Amniotic fluid or liquor amnii is the nourishing and protecting liquid contained by the amnion of a pregnant woman.

Amnion grows
and begins to fill, mainly with water, around two weeks after fertilization. After a further 10 weeks the liquid contains proteins,
carbohydrates, lipids and phospholipids, urea and electrolytes, all which aid in the growth of the fetus. In the late stages of gestation
much of the amniotic fluid consists of fetal urine.

The amniotic fluid increases in volume as the fetus grows. The amount of amniotic fluid is greatest at about 34 weeks after conception
or 34 weeks ga (gestational age). At 34 weeks ga, the amount of amniotic fluid is about 800 ml. This amount reduces to about 600 ml
at 40 weeks ga when the baby is born.

Amniotic fluid is continually being swallowed and "inhaled" and replaced through being "exhaled", as well as being urinated by the
baby. It is essential that the amniotic fluid be breathed into the lungs by the fetus in order for the lungs to develop normally.
Swallowed amniotic fluid contributes to the formation of meconium.

Analysis of amniotic fluid, drawn out of the mother's abdomen in an amniocentesis procedure, can reveal many aspects of the baby's
genetic health. This is because the fluid also contains fetal cells which can be examined for genetic defects. Recent research by
researchers led by Anthony Atala of Wake Forest University and a team from Harvard University has found that amniotic fluid is also
a plentiful source of non-embryonic stem cells.[1] These cells have demonstrated the ability to differentiate into a number of different
cell-types, including brain, liver and bone.

Amniotic fluid also protects the developing baby by cushioning against blows to the mother's abdomen, allows for easier fetal
movement, promotes muscular/skeletal development, and helps protect the fetus from heat loss.

The forewaters are released when the amnion ruptures, commonly known as when a woman's "water breaks". When this occurs during
labour at term, it is known as "spontaneous rupture of membranes" (SROM). If the rupture precedes labour at term, however, it is
referred to as "premature rupture of membranes" (PROM). The majority of the hindwaters remain inside the womb until the baby is
born.[2]

[edit] Complications related to amniotic fluid

Too little amniotic fluid (oligohydramnios) or too much (polyhydramnios or hydramnios) can be a cause or an indicator of problems
for the mother and baby. In both cases the majority of pregnancies proceed normally and the baby is born healthy but this isn't always
the case. Babies with too little amniotic fluid can develop contractures of the limbs, clubbing of the feet and hands, and also develop a
life threatening condition called hypoplastic lungs. If a baby is born with hypoplastic lungs, which are small underdeveloped lungs,
this condition is potentially fatal and the baby can die shortly after birth.

On every prenatal visit, the obstetrician/gynaecologist or midwife should measure the patient's fundal height with a tape measure. It is
important that the fundal height be measured and properly recorded to ensure proper fetal growth and the increasing development of
amniotic fluid. The obstetrician/gynaecologist should also routinely ultrasound the patient—this procedure will also give an indication
of proper fetal growth and amniotic fluid development. Oligohydramnios can be caused by infection, kidney dysfunction or
malformation (since much of the late amniotic fluid volume is urine), procedures such as chorionic villus sampling (CVS), and
preterm premature rupture of membranes (PPROM).

Oligohydramnios can sometimes be treated with bed rest, oral and intravenous hydration, antibiotics, steroids, and amnioinfusion.

Polyhydramnios is a predisposing risk factor for cord prolapse and is sometimes a side effect of a macrosomic pregnancy. Hydramnios
is associated with esophageal atresia. Amniotic fluid is primarily produced by the mother until 16 weeks of gestation.

Preterm premature rupture of membranes (PPROM) is a condition where the amniotic sac leaks fluid before 38 weeks of gestation.
This can be caused by a bacterial infection or by a defect in the structure of the amniotic sac, uterus, or cervix. In some cases, the leak
can spontaneously heal, but in most cases of PPROM, labor begins within 48 hours of membrane rupture. When this occurs, it is
necessary that the mother receive treatment to avoid possible infection in the newborn.

Color of the amniotic fluid, with possible meanings:

• GREEN - neco state

• YELLOW - Hemolytic Disease
• BROWN - Infection

Amniotic Fluid

What is amniotic fluid?

Amniotic fluid is an important part of pregnancy and fetal development. This watery fluid is inside a casing called the amniotic
membrane (or sac) and fluid surrounds the fetus throughout pregnancy. Normal amounts may vary, but, generally, women carry about
500 ml of amniotic fluid. Amniotic fluid helps protect and cushion the fetus and plays an important role in the development of many
of the fetal organs including the lungs, kidneys, and gastrointestinal tract. Fluid is produced by the fetal lungs and kidneys. It is taken
up with fetal swallowing and sent across the placenta to the mother's circulation. Amniotic fluid problems occur in about 7 percent of
pregnancies. Too much or too little amniotic fluid is associated with abnormalities in development and pregnancy complications.
Differences in the amount of fluid may be the cause or the result of the problem.

What is hydramnios?
Hydramnios is a condition in which there is too much amniotic fluid around the fetus. It occurs in about 3 to 4 percent of all
pregnancies. It is also called polyhydramnios.

What causes hydramnios?

There are several causes of hydramnios. Generally, either too much fluid is being produced or there is a problem with the fluid being
taken up, or both. Factors that are associated with hydramnios include the following:

• Maternal factors:

o diabetes

• Fetal factors:

o gastrointestinal abnormalities that block the passage of fluid

o abnormal swallowing due to problems with the central nervous system or chromosomal abnormalities

o twin-to-twin transfusion syndrome

o heart failure

o congenital infection (acquired in pregnancy)

Why is hydramnios a concern?

Too much amniotic fluid can cause the mother's uterus to become overdistended and may lead to preterm labor or premature rupture
of membranes (the amniotic sac). Hydramnios is also associated with birth defects in the fetus. When the amniotic sac ruptures, large
amounts of fluid leaving the uterus may increase the risk of placental abruption (early detachment of the placenta) or umbilical cord
prolapse (when the cord falls down through the cervical opening) where it may be compressed.

What are the symptoms of hydramnios?

The following are the most common symptoms of hydramnios. However, each woman may experience symptoms differently.
Symptoms may include:

• rapid growth of uterus

• discomfort in the abdomen
• uterine contractions

The symptoms of hydramnios may resemble other medical conditions. Always consult your physician for a diagnosis.

How is hydramnios diagnosed?

In addition to a complete medical history and a physical examination, hydramnios is usually diagnosed with ultrasound (a test using
sound waves to create a picture of internal structures) by measuring pockets of fluid to estimate the total volume. In some cases,
ultrasound is also helpful in finding a cause of hydramnios, such as multiple pregnancy or a birth defect.

Treatment for hydramnios:

Specific treatment for hydramnios will be determined by your physician based on:

• your pregnancy, overall health, and medical history

• extent of the condition
• your tolerance for specific medications, procedures, or therapies
• expectations for the course of the condition
• your opinion or preference

Treatment for hydramnios may include:

• close monitoring the amount of amniotic fluid and frequent follow-up visits with the physician

• medication (to decrease fetal urine production)

• amnioreduction - amniocentesis (inserting a needle through the uterus and into the amniotic sac) to remove some of the
amniotic fluid; this procedure may need to be repeated. This procedure is generally reserved for severe degrees of
hydramnios.

• delivery (if complications endanger the well-being of the fetus or mother, then an early delivery may be necessary)
The goal of treatment is to relieve the mother's discomfort and continue the pregnancy.

What is oligohydramnios?

Oligohydramnios is a condition in which there is too little amniotic fluid around the fetus. It occurs in about 4 percent of all
pregnancies.

What causes oligohydramnios?

There are several causes of oligohydramnios. Generally, it is caused by conditions that prevent or reduce amniotic fluid production.
Factors that are associated with oligohydramnios include the following:

• premature rupture of membranes (before labor)

• intrauterine growth restriction (poor fetal growth)
• post-term pregnancy
• birth defects, especially kidney and urinary tract malformations
• twin-to-twin transfusion syndrome

Why is oligohydramnios a concern?

Amniotic fluid is important in the development of fetal organs, especially the lungs. Too little fluid for long periods may cause
abnormal or incomplete development of the lungs called pulmonary hypoplasia. Intrauterine growth restriction (poor fetal growth) is
also associated with decreased amounts of amniotic fluid. Oligohydramnios may be a complication at delivery, increasing the risk for
compression of the umbilical cord, aspiration of thick meconium (baby's first bowel movement), and increasing the risk for cesarean
delivery.

What are the symptoms of oligohydramnios?

The following are the most common symptoms of oligohydramnios. However, each woman may experience symptoms differently.
Symptoms may include:

• leaking of amniotic fluid when the cause is rupture of the amniotic sac
• decreased amount of amniotic fluid on ultrasound

The symptoms of the oligohydramnios may resemble other medical conditions. Always consult your physician for a diagnosis.

How is oligohydramnios diagnosed?

In addition to a complete medical history and physical examination, a diagnosis is usually made using ultrasound. Pockets of amniotic
fluid can be measured and the total amount estimated. Ultrasound can also show fetal growth, the structure of the kidneys and urinary
tract, and detect urine in the fetal bladder. Doppler flow studies (a type of ultrasound used to measure blood flow) may be used to
check the arteries in the kidneys.

Treatment for oligohydramnios:

Specific treatment for oligohydramnios will be determined by your physician based on:

• your pregnancy, overall health, and medical history

• extent of the condition
• your tolerance for specific medications, procedures, or therapies
• expectations for the course of the condition
• your opinion or preference

Treatment for oligohydramnios may include:

• closely monitoring the amount of amniotic fluid and frequent follow-up visits with the physician

• amnioinfusion - instilling a special fluid into the amniotic sac to replace lost or low levels of amniotic fluid. Amnioinfusion
during pregnancy is experimental, but it may be offered at delivery to help prevent compression of the umbilical cord.

• delivery (if oligohydramnios endangers the well-being of the fetus, then an early delivery may be necessary)

Polyhydramnios

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Polyhydramnios (polyhydramnion, hydramnios) is a medical condition describing an excess of amniotic fluid in the amniotic sac.
It is seen in 0.5 to 2% of pregnancies.[citation needed] It is typically diagnosed when the amniotic fluid exceeds 2000 mL.[citation needed]

The opposite to polyhydramnios is oligohydramnios, a deficiency in amniotic fluid.

Causes

A single case of polyhydramnios may have one or more causes. About 20% of cases are due to maternal diabetes mellitus, which
causes fetal hyperglycemia and resulting polyuria (fetal urine is a major source of amniotic fluid). About another 20% of cases are
associated with fetal anomalies that impair the ability of the fetus to swallow (the fetus normally swallows the amniotic fluid). These
anomalies include:

• gastrointestinal abnormalities such as esophageal atresia, duodenal atresia, facial cleft, neck masses, and tracheoesophageal
fistula
• chromosomal abnormalities such as Down's syndrome and Edwards syndrome (which is itself often associated with GI
abnormalities)
• neurological abnormalities such as anencephaly, which impair the swallowing reflex

In a multiple gestation pregnancy, the cause of polyhydramnios usually is twin-twin transfusion syndrome.

It can also be caused by some systemic medical conditions in the mother, including cardiac or kidney problems.

Additionally, chorioangioma of the placenta can also cause this condition.

Associated conditions

Fetuses with polyhydramnios are at risk for a number of other problems including cord prolapse, placental abruption and perinatal
death. At delivery the baby should be checked for congenital abnormalities.

[edit] Treatment

In some cases, amnioreduction has been used in response to polyhydramnios.[1]

Dietary salt restriction is recommended

What is polyhydramnios?

Polyhydramnios means having too much amniotic fluid in the womb. It is a condition that occurs in about 1 in 250
pregnancies.

The waters or amniotic fluid surrounding your baby protect him from being hurt if you have a blow to your tummy or your
tummy is compressed. The fluid also plays an important part in protecting your baby against infection and in helping his
lungs to mature.

The amount of fluid round your baby gradually increases until there is about 800-1000ml at 36 to 37 weeks of pregnancy.
After this, the volume decreases slightly towards 40 weeks. Babies regularly swallow the amniotic fluid and it is passed
out of their bodies as urine. In this way, your baby controls the volume of amniotic fluid around him.

When this delicate balance is disturbed, the amniotic fluid can increase rapidly so that, in severe cases of
polyhydramnios, there may as much as 3000ml of fluid, or three times the normal amount.

How can you tell if you have polyhydramnios

Polyhydramnios usually starts from about the thirtieth week of pregnancy. You may feel that your tummy is getting
too large too quickly and that your skin is stretched and shiny. You might feel so breathless that it is hard to climb a flight
of stairs. Other symptoms include abdominal pain, severe heartburn and constipation, swollen legs and varicose veins.
When the midwife or doctor carries out an examination, you will appear to be 'large for dates'. They may find it difficult to
feel the baby or hear his heartbeat because there is so much fluid round him. Ultrasound scanning can confirm the
diagnosis of polyhydramnios.

It can be difficult to find out the cause of polyhydramnios and, sometimes, no cause can be found. There are many
possibilities, which include:

• having diabetes, where your blood sugar levels are not well controlled. Your baby's urine output increases and this in
turn increases the volume of amniotic fluid.
• being pregnant with twins, when you always carry a lot of fluid, especially if the babies are identical (monozygotic).
• infections that may affect your baby, such as rubella, cytomegalovirus, toxoplasmosis and syphilis, may be associated
with polyhydramnios.
• problems with the baby, which occur in about 20 per cent of cases of polyhydramnios. There may be a blockage in the
esophagus, meaning that he cannot swallow the amniotic fluid and control the amount of it around him. It may also be a
sign that the baby has a problem with his central nervous system, or with his heart or kidneys. Sometimes,
polyhydramnios is associated with babies who have chromosomal abnormalities, such as Edward's syndrome. However, it
is important to remember that most women with polyhydramnios go on to deliver healthy babies.

How is polyhydramnios managed?

If you are not known to have diabetes, you will be given a glucose tolerance test to check your blood sugar levels. If these
are high, you may be referred to a specialist who can get your blood sugar levels down. This will reduce the amount of
fluid. Ultrasound scanning can help spot any problems with your baby. If a detailed scan shows nothing untoward, your
baby is almost certainly fine and the polyhydramnios is caused by something else. There are other laboratory tests for
investigating polyhydramnios if it is thought that it might be due to infection.

In the last two months of pregnancy, you will have regular prenatsl appointments to keep a check on your progress. You
may have heard about draining the amniotic fluid to reduce the volume, but this treatment is rarely used because it can
set labour off. Instead, your doctor will advise you to rest as much as possible. This may mean giving up work. Because
your womb is so swollen, you may go into labour prematurely. Resting can help to reduce this risk. Your midwife or doctor
will explain the signs of premature labour to you so you can contact the hospital immediately if your waters break or you
start having contractions.

What will happen when it comes to the birth?

About 26 per cent of mothers with polyhydramnios go into labour early because the womb simply cannot hold the baby
and all the extra fluid any longer. It's important to get to hospital as quickly as you can if you are in labour before 37
weeks. Call your doctor or hospital and tell them what's happening. If there's no-one to take you to hospital, phone for an
ambulance.

If it is known that your baby has a problem, you will carefully efully monitored during labour. This is because, when there
is a lot of fluid in the womb, it is difficult for the baby to settle head down into the pelvis. So if the waters break, there is a
danger that the umbilical cord will be pulled down into the vagina in front of his head. If this happens, you may need an
emergency caesarean section. If you have diabetes and your baby has grown very large, your midwife will be watching to
make sure that the baby moves down steadily through your pelvis and doesn't get stuck. If this happened you would need
to have a caesarean.

Sometimes it might be suggested in advance that you have a caesarean section ('elective caesarean'). This may be the
case if you are carrying twins, if your baby is lying across your womb (transverse lie) or won't settle into any particular
position (unstable lie) or if he is thought to be very large.

You're likely to feel very anxious as well as very large:

• Get as much information as you can. Go to prenatal classes as soon as possible, rather than waiting until the end of
pregnancy.
• Try and distract yourself. If you don't want to be seen in public because you are self-conscious about your size, invite
friends to your house. Get hold of the videos you've been wanting to see for ages, and enjoy them!
• If you have any new symptoms, or your existing symptoms become worse, telephone your doctor or midwife
immediately, or go straight to the hospital.

Amniotic Fluid is the watery liquid that surrounds the baby / fetus within the uterus. This Amniotic Fluid allows the baby /
fetus to move about freely without the hindrance caused by the uterus walls being too tight around it. At the same time,
this fluid helps provide a cushioning within the uterus and gives the fetus buoyancy.

This Amniotic Fluid begins to fill up the Amniotic Sac from about 2 weeks of fertilization. Another 10 weeks later, the fluid
contains different proteins, carbohydrates, electrolytes, lipids, phospholipids and even urea, which provide nutrition to the
fetus. Towards the later stages of pregnancy, the amniotic fluid also begins to contain fetal urine. It has also been recently
discovered that the amniotic fluid also contains non-embryonic stem cells.

Leaking of Amniotic Fluid

Normally, when the pregnancy completes the full term, the membranes of the amniotic sac burst and the amniotic fluid
begins to leak out via the vagina. This is called ‘Spontaneous Rupture Of Membranes’ or SROM. In common parlance,
this is also termed as the time when a woman’s ‘Water Breaks’.

However, there are times, when the amniotic sac may develop a tear or may rupture causing the amniotic fluid to leak
before term. When this occurs 37 – 38 weeks before term, it is referred to as ‘Premature Rupture Of Membrane’ or
PROM.

When either of these cases occurs, the fluid may just gush out or may just leak out in a continuous trickle like a discharge.

When the premature rupture of amniotic sac occurs, it is necessary to determine the cause of the leaking amniotic fluid.
Normally, the leaking is caused by a bacterial infection or by a defect in the structure of the amniotic sac or the uterus or
the cervix. The mother-to-be is advised not to douche or have intercourse when the water breaks.

This leakage may lead to further complications for the growth of the fetus, as it may hamper the growth of the fetus and
may cause bacterial infection to spread from the vagina to the uterus and consequently to the fetus.

Sometimes when there is a small tear in the amniotic sac, it may heal itself over a period of time and the leaking may
simply stop of its own accord.

However, if the leaking amniotic fluid is a result of a severe rupture of the membranes of the amniotic sac, then labor may
begin within 48 hours. When this happens, the mother-to-be must receive treatment in order to avoid causing an infection
to the fetus.

Often what is thought of as leaking amniotic fluid can just turn out to be the urine. Therefore, in such cases, the mother-to-
be must ascertain if the fluid is urine or not. It is advised to wear a sanitary napkin and observe the color of the liquid. The
amniotic fluid is colorless. The mother-to-be must never use a tampon during pregnancy.

If the leaking amniotic fluid is brownish-yellow, green, or any other color, the mother-to-be is advised show it to her
physician and go to the hospital right away. The mother-to-be is also advised to note down the color of the fluid and the
time when the leaking began and tell her doctor about these details.

In such cases, most physicians will usually deliver the baby within 24 hours in order to avoid infection risk.

Nowadays, many over the counter products are available to test whether the fluid is urine or amniotic fluid. It is always
recommended that one avail of these tests to ensure the health of the baby.

Chorioamnionitis is a condition that can affect pregnant women in which the chorion and amnion (the membranes that
surround the fetus) and the amniotic fluid (in which the fetus floats) are infected by bacteria. This can lead to infection in
both the mother and fetus, and, in most cases means the fetus has to be delivered as soon as possible.

What are the causes of chorioamnionitis?

Chorioamnionitis is caused by a bacterial infection that usually starts in the mother’s urogenital tract. Specifically, the
infection can start in the vagina, anus, or rectum and move up into the uterus where the fetus is located.

Chorioamnionitis occurs in up to 2 percent of births in the United States.

What are the risk factors for chorioamnionitis?

Certain factors might create a higher risk for chorioamnionitis, including:

• Premature birth
• Fetal membranes that are ruptured (the water has broken) for a prolonged time

What are the symptoms of chorioamnionitis?

Although chorioamnionitis does not always cause symptoms, some women with the infection might have the following:

• High temperature and fever

• Rapid heartbeat (The fetus might also have a rapid heartbeat.)
• Sweating
• A uterus that is tender to the touch
• A discharge from the vagina that has an unusual smell

How is chorioamnionitis diagnosed?

Chorioamnionitis is most often diagnosed by physical exam and the findings listed above. Other clues can be found by
taking a blood sample from the mother and checking for bacteria. In addition, the doctor might take samples of the
amniotic fluid to look for bacteria. The doctor might also use ultrasound to check on the health of the fetus.

How is chorioamnionitis treated?

If your doctor diagnoses chorioamnionitis, he or she will treat you with antibiotics to help to treat the infection. However,
the treatment is to deliver the fetus. In addition, if the newborn has an infection, he or she will be given antibiotics, as well.

What are the complications of chorioamnionitis?

If the mother has a serious case of chorioamnionitis, or if it goes untreated, she might develop complications, including:

• Infections in the pelvic region and abdomen

• Endometritis (an infection of the endometrium, the lining of the uterus)
• Blood clots in the pelvis and lungs

The newborn might also have complications from a bacterial infection, including sepsis (infection of the blood), meningitis
(infection of the lining of the brain and the spinal cord), and respiratory problems.

Recognizing PROM:

PROM can be recognized with your complete medical history or physical examination. The procedures used to recognize PROM
include:

• Cervical examination – This shows if any fluid leaking from the opening of the cervix.
• By examining the pH nature of the fluid i.e. acidic or alkaline
• By observing the dried fluid under microscope
• Advanced ultrasound – This helps to know the functioning of internal organs and to assess the blood flow through various
blood vessels.