin. The considerable variation of the macroscore at a given duration of pregnancy indicates a great variation of fetal maturation. The fetus that is maturing faster, will be delivered earlier; the fetus that is maturing slower, later (c). This points to a correlation between the degree of fetal maturation and the start of labour. The higher macroscore during the last days before birth in pregnancies of longer duration (d) (Fig. 5 and 6) may be explained by a less sensitive uterus, requiring a greater maturity of the fetus for delivery to start. The drop of the mean macroscore in the 41 st week of pregnancy is due to a sudden increase of lower scores in this week (Fig. 4). A lower score at a given stage of pregnancy means a later birth (Tab. VI and VII). Thus in the 41 st week of pregnancy a considerable group of pregnant women appears, that has a total duration of gestation that is, on the average, two weeks longer than normally...

UI MeSH Term Description Entries
D007745 Labor Onset The beginning of true OBSTETRIC LABOR which is characterized by the cyclic uterine contractions of increasing frequency, duration, and strength causing CERVICAL DILATATION to begin (LABOR STAGE, FIRST ). Labor Onsets,Onset, Labor,Onsets, Labor
D011247 Pregnancy The status during which female mammals carry their developing young (EMBRYOS or FETUSES) in utero before birth, beginning from FERTILIZATION to BIRTH. Gestation,Pregnancies
D011262 Pregnancy Trimester, Second The middle third of a human PREGNANCY, from the beginning of the 15th through the 28th completed week (99 to 196 days) of gestation. Midtrimester,Pregnancy, Second Trimester,Trimester, Second,Midtrimesters,Pregnancies, Second Trimester,Pregnancy Trimesters, Second,Second Pregnancy Trimester,Second Pregnancy Trimesters,Second Trimester,Second Trimester Pregnancies,Second Trimester Pregnancy,Second Trimesters,Trimesters, Second
D011263 Pregnancy Trimester, Third The last third of a human PREGNANCY, from the beginning of the 29th through the 42nd completed week (197 to 294 days) of gestation. Pregnancy, Third Trimester,Trimester, Third,Last Trimester,Last Trimesters,Pregnancies, Third Trimester,Pregnancy Trimesters, Third,Third Pregnancy Trimester,Third Pregnancy Trimesters,Third Trimester,Third Trimester Pregnancies,Third Trimester Pregnancy,Third Trimesters,Trimester, Last,Trimesters, Last,Trimesters, Third
D003720 Densitometry The measurement of the density of a material by measuring the amount of light or radiation passing through (or absorbed by) the material. Densitometries
D005260 Female Females
D005865 Gestational Age The age of the conceptus, beginning from the time of FERTILIZATION. In clinical obstetrics, the gestational age is often estimated from the onset of the last MENSTRUATION which is about 2 weeks before OVULATION and fertilization. It is also estimated to begin from fertilization, estrus, coitus, or artificial insemination. Embryologic Age,Fetal Maturity, Chronologic,Chronologic Fetal Maturity,Fetal Age,Maturity, Chronologic Fetal,Age, Embryologic,Age, Fetal,Age, Gestational,Ages, Embryologic,Ages, Fetal,Ages, Gestational,Embryologic Ages,Fetal Ages,Gestational Ages
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000653 Amniotic Fluid A clear, yellowish liquid that envelopes the FETUS inside the sac of AMNION. In the first trimester, it is likely a transudate of maternal or fetal plasma. In the second trimester, amniotic fluid derives primarily from fetal lung and kidney. Cells or substances in this fluid can be removed for prenatal diagnostic tests (AMNIOCENTESIS). Amniotic Fluid Index,Amniotic Fluid Indices,Amniotic Fluids,Fluid Index, Amniotic,Fluid Indices, Amniotic,Fluid, Amniotic,Fluids, Amniotic,Index, Amniotic Fluid,Indices, Amniotic Fluid

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