Amniotic fluid platelet-activating factor (PAF) is elevated in patients with tocolytic failure and preterm delivery.

Certain biological properties of PAF, including its ability to promote PGE2 synthesis and to induce myometrial contractions, support its potential role in parturition. The presence of PAF in amniotic fluid of human pregnancy appears to correlate with normal and pathologic labor. To further refine this relationship, we selected the clinical endpoints of preterm labor, tocolytic failure and preterm delivery, and evaluated amniotic fluid PAF within these groups of patients. We also measured acetylhydrolase (AH), PAF's primary degradative enzyme, to identify any correlation with the observed PAF levels. 39 specimens were collected by amniocentesis: 17 for karyotype, 6 to assess lung maturity at term and 16 in cases of preterm labor; 8 each with intact membranes and ruptured membranes at the time of sampling. PAF and AH were measured by a 3H-serotonin release bioassay and an in vitro enzyme assay using radiolabelled substrate, respectively. A 12-fold increase in PAF was found in the 3 preterm labor patients in whom tocolysis failed (delivery less than 48 hrs after treatment) compared to the 7 patients in whom labor was arrested (mean PAF = 35.0 vs 2.9 ng/ml, respectively; p = .017). Four of 8 patients with membrane rupture had preterm deliveries; their PAF levels were also elevated when compared to those that delivered at term (mean PAF = 19.7 vs 4.95 ng/ml). The 2 patients with positive amniotic fluid gram stains had the highest PAF levels in the entire cohort (30.5, 44.1 ng/ml), with low or undetectable AH. These data suggest that increased PAF production may be associated with preterm labor subsequent to tocolytic failure.