3. Have u thought
…….!!!!
How a baby lives
inside a mother’s
womb ?
How can we
understand its living
?
Any analogy u can
think of ?
Do u think it swims
freely?
Do u think it was
better and safe….
inside the womb or
here in the outer
environment ?
4.
5. The amniotic fluid is the protective liquid contained by the
amniotic sac of a gravid amniote.
This fluid
• serves as a cushion for the growing fetus,
• serves to facilitate the exchange of nutrients, water, and
biochemical products between mother and fetus.
For humans, the amniotic fluid is commonly called water or
waters (Latin liquor amnii).
6. AMNIOTICFLUID
Amniotic fluid protects and nourishes the baby in the
womb.
While a baby is in the womb, it is situated within the
amniotic sac, a bag formed of two membranes, the
amnion, and the chorion. The fetus grows and develops
inside this sac, surrounded by amniotic fluid.
Amniotic fluid is a clear, yellow fluid which is found
within the first 12 days following conception within the
amniotic sac. It surrounds the growing baby in the
uterus.
8. Generated: from maternal plasma
passes through the fetal membranes
week 16: *Fetal kidneys begin to function
*Fetal urine also contributes to the fluid.
Absorption: through the fetal tissue and skin
After the
15th-25th week : fluid is primarily absorbed by the fetal
gut.
( as keratinization of skin occurs)
9. CONTENTS OF AMNIOTIC FLUID
At first, amniotic fluid consists of water from the
mother's body with electrolytes , but by about the 12-
14th week the liquid also contains proteins,
carbohydrates, lipids and phospholipids, and urea, all of
which aid in the growth of the fetus.
It helps protect the baby from bumps and injury
But gradually[ by 20 weeks of gestation], the larger
proportion is replaced by fetal’s urine.
10. FUNCTIONS
Amniotic fluid is responsible for:
Protecting the fetus: The fluid cushions the baby from
outside pressures, acting as a shock absorber.
Temperature control: The fluid insulates the baby,
keeping it warm and maintaining a regular temperature.
Infection control: The amniotic fluid contains antibodies.
Lung and digestive system development: By breathing
and swallowing the amniotic fluid, the baby practices
using the muscles of these systems as they grow.
11. • Muscle and bone development: As the baby floats inside the
amniotic sac, it has the freedom to move about, giving muscles
and bones the opportunity to develop properly.
• Lubrication : Amniotic fluid prevents parts of the body such as
the fingers and toes from growing together; webbing can occur
if amniotic fluid levels are low.
• Umbilical cord support: Fluid in the uterus prevents the
umbilical cord from being compressed. This cord transports
food and oxygen from the placenta to the growing fetus.
12. Normally, the level of amniotic fluid is at its highest
around 36 weeks of pregnancy, measuring around 1
quart.
This level decreases as birth nears.
When the water breaks, the amniotic sac tears
Amniotic fluid contained within the sac then begins to
leak out via the cervix and vagina.
The waters usually break toward the end of the first stage of labor.
According to Today's Parent, only about 15 percent of water
breaks upon at the onset of labor.
13. 10th to 20th week 400
(increases)
25
28th week
reaches a
plateau
800
42 weeks 400
@birth 1000
amount of
fluid
declines
25th week, when keratinization of skin is complete. Then the relationship
between fluid and fetal growth stops.
14. Accurate Measurement ?
Here is the first problem......
there is no accurate method for measuring AFV. The two ultrasound tests aimed at
assessing AFV are: Amniotic Fluid Index
Maximum Pool
15. Amniotic fluid index (AFI) is a quantitative
estimate of amniotic fluid(expressed in cm-seen
on ultrasonography of a pregnant uterus) and
an indicator of fetal well-being. It is a part of
the biophysical profile.
"Single Deepest Pocket" technique.
17. AFI score result
between 8-18 Normal
• Median AFI level is approximately 14 from week 20
to week 35, when the amniotic fluid begins to reduce
in preparation for birth.
< 5-6 Oligohydramnios
• The exact number can vary by gestational age.
• The fifth percentile for gestational age is sometimes
used as a cutoff value.
> 24-25 Polyhydramnios
• around 2000mls of fluid; >8cm maximum pool;
18. Oligohydramnios is present
when the amniotic fluid index
(AFI) seen on ultrasound
measures less than 5 cm (a
normal index is 5-25cm) and
the maximum vertical pocket
(MVP) is less than 2 cm.
Polyhydramnios is
present when the AFI is
more than 24 centimeters
(cm) and the MVP
measures more than 8cm.
19. Labour at term
Preceeding the labour at
term "premature rupture
of membranes’’.
Artificial rupture of membrane (ARM),
a manual rupture of the amniotic sac,
can also be performed to release the
fluid if the amnion has not
spontaneously ruptured.
20. Risks
1. The baby may turn to a breech
position, making birth more difficult
if the membranes are ruptured before
head engagement.
2. There is an increased risk of
umbilical cord prolapse.
3. There is an increased risk of
infection if there is a prolonged time
between rupture and birth.
21. ANALYSIS
• reveal many aspects of the baby's genetic health as well as the
age and viability of the fetus.
• But amniotic fluid also contains fetal cells, which can be examined
for genetic defects.
• Amniotic fluid normally has a pH of 7.0 to 7.5.[5] Because pH in
the upper vagina is normally acidic (pH 3.8-4.5), a vaginal pH test
showing a pH of more than 4.5 strengthens a suspicion of rupture
of membranes in case of clear vaginal discharge in pregnancy.
• One main test that is performed on amniotic fluid is the L/S ratio
test (lecithin/sphigomyelin). This test is used to determine fetal
lung maturity.
• Measuring a ratio of L/S of 2:1 or greater indicates that the
fetus can be safely delivered, with functioning lungs.
22. Leaking amniotic fluid
Polyhydramnios
Oligohydramnios
Premature rupture of
membranes
Amniotic fluid embolism
• Fluid has no color no smell
• Fluid is green/brownish-
green/foul smelling
• Premature rupture preterm
• Premature rupture at term
• A rare but very often fatal
condition (Fatal for both
mother and child.
• too much amniotic
fluid
• Low levels of
amniotic fluid
23. • According to the American Pregnancy Association,
only 1 in 10 women will experience a dramatic
flow of fluid as the waters break. For most, it will
start as a trickle, or leak.
• Sometimes, what looks like fluid leaking is
actually urine, because the uterus is pressing on the
bladder.
• If the fluid has no color and no smell, it will be
amniotic fluid, and you should contact a healthcare
provider as labor will normally begin soon.
• If the fluid is green, brownish-green, or foul-
smelling, this may indicate the presence of
meconium or an infection. Medical advice should
be sought.
leakage
36. It may also occur in mothers with a history of any of the following medical
conditions:
• prior growth-restricted pregnancies
• chronic high blood pressure (hypertension)
• problems with the placenta, for example,
abruption
• preeclampsia
• diabetes
• lupus
• multiple pregnancies, for example twins or triplets
• birth defects, such as kidney abnormalities
• delivering past the due date
• other unknown reasons, known as idiopathic
37. • Higher risk of birth
defects
• Loss of pregnancy
• Preterm birth
• Neonatal loss of life
During First six
months of
Pregnancy.
• Slow foetal growth
• Labor complications
• Need for a caesarian
delivery
During Last
trimester
Effects : If Amniotic fluid levels are
low
41. Causes of
PROM &
PPROM
2. Low socio-economic
status
1. Sexually transmitted
infections
3. Previous preterm birth
4.
5.Vaginal bleeding
6.Cigarratte smoking
7.Natural weakening of
membranes or from force of
contractions
8. infections
45. The process is similar to anaphylaxis than to embolism, so also
termed as Anaphylactoid syndrome of pregnancy because fetal
tissue or amniotic fluid components are not universally found in
women who present with signs and symptoms attributable to AFE.
Identified risk factors include:
• Older maternal age.
• Multiparity.
• Intense contractions during labor.
• Abdominal trauma.
• Cesarean section.
• Induction of labor.
• Placenta previa.
• Eclampsia.
• Multiple pregnancy.
• Tears in the uterus or cervix.
• Early separation of the placenta from the uterus wall.
Fetal factors:
• Fetal distress.
• Fetal death.
• Male baby.
The following signs
and symptoms are
indicative of
possible AFE:
• Acute dyspnea or
sudden,
• agitation,
• sudden chills,
shivering,
• sweating,
• coughing and
anxiety are
common
premonitory
symptoms.
• Labored breathing
and tachypnea
may occur.
