Amniotic fluid:

Maximum volume = 36-38 weeks = 1 liter

Rate of amniotic fluid turnover = 500 ml / hour

Major contributor of amniotic fluid:

Period of gestation Major contributor
Early weeks Maternal plasma
12-20 weeks Fetal skin
20 weeks Fetal urine
Overall  fetal urine

Normally amniotic fluid is colorless; @ term color

of fluid is straw color.
color Seen
Green color Fetal distress
(meconium) Breech presentation
Transverse lie
Listeria infection
Golden color Rh incompatibility
(bilirubin)
Tobacco juice Intra uterine death
Saffron color, Post dated pregnancy
yellowish green

Besides producing amniotic fluid, fetus also

swallows amniotic fluid, which is how amniotic
fluid is kept in balance.
Composition – 99% water
Functions: performs a number of functions,
except nutrition function.
How can we measure amniotic fluid: USG
Amniotic fluid index
Normal is 5 cm to 24 cm.
Single largest vertical pocket: most sensitive
method.
Normal is 2-8 cm.

Oligohydramnios: amniotic fluid less than

minimum value or <200 ml
Polyhydramnios: amniotic fluid more than
maximum value or ≥ 2 L
Oligohydramnios Polyhydramnios
MC cause of mild MC cause of mild
Oligo- Poly-
Idiopathic Idiopathic
MC cause of severe MC cause of severe
Oligo- Poly-
Renal anomalies CNS anomalies
- Neural tube defects.
Oligohydramnios:
 Post dated pregnancy
 Premature rupture of membrane

 Leaking after amniocentesis

1
 Pregnancy induced hypertension (P∝ V )

(low GFR)
 IUGR (low GFR)

Dil mein pyar

D = Drugs like Indomethacin

I = IUGR
L = leaking after amniocentesis
Mein = maternal high BP
P = post dated pregnancy
Y (P) = premature rupture of membrane
A = amnion nodosum, chromosomal
anomalies like triploidy
R = renal anomalies of fetus

Polyhydraminos:
Twin pregnancy
Diabetic mother
Swallowing defects in fetus
Oesophageal atresia
Intestinal obstruction
Duodenal atresia
Cleft lip and cleft palate
CSF leaks into amniotic fluid – neural tube defect

Chorangioma of placenta
TORCH infection
Rh negative pregnancy

Trisomy

Effects of oligohydraminos:
 Occurs early in pregnancy
Lungs of baby do not get enough space to grow and
that lead to pulmonary hypoplasia.
It can lead to limb reduction defects.
 Occurs late in pregnancy
There is less space in uterus, so cord of baby
compress.
Due to compression of cord, blood supply to fetus
decreases, so fetus feels distress, due to this distress
fetus passes meconium into amniotic fluid, and
fetus swallows this meconium and develops
meconium aspiration syndrome.
Polyhydraminos:
Excessive stretching of uterus – lead to preterm
labor and rupture of membrane
Now, when membrane of Polyhydraminos uterus
ruptures, it leads to sudden collapse of uterus, and
placenta detaches from uterus leads to ABRUPTIO
PLACENTA.
Post partum hemorrhage.

Management:

Oligohydraminos:
Amino infusion with normal saline
Polyhydraminos:
Serial amniocentesis

Indications for serial amniocentesis are:

Respiratory distress

Indomethacin - it is drug of choice for closure of

ductus arteriosis, so if we give this drug after 32
weeks leads to premature closure of ductus
arteriosis.