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Amniotic fluid function Clinical importance of AF Volume and composition Amniotic fluid abnormalities
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).
About 500 mls 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.
Clinical assessment is unreliable. Objective assessment depends on U/S to measure: - deepest vertical pocket (DVP). - Amniotic fluid index (AFI): It is a total of the DVPs in each of the four quadrants of the uterus. it is a more sensitive indicator of AFV throughout pregnancy.
Polyhydramnios: Defined as excessive amount of amniotic fluid of 2000 ml or more (AFI of > 25 cm or the deepest vertical pool of > 8 cm) .
Causes of oligohydramnios:
1.
Fetal causes:
* Renal causes: - Renal agenesis (Potters syndrome). - polycystic kidney. - Urethral obstruction (atresia/posterior urethral valve). * Fetal growth restriction. * Fetal death. * Postterm pregnancy. * Preterm premature rupture membranes.
Complications of oligohydramnios:
In early pregnancy: Amniotic adhesions or bands amputation/death. Pressure deformities (Flattened face). Pulmonary hypoplasia: - Thoracic compression. - No breathing movement. - No amniotic fluid retained in the lungs. Postural deformities (Talipes Equino Varus).
Complications of oligohydramnios:
In late pregnancy: Fetal growth restriction. Preterm labour. Fetal distress. Fetal death. Meconium aspiration. Labour induction/CS.
Diagnosis:
Management:
-Treat the cause (pprom, preeclampsia).
-Assess fatal wellbeing (U/S/CTG/Doppler/BPP). -Vesicoamniotic shunting (urethral obstruction). -Amnioinfusion: Indications of amnioinfusion: 1. Meconium stained amniotic fluid 2. Variable decelerations 3. Prophylactic for severe degrees
Polyhydramnios
Incidence: 1% of all pregnancies Degrees 1. Mild hydramnios (80%):
a pocket of amniotic fluid measuring 8 to 11 cm.
Causes of polyhydramnios
Fetal malformation: - GIT: esophageal/duodenal atresia, tracheoesophageal fistula. - CNS: anencephaly (swallowing, exposed meninges, no antidiuretic hormone). Twin-twin transfusion fetal polyuria.
Types: Acute: usually develops in the first half of pregnancy with rapid expansion to huge dimensions. Usually ends in abortion, or termination becomes mandatory Chronic: develops gradually so a much larger size can be tolerated.
Diagnosis of Polyhydramnios
Symptoms: - dyspnea. - edema. - abdominal distention - preterm labour. Abdominal examination: - uterus than expected. - difficult to palpate fetal parts. - difficult to hear fetal heart sound. - ballotable fetus.
Complications of Polyhydramnios
Preeclampsia UTI Preterm labor PROM Accidental hemorrhage Cord prolapse Abnormal presentations Increased risk for C.S. Post-partum hemorrhage
Management
Minor degrees: no treatment. Bed rest, diuretics, water and salt restriction: ineffective. Hospitalization: dyspnea, abdominal pain or difficult ambulation. Endomethacin therapy: - Decreases urine production - 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. Amniocentesis may be done
repeatedly.