Amniotic Fluid Disorders

What is Amniotic Fluid? Amniotic Fluid is the watery substance in the amniotic cavity which surrounds the fetus during pregnancy. The fluid serves as a protective cushion. It absorbs jolts, prevents adherence of the embryo to the amnion and allows for fetal movement. The volume of amniotic fluid increases from 30mL at 10 wks of gestation to 450mL at 20 wks to 800-1000 at 37 wks of gestation. The volume of amniotic fluid is replaced every 3hrs. From the beginning of the 5thmth the fetus swallows its own amniotic fluid (about half the total amount) Fetal urine is added daily to the amniotic fluid in the 5thmth

There are two types of Amniotic Fluid Disorders

Hydramnios or Polyhydramnios Oligohydramnios

Hydramnios
This is the term used to describe excessive amniotic fluid around the fetus (15002000mL) It is also called polyhydramnios It occurs in about 3-4% of all pregnancies

Fetus With Hydramnios

Causes
Causes are based on too much fluid being produced or a problem with intake, or both. Maternal Factors: Diabetes Mellitus may be a cause, but not usually a factor. Fetal Factors Gastrointestinal obstructions e.g. esophageal atresia Neurological conditions that affect swallowing e.g. anencephaly Chromosomal abnormalities e.g. Cardiac abnormalities Hydrops fetalis

Symptoms
The most common symptoms are: Rapid growth of the uterus Discomfort in the abdomen Uterine contractions Breathlessness

Possible Complications
Preterm labour or premature rupture of the amniotic sac. Placental abruption and umbilical cord prolapse Poor growth of the fetus Fetus birth defects Cesarean Delivery Severe bleeding by the mother after delivery

Diagnosis
Complete medical history and physical examination Ultrasound Blood Analysis

Treatment
Monitoring of the amniotic fluid Medication to decrease fetal urine production Amnioreduction Delivery

Oligohydramnios
What is Oligohydramnios? This is the condition where there is too little amniotic fluid (400mL) around the fetus. It occurs in about 4% of all pregnancies

Fetus With Oligohydramnios

Causes
This is caused by conditions that prevent or reduce amniotic fluid production. Premature rupture of membranes Post-term pregnancy Twin-to-twin transfusion syndrome Preeclampsia Urinary tract malformation Renal agenesis Placenta abnormality Certain medication e.g. Captopril

Symptoms
Leaking of amniotic fluid when the cause is rupture of amniotic sac Decreased amount of amniotic fluid on ultrasound Uterine contractions Abdominal discomfort

Possible Complications
Pulmonary Hypoplasia Increased risk of compression of the umbilical cord at delivery Poor fetal growth Aspiration of thick meconium Fetal malposition Miscarriage Dystocia

Diagnosis
Complete history and physical examination Ultrasound

Treatment
Monitoring of the amount of amniotic fluid Amnioinfusion Delivery Fetal surgery during pregnancy