7. FUNCTIONS OF AMNIOTIC FLUID
●
●
●
●
●
●
●
●
Shock absorber – protects from external trauma.
Protects cord from compression.
Permits fetal movements – development of
musculoskeletal system, prevents adhesions.
Swallowing of AF enhances growth & development
of GIT.
AF volume maintains AF pressure – reduces loss of
lung liquid – pulmonary development.
Maintenance of fetal body temperature.
Some fetal nutrition, water supply.
Bacteriostatic properties – decreases potential for
infection
Dr Mona Shroff
www.obgyntoday.info
*
8. DEFINITION
●
AMNIOTIC FLUID VOLUME < 5 th
percentile for gestational age
●
AMNIOTIC FLUID INDEX < 5
●
SINGLE VERTICAL POCKET < 2 cms
●
Amniotic fluid volume of less than 500 mL at
32-36 weeks' gestation
Dr Mona Shroff
www.obgyntoday.info
*
12. DIAGNOSIS
SYMPTOMS
SIGNS
NO SPECIFIC
SYMPTOMS
H/O leaking p/v
Postterm
s/o preeclampsia
Drugs
Less fetal movements
Dr
Uterus – small for
date
Feels full of fetus
Malpresentations
IUGR
Dr Mona Shroff
www.obgyntoday.info
Mona Shroff
*
14. Technique of AFI
●
●
●
●
●
Uterus divided into 4 quadrants
Transducer in vertical plane
Sum of 4 quadrants max pocket depth
excluding cord & limbs.
Prior to 20 wks 2 halves
Twins: composite AFI or individual
vertical pockets
Dr
Dr Mona Shroff
www.obgyntoday.info
Mona Shroff
*
15. Authors' conclusions
●
The single deepest vertical pocket measurement in
the assessment of amniotic fluid volume during fetal
surveillance seems a better choice since the use of
the amniotic fluid index increases the rate of
diagnosis of oligohydramnios and the rate of induction
of labor without improvement in peripartum outcomes.
A systematic review of the diagnostic accuracy of
both methods in detecting decreased amniotic fluid
volume is required.
Nabhan AF, Abdelmoula YA. Amniotic fluid index versus single deepest
vertical pocket as a screening test for preventing adverse pregnancy
outcome. Cochrane Database of Systematic Reviews 2008, Issue 3
Dr
Dr Mona Shroff
www.obgyntoday.info
Mona Shroff
*
20. Techniques for Monitoring
●
●
●
Single pocket without cord
AFI = sum of deepest pocket in each of 4 quadrants without
cord
BPP =
1.
2.
3.
4.
5.
●
●
NST
breathing 30sec in 30min
move 3 limb/body in 30min
extension of extremity with flexion or open/close hand
single vertical non-cord pocket of 2 cm
Scoring: 0 or 2 for each, 10 is normal, 6 equivocal, 4 abnormal
Modified BPP = NST, +/- acoustic stimulation, AFI
●
●
●
AFI > 5 ok
AFI < 5 or non-reactive NST not ok
modified BPP equally useful as BPP for monitoring, per ACOG
21. TREATMENT
●
●
●
●
●
ADEQUATE REST – decreases dehydration
HYDRATION – Oral/IV Hypotonic fluids(2 Lit/d)
temperory increase
helpful during labour,prior
to ECV, USG
SERIAL USG – Monitor growth,AFI,BPP
INDUCTION OF LABOUR/ LSCS
Lung maturity attained
Lethal malformation
Fetal jeopardy
Sev IUGR
Severe oligo
DDAVP: ? Research settings
Dr
Dr Mona Shroff
www.obgyntoday.info
Mona Shroff
*
22. Hofmeyr GJ, Gülmezoglu AM. Maternal hydration for increasing amniotic fluid
volume in oligohydramnios and normal amniotic fluid volume. Cochrane Database of
Systematic Reviews 2002, Issue 1.
Authors' conclusions
●
Simple maternal hydration /IV Hypotonic fluid (2 lit)
appears to increase amniotic fluid volume and may be
beneficial in the management of oligohydramnios and
prevention of oligohydramnios during labour or prior
to external cephalic version. Controlled trials are
needed to assess the clinical benefits and possible
risks of maternal hydration for specific clinical
purposes.
Dr
Dr Mona Shroff
www.obgyntoday.info
Mona Shroff
*
24. Hofmeyr GJ. Prophylactic versus therapeutic amnioinfusion for oligohydramnios in
labour. Cochrane Database of Systematic Reviews 1996,Issue 1
.
Authors' conclusions
● There appears to be no advantage of
prophylactic amnioinfusion over
therapeutic amnioinfusion carried out
only when fetal heart rate decelerations
or thick meconium-staining of the liquor
occur.
Dr
Dr Mona Shroff
www.obgyntoday.info
Mona Shroff
*
26. DDAVP : concerns
● Effect
on maternal & fetal bld
volume
● Long term effects on AFI
● Prophylactic or chronic use
● Mask oligohydramnios ??
Dr
Dr Mona Shroff
www.obgyntoday.info
Mona Shroff
*
28. TREATMENT ACC. TO CAUSE
●
●
●
●
Drug induced – OMIT DRUG
PROM – INDUCTION
PPROM – Antibiotics,steroid – Induction
FETAL SURGERY
VESICO AMNIOTIC SHUNT-PUV
Laser photocoagulation for TTTS
Dr
Dr Mona Shroff
www.obgyntoday.info
Mona Shroff
*
