Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-cd9895bd7-jn8rn Total loading time: 0 Render date: 2024-12-26T22:23:19.229Z Has data issue: false hasContentIssue false

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

By
Tak Yeung Leung  and
Stephen Sik Hung Suen
Edited by
Mark D. Kilby ,
Anthony Johnson  and
Dick Oepkes
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
Get access

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 hypoplasiamaximum vertical poololigohydramniospolyhydramniosultrasound measurementamniotic fluid volumeamnioreductionamniotic fluid index
Type
Chapter
Information
Fetal Therapy
Scientific Basis and Critical Appraisal of Clinical Benefits
 , pp. 137 - 144
Publisher: Cambridge University Press
Print publication year: 2012

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Harman, CR. Amniotic fluid abnormalities. Semin Perinatol 2008;32:288–94.Google Scholar
Brace, RA, Wolf, EJ. Normal amniotic fluid volume changes throughout pregnancy. Am J Obstet Gynecol 1989;161:382–8.Google Scholar
Queenan, JT, Thompson, W, Whitfield, CR, Shah, SI. Amniotic fluid volumes in normal pregnancies. Am J Obstet Gynecol 1972;114:34–8.Google Scholar
Gadelha, PS, Da Costa, AG, Filho, FM, El Beitune, P. Amniotic fluid volumetry by three-dimensional ultrasonography during the first trimester of pregnancy. Ultrasound Med Biol 2006;32:1135–9.Google Scholar
Zaretsky, MV, McIntire, DD, Reichel, TF, Twickler, DM. Correlation of measured amnionic fluid volume to sonographic and magnetic resonance predictions. Am J Obstet Gynecol 2004;191:2148–53.Google Scholar
Chamberlain, PF, Manning, FA, Morrison, I, Harman, CR, Lange, IR. Ultrasound evaluation of amniotic fluid volume. I. The relationship of marginal and decreased amniotic fluid volumes to perinatal outcome. Am J Obstet Gynecol 1984;150:245–9.Google Scholar
Crowley, P. Non quantitative estimation of amniotic fluid volume in suspected prolonged pregnancy. J Perinat Med 1980;8:249–51.Google Scholar
Manning, FA, Hill, LM, Platt, LD. Qualitative amniotic fluid volume determination by ultrasound: antepartum detection of intrauterine growth retardation. Am J Obstet Gynecol 1981;139(3):254–8.Google Scholar
Magann, EF, Sanderson, M, Martin, JN, Chauhan, S. The amniotic fluid index, single deepest pocket, and two-diameter pocket in normal human pregnancy. Am J Obstet Gynecol 2000;182:1581–8.Google Scholar
Moore, TR, Cayle, JE. The amniotic fluid index in normal human pregnancy. Am J Obstet Gynecol 1990;162:1168–73.Google Scholar
Chamberlain, PF, Manning, FA, Morrison, I, Harman, CR, Lange, IR. Ultrasound evaluation of amniotic fluid volume. II. The relationship of increased amniotic fluid volume to perinatal outcome. Am J Obstet Gynecol 1984;150:250–4.Google Scholar
Hill, LM, Breckle, R, Thomas, ML, Fries, JK. Polyhydramnios: ultrasonically detected prevalence and neonatal outcome. Obstet Gynecol 1987;69:21–5.Google Scholar
Thompson, O, Brown, R, Gunnarson, G, Harrington, K. Prevalence of polyhydramnios in the third trimester in a population screened by first and second trimester ultrasonography. J Perinat Med 1998;26:371–7.Google Scholar
Dashe, JS, McIntire, DD, Ramus, RM, Santos-Ramos, R, Twickler, DM. Hydramnios: anomaly prevalence and sonographic detection. Obstet Gynecol 2002;100:134–9.Google Scholar
Cardwell, MS. Polyhydramnios: a review. Obstet Gynecol Surv 1987;42:612–17.Google Scholar
Yoshihara, H, Nemoto, S, Suga, H, et al. Effect of high amniotic fluid pressure on fetal circulation. J Perinat Med 2000;28(3):221–7.Google Scholar
Fisk, NM, Vaughan, J, Talbert, D. Impaired fetal blood gas status in polyhydramnios and its relation to raised amniotic pressure. Fetal Diagn Ther 1994;9:7–13.Google Scholar
Vintzileos, AM, Turner, GW, Campbell, WA, et al. Polyhydramnios and obstructive renal failure: a case report and review of the literature. Am J Obstet Gynecol 1985;152(7 Pt 1):883–5.Google Scholar
Rivet, LC. Hydramnios. J Obstet Gynaecol Br Emp 1933;40:522–5.Google Scholar
Leung, WC, Jouannic, JM, Hyett, J, Rodeck, C, Jauniaux, E. Procedure-related complications of rapid amniodrainage in the treatment of polyhydramnios. Ultrasound Obstet Gynecol 2004;23:154–8.Google Scholar
Jauniaux, E, Holmes, A, Hyett, J, Yates, R, Rodeck, C. Rapid and radical amniodrainage in the treatment of severe twin-twin transfusion syndrome. Prenat Diagn 2001;21:471–6.Google Scholar
Myles, F, Taylor, O, Fisk, NM. Hydramnios and oligohydramnios. In: James, DK, Steer, PJ, Weiner, CP, Gonik, B, eds. High Risk Pregnancy, Management Options, 3rd edn. Philadelphia, Elsevier Publishers. 2006; 272–90
Caldeyro-Barcia, R, Pose, SV, Alvarez, H. Uterine contractility in polyhydramnios and the effects of withdrawal of the excess of amniotic fluid. Am J Obstet Gynecol 1957;73:1238–54.Google Scholar
Denbow, ML, Fisk, NM. The consequences of monochorionic placentation. Baillieres Clin Obstet Gynecol 1998;12:37–51.Google Scholar
Trespidi, L, Boschetto, C, Caravelli, E, et al. Serial amniocenteses in the management of twin-twin transfusion syndrome: when is it valuable. Fetal Diagn Ther 1997;12:15–20.Google Scholar
Engineer, N, O’Donoghue, K, Wimalasundera, RC, Fisk, NM. The effect of polyhydramnios on cervical length in twins: a controlled intervention study in complicated monochorionic pregnancies. PLoS One 2008;3(12):e3834.Google Scholar
Elliott, JP, Sawyer, AT, Radin, TG, Strong, RE. Large-volume therapeutic amniocentesis in the treatment of hydramnios. Obstet Gynecol 1994;84:1025–7.Google Scholar
Usberti, M, Pecoraro, C, Federico, S, et al. Mechanism of action of indomethacin in tubular defects. Pediatrics 1985;75:501–7.Google Scholar
Seyberth, HW, Rascher, W, Hackenthal, R, Wille, L. Effect of prolonged indomethacin therapy on renal function and selected vasoactive hormones in very-low-birth-weight infants with symptomatic patent ductus arteriosus. J Pediatr 1983;103(6):979–84.Google Scholar
Kirshon, B, Mari, G, Moise, K Jr. Indomethacin therapy in treatment of symptomatic polyhydramnios. Obstet Gynecol 1990;75:202–5.Google Scholar
Lange, IR, Harman, CR, Ash, KM, Manning, FA, Menticoglou, S. Twin with hydramnios: treating premature labor at source. Am J Obstet Gynecol 1989;160:552–7.Google Scholar
Carlan, SJ, O’Brien, WF, O’Leary, TD, Mastrogiannis, D. Randomized comparative trial of indomethacin and sulindac for the treatment of refractory preterm labor. Obstet Gynecol 1992;79:223–8.Google Scholar
Peek, MJ, McCarthy, A, Kyle, P, Sepulveda, W, Fisk, NM. Medical amnioreduction with sulindac to reduce cord complications in monoamniotic twins. Am J Obstet Gynecol 1997;176:334–6.Google Scholar
Schucker, JL, Mercer, BM. Midtrimester premature rupture of the membranes. Semin Perinatol 1996;20:389–400.Google Scholar
Martinez de Tejada, B, Boulvain, M, Dumps, P, et al. Can we improve the diagnosis of rupture of membranes? The value of insulin-like growth factor binding protein-1. BJOG 2006;113:1096–9.Google Scholar
Bronshtein, M, Amit, A, Achiron, R, Noy, I, Blumenfeld, Z. The early prenatal sonographic diagnosis of renal agenesis: techniques and possible pitfalls. Prenat Diagn 1994;14:291–7.Google Scholar
Hoffman, CK, Filly, RA, Callen, PW. The “lying down” adrenal sign: a sonographic indicator of renal agenesis or ectopia in fetuses and neonates. J Ultrasound Med 1992;11:533–6.Google Scholar
Lauria, MR, Gonik, B, Romero, R. Pulmonary hypoplasia: pathogenesis, diagnosis, and antenatal prediction. Obstet Gynecol 1995;86:466–75.Google Scholar
Harding, R, Hooper, SB, Dickson, KA. A mechanism leading to reduced lung expansion and lung hypoplasia in fetal sheep during oligohydramnios. Am J Obstet Gynecol 1990;163(6 Pt 1):1904–13.Google Scholar
Dickson, KA, Harding, R. Decline in lung liquid volume and secretion rate during oligohydramnios in fetal sheep. J Appl Physiol 1989;67:2401–7.Google Scholar
Winn, HN, Chen, M, Amon, E, et al. Neonatal pulmonary hypoplasia and perinatal mortality in patients with midtrimester rupture of amniotic membranes – a critical analysis. Am J Obstet Gynecol 2000;182:1638–44.Google Scholar
Kilbride, HW, Yeast, J, Thibeault, DW. Defining limits of survival: lethal pulmonary hypoplasia after midtrimester premature rupture of membranes. Am J Obstet Gynecol 1996;175(3 Pt 1):675–81.Google Scholar
van Teeffelen, AS, van der Ham, DP, Oei, SG, et al. The accuracy of clinical parameters in the prediction of perinatal pulmonary hypoplasia secondary to midtrimester prelabour rupture of fetal membranes: a meta-analysis. Eur J Obstet Gynecol Reprod Biol 2010;148:3–12.Google Scholar
Vergani, P, Andreani, M, Greco, M, et al. Two- or three-dimensional ultrasonography: which is the best predictor of pulmonary hypoplasia? Prenat Diagn 2010;30:834–8.Google Scholar
Rizzo, G, Capponi, A, Angelini, E, Mazzoleni, A, Romanini, C. Blood flow velocity waveforms from fetal peripheral pulmonary arteries in pregnancies with preterm premature rupture of the membranes: relationship with pulmonary hypoplasia. Ultrasound Obstet Gynecol 2000;15:98–103.Google Scholar
Yoshimura, S, Masuzaki, H, Gotoh, H, Fukuda, H, Ishimaru, T. Ultrasonographic prediction of lethal pulmonary hypoplasia: comparison of eight different ultrasonographic parameters. Am J Obstet Gynecol 1996;175:477–83.Google Scholar
Kilbride, HW, Thibeault, DW. Neonatal complications of preterm premature rupture of membranes. Pathophysiology and management. Clin Perinatol 2001;28:761–85.Google Scholar
Sciscione, AC, Manley, JS, Pollock, M, et al. Intracervical fibrin sealants: a potential treatment for early preterm premature rupture of the membranes. Am J Obstet Gynecol 2001;184:368–73.Google Scholar
Calado, E, Ayres-de-Campos, D. Premature rupture of membranes at 20 weeks: report of a successful outcome after transcervical application of fibrin glue. Fetal Diagn Ther 2007;22:14–17.Google Scholar
Gramellini, D, Piantelli, G, Delle Chiaie, L, Rutolo, S, Vadora, E. Amnioinfusion in the management of oligohydramnios. J Perinat Med 1998;26:293–301.Google Scholar
Singla, A, Yadav, P, Vaid, NB, Suneja, A, Faridi, MM. Transabdominal amnioinfusion in preterm premature rupture of membranes. Int J Gynaecol Obstet 2010;108:199–202.Google Scholar
Locatelli, A, Ghidini, A, Verderio, M, et al. Predictors of perinatal survival in a cohort of pregnancies with severe oligohydramnios due to premature rupture of membranes at <26 weeks managed with serial amnioinfusions. Eur J Obstet Gynecol Reprod Biol 2006;128:97–102.Google Scholar
Hofmeyr, GJ, Essilfie-Appialia, G, Lawrie, TA. Amnioinfusion for preterm rupture of membranes. Cochrane Database Syst Rev 2011;(12):CD00942.Google Scholar
Tranquilli, AL, Giannubilo, SR, Bezzecheri, V, Seafnoli, C. Transabdominal amnioinfusion in preterm premature rupture of membranes: a randomised controlled trial. BJOG 2005; 112: 759–63.Google Scholar
Singla, A, Yadav, P, Vaid, NB, Suneja, A, Faridi, MMA. Transabdominal amnioinfusion in preterm premature rupture of membranes. Int J Gynecol Obstet 2010; 108:199–202.Google Scholar
Edwards, RK, Duff, P. Prophylactic cefazolin in amnioinfusions administered for meconium-stained amniotic fluid. Infect Dis Obstet Gynecol 1999;7:153–7.Google Scholar
Ogita, S, Imanaka, M, Matsumoto, M, Oka, T, Sugawa, T. Transcervical amnioinfusion of antibiotics: a basic study for managing premature rupture of membranes. Am J Obstet Gynecol 1988;158:23–7.Google Scholar
Vergani, P, Locatelli, A, Strobelt, N, et al. Amnioinfusion for prevention of pulmonary hypoplasia in second-trimester rupture of membranes. Am J Perinatol 1997;14:325–9.Google Scholar
Hsu, TY, Hsu, JJ, Fu, HC, et al. The changes in Doppler indices of fetal ductus venosus and umbilical artery after amnioinfusion for women with preterm premature rupture of membranes before 26 weeks’ gestation. Taiwan J Obstet Gynecol 2009;48:268–72.Google Scholar
De Carolis, MP, Romagnoli, C, De Santis, M, et al. Is there significant improvement in neonatal outcome after treating pPROM mothers with amnio-infusion? Biol Neonate 2004;86:222–9.Google Scholar
Gramellini, D, Fieni, S, Kaihura, C, Faiola, S, Vadora, E. Transabdominal antepartum amnioinfusion. Int J Gynaecol Obstet 2003;83:171–8.Google Scholar
Ogunyemi, D, Thompson, W. A case controlled study of serial transabdominal amnioinfusions in the management of second trimester oligohydramnios due to premature rupture of membranes. Eur J Obstet Gynecol Reprod Biol 2002;102:167–72.Google Scholar
Turhan, NO, Atacan, N. Antepartum prophylactic transabdominal amnioinfusion in preterm pregnancies complicated by oligohydramnios. Int J Gynaecol Obstet 2002;76:15–21.Google Scholar
Chen, M, Hsieh, CY, Cameron, AD, et al. Management of oligohydramnios with amnioinfusion, amniopatch, and cerclage. Taiwan J Obstet Gynecol 2005;44:347–352.Google Scholar
Tan, LK, Kumar, S, Jolly, M, et al. Test amnioinfusion to determine suitability for serial therapeutic amnioinfusion in midtrimester premature rupture of membranes. Fetal Diagn Ther 2003;18:183–9.Google Scholar
Vergani, P, Locatelli, A, Verderio, M, Assi, F. Premature rupture of the membranes at <26 weeks’ gestation: role of amnioinfusion in the management of oligohydramnios. Acta Biomed 2004;75 Suppl 1:62–6.Google Scholar
Kilpatrick, SJ, Safford, KL. Maternal hydration increases amniotic fluid index in women with normal amniotic fluid. Obstet Gynecol 1993;81:49–52.Google Scholar
Hofmeyr, GJ, Gulmezoglu, AM. Maternal hydration for increasing amniotic fluid volume in oligohydramnios and normal amniotic fluid volume. Cochrane Database Syst Rev 2002;(1):CD000134.Google Scholar
Fait, G, Pauzner, D, Gull, I, et al. Effect of 1 week of oral hydration on the amniotic fluid index. J Reprod Med 2003;48:187–90.Google Scholar

Save book to Kindle

To save this book to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×