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    Amniotic Fluid

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    annu panchal
    1) Amniotic fluid is formed early in pregnancy through transudation of maternal and fetal fluids and later through fetal urination and secretions. 2) Amniotic fluid volume normally increases throughout pregnancy, peaking at around 800ml at 34 weeks before decreasing slightly at term. Amniotic fluid aids fetal growth, development, and protection. 3) Abnormal amniotic fluid volumes, including oligohydramnios (less than 200ml) and polyhydramnios (more than 2000ml), can impact the health of both mother and fetus. Their causes and management must be determined.

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    Amniotic Fluid

    Uploaded by

    annu panchal
    182 views34 pages
    1) Amniotic fluid is formed early in pregnancy through transudation of maternal and fetal fluids and later through fetal urination and secretions. 2) Amniotic fluid volume normally increases throughout pregnancy, peaking at around 800ml at 34 weeks before decreasing slightly at term. Amniotic fluid aids fetal growth, development, and protection. 3) Abnormal amniotic fluid volumes, including oligohydramnios (less than 200ml) and polyhydramnios (more than 2000ml), can impact the health of both mother and fetus. Their causes and management must be determined.

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    AMNIOTIC FLUID

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    1) Amniotic fluid is formed early in pregnancy through transudation of maternal and fetal fluids and later through fetal urination and secretions. 2) Amniotic fluid volume normally increases throughout pregnancy, peaking at around 800ml at 34 weeks before decreasing slightly at term. Amniotic fluid aids fetal growth, development, and protection. 3) Abnormal amniotic fluid volumes, including oligohydramnios (less than 200ml) and polyhydramnios (more than 2000ml), can impact the health of both mother and fetus. Their causes and management must be determined.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    182 views34 pages

    Amniotic Fluid

    Uploaded by

    annu panchal
    1) Amniotic fluid is formed early in pregnancy through transudation of maternal and fetal fluids and later through fetal urination and secretions. 2) Amniotic fluid volume normally increases throughout pregnancy, peaking at around 800ml at 34 weeks before decreasing slightly at term. Amniotic fluid aids fetal growth, development, and protection. 3) Abnormal amniotic fluid volumes, including oligohydramnios (less than 200ml) and polyhydramnios (more than 2000ml), can impact the health of both mother and fetus. Their causes and management must be determined.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 34

    AMNIOTIC FLUID

    Amniotic fluid formation and composition:


    First & early second trimester:
    • Amount is 5-50 ml & arises from:
    • ultrafiltrate of Maternal plasma through the vascularized
    uterine decidua (in early pregnancy).
    • Transudation of fetal plasma through the fetal skin &
    umbilical cord (up to 20 weeks' gestation).
    * It is iso-osmolar with fetal & maternal plasma,
    though it is devoid of proteins.
    Volume and composition
    • From 20 weeks up to term (mainly fetal urine):
    • At 18th week, the fetus voids 7-14ml/day; at term fetal kidneys secretes 600-
    700ml of urine/day into AF.
    • Fetal respiratory tract secretes 250ml/day into AF.
    • Fluid transfers across the placenta.
    • Fetal oro-nasal secretions.
    • Secretion is controlled by:
    - Fetal swallowing at term removes 500ml/day.
    - Reabsorption into maternal plasma (osmotic gradient).
    • AF constituents:
    - urea, creatinine & uric acid + desquamated fetal cells, vernix, lanugo hair &
    others→ hypo-osmolar amniotic fluid….
    Amniotic fluid circulation
    Amniotic fluid volume :
    • About 500mls enter and leave the amniotic sac each hour.
    • gradual ↑ up to 36 weeks to around 600 to 1000 ml
    then↓ after that.
    • The normal range is wide but the approximate volumes
    are:
    - 500 ml at 18 weeks
    - 800 ml at 34 weeks.
    - 600 ml at term.
    Amniotic fluid function:
    1. Allow room for fetal growth, movement and development.
    2. Ingestion into GIT→ growth and maturation.
    3. Fetal pulmonary development (20 weeks).
    4. Protects the fetus from trauma.
    5. Maintains temperature.
    6. Contains antibacterial activity.
    7. Aids dilatation of the cervix during labour.
    Clinical importance of AF:
    1. Screening for fetal malformation (serum α-
    fetoprotien).
    2. Assessment of fetal well-being (amniotic fluid
    index).
    3. Assessment of fetal lung maturity (L/S ratio).
    4. Diagnosis and follow up of labour.
    5. Diagnosis of PROM (ferning test).
    Amniotic fluid volume assessment
    • Clinical assessment is unreliable.
    • Objective assessment depends on U/S to
    measure:
    - deepest vertical pool (DVP).
    - Amniotic fluid index (AFI).
    • It is a total of the DVPs in each four
    quadrants of
    the uterus. it is a more sensitive indicator of AFV
    throughout pregnancy.
    Amniotic fluid abnormalities
     Oligohydramnios:
    Defined as reduced amniotic fluid of 200ml or less i.e.
    amniotic fluid index of 5 cm or less or the deepest
    vertical pool < 2 cm.

     Polyhydramnios:
    Defined as excessive amount of amniotic fluid of
    2000ml or more (AFI of > 25 cm or the deepest
    vertical pool of > 8 cm) .
    POLYHYDROMNIOUS
    Polyhydramnio
    s
    types
    1. Mild hydramnios (80%):
    a pocket of amniotic fluid measuring 8 to 11 cm.
    2. moderate hydramnios (15%):
    a pocket of amniotic fluid measuring 12 to 15 cm.
    3. Severe hydramnios (5%) - twin-twin transfusion
    syndrome :
    a pocket of amniotic fluid measuring 16 cm or more.
    ETIOLOGY OF POLYHYDRAMNIOS
    1. Idiopathic
    2. Fetal Anomalies
    3. Diabetes
    4. Multifetal gestation
    5. Immune/Non-immune hydrops
    6. Fetal infection
    7. Placental haemangiomas
    Fetal Anomalies
    • Problems with swallowing and GI absorption
    • Increased transudation of fluid:
    • anencephaly, spina bifida
    • Increased urination: anencephaly (lack of ADH,
    stimulation of urination centers)
    • Decreased inspiration
    SYMPTOM
    S. Dyspnea
    1
    2. Abdominal pain
    3. Venous stasis
    4. Contractions  preterm
    labor
    5. Decreased Perception of
    Fetal Movements
    diagnosis of polyhydramnios
    • Symptoms:
    - dyspnea. • Ultrasound:
    - edema. -excessive amniotic
    - abdominal distention
    fluid.
    - preterm labour.
    • Abdominal examination: - fetal
    - ↑uterus than expected. abnormalities.
    - difficult to palpate fetal parts.
    - difficult to hear fetal
    heart sound.
    - ballotable fetus.
    - Decreased fetal mov’t
    COMPLICATIONS
    (fetus)?
    • Fetal prognosis worsens with more severe
    hydramnios and congenital anomalies
    • 15-20% fetal malformations
    • Preterm delivery
    • Suspect diabetes
    • Prolapse of cord
    • Abruption
    (Mother)?
    • Dyspnea
    • Venous Stasis
    • Placental abruption
    • Uterine atony
    • PPH
    • Abnormal presentation -- C/S
    TREATMEN
    •TMild to Moderate hydramnios: rarely requires
    treatment
    • Hospitalization, bed rest
    • Amniocentesis
    • NSAIDs
    • Blood sugar control
    OLIGOHYDRAMNIOS
    DEFINITION
    reduced amniotic
    fluid <200mls i.e.
    amniotic fluid index
    of 5 cm or less or
    the deepest vertical
    pool < 2 cm.
    AETIOLOGY
    FETAL MATERNAL
    • PROM (50%)
    • PREECLAMPSIA
    • CHROMOSOMAL ANOMALIES
    • CONGENITAL ANOMALIES • APLA SYNDROME
    • IUGR • CHRONIC HT
    • IUFD
    • POSTTERM PREGNANCY DRUGS
    • PG SYNTHETASE INHIBITORS
    PLACENTAL • ACE INHIBITORS
    • CHRONIC ABRUPTION
    • TTTS
    • CVS
    IDIOPATHIC
    Complications of oligohydramnios:
    In early pregnancy:
    • Amniotic adhesions or bands→ amputation/death.
    • Pressure deformities (club feet).
    • Pulmonary hypoplasia:
    - Thoracic compression.
    - No breathing movement.
    - No amniotic fluid retain.
     Flattened face.
     Postural deformities.
    In late pregnancy:
    • Fetal growth restriction.
    • Placental abruption.
    • Preterm labour.
    • Fetal distress.
    • Fetal death.
    • Meconium aspiration.
    • Labour induction/CS.
    • Extremely poor fetal prognosis, especially in
    early pregnancy
    • Adhesions between amnion and fetal parts ---
    malformations and amputations
    • Musculoskeletal deformities
    • Pulmonary hypoplasia
    • Cord Compression -- >fetal hypoxia
    • Passage of meconium into low AF volume: thick
    particulate suspension -->respiratory
    compromise
    management
    • Minor degrees: no treatment.
    • Bed rest, diuretics, water and salt restriction: ineffective.
    • Hospitalization: dyspnea, abdominal pain or difficult ambulation.
    • Endomethacin therapy: .
    - impairs lung liquid production/enhances absorption.
    - ↓fluid movement across fetal membranes.
    * complications: premature closure of ductus arteriosus, impairment of renal
    function, and cerebral vasoconstriction. So not used after 35 weeks
    • Amniocentesis: to relieve maternal distress and to test for fetal lung maturity.
    Complications: ruptured membrane, chorioamnionitis, placental abruption,
    preterm labour.
    Dr Mona Shroff www
    32
    .obgyntoday.info
    TREATMENT
    • ADEQUATE REST – decreases dehydration
    • HYDRATION – Oral/IV Hypotonic fluids(2 Lit/d)
    temporary increase
    helpful during labour,
    • SERIAL USG – Monitor growth, AFI, BPP
    • INDUCTION OF LABOUR/ LSCS
    Lung maturity attained
    Lethal malformation
    Fetal jeopardy
    Severe IUGR
    Severe
    oligohydramnios
    • AMNIOINFUSION
    • AMNIOINFUSION

    INDICATIONS
    1.Diagnostic
    2.Prophylactic
    3.Therapeutic

    • Decreases cord
    compression
    • Dilutes meconium

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