ultrasonography of amniotic fluid

1. U/S of Amniotic Fluid
Aboubakr Elnashar
elnashar53@hotmail.com
Aboubakr Elnashar

2. Amniotic Fluid
• Sources: Early stages: Skin & placenta
12 - 14 W: lung & kidney
20 W: kidney
• Amount: 33 - 34 W: 800-1000 ml
At term: 600 ml
• U/S parameters: I. AFV
II. FFP
Aboubakr Elnashar

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4. I. AFV
• Subjective:
Normal
Absent
Reduced
Increased
• Objective:
1.Maximum vertical pool (MVP)
2.Amniotic fluid index (AFI)
Aboubakr Elnashar

5. 1. Maximum vertical pool
(minimum of 1cm width)
* How ?
•Oligohyd: <2 cm
•Reduced: 2-3 cm
•Normal: 3 - 8 cm
•Polyhyd: >8cm
Mild 8-12 cm
Severe > 16
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7. 2. Amniotic fluid index
•How ?
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13. Interpretation:
•Oligohyd: < 5 cm
Reduced: 5-10 cm
Normal: 10- 20 cm
More than average: 20-25 cm
Polyhyd: > 25 cm
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14. AFI & gestational age
Ges age (W) 5th
50th
95th
28 94 mm 146 mm 228 mm
32 86 mm 144 mm 242 mm
36 77 mm 138 mm 249 mm
38 73 mm 132 mm 239 mm
40 71 mm 123 mm 214 mm
42 69 mm 110 mm 175 mm
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15. Causes of polyhydramnios
1. Idiopathic
2. D. M.
3. Isoimmunization
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16. 4. Foetal anomalies:
• CNS: Hydrocephaly, Anencephaly, S.
bifida
• Neck &face: Cystic hygroma.
• Pulmonary: Diaphragmatic hernia.
• GIT: Oesophygeal atresia, Dud. atresia,
Omphalocele
• Other: Cong. infection, Chromosomal
anomalies
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19. Causes of oligohydramnios
1. Spontaneous ROM.
2. Placental insufficiency.
3. IUGR.
4. Renal agenesis, uretheral stenosis.
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21. Keyhole bladder, posterior urethral valve
Cystic hygroma, olighyd, Turner s synd
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22. Fetal biophysical profile
Score 2 Score 0
CTG >2acc./40 min <
F. movements >3/30 min <
F.br. movements 30 sec sustained
fbm /30 min
<
F.tone closed fist or
flex .to ex.
movement
Neither
AFV >1 cm pocket <
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23. Interpretation:
If all parameters detected by U/S are
normal, no need to perform NST
8: reassuring.
6 or 7: equivocal, and must be repeated
within 24 hours.
4 or less: a positive test and strongly
suggests preparing the patient for delivery.
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24. •Modifications:
Manning (1990)
NST
MVP
Fetal breathing.
More recently
NST
AFI
It is less cumbersome than the original BPP
and its results are just as predictive. AFI is the
indicator of long term uteroplacental function
and the NST is the short term indicator of fetal
acid-base status. Aboubakr Elnashar

25. II. Free floating particles
•What: Multiple linear densities, 1- 5 mm
suspended, but gradually settling
•Significance: * No
* F. maturity
* F. distress.
* LFGA.
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