Abstract
This chapter discusses the amniotic fluid. It discusses reasons for various pathologies (e.g., oligohydramnios and polyhydramnios). It also discusses amniocentesis.
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1.
Amniocentesis – sampling of amniotic fluid
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(a)
Most common indication during second trimester is cytogenetic analysis of fetal cells
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Occasionally used to determine AFP levels and acetylcholinesterase activity to diagnose fetal neural tube defects
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Not recommended prior to 15 weeks’ gestation due to a high incidence of procedure-related pregnancy loss
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Performed later in pregnancy for non-genetic indications:
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Measures lecithin and sphingomyelin to assess fetal lung maturity
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(ii)
Amnioreduction in pregnancies with severe polyhydramnios
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(iii)
Confirm preterm rupture of membranes (PROM)
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(iv)
Confirm or exclude an intra-amniotic infection
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For spectrophotometric analysis of amniotic fluid bilirubin to determine fetal Rh type in pregnancies complicated by isoimmunization
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Oligohydramnios – decreased amniotic fluid volume
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(a)
In the latter half of pregnancy (and in the absence of ruptured membranes) reflects chronic uteroplacental insufficiency and/or increased renal artery resistance causing diminished urine output
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Predisposes fetus to umbilical cord compression, which may cause intermittent fetal hypoxemia, meconium passage, or meconium aspiration
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3.
Polyhydramnios – increased amniotic fluid volume
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Typically indicates fetal anatomic abnormalities (e.g., esophageal atresia)
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(a)
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Wasson, C., Kelly, A., Ninan, D., Tran, Q. (2019). Amniotic Fluid. In: Absolute Obstetric Anesthesia Review. Springer, Cham. https://doi.org/10.1007/978-3-319-96980-0_18
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DOI: https://doi.org/10.1007/978-3-319-96980-0_18
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