AMNIOTIC FLUID

ALODIA 14’08

Normal amniotic fluid 30 ml (10 weeks )  200 ml (16 weeeks)  800 ml (mid third trimester)  aterm 2800 ml water, 400 ml plasenta

Early  cairan mirip cairan ekstraseluler  transport cairan dan molekul kecil lewat 3 jalur (transmembran yaitu lewat
amnion, intramembran lewat intrafetal vessel di plasenta, fetal skin.

Fetal urin  8 sampe 11 minggu  tapi mulai dominasi di sekitar 2nd trimester .
Water transportation terus sampe keratinisasi  22 25 minggu  makanya severe oligo ga keliatan sampe 18 minggu

Fetal amnion regulation:

 Fetal urination (primary di 2nd half of pregnancy)  1 liter/ hari hipotonik terhadap maternal and fetal plasma
(280  260mosm/l) makanya bisa intramembrane fluid transfer ( lalu ke vessel on placental surface, fetus) 
400 ml
 -fluid transfer . maternal dehydration  osmolalitas ibu >>>  fluid dari fetus ke ibu dan dari amniotic fluid
compartment into the detus
 Regulation of respiratory tract  350 ML DAILY  setengahnya diminum (impaired of swallowin dari ggn ssp, gi
obstruction. Transmembrane flow dan fetal skin  dikit banget

Measurement Direk  disuntikkan zat warna (amino hipurat) ke amnion dalam guidance usg
Indirek  usg
22-39 weeks sama  750 ml, 5%  300 ml, 95% 2000 ml
Ada yang bialng kalo makin gede makin juga si amniotic sac nya  400 ml di 22 and 30 weeks  800 ml sampe 40
weeks  menurun 8 persen per minggu setelah 40 weeks
Ssonographic assesment Dilakukan di 2nd atau 3rd trimester

Single deepest pocket  transducer perpendicular dari floor, parallel dengan long axis. Sagittal plane  lagest di
identifikasi (bayi, fetal cord ga masuk perhitungan)
N  2-8 cm <2  oligo, > 8  poli
Bisa analisis single pocket secara vertical dan transversal. 2x2, 2x1 (kalo twin, multigestation)

Amniotic fluid index (AFI)

Sama kaya tadi, long axis dan parallel  bagi 4 kuadran yg sama besar di uterusnya  jumlah single deepest pocket dari
semua kuadran.. cord ga dimasukin ke measurement. Intraobserver variability  1-2 cm
Normal  5-24 cm In the Moore (1990) nomogram,
a threshold of 5 cm is
< 2.5th percentile throughout
the second and third trimesters.
 A value of 25 cm is > 95th percentile,
but is not necessarily the
97.5th percentile, depending
on gestational age. Using other
published nomograms, a value of
25 cm exceeds the 97.5th percentil

Hidramnion Hidramnion  uterus lebih besar dari gestatonal age, susah cari djj nya. Ada kategorinya
 Mild  25-29.9
 Moderate 30-34
 severe > 35 cm

kalo single pocket:

 mild 8-9.9  biasanya benign
 mpderate 10-11.9
 severe > sama dengan 12 cm

etiolgi Hydramnion  biasa salah satu komponen hidrops fetalis

Dm  kadar glukosa amnion lebih banyak  fetal osmsis diuresis into amniotic fluid

Kongenital
 kelainan SSP

Oligohidramnion Jumlah cairan amnion yang berkurang. AFI <= 5 cm, atau single deepest pocked <= 2 cm (biasanya twin). atau AFI < 5
atau 2.5 th percentile dari normal gestational age normogram
Anhidramnion  ga ada amniotic fluid.
etiologi Early onset oligohidramnion
Dari 2nd trimester 
Fetal abnormality
Placental abnotmalitu  impairs perfusion
Midpregnancy
Late 2nd  3rd trimester  uteroplacental insufficiency  fetal growth, urine output menurun
Fetal growth restriction
Placental abnormality
 Maternal complication  preklamsia,
Kehamilan postterm  8% menurut per week after week 40
Congenital anomaly

18 minggu  renal sebagai penyumbang utama cairan amnion

Jadi biasanya olio  kelainan genitourinary (renal agenesis, ressesive polikistik disease,
autosomal polikistik disease) urinyary  bladder outlet obstruction (posterior urethral valve,
urethral atresia, megacystis microcoon intestinal hipoperistaltic syndrome), perisistent cloaca,
sirenomelia

Potter syndrome  bilateral renal ageness  anhydramnion, limb contracture, compressed

face, death from pulmonary dysplasia
Medication

Yang block RAAS (ACE inhibitor)  hipotensi, renal hipeperfusion, renal ischemia
dan nsaid  contract ductus arteriosus, decrease fetal urine production
Pregnancy outcome STILLBIRTH, IUGR, ASPIRASI MEKONIUM
Kalo pake yg kriteria afi  bakal lebih banyak yg oligohidramnion dibandingin yang single
deepest pocket

Pulomonary hypoplasia
Kalo ada sebelum second midsemester  curiga hioiokasia, placental hematoma/ chronic
abruption  growth restriction
managemtn Underlying etiology
Iugr kalo e.c oligohidramnion -> close fetal surveillance
Amnioinfusion  kalo ada fetal deselerasi yang secondary k umbilical cord compression
Borderline AFI 5-8 cm