Amniotic Fluid Index (AFI)

Etiology and Epidemiology

Decreased fetal urine output can have a number of causes, which fall into
two general categories: fetal urinary tract obstruction and decreased urine
production by the fetal kidney. Urinary tract obstruction can occur
anywhere along the fetal urinary tract and can be catastrophic for the fetus.
Decreased urine production by the fetal kidney typically reflects
inadequate blood flow to the fetal kidney, caused by shunting of fetal blood
flow away from the kidney to the heart and brain. It is the same
mechanism which causes oliguria in critically ill adults.[5][6][7]

Oligohydramnios

When the fetus receives adequate nutrients and oxygen from the placenta,
blood is shunted away from the fetal kidney, glomerular filtration rate
decreases, and urinary output decreases. Therefore, decreased amniotic
fluid volume due to decreased urine production by the fetal kidney is a
reflection of chronic hypoperfusion of the fetus.

Oligohydramnios can also occur because the patient's amniotic membrane

has ruptured and amniotic fluid is leaking out of the uterus.

Polyhydramnios

The normal fetus is constantly swallowing amniotic fluid and urinating to

create more fluid. If the fetus is unable to swallow the typical amounts of
amniotic fluid, this can lead to polyhydramnios. This can occur due to
gastrointestinal malformations, fetal neurologic problems such as
anencephaly, or mechanical obstruction of the esophagus by other
intrathoracic processes.

Increased amniotic fluid production occurs as a result of fetal polyuria,

such as in uncontrolled maternal diabetes with persistently elevated
maternal blood sugars. In these cases, it may be associated with fetal
macrosomia.

Many cases of polyhydramnios are idiopathic, meaning no definite cause is

identified.

Pathophysiology
Oligohydramnios

Since amniotic fluid is primarily made up of fetal urine, low amniotic fluid
volume, or oligohydramnios, typically indicates either fetal urine output or
leakage of amniotic fluid from the uterus, such as when the patient's water
breaks.

Polyhydramnios

Polyhydramnios, or increased amniotic fluid volume, also has a number of

potential causes, with two primary common mechanisms: decreased fetal
swallowing of amniotic fluid, or increased fetal production of amniotic
fluid. Polyhydramnios can lead to overdistension of the gravid uterus,
especially in cases where the fetus is normal size or large for dates, which
increases the patient's risk for preterm contractions and preterm delivery,
as well as premature rupture of membranes, in which the patient's water
breaks before the onset of labor. Overdistension of the uterus is also a risk
factor for postpartum hemorrhage after delivery.