Amniotic fluid

Amniotic fluid maintain the perfect homeostasis between mother and fetus. It protect both mother and fetus from various complications. Details is enclosed in presentation.

1. Clinical importance of AF: Screening for fetal malformation (serum α -fetoprotien). Assessment of fetal well-being (amniotic fluid index). Assessment of fetal lung maturity (L/S ratio). Diagnosis and follow up of labour. Diagnosis of PROM (ferning test). PROM: Premature rupture of membranes

2. From 20 weeks up to term (mainly fetal urine) At 18th week, the fetus voids 7-14ml/day; at term fetal kidneys secretes 600-700ml of urine/day into AF. - Fetal respiratory tract secretes 250ml/day into AF. - Fluid transfers across the placenta. - Fetal oro -nasal secretions. Secretion is controlled by: - Fetal swallowing at term removes 500ml/day. - Reabsorption into maternal plasma (osmotic gradient). AF constituents: - urea, creatinine & uric acid + desquamated fetal cells, vernix , lanugo hair & others→ hypo- osmolar amniotic fluid Normal amniotic fluid volume

3. Amniotic fluid volume (AFV) assessment Clinical assessment is unreliable. Objective assessment depends on U/S to measure: Deepest vertical pool (DVP) & Amniotic fluid index (AFI)

4. Signs/symptoms Fundal height < gestational age Decreased fetal movement Fetal Heart Rate tracing abnormality Diagnosis: Ultrasound

5. 2. Maternal causes: Uteroplacental insufficiency. Preeclampsia. 3. Placental causes: twin-twin transfusion. 4. Drug causes: Prostaglandin synthase inhibitor as NSAID. 5. Idiopathic Causes of oligohydramnios

6. Complications of oligohydramnios In early pregnancy: Amniotic adhesions or bands → amputation/death . Pressure deformities (club feet). Pulmonary hypoplasia : - Thoracic compression. - No breathing movement. - No amniotic fluid retain. Flattened face. Postural deformities.

7. In late pregnancy : Fetal growth restriction. Placental abruption. Preterm labour . Fetal distress. Fetal death. Meconium aspiration. Labour induction/CS. Complications of oligohydramnios

8. Low level of nitric oxide (NO) plays an important role in the pathogenesis of pregnancy complications and other diseases. J Obstet Gynaecol Res. 2010 Apr;36(2):239-47 Free Radic Biol Med. 2010 Aug 1;49(3):493-500 Pflugers Arch. 2010 May;459(6):841-51 Int J Gynaecol Obstet. 2005 Jan;88(1):15-8 A recent research ………

9. The endothelium (inner lining) of blood vessels uses nitric oxide to relax smooth muscle, thus resulting in vasodilation and increasing blood flow

10. NO causes vasodilation & increasing blood flow

11. L- Arginine may be a useful treatment in Oligohydramnios

12. Polyhydramnios

13. Causes of polyhydramnios Fetal malformation: - GIT: esophageal/duodenal atresia , tracheoesophageal fistula. - CNS: anencephaly ( ↓swallowing, exposed meninges , no antidiuretic hormone) . Twin-twin transfusion → fetal polyuria . Hydrops fetalis : congestive heart failure, severe anaemia or hypoproteinemia → placental transudation D iabetes mellitus (osmotic diuresis ). Idiopathic .

14. (fetus)? Fetal prognosis worsens with more severe hydramnios and congenital anomalies 15-20% fetal malformations Preterm delivery Suspect diabetes Prolapse of cord Abruption

15. (Mother)? Dyspnea Venous Stasis Placental abruption Uterine dysfunction Post-partum hemorrhage Abnormal presentation -- C/S

16. Management of polyhydramnios Minor degrees: no treatment. Bed rest, diuretics, water and salt restriction: ineffective. Hospitalization : dyspnea , abdominal pain or difficult ambulation. I ndomethacin therapy: . - impairs lung liquid production/enhances absorption. - ↓fluid movement across fetal membranes. * C omplications : premature closure of ductus arteriosus , impairment of renal function, and cerebral vasoconstriction. Amniocentesis : to relieve maternal distress and to test for fetal lung maturity. Complications: ruptured membrane, chorioamnionitis , placental abruption, preterm labour .

17. Thanks