Manipulation of amniotic fluid volume

Tak Yeung Leung; Stephen Sik Hung Suen

doi:10.1017/CBO9780511997778.016

Chapter 10.2 - Manipulation of amniotic fluid volume

Oligohydramnios and polyhydramnios

from Section 2 - Fetal disease

Published online by Cambridge University Press: 05 February 2013

Tak Yeung Leung and

Stephen Sik Hung Suen

Edited by

Mark D. Kilby ,

Anthony Johnson and

Dick Oepkes

Show author details

Mark D. Kilby: Affiliation:
Department of Fetal Medicine, University of Birmingham
Anthony Johnson: Affiliation:
Baylor College of Medicine, Texas
Dick Oepkes: Affiliation:
Department of Obstetrics, Leiden University Medical Center

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Summary

Introduction

Amniotic fluid serves several important functions during the in-utero life of the fetus including amnion metabolism, thermoregulation, hydraulic protection, anti-inflammation, provision of space for fetal breathing, swallowing, and limb movements [1]. The normal amount of amniotic fluid varies with gestation. The median volume is about 600 ml at 22 weeks, and gradually increases to a peak of 800 ml at 33 weeks, and finally declines to 700 ml at 40 weeks [2]. Although practically we cannot measure the absolute volume of amniotic fluid antenatally, we can estimate it through ultrasound measurement of the depth of the amniotic fluid. Deviation of liquor volume, either too much (polyhydramnios) or too low (oligohydramnios), is caused by varieties of fetal, placental, and maternal diseases which themselves are associated with significant perinatal morbidity and mortality. Furthermore, a severe degree of polyhydramnios and oligohydramnios can also lead to adverse outcomes. Ideally, treatment should target on the underlying etiology, which, however, is often not treatable prenatally. Therefore, the main aim of prenatal management is to correct the liquor volume, such as by amnioinfusion for oligohydramnios, or amnioreduction for polyhydramnios, so as to minimize the risk of adverse consequences of too much or too little amniotic fluid. In this chapter, we will discuss the measurement of amniotic fluid, followed by the definition, causes, diagnosis, and treatment of both polyhydramnios and oligohydramnios.

Assessment of amniotic fluid volume

Amniotic fluid volume is a three-dimensional (3D) parameter and practically its absolute volume cannot be measured directly, although half a century ago it was measured by indicator dye dilution technique [3]. Recent advances in 3D ultrasound and MRI may allow us to estimate the volume of liquor, but the technique is sophisticated, time-consuming, and expensive [4, 5]. Therefore, the simplest and easiest way of assessing amniotic fluid volume is still by 2D-ultrasonic measurement of the depth of amniotic pool used as the surrogate, which was derived 30 years ago [6–8].

Keywords

pulmonary hypoplasia maximum vertical pool oligohydramnios polyhydramnios ultrasound measurement amniotic fluid volume amnioreduction amniotic fluid index

Type: Chapter
Information: Fetal Therapy
Scientific Basis and Critical Appraisal of Clinical Benefits
, pp. 137 - 144

DOI: https://doi.org/10.1017/CBO9780511997778.016 [Opens in a new window]

Publisher: Cambridge University Press

Print publication year: 2012

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Chapter 10.2 - Manipulation of amniotic fluid volume

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