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The volume of amniotic fluid typically increases until 36 weeks and starts decreasing after 40 weeks in post-term gestations. [4] For this reason, discrepancies between fundal height measurements and gestational age can be a clinical indication of amniotic fluid abnormality and should be evaluated by ultrasound.
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.
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.
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.
A score of 6/10 with normal amniotic fluid is considered equivocal, and a repeated test within 24 hours may be needed. A score of 4/10 or less is considered abnormal, and delivery may be indicated. [29] Low amniotic fluid can cause pinching umbilical cord, decreasing blood flow to the fetus. Therefore, a score of 0 points for amniotic fluid may ...
The lecithin–sphingomyelin ratio is a marker of fetal lung maturity. The outward flow of pulmonary secretions from the fetal lungs into the amniotic fluid maintains the level of lecithin and sphingomyelin equally until 32–33 weeks gestation, when the lecithin concentration begins to increase significantly while sphingomyelin remains nearly the same.
Ultrasound image of the foetus at 12 weeks of pregnancy in a sagittal scan. Measurements of fetal Crown Rump Length (CRL). The embryo and fetus float in the amniotic fluid inside the uterus of the mother usually in a curved posture resembling the letter C. The measurement can actually vary slightly if the fetus is temporarily stretching ...