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Chapter 20 - Oligohydramnios and Polyhydramnios: Therapeutic Manipulation of Amniotic Fluid Volume

from Manipulation of Fetal Amniotic Fluid Volume

Published online by Cambridge University Press:  21 October 2019

By
Janice Gibson  and
Janet Brennand
Edited by
Mark D. Kilby ,
Anthony Johnson  and
Dick Oepkes
Mark D. Kilby
Affiliation:
University of Birmingham
Anthony Johnson
Affiliation:
University of Texas Medical School at Houston
Dick Oepkes
Affiliation:
Leids Universitair Medisch Centrum
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Summary

The volume of amniotic fluid, for which nomograms exist [1], is the result of a balance between its production and removal. Amniotic fluid production largely reflects fetal urine production, but includes respiratory tract and oral secretions. Amniotic fluid removal relies on fetal swallowing. Fluid dynamics across the membranes are the third component of this balance. In current clinical practice a surrogate estimate for amniotic volume is made by 2-dimensional ultrasound-derived measurements of vertical cord-free liquor pools, either by amniotic fluid index (AFI) – a cumulative measurement of vertical pools made within 4 quadrants of the uterus – or by the measurement of the single deepest vertical pocket (DVP) within the uterus. Increased production or decreased removal will result in the development of polyhydramnios. The converse will result in development of oligohydramnios. The importance of these abnormalities of amniotic fluid volume is that they are a marker for fetal pathology. Their significance in isolation is limited, as are indications for their manipulation.

Type
Chapter
Information
Fetal Therapy
Scientific Basis and Critical Appraisal of Clinical Benefits
 , pp. 200 - 214
Publisher: Cambridge University Press
Print publication year: 2020

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