title: Biochemical analysis of ascites fluid as an aid to etiological diagnosis: a series of 100 cases of nonimmune fetal ascites.
abstract: OBJECTIVE
  The aim of this study is to analyze the contribution of biochemistry and cytology of fetal ascites fluid to the etiological diagnosis of ascites after ultrasonographic scan, maternal blood sampling, and fetal karyotyping.
  
  
  METHODS
  This is a retrospective study of 100 consecutive cases of nonimmune fetal ascites in which ascites fluid was sampled. All women underwent referral ultrasound scan and fetal karyotyping. All cases of fetal ascites were studied by biochemistry (total protein, β2 -microglobulin, IgM, gamma-glutamyl transpeptidase, aspartate aminotransferase, aminopeptidase M, and intestinal isoform of alkaline phosphatase) and cytology (lymphocyte count and vacuolated cells).
  
  
  RESULTS
  The etiology of ascites was diagnosed at ultrasound scan in only 50% of cases. We observed significantly (P < 0.001) low levels of total protein in ascites of urinary origin, high levels of digestive enzymes in ascites of digestive origin, and high β2 -microglobulin in infectious ascites. Vacuolated cells were observed in all ten storage metabolic diseases.
  
  
  CONCLUSIONS
  Sampling of fetal ascites fluid for biochemical and cytological examination provides important additional information. We propose a two-step management: (1) detailed ultrasound scan examination, maternal blood analysis, and fetal karyotyping and (2) biochemical and cytological analyses. On the basis of such an approach, 63% and 96% of etiologies would have been identified in our series after the first and second steps, respectively. © 2014 John Wiley & Sons, Ltd.
authors.affiliation: Biochimie-Hormonologie, CHU Robert Debré AP-HP, Paris, France.
authors.forename: Sophie
authors.initials: S
authors.lastname: Dreux
authors.forename: Laurent J
authors.initials: LJ
authors.lastname: Salomon
authors.forename: Jonathan
authors.initials: J
authors.lastname: Rosenblatt
authors.forename: Romain
authors.initials: R
authors.lastname: Favre
authors.forename: Véronique
authors.initials: V
authors.lastname: Houfflin-Debarge
authors.forename: Bernard
authors.initials: B
authors.lastname: Broussin
authors.forename: Fabien
authors.initials: F
authors.lastname: Guimiot
authors.forename: Honorine
authors.initials: H
authors.lastname: Fenaux
authors.forename: Anne-Lise
authors.initials: AL
authors.lastname: Delezoide
authors.forename: Françoise
authors.initials: F
authors.lastname: Muller
mesh_terms: D000469:Alkaline Phosphatase / Q000378:metabolism; D000740:Anemia / Q000150:complications* / Q000175:diagnosis / Q000378:metabolism; D000782:Aneuploidy; D001201:Ascites / Q000000981:diagnostic imaging / Q000209:etiology* / Q000378:metabolism; D001202:Ascitic Fluid / Q000737:chemistry* / Q000166:cytology; D001219:Aspartate Aminotransferases / Q000378:metabolism; D018826:CD13 Antigens / Q000378:metabolism; D002915:Chylous Ascites / Q000175:diagnosis / Q000378:metabolism; D015331:Cohort Studies; D004066:Digestive System Diseases / Q000150:complications* / Q000175:diagnosis / Q000378:metabolism; D005260:Female; D005315:Fetal Diseases / Q000000981:diagnostic imaging / Q000209:etiology* / Q000378:metabolism; D058851:GPI-Linked Proteins / Q000378:metabolism; D006330:Heart Defects, Congenital / Q000150:complications* / Q000175:diagnosis / Q000378:metabolism; D006801:Humans; D007075:Immunoglobulin M / Q000378:metabolism; D018655:Lymphocyte Count; D011247:Pregnancy; D011506:Proteins / Q000378:metabolism; D012189:Retrospective Studies; D016216:Ultrasonography, Prenatal; D014570:Urologic Diseases / Q000150:complications* / Q000175:diagnosis / Q000378:metabolism; D014617:Vacuoles; D014777:Virus Diseases / Q000150:complications* / Q000175:diagnosis / Q000378:metabolism; D001613:beta 2-Microglobulin / Q000378:metabolism; D005723:gamma-Glutamyltransferase / Q000378:metabolism
chemical_list: D058851:GPI-Linked Proteins; D007075:Immunoglobulin M; D011506:Proteins; D001613:beta 2-Microglobulin; D005723:gamma-Glutamyltransferase; D001219:Aspartate Aminotransferases; C063088:ALPI protein, human; D000469:Alkaline Phosphatase; D018826:CD13 Antigens