scholarly journals The Inflammatory Milieu of Amniotic Fluid Increases with Chorio-Deciduitis Grade in Inflammation-Restricted to Choriodecidua, but Not Amnionitis, of Extra-Placental Membranes

2021 ◽  
Vol 10 (14) ◽  
pp. 3041
Author(s):  
Joon Hyung Lee ◽  
Chan-Wook Park ◽  
Kyung Chul Moon ◽  
Joong Shin Park ◽  
Jong Kwan Jun
Keyword(s):  
Inflammatory Response ◽  
Amniotic Fluid ◽  
Pregnant Women ◽  
Preterm Births ◽  
Significant Difference ◽  
Study Population ◽  
Placental Membranes ◽  
Wbc Count ◽  
Inflammatory Milieu

No information exists about whether intra-amniotic inflammatory response increases with a chorio-deciduitis grade in the context of both inflammation-restricted to chorio-decidua and amnionitis of extra-placental membranes among spontaneous preterm births. The objective of current study is to examine this issue. A study population included 195 singleton pregnant women with chorio-deciduitis, and who spontaneously delivered at preterm (21.6~35.7 weeks) within 7 days of amniocentesis. We examined intra-amniotic inflammatory response according to the chorio-deciduitis grade in the context of inflammation restricted to chorio-decidua and amnionitis of extra-placental membranes. Intra-amniotic inflammatory response was measured by MMP-8 concentration (ng/mL) and WBC-count (cells/mm3) in amniotic-fluid (AF). Inflammation restricted to chorio-decidua and amnionitis were present in 47.7% (93/195) and 52.3% (102/195) of cases, respectively. Median AF MMP-8 concentration and WBC-count significantly increased with chorio-deciduitis grade in the context of inflammation restricted to chorio-decidua. However, there was no significant difference in median AF MMP-8 concentration and WBC-count between chorio-deciduitis grade-1 and grade-2 in the context of amnionitis. The inflammatory milieu of AF increases with chorio-deciduitis grade in inflammation-restricted to chorio-decidua, but not amnionitis, of extra-placental membranes. This finding suggests that a chorio-deciduitis grade may have little effect on the intensification of intra-amniotic inflammatory response in the context of amnionitis of extra-placental membranes.

scholarly journals Changes in pregnancy outcomes during the COVID-19 lockdown in Iran

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Fahimeh Ranjbar ◽  
Leila Allahqoli ◽  
Soheila Ahmadi ◽  
Robab Mousavi ◽  
Maryam Gharacheh ◽  
...  
Keyword(s):  
Health Care ◽  
Birth Weight ◽  
Low Birth Weight ◽  
Pregnant Women ◽  
Pregnancy Outcomes ◽  
Health Care Services ◽  
Mode Of Delivery ◽  
Preterm Births ◽  
Future Health ◽  
Significant Difference

Abstract Background The Covid-19 pandemic response is influencing maternal and neonatal health care services especially in developing countries. However, the indirect effects of Covid-19 on pregnancy outcomes remain unknown. The aim of the present study was to compare pregnancy outcomes before and after the beginning of the Covid-19 pandemic in Iran. Methods We performed a retrospective analysis of the medical records of 2,503 pregnant women with singleton pregnancies, admitted to the maternity department of a women’s hospital in Tehran, Iran, during the pre-Covid-19 pandemic (February 19 to April 19, 2019) and the intra-Covid- 19 pandemic (February 19 to April 19, 2020) period. Results We included 2,503 women admitted to the hospital; 1,287 (51.4 %) were admitted before the Covid-19 lockdown and 1,216 (48.6 %) during the Covid-19 lockdown. There were no significant differences in stillbirth rates (p = 0.584) or pregnancy complications (including preeclampsia, pregnancy-induced hypertension and gestational diabetes) (p = 0.115) between pregnant women in the pre- and intra-pandemic periods. However, decreases in preterm births (p = 0.001), and low birth weight (p = 0.005) were observed in the pandemic period compared to the pre-pandemic period. No significant difference in the mode of delivery, and no maternal deaths were observed during the two time periods. Conclusions In our study we observed a decrease in preterm births and low birth weight, no change in stillbirths, and a rise in the admission rates of mothers to the ICU during the initial Covid-19 lockdown period compared to pre-Covid-19 lockdown period. Further research will be needed to devise plan for immediate post-pandemic care and future health care crises.

Inflammatory Response of a New Synthetic Dialyzer Membrane. a Randomised Cross-over Comparison between Polysulfone and Helixone

2003 ◽  
Vol 26 (1) ◽  
pp. 26-32 ◽  
Author(s):  
S. Stefoni ◽  
L. Colì ◽  
G. Cianciolo ◽  
G. Donati ◽  
G. Ruggeri ◽  
...  
Keyword(s):  
Platelet Count ◽  
Inflammatory Response ◽  
Intercellular Adhesion Molecule ◽  
Complement Factor ◽  
Intercellular Adhesion Molecule 1 ◽  
Leukocyte Elastase ◽  
Inflammatory Parameters ◽  
Significant Difference ◽  
Wbc Count

Hemodialysis patients suffer from chronic inflammation due to intradialytic contact of blood with artificial materials. The FX 60 dialyzer which belongs to the new FX-class series of dialyzers is composed of the new membrane Helixone®. This membrane is derived from the original Fresenius Polysulfone® membrane. The FX-class design is based on modified geometry of fibres and housing and has resulted in a new dialyzer with improved efficiency, safety and ease of handling compared to the F series (F 60S) dialyzer. The aim of the study was to investigate whether the biocompatibility pattern in terms of inflammatory parameters of the new type of polysulfone dialyzer has changed compared to the standard. A clinical in vivo study was conducted to compare the intradialytic inflammatory response of the two dialyzers, FX 60 and F 60S. Eight chronic dialysis patients were selected for the study: mean age 65.5±15.5 years, mean time on dialysis 100±95 months. The randomized cross-over study involved a treatment period of 2 weeks (total 6 sessions), one week with each dialyzer, starting with one or the other according to the randomization scheme. Blood samples were taken at 0 (T0), 15, 60, and 240 minutes to evaluate white blood cell (WBC) count, complement factor C5a, leukocyte elastase, soluble intercellular adhesion molecule 1 (sICAM-1), platelet count, C-reactive protein (CRP). At 15 min, WBC count showed a comparably, low decrease for both dialyzers: −7.6 % for FX 60 versus −6.6 % for F 60S, p=not significant (ns). At the same time the C5a concentration decreased from 15.0±7.5 ng/ml to 13.5±6.7 ng/ml (p=ns) for FX 60, and from 15.1±12.5 ng/ml to 14.9±25.0 ng/ml for F 60S (p=ns). The elastase concentration progressively increased over time with no statistical difference between the two dialyzers. The levels of sICAM-1, CRP, and platelet count were similar at each time point for both dialyzers, varying around the baseline values (p=ns). No significant difference emerged in terms of inflammatory response between the two dialyzers, demonstrating that the biocompatibility of the F-series was maintained in the FX-class series of dialyzers and is independent of design factors.

scholarly journals The Influence of Fasting in Summer on Amniotic Fluid During Pregnancy

2016 ◽  
Vol 6 ◽  
pp. 21
Author(s):  
Ayşegül Altunkeser ◽  
Muslu Kazım Körez
Keyword(s):  
Amniotic Fluid ◽  
Pregnant Women ◽  
Fetal Growth ◽  
Growth Parameters ◽  
Fluid Volume ◽  
Control Group ◽  
Growth Data ◽  
Amniotic Fluid Index ◽  
Amniotic Fluid Volume ◽  
Significant Difference

Objectives: Ramadan is a holy month in which eating and drinking are forbidden from dawn to sunset. In this study, we investigated using ultrasonography (USG) whether fasting in summer (as occurred in Ramadan 2014) had an influence on the volume of amniotic fluid during pregnancy. Materials and Methods: The study included 119 pregnant women in total who were admitted to our department with a request of obstetric USG between June 28, 2014, and July 27, 2014. The fasting group included 61 pregnant women and the control group of 58 pregnant women. In our study, all the fasting pregnant women had Sahur (predawn meal eaten before starting fasting) and Iftar (the evening meal for fast-breaking) every day, regularly. The women in the control group did not fast. In addition to amniotic fluid index and fetal biometric measurements during Ramadan, amniotic fluid volume was measured ultrasonographically throughout pregnancy. All ultrasound examinations were performed at least 8 h after Sahur during Ramadan. Chi-square test was utilized to compare the measurements of amniotic fluid volume, and Mann–Whitney U-test was utilized to analyze the differences in fetal growth data. Moreover, difference was considered statistically significant when the P value was <0.05. Results: The mean age was 25.7 years in the fasting group and 25.8 years in the control group. Other characteristics and mean gestational weeks of the two groups were similar. Ultrasonographically, there was no significant difference between two groups in respect to amniotic fluid amount during pregnancy (P = 0.7). There was no significant difference with regard to fetal growth parameters either (P > 0.05). Conclusion: In pregnant women who had regular predawn and fast-breaking meals, fasting in summer did not elicit alteration in the amount of amniotic fluid throughout pregnancy.

scholarly journals Comparison of the Mode of Delivery between COVID and Non-COVID Pregnancies

2021 ◽  
Vol 11 (9) ◽  
pp. 277-283
Author(s):  
Saima Najam ◽  
Shehla Aqeel ◽  
Syeda Ifra Hassan
Keyword(s):  
Caesarean Section ◽  
Pregnant Women ◽  
Null Hypothesis ◽  
Mode Of Delivery ◽  
Active Phase ◽  
Current Evidence ◽  
Control Group ◽  
Significant Difference ◽  
Third Stage ◽  
Study Population

Background: The pregnant women and the newborn infants represent the vulnerable population in every society. Therefore Improvement efforts for the survival and the well being of the mothers and the neonates is indisputably a global priority especially during this pandemic of severe acute respiratory syndrome caused by a novel corona virus, called Covid-19. declared by the WHO ( World Health Association ) as global pandemic on March 11,2020. This pandemic has significantly altered the life styles of the pregnant women, boosting their apprehensions and concerns and importing great impacts on their health management. Current evidence suggests that the pregnant women are not at increased risk of Covid -19 as compared to the other adults. Similarly the condition is not severe in them. At the place of the current study the mode of delivery of the Covid patients is individualized and based on severity of the Covid infection and purely on the obstetric indications, as the evidence suggests that no mode of delivery is superior in terms of prevention of the vertical transmission. Objective: We performed this study to compare the mode of delivery between the pregnant Covid and the non Covid pregnant population with the null hypothesis that the Covid effected pregnant patients are more prone to have caesarean section as compared to non Covid pregnant females and they are more prone to have CTG (cardiotocographic) abnormalities. Material and Methods: It was a retrospective observational study done to compare the mode of delivery and the rate of CTG abnormalities in the study and the control group as the primary outcome. The secondary outcome was duration of active phase of the first stage, second and third stage of the labour between the pregnant Covid and the non Covid pregnant population for a period of 6 months (First January 2021 -30th June 2021) in labor ward of Dr. Sulaiman Al-Habib Hospital, Sweidi, Riyadh, Saudi Arabia. The study population comprised of 100 pregnant patients meeting our inclusion and exclusion criteria. The number of patients in each group was equal. Results: No statistically significant difference was observed in the age, parity and ethnicity of both the groups. The rate of caesarean section was 38% (n=19) in the Covid group while in the control group it was 10% (n=05), the difference is statistically significant as shown by the P-Value of 0.004. No significant difference in the CTG abnormalities was found in both the groups. However statistically significant reduction in the active phase of the first, second and third stage of labour was noted in the study population. Conclusion: We hereby prove our null hypothesis that the Covid-19 effected pregnant patients are prone to have higher caesarean section rate, however no difference in rate of CTG (cardiotocographic) abnormalities was observed in both the groups. Significant reduction in the duration of all stages of the labour was also noticed which is a fruit of thought for the upcoming research. Key words: Pregnancy, labour, caesarean section, Covid-19, duration of labour.

Amniotic fluid concentrations of soluble endoglin and endothelial cell-specific molecule-1 in pregnancies complicated with neural tube defects

2020 ◽  
Vol 48 (2) ◽  
pp. 132-138
Author(s):  
Ali Ovayolu ◽  
Gamze Ovayolu ◽  
Tuncay Yuce ◽  
Murat Aykut Ozek ◽  
Ilkay Dogan ◽  
...  
Keyword(s):  
Endothelial Cell ◽  
Amniotic Fluid ◽  
Pregnant Women ◽  
Neural Tube ◽  
Neural Tube Defects ◽  
Gestational Age ◽  
Enzyme Linked Immunosorbent Assay ◽  
Study Group ◽  
Soluble Endoglin ◽  
Significant Difference

AbstractObjectiveTo determine the concentrations of soluble endoglin (sCD105) and endothelial cell-specific molecule-1 (ESM-1) in the amniotic fluid (AF) of pregnant women, and to investigate the relationship between these concentrations and neural tube defects (NTDs).MethodsAF concentrations of sCD105 and ESM-1 were measured in the study group, which included 60 pregnant women complicated with NTDs, and 64 pregnant women with unaffected healthy fetuses (control group). The AF concentrations of sCD105 and ESM-1 in both groups were measured using enzyme-linked immunosorbent assay and compared.ResultsThere were no significant differences in terms of the mean AF concentrations of sCD105 and ESM-1 between the groups (P=0.141, P=0.084, respectively). There was a significant difference between the AF sCD105 concentrations in those with gestational age <24 weeks (n=101) and ≥24 weeks (n=23) (X̅<24=76.35±126.62 vs. X≥24=39.87±58.32, P=0.041). AF ESM-1 concentrations were found to be statistically significant in the gestational age <22 weeks (n=90) and ≥22 weeks (n=34) groups (X̅<22=135.91±19.26 vs. X̅≥22=148.56±46.85, P=0.035). A positive and low-level relation at a statistically significant level was determined between the gestational age and AF ESM-1 concentration in the study group (r=0.257; P=0.048).ConclusionAF concentrations of sCD105 and ESM-1 were not associated with the development of NTDs. Unlike studies that reported that ESM-1 concentrations decreased in maternal plasma with increased gestational age, we determined an increase that was proportionate to gestational age in AF.

scholarly journals Cellular immune responses in amniotic fluid of women with preterm prelabor rupture of membranes

2020 ◽  
Vol 48 (3) ◽  
pp. 222-233 ◽  
Author(s):  
Jose Galaz ◽  
Roberto Romero ◽  
Rebecca Slutsky ◽  
Yi Xu ◽  
Kenichiro Motomura ◽  
...  
Keyword(s):  
T Cells ◽  
Immune Responses ◽  
Amniotic Fluid ◽  
Preterm Births ◽  
Neonatal Morbidity ◽  
Cellular Immune Responses ◽  
Prelabor Rupture Of Membranes ◽  
Wbc Count ◽  
Cellular Immune ◽  
Fluid Culture

Abstract Background Preterm birth is the leading cause of perinatal morbidity and mortality. Preterm prelabor rupture of membranes (pPROM) occurs in 30% of preterm births; thus, this complication is a major contributor to maternal and neonatal morbidity. However, the cellular immune responses in amniotic fluid of women with pPROM have not been investigated. Methods Amniotic fluid samples were obtained from women with pPROM and a positive (n = 7) or negative (n = 10) microbiological culture. Flow cytometry was performed to evaluate the phenotype and number of amniotic fluid leukocytes. The correlation between amniotic fluid immune cells and an interleukin-6 (IL-6) concentration or a white blood cell (WBC) count in amniotic fluid was calculated. Results Women with pPROM and a positive amniotic fluid culture had (1) a greater number of total leukocytes in amniotic fluid, including neutrophils and monocytes/macrophages and (2) an increased number of total T cells in amniotic fluid, namely CD4+ T cells and CD8+ T cells, but not B cells. The numbers of neutrophils and monocytes/macrophages were positively correlated with IL-6 concentrations and WBC counts in amniotic fluid of women with pPROM. Conclusion Women with pPROM and a positive amniotic fluid culture exhibit a more severe cellular immune response than those with a negative culture, which is associated with well-known markers of intra-amniotic inflammation.

The association of the IL-1β-31 polymorphism and the development of neuroinfections

10.20883/156 ◽  
2016 ◽  
Vol 85 (4) ◽  
pp. 289
Author(s):  
Grażyna Biesiada ◽  
Jacek Czepiel ◽  
Anna Piątek ◽  
Malwina Birczyńska ◽  
Justyna Żurańska ◽  
...  
Keyword(s):  
Inflammatory Response ◽  
Viral Meningitis ◽  
Control Group ◽  
Nucleotide Polymorphisms ◽  
Single Nucleotide ◽  
Tnf Α ◽  
Significant Difference ◽  
Laboratory Results ◽  
Genes Encoding ◽  
Wbc Count

Introduction. Inflammation of the meninges can have various clinical courses, from mild, self‑limiting in some viral neuroinfections to severe, sometimes ending in death. The pro‑inflammatory cascade and defects in the inhibitors of the inflammatory response play an important prognostic role. Single nucleotide polymorphisms (SNPs) of the genes encoding cytokines, influence the severity of the inflammatory response.Aim. The aim of this study was to evaluate the effect of selected polymorphisms of proinflammatory cytokines IL-1β, TNF‑α and IL-8 on the development of neuroinfections.Material and Methods. We evaluated the laboratory results of 30 patients treated for bacterial and viral meningitis and compared those to 30 healthy volunteers. The following 4 variants were analyzed for occurrence of genetic polymorphism in patients with meningitis versus the control group: IL-1β 3953, IL-1β -31, TNF‑α -308, and IL-8 781. Then, we assessed the association between these genetic polymorphisms and the inflammatory response during the course of meningitis.Results and Conclusions. We observed that polymorphism of the IL-1β-31 significantly differs between patients and healthy subjects, the IL-1β -31AA polymorphism existed only in healthy individuals (p < 0.001). The WBC count was dependent on the TNF‑α -308 polymorphism with a statistically significant difference (p = 0.021) occurring among persons with variants AA and AG. In conclusion the study showed that the presence of the AA genotype of IL-1β-31polymorphism may have a protective effect on the development of meningitis. This polymorphism was not observed in any patient with meningitis.

scholarly journals The earlier the gestational age, the greater the intensity of the intra-amniotic inflammatory response in women with preterm premature rupture of membranes and amniotic fluid infection by Ureaplasma species

2019 ◽  
Vol 47 (5) ◽  
pp. 516-527 ◽  
Author(s):  
Kyung Joon Oh ◽  
Roberto Romero ◽  
Jee Yoon Park ◽  
Joon-Seok Hong ◽  
Bo Hyun Yoon
Keyword(s):  
Inflammatory Response ◽  
Amniotic Fluid ◽  
Gestational Age ◽  
Maternal Blood ◽  
Late Preterm ◽  
Premature Rupture Of Membranes ◽  
Premature Rupture ◽  
Preterm Premature Rupture ◽  
Group 2 ◽  
Wbc Count

AbstractObjectivesTo determine the relationship between the intensity of the intra-amniotic inflammatory response and the gestational age at the time of diagnosis in cases with preterm premature rupture of membranes (PROM) and intra-amniotic infection caused byUreaplasmaspp.MethodsA retrospective cohort study was conducted which included 71 women with preterm PROM and a positive amniotic fluid culture withUreaplasmaspp. Women with mixed intra-amniotic infections were excluded. The study population was classified into three groups according to gestational age: group 1, <26 weeks (extreme preterm PROM, n = 17); group 2, 26.0–33.9 weeks (moderate preterm PROM, n = 39); group 3, 34.0–36.9 weeks (late preterm PROM, n = 15). The intensity of the intra-amniotic and maternal inflammatory response was compared among the three groups. The intensity of the intra-amniotic inflammatory response was assessed by the concentration of amniotic fluid matrix metalloproteinase-8 (MMP-8) and white blood cell (WBC) count. The maternal inflammatory response was assessed by the concentration of C-reactive protein (CRP) and WBC count in maternal blood at the time of amniocentesis.Results(1) The median values of amniotic fluid MMP-8 concentration and WBC count were the highest in the extreme preterm PROM group and the lowest in the late preterm PROM group (P < 0.001 and P = 0.01, respectively); (2) the intensity of the maternal inflammatory response measured by maternal blood WBC count and CRP concentration was not significantly associated with gestational age at the time of diagnosis.ConclusionThe earlier the gestational age at the time of PROM, the higher the intensity of the intra-amniotic inflammatory response in women with preterm PROM and intra-amniotic infection caused byUreaplasmaspp.

scholarly journals The association of the IL-1ß-31 polymorphism and the development of neuroinfections

2016 ◽  
Vol 85 (4) ◽  
pp. 289-293
Author(s):  
Grażyna Biesiada ◽  
Jacek Czepiel ◽  
Anna Piątek ◽  
Malwina Birczyńska ◽  
Justyna Żurańska ◽  
...  
Keyword(s):  
Inflammatory Response ◽  
Viral Meningitis ◽  
Control Group ◽  
Nucleotide Polymorphisms ◽  
Prognostic Role ◽  
Single Nucleotide ◽  
Significant Difference ◽  
Laboratory Results ◽  
Genes Encoding ◽  
Wbc Count

Introduction. Inflammation of the meninges can have various clinical courses, from mild, self-limiting in some viral neuroinfections to severe, sometimes ending in death. The pro-inflammatory cascade and defects in the inhibitors of the inflammatory response play an important prognostic role. Single nucleotide polymorphisms (SNPs) of the genes encoding cytokines, influence the severity of the inflammatory response.Aim. The aim of this study was to evaluate the effect of selected polymorphisms of proinflammatory cytokines IL-1ß, TNF-? and IL-8 on the development of neuroinfections.Material and Methods. We evaluated the laboratory results of 30 patients treated for bacterial and viral meningitis and compared those to 30 healthy volunteers. The following 4 variants were analyzed for occurrence of genetic polymorphism in patients with meningitis versus the control group: IL-1ß 3953, IL-1ß -31, TNF-? -308, and IL-8 781. Then, we assessed the association between these genetic polymorphisms and the inflammatory response during the course of meningitis.Results and Conclusions. We observed that polymorphism of the IL-1ß-31 significantly differs between patients and healthy subjects, the IL-1ß -31AA polymorphism existed only in healthy individuals (p < 0.001). The WBC count was dependent on the TNF-? -308 polymorphism with a statistically significant difference (p = 0.021) occurring among persons with variants AA and AG. In conclusion the study showed that the presence of the AA genotype of IL-1ß-31polymorphism may have a protective effect on the development of meningitis. This polymorphism was not observed in any patient with meningitis.

scholarly journals Hubungan Asupan Cairan Ibu Hamil terhadap Indeks Cairan Amnion

2018 ◽  
Vol 5 (2) ◽  
pp. 89
Author(s):  
Eny Fatmawati ◽  
Diah Rumekti Hadiati ◽  
Heru Pradjatmo
Keyword(s):  
Amniotic Fluid ◽  
Pregnant Women ◽  
Fluid Intake ◽  
Scientific Basis ◽  
Amniotic Fluid Index ◽  
The Third ◽  
Significant Difference ◽  
External Variables ◽  
Observational Cohort ◽  
The Mean

Introduction: Adequate amniotic fluid volume is a requirement for intra uterine fetal development and good pregnancy outputs / neonatal. Adequate intake of fluid in pregnant women can increase both the amniotic fluid index on oligohydramniotic or normoamniotic, but the scientific basis for the adequacy of the recommended daily fluid have not clear yet. Furthermore, the fluid intake counseling in addition to nutrition for pregnant women is neededObjective: To determine the fluid intake in pregnant women and the mean difference of  amniotic fluid index on adequate fluid intake compared to less fluid intake.Methods: This research used prospective observational cohort study, conducted against the third semester pregnant women in Puskesmas Mergangsan and Tegalrejo Yogyakarta during July until September 2014. The subjects who met the inclusion criteria were divided into adequate and less fluid intake groups. The correlation between fluid intake and amniotic fluid index was analyzed using t-test and linear regression.Result and Discussion: The total subjects who met the criteria were 27 people, consist of 12 people in adequate fluid intake group and 15 people in less fluid intake group. The mean of subject’s fluid intake 2078 ml (enough), while the mean of amniotic fluid index (AFI) 12,76 cm (normoamniotic).The result showed that there was a significant difference (3,50 cm (IK 95%; 1,5-5,48); P < 0,05) between the mean of AFI from adequate fluid intake group compared to less fluid intake group . Simple linear regression test showed the effect of fluid intake for AFI namely 31,7%; with the amount of predicted AFI = 10,686 + 3,545 x fluid intake – 1,015 x age – 1,317 x education + 0,314 x occupation (ARS= 44,5%). External variables (age, education, and occupation) had no significant effect for AFI .Conclusion : The mean preview of fluid intake in the third semester pregnant women in Yogyakarta was adequate. Moreover, there was a AFI signifficant difference between adequate fluid intake compared to less fluid intake.  Keywords: fluid intake; amniotic fluid index; AFI

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