2. By the end of this presentation you will be
able to :
Identify the impotence of amniotic fluid
Explain the amniotic fluid function
Discuss amniotic fluid formation , volume and
test .
Differentiate between oligohydramnios and
polyhydramnios
3. Amniotic fluid fills the amniotic sac, which is a
bag inside a woman’s uterus (womb) where an
unborn baby will develop.The amniotic sac
provides protection for baby .
4. Act as a cushion to
protect the fetus
against physical
injury
Help control the
fetus’s
temperature (
Thermoregulatio
n
Permit symmetric
external growth and
development of the
embryo.
Prevents pressure
on the umbilical
cord.
Provide fluid for
analysis to determine
fetal health and
maturity
The bag of water
allows regular
dilatation of the
cervix
allow freedom of
movement so that
the embryo-fetus
can change position
(flexion and
extension), thus
aiding in
musculoskeletal
development
5. Identification of fetal abnormality. (Genetic
Screening)
Assessment of fetal growth. (AFI )
Fetal wellbeing/functional lung maturity
Diagnosis of PROM
6. Amniotic fluid is slightly alkaline and contains
albumin, urea, uric acid, creatinine, lecithin,
bilirubin, fat, fructose, leukocytes, proteins,
epithelial cells, enzymes, and fine hair called
lanugo
7. Early pregnancy From 20 weeks up to term
In the period from fertilization
to 20 weeks , the amniotic
fluid is composed mainly of
water from the mother.
Filtrate maternal plasma
In the second and third
trimesters, the amniotic sac
expands and amniotic fluid is
mainly composed of fetal urine
lung secretions from the fetus,
as well as gastrointestinal
secretion and excretions from
the umbilical cord
8. Normal range :
30 ml at
10 weeks
350 ml at
20 weeks
800 ml at
34
700 to
1000 ml
at term
9. Amniotic fluid volume changes with gestational
age.
In general, a subjective assessment of amniotic
fluid volume as decreased, normal, or increased
is adequate during the second trimester
examination
However, the amniotic fluid index (AFI) is
another method of reporting fluid volume
20 to 34 weeks
10. The AFI is calculated by dividing the maternal
abdomen into four quadrants with the
umbilicus as the reference point.
The deepest vertical pocket of fluid in each
quadrant is then measured, and these four
measurements are summed to calculate the
AFI.
11.
12.
13. Amniotic Fluid Index Assessment of amniotic
fluid volume is based on the rationale that
decreased uteroplacental perfusion may lead
to diminished fetal renal blood flow,
decreased urination, and, ultimately
14.
15. Oligohydramnios is defined as a less than
normal amount of amniotic fluid
(approximately 500 ml is considered normal).
oligohydramnios is diagnosed when the
largest vertical pocket of amniotic fluid visible
on ultrasound examination is 5 cm or less
16. Fetal cause : Maternal cause :
Postmaturity
fetal conditions associated with
major renal malformations,
including renal aplasia with
dysplastic kidneys
intrauterine growth restriction
PROM
Uterpolcenta insufficiency
Preeclampsia
Placental abnormalities
If oligohydramnios occurs in the first part of
pregnancy, there is a danger of fetal adhesions
17. fetal skin and skeletal abnormal
pulmonary hypoplasia
During the labor and birth, the lessened amounts of fluid reduce the
cushioning effect for the umbilical cord, and cord compression
18. Amnioinfusion
Amnioinfusion (AI) is a technique by which a
volume of warmed, sterile, normal saline or
Ringer’s lactate solution is introduced into the
uterus through the use of an intrauterine
pressure catheter (IUPC)
19.
20.
21. Occurs when there is over 2000 ml of
amniotic fluid , or more AFI 25 cm or DVP
more 8 cm
The exact cause of hydramnios is unknown;
however, it often occurs in cases of major
congenital anomalies.
22. Fetal cause : Maternal casues
fetal abnormality (swallowing
mechanism—as well as
neurologic disorder )
diabetes
anencephaly heart disease
Twin baby (polyuria ) pre-eclampsia.
23. Fetal malformations
preterm birth
Prolapsed umbilical cord
malpresentations is also increase
24. Hydramnios is managed with supportive
treatment unless the intensity of the woman’s
distress and symptoms dictate otherwise
If the accumulation of amniotic fluid is severe
enough to cause maternal dyspnea shortness of
breath , edem and pain, hospitalization and
removal of the excessive fluid are required.This
can be done vaginally by artificial rupture of
membranes (AROM) or by amniocentesis
25. Amniocentesis is a procedure
used for genetic diagnosis.
A sterile needle (under ultrasound
guidance) is inserted into the
uterine cavity through the maternal
abdomen so a small amount of
amniotic fluid can be removed, and
genetic testing is performed.
Amniocentesis is performed
between 15 and 20 weeks’
26.
27. Amniotic fluid is produced to help an
unborn baby grow its musculoskeletal
system and protect the fetus from injury.
28. 1- Myles textbook for midwives. [Jayne E Marshall; Maureen D Raynor 2020
2- Olds' maternal-newborn nursing & women's health across the lifespan /
Michele R. Davidson, Marcia L. London, PatriciaA.Wieland Ladewig. -- 9th ed.
2012
3- KEVIN P. Consultant Obstetrician and Gynaecologist,The Queen Mother's
Hospital,Glasgow; Honorary Clinical Senior Lecturer, University of Glasgow,
Glasgow, UK
Editor's Notes
Lung and digestive system development: By breathing and swallowing the amniotic fluid, the baby practices using the muscles of these systems as they grow
Prevent adherence of the embryo-fetus to the amnion (decreases chance of amniotic band syndrome) to allow freedom of movement so that the embryo-fetus can change position (flexion and extension), thus aiding in musculoskeletal development
l/s ratio The lecithin/sphingomyelin (L:S) ratio is the traditional standard for fetal lung maturit
Early in the first trimester of pregnancy, amniotic fluid is osmolar with fetal and maternal plasma and is secreted from the developing trophoblast or embryo
During the rest of the pregnancy, the fetal kidneys are the major source of fluid that enters the amniotic sac. Abnormalities of fetal urine production can result in changes in amniotic fluid volum
The major mechanism by which amniotic fluid is removed in the last half of the pregnancy is fetal swallowing, which occurs mostly during periods of fetal breathing movements. In pregnancy, when the fetus does not swallow normal amounts of amniotic fluid (as in esophageal atresia and anencephalus), hydramnios will result
If oligohydramnios occurs in the first part of pregnancy, there is a danger of fetal adhesions (one part of the fetus may adhere to another part)
Procedure used to infuse a sterile fluid (such as normal saline) through an intrauterine catheter into the uterus in an attempt to increase the fluid around the umbilical cord to decrease or prevent cord compression during labor contractions; also used to dilute thick meconium-stained amniotic fluid.
■ Amniocentesis. The woman is usually scanned by ultrasound to determine the placental site and to locate a pocket of fluid. As the needle is inserted, three levels of resistance are felt when the needle penetrates the skin, fascia, and uterine wall. When the needle is placed within the amniotic cavity, amniotic fluid is withdrawn.
