Medical Archive

C11 Amniotic fluid

Introduction

??? ???? ??, 20???? ?? ??? ??? ??? ?.
Cox inh.? vasopressor ??? ?? ??? ???? ???.

	???	???
?? ??	idiopathic (60%) Anencephaly Hydrocephalus Spina bifida Esosphageal atresia, TEF Diaphragmatic hernia	???? (Uro, nephro) ???? (FGR) ???? ROM
?? ??	DM, ????	???, ????, DM, NSAID(PG ?? ??), ACEI
??	????, ??
Cx	???? (??? ?????) Atony (?? ???? ??)	Cord compression ? ?? ?? (1, 2???)
??	Amniocentesis (500mL/hr) Indomethacin (??, urine ??) ??/~~????~~, ~~???~~	Amnioinfusion

Normal amniotic fluid volume

Physiology

Measurement

Sonographic assessment

AFI 5~24cm / ?? ?????? 2~8cm
AFI = Sum of 4?? quadrants ??? largest vertical D

FIGURE 11-1
Amnionic fluid index (AFI) according to gestational-age-specific and threshold values. The blue curves represent the 2.5th, 50th, and 97.5th AFI percentile values, based on the nomogram by Moore (1990). Red and tan curves represent 50th percentile values for AFI from Machado (2007) and from Hinh and Ladinsky (2005), respectively. The light blue and yellow shaded bars indicate threshold values used to define hydramnios and oligohydramnios, respectively.

Hydramnios

Etiology

Most causes are idiopathic.

Multiple gestation
Diabetes mellitus

Complications

Fetal malposition
Umbilical cord prolapse
Preterm labor
PPROM

Pregnancy outcomes

Managment

~~Bed rest, diuretics, water and salt restriction~~
<32 weeks gestation
- Indomethacin
  - Reduces amniotic fluid volume by decreasing PG synthesis.
  - Contraindicated at ?32 weeks gestation d/t the risk of premature fetal ductus arteriosus closure. ?? ??? ?? ??? ?? ??? ??.
Severe or symptomatic at preterm gestation
- Amnioreduction
Mild, asymptomatic at term gestation
- Expectant management

Oligohydramnios

Etiology

Early-gestation
Fetal etiologies (eg, aneuploidy, renal agenesis, posterior urethral valves) b/c amniotic fluid volume is dependent on normal fetal urine production

Second- and third-trimester
Uteroplacental insufficiency (with concomitant fetal growth restriction) or maternal causes, such as dehydration or rupture of membranes (with normal fetal growth)