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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.
Amniotic fluid is composed of fetal cells, urine, and lung secretions. [46] 18-20 mL of amniotic fluid is slowly aspirated, with the first 1-2 mL typically discarded due to higher risk of maternal cell contamination. [2] The remaining sample is submitted for laboratory testing. [1]
Positive fern test with amniotic fluid as seen under the microscope. The fern test is a medical laboratory test used in obstetrics and gynecology.The name refers to the detection of a characteristic "fern like" pattern of vaginal secretions when a specimen is allowed to dry on a glass slide and is viewed under a low-power microscope.
The presence of these biophysical variables implies absence of significant central nervous system hypoxemia/acidemia at the time of testing. By comparison, a compromised fetus typically exhibits loss of accelerations of the fetal heart rate (FHR), decreased body movement and breathing, hypotonia, and, less acutely, decreased amniotic fluid volume.
Amniotic fluid is mildly basic (pH 7.1–7.3) compared to normal vaginal secretions which are acidic (pH 4.5–6). [10] Basic fluid, like amniotic fluid, will turn the nitrazine paper from orange to dark blue. [9] Fern test: A sterile cotton swab is used to collect fluid from the vagina and place it on a microscope slide.
An amniotic fluid sample is collected via amniocentesis and the sample is spun down in a centrifuge at 1000 rpm for 3–5 minutes. Thin layer chromatography (TLC) is performed on the supernatant, which separates out the components. Lecithin and sphingomyelin are relatively easy to identify on TLC and the predictive value of the test is good. [4]
Polyhydramnios is a medical condition describing an excess of amniotic fluid in the amniotic sac.It is seen in about 1% of pregnancies. [1] [2] [3] It is typically diagnosed when the amniotic fluid index (AFI) is greater than 24 cm. [4] [5] There are two clinical varieties of polyhydramnios: chronic polyhydramnios where excess amniotic fluid accumulates gradually, and acute polyhydramnios ...
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