Amniotic fluid

Amniotic fluid is found around the developing

fetus, inside a membraneous sac, called amnion
 Physical characteristics
The amniotic fluid is the fluid surrounding the
developing fetus that is found within the
amniotic sac contained in the mother's womb.
- It is clear pale yellow fluid.
• Volume depends on gestation , 400ml at mid
pregnancy and reaches about 1000ml at 36-38
weeks .
- Amniotic fluid is found around the developing fetus,
inside a membraneous sac, called amnion

-Amniotic fluid immediately begins to fill the sac. In the

early weeks of pregnancy, amniotic fluid consists
mainly of water supplied by the mother. After about 20
weeks, fetal urine makes up most of the fluid.

- Amniotic fluid also contains nutrients, hormones and

disease-fighting antibodies
 Amniotic fluid function
• This fluid protects the developing fetus.

• Serves a key role in the exchange of water and molecules

between the fetus and the maternal circulation.

• It helps the developing fetus to move in the womb, which

allows for proper bone growth and muscle development.

Helps prevent compression of the umbilical cord.

• Contains Ig that also help in fighting pathogens.
 Amniotic Fluid composition
The composition of the amniotic fluid changes with
gestation in early pregnancy it is similar to maternal
and fetal serum.
- 98-99% of the amniotic fluid is water.
- A large number of dissolved substances such as
creatinine, urea, bile pigments ,renin, glucose ,
fructose, proteins (albumin and globulin)
lipids,hormones(estrogen and progestrone ),
enzymes , minerals (Na+ ,K+ Cl- ) .
- Suspended in it are some undissolved material such
as some fetal epithelial cells
The amount of amniotic fluid increases until 28 to 32
weeks of pregnancy. After that time, the level of fluid
generally stays constant until the baby is full term (37 to
40 weeks), when the level begins to decline.

In some pregnancies, however, there may be too little or

too much amniotic fluid.

• Having too little amniotic fluid is called:

oligohydramnios.
• Having too much amniotic fluid is called:
polyhydramnios
 oligohydramnios
• About 4% of pregnant women have
oligohydramnios.
• It can develop at any time during pregnancy,
although it is most common in the last trimester.
• 12 percent of women whose pregnancies last
about two weeks beyond their due dates (42
weeks gestation) develop oligohydramnios,
because the level of amniotic fluid tends to
decrease by that time in gestation
 Does oligohydramnios pose risks to
mother or baby?
• The problems associated with oligohydramnios differ
depending on the stage of the pregnancy.
• Oligohydramnios is more likely to have serious
consequences if it occurs in the first half of pregnancy
than if it occurs in the last trimester. These
consequences include :
• Birth defects (too little amniotic fluid early in
pregnancy can lead to compression of fetal organs,
resulting in lung and limb defects)
• Miscarriage
• Premature birth
• Stillbirth
• When oligohydramnios occurs in the second half
of pregnancy, it may be associated with poor
fetal growth. Near term, oligohydramnios may
increase the risk of complications of labor and
delivery, including compression of the umbilical
cord.
 This can deprive the baby of oxygen, sometimes
resulting in stillbirth. Women with
oligohydramnios are more likely than unaffected
women to need a cesarean section.
 polyhydramnios
• About 1 percent of pregnant women have too
much amniotic fluid .
• Most cases are minor and result from a
gradual build up of excess fluid in the second
half of pregnancy.
• However, a small number of women have a
rapid build up of fluid occurring as early as 16
weeks of pregnancy that usually results in very
early delivery
 What complications can polyhydramnios cause
for mother and baby?
 Polyhydramnios may increase the risk of pregnancy
complications including :
• Premature delivery
• Placental abruption (the placenta partially or
completely peels away from the uterine wall before
delivery)
• Stillbirth
• Postpartum hemorrhage (severe bleeding after
delivery)
• Fetal malposition (the baby is not lying in a head-down
position and may need to be delivered by cesarean
section)
Amniocentesis
• Amniocentesis is used to determine the health
of an unborn baby.
• Amniotic fluid contains cells that are normally
shed from the fetus. Samples of these cells are
obtained by withdrawing some amniotic fluid.
Studies of the cells obtained from the amniotic fluid
permit:
1)Chromosomal analysis of the cells which can be
performed to investigate:
Diagnosis of sex of the fetus
Detection of chromosomal abnormalities e.g. (Down’s syndrome)
DNA studies

2) The cells may be cultured and analyzed for enzymes,

or for other materials that may indicate genetically
transmitted disease.
Who is indicated
amniocentesis?
- That the pregnancy is 35
years or more.
- Family history of genetic
alterations
When we will have an amniocentesis?

Usually made between 15 to 18 weeks, reaching even to

11 or 12.

What are the risks of amniocentesis?

- Abortion: about 1 in 200 to 400 women aborted (higher

risk if done in the first quarter)
- Uterine infection: 1 in 1000
 Backbone that did not close properly

Extra chromosome
●Differentiation of amniotic fluid from maternal
urine:
Differentiation between amniotic fluid and maternal
urine may be necessary to determine accidental
puncture of the maternal bladder during specimen
collection.

 Chemical analysis of creatinine, urea, glucose, and

protein aids in the differentiation.
 Levels of creatinine and urea are much lower in
amniotic fluid than in urine.
 while glucose and protein tend to be higher in the
amniotic fluid than in urine.
Fetal lung maturity test:
Lecithin – sphingomyelin ratio:
Measurment of the lecithine/sphingomyelin ratio .
- This test is done to assess the maturation of the fetal
lungs.
- A lecithin- sphingomyelin ratio of 2 or greater is
associated with fetal pulmonary system maturity.
Fetal distress testing:
- Erythroblastosis fetalis is caused when mother
develops antibodies to an antigen on the fetal
erythrocytes and these antibodies cross the placenta
to destroy many fetal RBCs.

- Measurment of bilirubin indicates the degree of fetal

red blood cell destruction.