AMNIOTIC FLUID

1. Amniotic fluid and umbilical cord

2. Amniotic fluid
Origin : the sources of amniotic fluid
is thought to be both fetal and maternal
. It is secreted by the amnion , especially
the part covering the placenta and
umbilical cord. Some fluid is exuded from
maternal vessels in the decidua and some
fatal vessels in the placenta .fetal urine
also contributes at the 10 wks.

3. water exchanged
The water in amniotic
fluid is exchanged at 3
hours.

4. color
 Colorless , near term , pale straw due to
lanugo and Epithelial cell from skin .
 Abnormal
 Me conium stained – green
 Golden – heamolysis of RBC. Bilirubin
, in Rh negative mother .
 Green yellow in post maturity

5. Composition
 Protein 0.3 gm %
 glucose20 gm % urea 30 gm %
 Uric acid 4 gm % creatinine 2 gm %
 Hormones – insulin , renin . Prolactin
 Sodium , chloride , potassium
 lanugo and Epithelial cell from skin,vernix
, cell of RS , urinary bladder and vagina .

6. FUNCTIONS
 DURING PREGNANCY :
 Shock absorber
 Temperature
 Prevent adhesion
 Freely movement
 Nutrition small amount


7. DURING labour
 Dilatation of cervix .
 Mambrane intact .
 Aseptic and bactericidal action .

8.  Clinical importance
 Method if induction
 Dignosis
 amniocentesis

9. Volume
 50ml – 12 weeks
 400ml 20 weeks
 1000ml 36 - 38 weeks
 At term 600-800ml
 At 43 weeks about 200ml

10. abnormality
 Exceeds 1500ml –
polyhydramnios
Less than 300ml
oligohydramnios

11. polyhydramnios
hydramnious
 Definition : Exceeds 2000ml or
excessive accumulation of
liquor amni causing discomfort
to the patient and or when an
imaging help is needed to
substantiate the clinical
diagnosis of the lie and
presentation of the fetus .

12. Etiology
1. Fetal
 anencephaly production of liquor amni may be
due to absence of fetal swallowing reflex and
possible suppression of fetal ant diuretic
hormone leading to excessive urination .
 Open spin bifida
 Esophageal or duodenal Artesia and facial clefts
and neck masses –prevent of fetal swallowing
reflex
 Hydrops fetalis due to isoimmunization ,
cardiothoracic anomalies and fetal cirrhosis are
often associated this .

13. 2- placenta
 2- placenta
Chorioangioma of the placenta – tumor
growing from a single villus consisting of
hyperplasia of blood vessels .
3 multiple pregnancy –
4 maternal - - diabetes – raised blood sugar
– raised fetal blood sugar – fetal diuresis –
hydramnios

14. Clinical types
 May be acute or chronic
 The patient may suffer dyspnea or even in
the sitting position for easier breathing.
 Oedema of the legs
 Evidence of pre- eclamsia

15. Abdominal examination
 INSPECTION
 Markedly enlarged , looks globular with fullness at the
flanks .
 The skin is tense . Shiny with large striae
 Palpation –
 height of the uterus is more than the period
 A.G is more than normal
 Fluid thrill
 Fetal part cannot well defined
 External ballottement can be elicited more easily .

16.  AUSCULTATION – FHS can not heard
easily or need use of Doppler
 INTERNAL EXAMINATION
The cervix is pulled up may be partially
taken up or at time dilated to admit a
finger tip

17. INVESTIGATIONS
 Sonography – the large eco- free space
between fetus and uterine wall [ single
pool > 8 cm – multiple fetus – position –
congenital anomalies .
 Blood – Rh factors
 Amniotic fluid – estimation of AFI – HIGH
IN OPEN NEURAL TUBE DEFECT

18. COMPLICATION
MATRNAL
 PRE-ECLAMPSIA
 MALPRESENTATION
 PROM
 PRETERM LABOUR
 ACCIDENTAL
HAEMORRHAGE
 CORD PROLAPSE
 UTERINE ATONY
 RETAINED PLACENTA
FETAL
PREMATURITY
CONGINATAL ANOMALY
PERINAL MORTALITY

19. PRINCIPLE OF MANEGAMENT
 TO relive symptoms
 To find out cause
 To avoid complication

20. TRETMANT
 Bed rest only for minor hydramnios
 For severe – patient may hospitalization
and deal as HIGH RISK
 Supportive therapy
 Amniocentesis – less than 37 weeks for
amnio reduction 1-1.5 liter –not exceed
 Induction of labour – more than 37 weeks
with oxyticin infusion .
 Termination if congenital abnormality .

21. During labour
 Assess for cord prolapsed
 Uterine contraction may sluggish - oxyticin
infusion may be started
 Inj –oxytocin 10 unit IM with delivery of
anterior shoulder prevent PPH.
 WATCH FOR RETAINED PLACENTA
 OESOPHAGEAL ATRESIA OF THE BABY
SHOULD BE EXCLUDED.

22. OLIGOHYRAMNIOS
 Definition : it is an extremely rare
condition where the liquor amnii is
deficient in amount to the extent of less
than 200 ml at term . Sonographically it is
defined vertical pool is less than 2 cm .

23. ETIOLOGY
 UNKNOWN
 Amnion nodosum – failure of secretion by the
cell of the amnion covering the placenta .
 Associated with fetal chromosomal anomalies
 Intrauterine infection
 Drugs
 Renal agenesis or obstruction
 IUGR
 Post maturity

24. Diagnosis
 Markedly smaller size uterus
 looks fullness of fetus .
 Fetal movement less
 Malpresentation - breech is common
 height of the uterus is less than the period
 A.G is less than normal
 Fetal part can well defined
 USG – FETAL BLEDDER FILLING ANE EMTYING
FERQUTELY INDICATED ANOMALY

25. COMLICATION
MATERNAL
 PPROLONGED LABOUR
 MALPRESENTATION
 PROM
 CORD COMPRSSION
 UTERINE INERTIA
 INCREASED MMR
FETAL
 PREMATURITY
 CONGINATAL ANOMALY-
SHAPE OF SKULL, WRY
NECK , CLUB FOOT OR
AMPUTATION OF LEG
 HIGH FETAL MORTALITY
 ABORT ION

26. TREATMENT
 PROM is common .
 Contraction may be painful.
 Fetal distress occurs .
 Vaginal delivery is favored .

27. The umbilical cord or funis
 From the fetus to placenta . It is
developed from the connective or body
stalk . With enlargement of amniotic cavity
, elongation of the connective stalk , form
cord.
.

28. Structure
1. Covering epithelial cell
2. Wharton's jelly : protective
3. Blood vessels 2 arteries and 2 vein – at
4 month – 1 vein
4. If 1 arteries – fetal abnormality-
down syndrome / twins / renal and
genital abnormality –Heart
anomalies
5. Yock sac – near attachment cord

29. Characteristics
 Length – 50cm normaly
 Short less than 20 cm
 True note
 Falls note
 Cord prolapse
 Compression

31. Abnormality
 Placenta accreta :
 Placenta attached to the uterine wall
muscle.
 Placenta increta :
 Placenta extends into the uterine muscles
 Placenta percreta :
 Placeta extends through the entire wall of
the uterus

32.  Bipartiate Placenta :
 Placenta containing 2
or more lobes

34.  Succenturiate Placenta :
small accessory lobes
develop at a small distance
from the main placenta

35.  Circumvellete placenta :
 fetal surface has a
central depression
surrounded by thickened
grey white ring composed
of a double fold of
chorion, amnion,
degenerated decidua and
fibrin deposits

36.  Battledore placenta :
 Cord is attached to
the edge of placenta

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