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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

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).

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