Amniotic fluid maintain the perfect homeostasis between mother and fetus. It protect both mother and fetus from various complications. Details is enclosed in presentation.

4. • Screening for fetal malformation (serum α-fetoprotien).
• Assessment of fetal well-being (amniotic fluid index).
• Assessment of fetal lung maturity (L/S ratio).
• Diagnosis and follow up of labour.
• Diagnosis of PROM (ferning test).
PROM: Premature rupture of membranes

6. • From 20 weeks up to term (mainly fetal urine)
• At 18th week, the fetus voids 7-14ml/day; at term fetal
kidneys secretes 600-700ml of urine/day into AF.
- Fetal respiratory tract secretes 250ml/day into AF.
- Fluid transfers across the placenta.
- Fetal oro-nasal secretions.
• Secretion is controlled by:
- Fetal swallowing at term removes 500ml/day.
- Reabsorption into maternal plasma (osmotic gradient).
• AF constituents:
- urea, creatinine & uric acid + desquamated fetal
cells, vernix, lanugo hair & others→ hypo-osmolar amniotic
fluid

8. • Clinical assessment is unreliable.
• Objective assessment depends on U/S to
measure:
Deepest vertical pool (DVP) &
Amniotic fluid index (AFI)

13. • Fundal height < gestational age
• Decreased fetal movement
• Fetal Heart Rate tracing abnormality
• Diagnosis: Ultrasound

14. 2. Maternal causes:
• Uteroplacental insufficiency.
• Preeclampsia.
3. Placental causes:
• twin-twin transfusion.
4. Drug causes:
Prostaglandin synthase inhibitor as NSAID.
5. Idiopathic

15. • In early pregnancy:
• Amniotic adhesions or bands→ amputation/death.
• Pressure deformities (club feet).
• Pulmonary hypoplasia:
- Thoracic compression.
- No breathing movement.
- No amniotic fluid retain.
 Flattened face.
 Postural deformities.

16. • In late pregnancy:
• Fetal growth restriction.
• Placental abruption.
• Preterm labour.
• Fetal distress.
• Fetal death.
• Meconium aspiration.
• Labour induction/CS.

18. J Obstet Gynaecol Res. 2010 Apr;36(2):239-47
Free Radic Biol Med. 2010 Aug 1;49(3):493-500
Pflugers Arch. 2010 May;459(6):841-51
Int J Gynaecol Obstet. 2005 Jan;88(1):15-8

20. The endothelium (inner lining) of blood vessels uses
nitric oxide to relax smooth muscle, thus resulting in
vasodilation and increasing blood flow

21. NO causes vasodilation &
increasing blood flow

30. • Fetal malformation: • Hydrops fetalis: congestive
- GIT: esophageal/duodenal heart failure, severe
atresia, tracheoesophageal anaemia or hypoproteinemia
fistula. → placental transudation
- CNS: anencephaly
(↓swallowing, exposed • Diabetes mellitus (osmotic
meninges, no antidiuretic diuresis).
hormone).
• Twin-twin transfusion → • Idiopathic.
fetal polyuria.

31. • Fetal prognosis worsens with more severe
hydramnios and congenital anomalies
• 15-20% fetal malformations
• Preterm delivery
• Suspect diabetes
• Prolapse of cord
• Abruption

32. • Dyspnea
• Venous Stasis
• Placental abruption
• Uterine dysfunction
• Post-partum hemorrhage
• Abnormal presentation -- C/S

33. • Minor degrees: no treatment.
• Bed rest, diuretics, water and salt restriction: ineffective.
• Hospitalization: dyspnea, abdominal pain or difficult
ambulation.
• Indomethacin therapy: .
- impairs lung liquid production/enhances absorption.
- ↓fluid movement across fetal membranes.
* Complications: premature closure of ductus
arteriosus, impairment of renal function, and cerebral
vasoconstriction.
• Amniocentesis: to relieve maternal distress and to test for fetal
lung maturity. Complications: ruptured
membrane, chorioamnionitis, placental abruption, preterm
labour.