Essay: Amniotic fluid volume

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  • Published on: November 8, 2015
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  • Amniotic fluid volume
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The maintenance of amniotic fluid volume is a dynamic process that shows a balance between
fluid production and absorption. It may vary with the gestational age. At term it is about 800 ml
with a wide range from 400-1500ml in normal cases1. It has number of functions like that of
cushioning the fetus from any external trauma, maintaining the body temperature and
development of musculoskeletal system by permitting the fetal movements, growth and
development of intestinal tract by swallowing the amniotic fluid and providing nutrition to fetus ,
contribution to the fetal pulmonary development, lubrication of the fetal skin, prevention of
maternal chorioamnionitis and fetal infection through its bacteriostatic properties. Amniotic fluid
volume is known to be a marker of fetal wellbeing, Normal amniotic fluid volume suggest that
uteroplacental perfusion is adequate and that any abnormal amount of amniotic fluid volume is
associated with unfavorable perinatal outcome such as meconium staining, any congenital
anomalies, growth retardation, dysmaturity and fetal asphyxia have been associated with reduced
amniotic fluid volume2.
Assessment of AFI by Ultrasound is found to be more reliable 5. It is calculated from the
maximum depth of the amniotic fluid pocket in each uterine quadrant with the uterus being
divided into quadrant by the midline being bisected by a horizontal meridian drawn through the
umbilicus or at a point half of the height of the uterine fundus. The four quadrant assessment is
referred to AFI. It refers to the sum of the maximum vertical pockets of amniotic fluid in
centimeters in each of four quadrants of the uterus. Subjective assessment of amniotic fluid
volume can also be done. Normal AFI beyond 20 weeks’ gestation ranges from 5cm to 20cm
Amniotic Fluid volume is maximum at 34 weeks ( 750- 800 mL) and decreases thereafter to
600mL at 40 weeks.
Amniotic Fluid Index (AFI) ‘5cm is defined as oligohydroamnios 3. Its incidence of all the
pregnancy is 2.3% . Leeman et al. reported that it occurs in about 1% to 5% of the pregnancies 4
The commonest cause of decrease liquor in 25% of the cases is the prelabor rupture of
membranes. Decrease AFI is associated with increased pregnancy complications, any congenital
anomalies(renal tract or GIT anomalies) and perinatal mortality and it might be associated with
uteroplacental insufficiency, idiopathic fetal growth restriction (IUGR), premature rupture of the
fetal membrane, fetal hypoxia, meconium stained fluid 6.
Reduced amniotic fluid may lead to umbilical cord compression and increase the risk of fetal
hypoxemia that eventually may affect the Apgar score of baby. However the picture in low risk
pregnancies is unclear as conflicting views are expessed in various types of studies. 7,8
Patient with decrease AFI ‘5cm should be admitted to hospital for fetal monitoring. The
antepartum treatment options are limited. The timing of delivery depends on the gestational age,
etiology and the fetal well being. Decrease AFI should be monitored conservatively by CTG and
ultrasound. It has been observed that decrease AFI has an increased risk of lower segment
caesarean section for fetal distress.
Amniotic fluid measurements are one of the important aspects of fetal surveillance. Role of
AFI, as an isolated predictor on the fetal outcome should be checked in pregnancy The aim of
study is to explore the factors that affect fetomaternal outcome in terms of maternal morbidity,
perinatal morbidity and mortality and to evaluate and further define the current management of
women with such pregnancies. This field needs to be explored further and thus the study was
planned to find out the effect of decreased amniotic fluid index on pregnancy. The goal is to
deliver the fetus in the best physiological condition possible while minimizing the risk
to mother

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