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Amniotic Fluid Problems

There are four categories of amniotic fluid:

  1. Oligohydramnios . Too little amniotic fluid.
  2. Pockets seen greater than 1 cm in diameter (normal).
  3. Adequate fluid, seen everywhere between the foetus and uterine wall (normal).
  4. Polyhydramnios . Too much amniotic fluid.

Measurement is commonly taken by using an ultrasound to determine the Amniotic Fluid Index (AFI).

Oligohydramnios

When a woman is said to have too little amniotic fluid she has oligohydramnios. This is defined as having less than 200 ml of amniotic fluid at term or an AFI of less than 5 cm. This means that during an ultrasound the largest pocket of fluid found did not measure 1 cm or greater at its largest diameter. It is clinically very hard to prove prior to delivery. After the birth, examining the placenta for the presence of amnion nodosum on the placenta is highly correlated with oligohydramnios.

Depending on when the woman is diagnosed with oligohydramnios, there are different complications to look for, although the majority of women diagnosed will not have problems.

In early pregnancy there is the worry of amniotic adhesions causing deformities or constriction of the umbilical cord. There is also concern about pressure deformities, like clubfeet, from not having enough free space in the womb.

Even with oligohydramnios, ultrasound resolution and screening for anomalies is very adequate. So ultrasound is still an effective way to screen for deformities both associated and non-associated with the oligohydramnios.

Later in pregnancy oligohydramnios is one of the signs of foetal distress. This occurrence can cause compression of the cord, which can lead to foetal hypoxia, meaning that the baby is not getting enough oxygen.

Induction is not always the best option when oligohydramnios is present. There are many factors that need to be taken into consideration.

Meconium , if passed cannot be diluted in cases of true oligohydramnios, however, one study found that there were fewer incidences of meconium staining when low amniotic fluid volumes were reported. However, there was an increase in the numbers of babies having foetal distress requiring a caesarean birth.

Other concerns with oligohydramnios:

Diabetes is commonly thought of as a reason for oligohydramnios, it does not have to cause a problem with the pregnancy with proper treatment.

What treatment options are available for women with oligohydramnios?

Originally we felt that replacing the fluid through amnioinfusion was a great idea. However, this did not appear to be beneficial. We do know that immersion works well at reversing the signs of oligohydramnios.

In the absence of IUGR and foetal anomalies, women diagnosed with oligohydramnios can have an appropriate sized baby with no health problems.

Polyhydramnios

Polyhydramnios is the opposite end of the scale, being defined as 2000 ml of fluid at term or greater. This occurs in fewer that 1 % of pregnancies.

While some feel that polyhydramnios is a cause for preterm labour because of uterine distension, polyhydramnios in and of itself is not a predictor for preterm labour, rather the cause of the increase in fluid is predictive of whether the pregnancy will go to term.

Polyhydramnios is more likely to occur when:

There are varying degrees of polyhydramnios. The severity of polyhydramnios does not have an influence on the weight of your baby, as earlier studies had predicted.

Treatment varies for polyhydramnios, and includes drug treatments, as well as selective use of amniocentesis to reduce the fluid volume.

Left untreated there may be further risks at the birth, small in number, but they should be addressed. These would include a greater incidence of cord prolapse , foetal malpresentation, placental abruption , and postpartum hemorrhage .

The information in this page is presented in summarised form and has been taken from the following source(s):
1. Pregnancy at About.com http://pregnancy.about.com/


Other HON resources 
   From MedHunt
    (websites)


Amniotic Fluid problems in Pregnancy
    From HONselect
     (def;articles & more)   

Amniotic Fluid
Oligohydramnios
Polyhydramnios

    Recent articles
       from
Medline

Amniotic Fluid
Oligohydramnios
Polyhydramnios
 

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  http://www.hon.ch/Dossier/MotherChild/complications/amnion.html Last modified: Oct 20 2004