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In the case that the fluid does not reaccumulate, the reduction of amniotic fluid stabilizes the pregnancy. Otherwise, the treatment is repeated as necessary. There is no standard procedure for how much fluid is removed each time. There is a danger that if too much fluid is removed, the recipient twin could die.
Amniotic fluid index (AFI) is a quantitative estimate of amniotic fluid [1] and an indicator of fetal well-being. It is a separate measurement from the biophysical profile. [1] AFI is the score (expressed in centimetres) given to the amount of amniotic fluid seen on ultrasonography of a pregnant uterus.
Low amniotic fluid can be attributed to a maternal, fetal, placental or idiopathic cause and can result in poor fetal outcomes including death. The prognosis of the fetus is dependent on the etiology, gestational age at diagnosis, and the severity of the oligohydramnios.
There is believed to be a correlation between volume of amniotic fluid retained and neonatal outcomes before 26 weeks' gestation. [10] Amniotic fluid levels are an important consideration when debating expectant management vs clinical intervention, as low levels, or oligohydramnios, can result in lung and limb abnormalities. [10]
It is characterized by changes in fetal movement, growth, heart rate, and presence of meconium stained fluid. [4] Risk factors for fetal distress/non-reassuring fetal status include anemia, restriction of fetal growth, maternal hypertension or cardiovascular disease, low amniotic fluid or meconium in the amniotic fluid, or a post-term pregnancy.
Amniotic fluid is removed from the mother by an amniocentesis procedure, where a long needle is inserted through the abdomen into the amniotic sac, using ultrasound guidance such that the fetus is not harmed. Amniocentesis is a low risk procedure, with risk of pregnancy loss between 1 in 1,500 – 1 in 700 procedures.
Risk factors of pregnancies with PPROM include race (black patients are at increased risk), low socioeconomic status, history of sexually transmitted disease, distension of the uterus (which may result from factors such as excessive amniotic fluid (polyhydramnios) or carrying more than one fetus (multifetal pregnancy)), and tobacco smoking. [9]
Amniotic fluid embolism [100] Delayed delivery [103] Fetal death [104] Incontinence; Preterm birth [105] Neonatal infection [100] Low birth-weight infant [100] Premature rupture of membranes [106] Incompetent cervix [107] Posterm infant [108] Fetal growth restriction [109] Macrosomia [110] Twin pregnancy [111] Triplets and more [112] [113 ...