Amniotic Fluid

Question 1

Maximum volume of AF is seen when?

Answer 1

At 34 weeks of gestation, 1000 mL

Question 2

Overall main contributor to AF formation?

Answer 2

Feral urine (but not before 12 weeks)

Question 3

3 different contributors to amniotic fluid

Answer 3

Upto 12 wk - Ultrafiltrate of maternal plasma
12-29 wks - Fetal skin
>20 weeks - Fetal urine

Question 4

How long does Fetal skin contribute to AF

Answer 4

Upto 22-25 weeks, when keratinisation occurs.
It does not contribute after keratinisation has occurred.

Question 5

2 drugs which decreas AF Volume

Answer 5

1) Indomethacin
2) ACE Inhibitors

Question 6

What is the normal AFI?
Drawback of AFI?

Answer 6

Normal = 5-25cm
Polyhydramnios >/= 25cm
Oligohydramnios </= 5cm

Drawback: Cannot be used in twin pregnancy

Question 7

Method used to measure AF volume in twin pregnancy

Answer 7

Single largest vertical pocket (SVP) or Single deepest pocket (SDP) or MVP

Normal = 2-8cm

<2cm — oligo
>/=8cm — poly

Question 8

Treatment of ployhydramnios.

Answer 8

Mild and moderate cases do not need treatment
Severe cases (SCP >/=16 & AFI>/=35 cm) are treated

1) Amnioteduction - by therapeutic amniocentesis
- reduces respiratory distress immediately
- Under USG Guidance
- 2-2.5 L removed in one sitting using 18G needle, at rate of 1L per 20 mins
2) Tocolytic - for severe uterine irritability leading to PTL

<32 weeks: Indomethacin, Corticosteroids
32-34 weeks: Nifedipine, corticosteroids
>/=34 weeks: Only corticosteroids & no tocolytics

Question 9

What is potter’s syndrome.

Answer 9

It is severe oligohydramnios due to renal defect ie. Renal agenesis or poly cystic kidneys.

Associated with:
1) Lung hypoplasia
2) Typical facies ie. Flat facies

Question 10

What is Streeter syndrome

Answer 10

Also known as
- Amniotic band syndrome
- Constriction band syndrome

Membranes rupture—> severe oligo —> membranes wrap around foetus forming construction bands —> deceased blood supply to the part distal to the band —> can lead to distal limb amputation & craniofacial abnormalities

M/c - Digital amputation

Question 11

When is IOL done in polyhydramnios?

Answer 11

Mild cases: 39- 40+6 weeks

Moderate/Severe: 37 weeks

Question 12

When is IOL done in oligohydramnios?

Answer 12

Mild: 39 weeks

Moderate/severe: 36 to 37+6 weeks