Manipulation of amniotic fluid volume

doi:10.1017/CBO9780511997778.015

Chapter 10.1 - Manipulation of amniotic fluid volume

Homeostasis of fluid volumes in the amniotic cavity

from Section 2 - Fetal disease

Published online by Cambridge University Press: 05 February 2013

Marie H. Beall and

Edited by

Anthony Johnson and

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

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Summary

Introduction

Human pregnancies contain large amounts of water in several compartments, including the fetal body, the placenta and membranes, and the amniotic fluid (AF). This water circulates within the conceptus and also between fetus and mother. Normal acquisition and circulation of water is critical to fetal health and development and abnormal amounts of water, evidenced as insufficient (oligohydramnios) or excessive (polyhydramnios) amounts of AF, are associated with impaired fetal outcome, even in the absence of structural fetal abnormalities. This chapter will review the current understanding of water flow into the gestation and into and out of the amniotic cavity, and will review evidence suggesting that the fetus may regulate the AF volume.

Fetal water compartments

The fetal body is composed largely of water. A preterm fetus may be almost 90% water, although near term the proportion is closer to 70% [1, 2]. A 3500 g term human fetus would therefore contain about 2500 ml of water, 350 ml of which are in the vascular compartment, 1000 ml in the intracellular space, and the remainder extracellular [3]. Similarly, the placenta is approximately 85% water [4]; the term fetus would therefore devote about 500 ml of water to the placenta. Lastly, the fetus has a variable, but relatively large, amount of water stored in the amniotic cavity – the AF. Although AF volume is much less related to fetal size, a normal term fetus would have 500–1200 ml [5] in the AF (Figure 10.1.1).

Keywords

membrane water gestation homeostasis human pregnancies placenta fetus amniotic cavity amniotic fluid

Type: Chapter
Information: Fetal Therapy
Scientific Basis and Critical Appraisal of Clinical Benefits
, pp. 128 - 136

DOI: https://doi.org/10.1017/CBO9780511997778.015 [Opens in a new window]

Publisher: Cambridge University Press

Print publication year: 2012

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References

Greizerstein, HB. Placental and fetal composition during the last trimester of gestation in the rat. Biol Reprod 1982;26(5):847–53.Google Scholar

Engle, WA, Lemons, JA. Composition of the fetal and maternal guinea pig throughout gestation. Pediatr Res 1986;20(11):1156–60.Google Scholar

Hartnoll, G, Betremieux, P, Modi, N. Randomised controlled trial of postnatal sodium supplementation on body composition in 25 to 30 week gestational age infants. Arch Dis Child Fetal Neonatal Ed 2000;82(1):F24–8.Google Scholar

Barker, G, Boyd, RD, D’Souza, SW, et al. Placental water content and distribution. Placenta 1994;15(1):47–56.Google Scholar

Goodwin, JW, Godden, JO, Chance, GW. Perinatal Medicine: The Basic Science Underlying Clinical Practice. Baltimore, MD, The Williams and Wilkins Co, 1976.

Campbell, J, Wathen, N, Macintosh, M, et al. Biochemical composition of amniotic fluid and extraembryonic coelomic fluid in the first trimester of pregnancy. Br J Obstet Gynaecol 1992;99(7):563–5.Google Scholar

Faber, J, Gault, TJ, Long, LR, Thornburg, KL. Chloride and the generation of amniotic fluid in the early embryo. J Exp Zool 1973;183(3):343–52.Google Scholar

Gillibrand, PN. Changes in the electrolytes, urea and osmolality of the amniotic fluid with advancing pregnancy. J Obstet Gynaecol Br Commonw 1969;76(10):898–905.Google Scholar

Desai, M, Ladella, S, Ross, MG. Reversal of pregnancy-mediated plasma hypotonicity in the near-term rat. J Matern Fetal Neonatal Med 2003;13(3):197–202.Google Scholar

Cheung, CY, Brace, RA. Amniotic fluid volume and composition in mouse pregnancy. J Soc Gynecol Investig 2005;12(8):558–62.Google Scholar

Brace, RA, Wolf, EJ. Normal amniotic fluid volume changes throughout pregnancy. Am J Obstet Gynecol 1989;161(2):382–8.Google Scholar

Gadd, RL. The volume of the liquor amnii in normal and abnormal pregnancies. J Obstet Gynaecol Br Commonw 1966;73(1):11–22.Google Scholar

Beischer, NA, Brown, JB, Townsend, L. Studies in prolonged pregnancy. 3. Amniocentesis in prolonged pregnancy. Am J Obstet Gynecol 1969;103(4):496–503.Google Scholar

Queenan, JT, Von Gal, HV, Kubarych, SF. Amniography for clinical evaluation of erythroblastosis fetalis. Am J Obstet Gynecol 1968;102(2):264–74.Google Scholar

Sibley, CP, Boyd, DH. Mechanisms of transfer across the human placenta. In: Polin, RA, Fox, WW, Abman, S, eds. Fetal and Neonatal Physiology. Philadelphia, PA, WB Saunders. 2006; 111–22.

Stulc, J, Stulcova, B, Sibley, CP. Evidence for active maternal-fetal transport of Na+ across the placenta of the anaesthetized rat. J Physiol 1993;470:637–49.Google Scholar

Faber, JJ, Anderson, DF. Current topic: water volume of the ovine conceptus; point of view. Placenta 1992;13(3):199–212.Google Scholar

Lumbers, ER, Smith, FG, Stevens, AD. Measurement of net transplacental transfer of fluid to the fetal sheep. J Physiol 1985;364:289–99.Google Scholar

Faichney, GJ, Fawcett, AA, Boston, RC. Water exchange between the pregnant ewe, the foetus and its amniotic and allantoic fluids. J Comp Physiol B 2004;174(6):503–10.Google Scholar

Brace, RA. Progress toward understanding the regulation of amniotic fluid volume: water and solute fluxes in and through the fetal membranes. Placenta 1995;16(1):1–18.Google Scholar

Schroder, HJ. Basics of placental structures and transfer functions. In: Brace, RA, Ross, MG, Robillard, JE, eds. Fetal & Neonatal Body Fluids. Ithaca, NY: Perinatology Press. 1989; 187–226.

Hempstock, J, Bao, YP, Bar-Issac, M, et al. Intralobular differences in antioxidant enzyme expression and activity reflect the pattern of maternal arterial bloodflow within the human placenta. Placenta 2003;24(5):517–23.Google Scholar

Stulc, J, Stulcova, B. Asymmetrical transfer of inert hydrophilic solutes across rat placenta. Am J Physiol 1993;265(3 Pt 2):R670–5.Google Scholar

Schroder, H, Nelson, P, Power, G. Fluid shift across the placenta: I. The effect of dextran T 40 in the isolated guinea-pig placenta. Placenta 1982;3(4):327–38.Google Scholar

Hanson, RS, Powrie, RO, Larson, L. Diabetes insipidus in pregnancy: a treatable cause of oligohydramnios. Obstet Gynecol 1997;89(5):816–17.Google Scholar

Ross, MG, Cedars, L, Nijland, MJ, Ogundipe, A. Treatment of oligohydramnios with maternal 1-deamino-[8-D-arginine] vasopressin-induced plasma hypoosmolality. Am J Obstet Gynecol 1996;174(5):1608–13.Google Scholar

Ross, MG, Nijland, MJ, Kullama, LK. 1-Deamino-[8-D-arginine] vasopressin-induced maternal plasma hypoosmolality increases ovine amniotic fluid volume. Am J Obstet Gynecol 1996;174(4):1125–7.Google Scholar

Leichtweiss, HP, Schroder, H. The effect of elevated outflow pressure on flow resistance and the transfer of THO, albumin and glucose in the isolated guinea pig placenta. Pflugers Arch 1977;371(3):251–6.Google Scholar

Brace, RA, Moore, TR. Transplacental, amniotic, urinary, and fetal fluid dynamics during very-large-volume fetal intravenous infusions. Am J Obstet Gynecol 1991;164(3):907–16.Google Scholar

Brownbill, P, Sibley, CP. Regulation of transplacental water transfer: the role of fetoplacental venous tone. Placenta 2006;27(6–7):560–7.Google Scholar

Reynolds, LP, Redmer, DA. Utero-placental vascular development and placental function. J Anim Sci 1995;73(6):1839–51.Google Scholar

Coan, PM, Ferguson-Smith, AC, Burton, GJ. Developmental dynamics of the definitive mouse placenta assessed by stereology. Biol Reprod 2004;70(6):1806–13.Google Scholar

Jansson, T, Powell, TL, Illsley, NP. Gestational development of water and non-electrolyte permeability of human syncytiotrophoblast plasma membranes. Placenta 1999;20(2–3):155–60.Google Scholar

Faber, JJ, Thornburg, KL. Fetal homeostasis in relation to placental water exchange. Ann Rech Vet 1977;8(4):353–61.Google Scholar

Jansson, T, Illsley, NP. Osmotic water permeabilities of human placental microvillous and basal membranes. J Membr Biol 1993;132(2):147–55.Google Scholar

Liu, H, Koukoulas, I, Ross, MC, Wang, S, Wintour, EM. Quantitative comparison of placental expression of three aquaporin genes. Placenta 2004;25(6):475–8.Google Scholar

Beall, MH, Chaudhri, N, Amidi, F, et al. Increased expression of aquaporins in placenta of the late gestation mouse fetus. J Soc Gynecol Investig 2005;12(2 Suppl):780.Google Scholar

Zhu, X, Jiang, S, Zou, S, Hu, Y, Wang, Y. Expression of aquaporin 3 and aquaporin 9 in placenta and fetal membrane with idiopathic polyhydramnios. Zhonghua Fu Chan Ke Za Zhi 2009;144(12):920–3.Google Scholar

Zhu, XQ, Jiang, SS, Zhu, XJ, et al. Expression of aquaporin 1 and aquaporin 3 in fetal membranes and placenta in human term pregnancies with oligohydramnios. Placenta 2009;30(8):670–6.Google Scholar

Rabinowitz, R, Peters, MT, Vyas, S, Campbell, S, Nicolaides, KH. Measurement of fetal urine production in normal pregnancy by real-time ultrasonography. Am J Obstet Gynecol 1989;161(5):1264–6.Google Scholar

Fagerquist, M, Fagerquist, U, Oden, A, Blomberg, SG. Fetal urine production and accuracy when estimating fetal urinary bladder volume. Ultrasound Obstet Gynecol 2001;17(2):132–9.Google Scholar

Ross, MG, Ervin, MG, Rappaport, VJ, et al. Ovine fetal urine contribution to amniotic and allantoic compartments. Biol Neonate 1988;53(2):98–104.Google Scholar

Wlodek, ME, Challis, JR, Patrick, J. Urethral and urachal urine output to the amniotic and allantoic sacs in fetal sheep. J Dev Physiol 1988;10(4):309–19.Google Scholar

Gresham, EL, Rankin, JH, Makowski, EL, Meschia, G, Battaglia, FC. An evaluation of fetal renal function in a chronic sheep preparation. J Clin Invest 1972;51(1):149–56.Google Scholar

Hargrave, BY, Castle, MC. Effects of phenylephrine induced increase in arterial pressure and closure of the ductus arteriosus on the secretion of atrial natriuretic peptide (ANP) and renin in the ovine fetus. Life Sci 1995;57(1):31–43.Google Scholar

Silberbach, M, Woods, LL, Hohimer, AR, et al. Role of endogenous atrial natriuretic peptide in chronic anemia in the ovine fetus: effects of a non-peptide antagonist for atrial natriuretic peptide receptor. Pediatr Res 1995;38(5):722–8.Google Scholar

Lee, SM, Jun, JK, Lee, EJ, et al. Measurement of fetal urine production to differentiate causes of increased amniotic fluid volume. Ultrasound Obstet Gynecol 2010;36(2):191–5.Google Scholar

Xu, Z, Glenda, C, Day, L, Yao, J, Ross, MG. Osmotic threshold and sensitivity for vasopressin release and fos expression by hypertonic NaCl in ovine fetus. Am J Physiol Endocrinol Metab 2000;279(6):E1207–15.Google Scholar

Horne, RS, MacIsaac, RJ, Moritz, KM, Tangalakis, K, Wintour, EM. Effect of arginine vasopressin and parathyroid hormone-related protein on renal function in the ovine foetus. Clin Exp Pharmacol Physiol 1993;20(9):569–77.Google Scholar

Cabrol, D, Landesman, R, Muller, J, Sureau, C, Saxena, BB. Treatment of polyhydramnios with prostaglandin synthetase inhibitor (indomethacin). Am J Obstet Gynecol 1987;157(2):422–6.Google Scholar

Kullama, LK, Nijland, MJ, Ervin, MG, Ross, MG. Intraamniotic deamino(D-Arg8)-vasopressin: prolonged effects on ovine fetal urine flow and swallowing. Am J Obstet Gynecol 1996; 174(1 Pt 1):78–84.Google Scholar

Brace, RA, Wlodek, ME, Cock, ML, Harding, R. Swallowing of lung liquid and amniotic fluid by the ovine fetus under normoxic and hypoxic conditions. Am J Obstet Gynecol 1994;171(3):764–70.Google Scholar

Evrard, VA, Flageole, H, Deprest, JA, et al. Intrauterine tracheal obstruction, a new treatment for congenital diaphragmatic hernia, decreases amniotic fluid sodium and chloride concentrations in the fetal lamb. Ann Surg 1997;226(6):753–8.Google Scholar

Ross, MG, Ervin, G, Leake, RD, Fu, P, Fisher, DA. Fetal lung liquid regulation by neuropeptides. Am J Obstet Gynecol 1984;150(4):421–5.Google Scholar

Lawson, EE, Brown, ER, Torday, JS, Madansky, DL, Taeusch, HWJ. The effect of epinephrine on tracheal fluid flow and surfactant efflux in fetal sheep. Am Rev Respir Dis 1978;118(6):1023–6.Google Scholar

Dodic, M, Wintour, EM. Effects of prolonged (48 h) infusion of cortisol on blood pressure, renal function and fetal fluids in the immature ovine foetus. Clin Exp Pharmacol Physiol 1994;21(12):971–80.Google Scholar

Jain, L, Eaton, DC. Physiology of fetal lung fluid clearance and the effect of labor. Semin Perinatol 2006;30(1):34–43.Google Scholar

Norlin, A, Folkesson, HG. Ca(2+)-dependent stimulation of alveolar fluid clearance in near-term fetal guinea pigs. Am J Physiol Lung Cell Mol Physiol 2002;282(4):L642–9.Google Scholar

Pritchard, JA. Fetal swallowing and amniotic fluid volume. Obstet Gynecol 1966;28(5):606–10.Google Scholar

Bradley, RM, Mistretta, CM. Swallowing in fetal sheep. Science 1973;179(77):1016–17.Google Scholar

Nijland, MJ, Day, L, Ross, MG. Ovine fetal swallowing: expression of preterm neurobehavioral rhythms. J Matern Fetal Med 2001;10(4):251–7.Google Scholar

Matsumoto, LC, Cheung, CY, Brace, RA. Effect of esophageal ligation on amniotic fluid volume and urinary flow rate in fetal sheep. Am J Obstet Gynecol 2000;182(3):699–705.Google Scholar

Xu, Z, Nijland, MJ, Ross, MG. Plasma osmolality dipsogenic thresholds and c-fos expression in the near-term ovine fetus. Pediatr Res 2001;49(5):678–85.Google Scholar

El-Haddad, MA, Ismail, Y, Gayle, D, Ross, MG. Central angiotensin II AT1 receptors mediate fetal swallowing and pressor responses in the near term ovine fetus. Am J Physiol Regul Integr Comp Physiol 2005;288(4):R1014–20.Google Scholar

El-Haddad, MA, Ismail, Y, Guerra, C, Day, L, Ross, MG. Neuropeptide Y administered into cerebral ventricles stimulates sucrose ingestion in the near-term ovine fetus. Am J Obstet Gynecol 2003;189(4):949–52.Google Scholar

El-Haddad, MA, Ismail, Y, Guerra, C, Day, L, Ross, MG. Effect of oral sucrose on ingestive behavior in the near-term ovine fetus. Am J Obstet Gynecol 2002;187(4):898–901.Google Scholar

Sherman, DJ, Ross, MG, Day, L, Humme, J, Ervin, MG. Fetal swallowing: response to graded maternal hypoxemia. J Appl Physiol 1991;71(5):1856–61.Google Scholar

Queenan, JT, Allen FH, Jr, Fuchs, F, et al. Studies on the method of intrauterine transfusion. I. Question of erythrocyte absorption from amniotic fluid. Am J Obstet Gynecol 1965;92:1009–13.Google Scholar

Gilbert, WM, Brace, RA. The missing link in amniotic fluid volume regulation: intramembranous absorption. Obstet Gynecol 1989;74(5):748–54.Google Scholar

Gilbert, WM, Cheung, CY, Brace, RA. Rapid intramembranous absorption into the fetal circulation of arginine vasopressin injected intraamniotically. Am J Obstet Gynecol 1991;164(4):1013–18.Google Scholar

Jang, PR, Brace, RA. Amniotic fluid composition changes during urine drainage and tracheoesophageal occlusion in fetal sheep. Am J Obstet Gynecol 1992;167(6):1732–41.Google Scholar

Brace, RA. Physiology of amniotic fluid volume regulation. Clin Obstet Gynecol 1997;40(2):280–9.Google Scholar

Hedriana, HL, Gilbert, WM, Brace, RA. Arginine vasopressin-induced changes in blood flow to the ovine chorion, amnion, and placenta across gestation. J Soc Gynecol Invest 1997;4(4):203–8.Google Scholar

Verkman, AS, Dix, JA. Effect of unstirred layers on binding and reaction kinetics at a membrane surface. Anal Biochem 1984;142(1):109–16.Google Scholar

Daneshmand, SS, Cheung, CY, Brace, RA. Regulation of amniotic fluid volume by intramembranous absorption in sheep: role of passive permeability and vascular endothelial growth factor. Am J Obstet Gynecol 2003;188(3):786–93.Google Scholar

Wynn, RM, French, GL. Comparative ultrastructure of the mammalian amnion. Obstet Gynecol 1968;31(6):759–74.Google Scholar

Curran, MA, Nijland, MJ, Mann, SE, Ross, MG. Human amniotic fluid mathematical model: determination and effect of intramembranous sodium flux. Am J Obstet Gynecol 1998;178(3):484–90.Google Scholar

Faber, JJ, Anderson, DF. Absorption of amniotic fluid by amniochorion in sheep. Am J Physiol Heart Circ Physiol 2002;282(3):H850–4.Google Scholar

Matsumoto, LC, Cheung, CY, Brace, RA. Increased urinary flow withoug development of polyhydramnios in response to prolonged hypoxia in the ovine fetus. Am J Obstet Gynecol 2001;184(5):1008–14.Google Scholar

Faber, JJ, Anderson, DF. Regulatory response of intramembranous absorption of amniotic fluid to infusion of exogenous fluid in sheep. Am J Physiol 1999; 277(1 Pt 2):R236–42.Google Scholar

Matsumoto, LC, Bogic, L, Brace, RA, Cheung, CY. Prolonged hypoxia upregulates vascular endothelial growth factor messenger RNA expression in ovine fetal membranes and placenta. Am J Obstet Gynecol 2002;186(2):303–10.Google Scholar

Zhu, X, Jiang, S, Hu, Y, et al. The expression of aquaporin 8 and aquaporin 9 in fetal membranes and placenta in term pregnancies complicated by idiopathic polyhydramnios. Early Hum Dev 2010;86(10):657–63.Google Scholar

Huang, J, Qi, HB. Expression of aquaporin 8 in human fetal membrane and placenta of idiopathic polyhydramnios. Zhonghua Fu Chan Ke Za Zhi 2009;44(1):19–22.Google Scholar

Qi, H, Li, L, Zong, W, Hyer, BJ, Huang, J. Expression of aquaporin 8 is diversely regulated by osmotic stress in amnion epithelial cells. J Obstet Gynaecol Res 2009;35(6):1019–25.Google Scholar

Wang, S, Amidi, F, Yin, S, Beall, M, Ross, MG. Cyclic adenosine monophosphate regulation of aquaporin gene expression in human amnion epithelia. Reprod Sci 2007;14(3):234–40.Google Scholar

Ross, MG, Ervin, MG, Leake, RD, et al. Bulk flow of amniotic fluid water in response to maternal osmotic challenge. Am J Obstet Gynecol 1983;147(6):697–701.Google Scholar

Leontic, EA, Tyson, JE. Prolactin and fetal osmoregulation: water transport across isolated human amnion. Am J Physiol 1977;232(3):R124–7.Google Scholar

Holt, WF, Perks, AM. The effect of prolactin on water movement through the isolated amniotic membrane of the guinea pig. Gen Comp Endocrinol 1975;26(2):153–64.Google Scholar

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Chapter 10.1 - Manipulation of amniotic fluid volume

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