Manipulation of amniotic fluid volume

doi:10.1017/CBO9780511997778.016

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

Tak Yeung Leung and

Stephen Sik Hung Suen

Edited by

Mark D. Kilby ,

Anthony Johnson and

Dick Oepkes

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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

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 hypoplasia maximum vertical pool oligohydramnios polyhydramnios ultrasound measurement amniotic fluid volume amnioreduction amniotic fluid index

Type: Chapter
Information: Fetal Therapy
Scientific Basis and Critical Appraisal of Clinical Benefits
, pp. 137 - 144

DOI: https://doi.org/10.1017/CBO9780511997778.016 [Opens in a new window]

Publisher: Cambridge University Press

Print publication year: 2012

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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

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Chapter 10.2 - Manipulation of amniotic fluid volume

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