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NeoReviews Vol.7 No.6 2006 e292
© 2006 American Academy of Pediatrics

Amniotic Fluid Dynamics

^* Regional Medical Director, Women’s Services, Sutter Health, Sacramento Sierra Region; Clinical Professor, Department of OB/GYN, University of California, Davis, Sacramento, Calif.

The first 300 words of the full text of this article appear below.

	Objectives

 
After completing this article, readers should be able to:

1. Describe clinical assessments of amniotic fluid volume.
   
2. Explain the processes of amniotic fluid formation and removal.
   
3. Describe the presentations and treatments for oligohydramnios and polyhydramnios.
   

	Introduction

 
Fortunately for most healthy pregnant women, amniotic fluid (AF) is an unimportant byproduct of the delivery. Little attention, if any, is paid to the AF unless meconium staining occurs in labor. It is only in the presence of certain complications that may compromise fetal well-being that any interest is taken in the AF. When there is too much AF (polyhydramnios) or too little (oligohydramnios), perinatal morbidity or mortality may be increased significantly, raising sudden concern among patients and clinicians. When severe oligohydramnios occurs in the second trimester, the perinatal mortality rate approaches 90% to 100%. (1)(2)(3) Similarly, with severe polyhydramnios in mid-pregnancy, the perinatal mortality rate can be greater than 50%. (4)(5) Attempts to study abnormalities of AF are hindered by the realization that little is known about the processes involved in the regulation of normal amniotic fluid volume (AFV).

This review examines the limited information available on the normal physiology of AFV regulation, including routes of formation, removal, and regulation and the changes in AF composition across gestation. Additionally, the clinical impact and treatment options on disease conditions are discussed.

	Normal Amniotic Fluid Volume

 
Attempts to measure actual AFV are limited by the invasiveness required to access the amniotic cavity. The most common method is injection of an inert dye into the amniotic cavity via amniocentesis, followed by timed removals of AF to determine a dilution curve. (6)(7)(8)(9) This method has been shown to be accurate compared with actual measurement of AF, but because of its invasive nature, has limited application . . . [Full Text of this Article]