The article was consulted professionally by Dr. Nguyen Anh Tu – Doctor of Obstetrics ultrasound – Pre-birth diagnosis – Obstetrics department – Share99 Hai Phong International Health Hub.
Abnormalities in the color and volume of amniotic fluid can occur either urgently or chronically, due to biological or physical causes. Amniotic fluid abnormalities can increase illness and increase the risk of death for both mother and baby.
1. The role of amniotic fluid
The fetus is located in the mother's uterus surrounded by amniotic fluid. Amniotic fluid is an environment very rich in nutrients and capable of regeneration and exchange. It plays an extremely important role for the life and development of the fetus while lying in the womb.
In the early stages, amniotic fluid begins to be formed due to the osmosis of the mother's serum through the amniotic membrane, or the osmosis of the baby's serum through the fetal skin. At a later stage, when the fetus is 10-12 weeks old, amniotic fluid is formed due to urine secreted from the kidneys and pulmonary fluid of the fetus. When the fetus is 16-32 weeks old, the amount of amniotic fluid is reached from 250ml-800ml, and then increased to 1000ml, it remains until the fetus is 36 weeks old. Starting from this moment until the baby is born, the amount of amniotic fluid will gradually decrease and remain only about 500ml. Therefore, the older the fetus, the less amniotic fluid will be.
Amniotic fluid functions to nourish the embryo by reabsorption of amniotic fluid, which is carried out mainly through the digestive system of the fetus. From the 20th week of pregnancy, the fetus has begun to swallow amniotic fluid. In addition, amniotic fluid is re-absorbed through the umbilical cord, amniotic membrane and through the skin of the fetus. At the 24th week of pregnancy 100ml-500ml of amniotic fluid per day. This amount of amniotic fluid will enter the bloodstream, contributing to the balance of fluid in the body of the fetus and will be filtered in part to form urine for the baby, into the intestines contributing to the formation of stools.
Amniotic fluid also protects and protects the fetus from collisions, traumas and especially ensures a sterile environment for babies in amniotic wrap. Mechanically, amniotic fluid creates an environment for the fetus to develop normally and harmoniously about the fetus in the mother's genitals in the last months of pregnancy. During labor, amniotic fluid will continue to protect the fetus from the trauma of uterus contractions and infections. Amniotic fluid helps to form the head of the mother's cervical amniotic fluid, which makes the removal of the cervical opening more convenient.
After the rupture of the amniotic fluid, the greasiness of the amniotic fluid plays a role in lubricating the mother's genitals to make it easier for the fetus to be born. As such, amniotic fluid is a rotating fluid, from the second trimepcle, amniotic fluid is derived largely due to fetal excretion from the urinary tract and amniotic fluid is re-absorbed by the pregnancy swallowed through the digestive system. Amniotic fluid is normal when:
- In volume: Amniotic fluid varies from 50ml when the fetus is 4 to 8 weeks old to 1000ml when the fetus is 38 weeks old. After that, the volume of amniotic fluid tends to decrease and to about 500-800ml by the 40th week of pregnancy and until labor of the baby.
- About color :At the beginning of pregnancy the amniotic fluid is pure white. The larger the fetus, the color of the amniotic fluid will be whitening because it contains many substances. Pregnancy is mature enough (from the 38th week), the amniotic fluid will be opaque white almost identical to rice water.
Through the pathology survey of amniotic fluid, we can assess the state of health and some pathology of the fetus. Amniotic fluid can be abnormal in color and volume.
2. Volume abnormalities
2.1 Multiple amniotic fluid
When the volume of amniotic fluid is greater than 2000ml: Common in the case of multiple pregnancies and some abnormalities in the central nervous system of the fetus such as inopranial pregnancy, hydrocephalus, meningeal hernia, forked spine,… Multiple amniotic fluid can also be caused by the pathology of the amniotic membrane, or of the umbilical cord cake, the large fetus, the placenta edema. Or your pathology like yours with diabetes,… or i aligned.
Effects of multiple amniotic fluid on fetal development and health: Multiple amniotic fluids if due to deformities or malformations, the reacceptation is very bad. Most amniotic fluid will make the baby quite mobile in the uterus, so it is prone to umbilical cords wrapped around the neck, abnormal stars. Multiple amniotic fluid makes the womb larger than usual, especially multiple amniotic fluid levels. Mother feels shortness of breath, prone to uterus contractions and premature labor increases the mortality rate during childbirth. During labor, multiple amniotic fluid is very likely to be the cause of prolonged labor that makes the baby prone to pregnancyfailure , the mother has uterine phlegm that causes post-birth blood bandages. At the same time, multiple amniotic fluid will lead to sudden amniotic rupture and sudden amniotic rupture: placentapeeling, umbilical cord prolapse,abnormal throne and amniotic embolism.
Amniotic embolism is a symptom that can be said to be the most dangerous for a pregnant mother. This is a condition where amniotic fluid is present in the mother's veins, which makes the maternity embolism, acute respiration and bilular ins depleting. Amniotic embolism has no factors, risk of fore warning as well as prevention, although it is a rare disease but has a very severe effect, more than 50% of deaths. These are life-threatening for both of you.
2.2 Amniotic mitigation (less amniotic fluid) and amniotic fluid
When the volume of amniotic fluid is less than 200ml: Common in abnormal urinary system and fetal digestive system such as ureteral stenosis, no stomach, rear urethra valve in male babies, kidney abnormalities…. Amniotic mitigation is also encountered in the condition of malnourished mother, malnourished pregnancy, pregnancy beyond the date of birth, rupture of young amnioticfluid, premature amniotic rupture ….
The effect of amniotic mitigation on fetal development: Amniotic mitigation if it appears early in the 2nd trimepcle has a great influence on the development of the fetus. If it is not due to birth defects, the baby also has great consequences because of the prolonged amniotic sac: Congenital hip dislocation, sclerosis of the joints, limbs due to not able to move well in the uterus with little amniotic fluid, minimal lung production causing respiratory failure. In the third trimeennial, if the amniotic fluid is usually caused by malnourished babies and the risk is also great: The risk of limbs, joint sclerosis, pulmonary dysenterosis and, importantly, compression of the umbilicalcord , the baby is prone to pregnancy failure and does not normally correct the pregnancy can have abnormalities that cause difficult calving. If an amniotic rupture causes amniotic fluid in labor or at the beginning of abdominal pain at birth, it can lead to the risk of amniotic infection, thereby infecting the fetus, infection of the uterus … both mother and baby are dangerous, affected health and life.
Amniotic atrosiotic harm to the fetus such as the risk of deformation of the lying 3 estents (scarred, crooked), facial muscle deformity, low weight, even pregnancy death, when labor is severely pinched umbilical cord, disorders of the mound. Harm both for the mother such as: disorders of the mound, leading to problematic labor.
In order to deal with a woman with amniotic mitigation, it is necessary to determine the cause; assess the extent, progress and consequences for the fetus; delayed so that the pregnancy is sufficiently mature – increase the amount of amniotic fluid by drinking water or infusion of water into the amniotic chamber. When the fetus is large enough to be able to feed, it is possible to end the pregnancy early to save the pregnancy. Parents will even have to accept abortion, as the fetus has a serious medical condition, a high death ton, or severe abnormalities
2.3 How to assess the volume of amniotic fluid
Ways to assess the volume of amniotic fluid include:
- Based on physical examination:by palpation of the abdomen, palpation of the fetus as well as vaginal examination, the clinicians can know if there is more or less amniotic fluid condition. However, in order to more accurately estimate the volume of amniotic fluid, we must rely on ultrasound to measure the amniotic fluid intervals in the amniotic chamber
- Relying on semi-dosing ultrasound to measure amniotic fluidvolume : There are many semi-dosing methods in evaluatiy the volume of amniotic fluid through ultrasound. Most often, the amniotic fluid index is measured by a total of 4 amniotic fluid chambers at 4 corners of the amniotic chamber.
The estimated amount of amniotic fluid thanks to the ultrasound, calculated by dividing the mother's abdominal cavity into four parts and then measuring the largest amniotic cavity (cm) in each part and then combined, so we have the amniotic fluid index as follows:
Normal amniotic index from: 6-12 cm
Abnormal amniotic index:
- Amniotic fluid: greater than or equal to 20cm (>=20cm)
- Amniotic mitigation: less than or equal to 5cm (<= 5cm)
- Amniotic fluid: less than 3cm (< 3cm)
In addition, one can use the method such as measuring the largest amniotic cavity in the amniotic chamber, through ultrasound to assess the volume of amniotic fluid. It can be considered as a minimum amniotic fluid when the largest amniotic cavity is still less than or equal to 3cm.
However, the measurement of the amniotic fluid index by ultrasound must be evaluated at least 2 times continuously, each time 2 to 6 hours apart to determine the state of amniotic mitigation or amniotic fluid. The color of amniotic fluid can change very quickly in just 30 minutes to 2 hours, and the volume of amniotic fluid can change in just 12 hours.
3. Color abnormalities
Abnormalities in amniotic fluid color include:
- Amniotic fluid of yellow-greencolor : The phenomenon of fetal or fetal hemolysis of developmental delay in the uterus.
- Dirty amniotic fluid or mossy green color, even withthe same coins of the baby: The fetus is severely weakened in the womb, which is life-threatening for both mother and baby.
- Turbid green amniotic fluid aswell as pus, and can be accompanied by a bad smell : it is an amniotic infection, the baby is at high risk of infection in the uterus.
- Amniotic fluid is reddish-brown: means that the baby is no longer alive or that the fetus has died in the womb
The color of amniotic fluid is seen by amniotic fluid in cases where the open cervical is larger than 1cm or sucking the amniotic fluid through the abdominal wall. When breaking naturally or pressing the amniotic fluid, it is possible to see the color of the amniotic fluid correctly and clearly.
For pregnancy, amniotic fluid plays a very important role, being able to be on par with the uterus, leaves and tangled wires in the role of nourishing and protecting the fetus. Thanks to the survey of the color, volume and proportion of amniotic fluid, one can predict and predict the state of health and development of the baby still in the womb.
Therefore, during pregnancy, the mother needs to periodically monitor to ensure the quality of amniotic fluid. If there are abnormal manifestations, it is necessary to visit specialized medical facilities for appropriate treatment. Doctors will have reviews of the quality of amniotic fluid through the color of the amniotic fluid. Often the amniotic fluid of the premature pregnancy will be colorless. As the fetus grows, the substance that adheres to the fetal skin peels off, so the amniotic fluid will be as opaque as rice water. If the amniotic fluid is white, turbid white, then good; but if the amniotic fluid is blue, yellow is not good. During the mother's labor, if the doctor sees that the amniotic fluid has a lot of coins (which are thrown out of the fetus) there will be appropriate treatment direction, since at this time it is possible that the baby is asphyxiated due to lack of oxygen.
Share99 International Health Hub offers a full maternity care program for women from the very beginning of pregnancy from the first months with a full range of pregnancy examinations, 3D ultrasounds, 4D routines and routine tests to ensure the mother is always healthy and the fetus develops comprehensively.
Dr. Nguyen Anh Tu has 6 years of experience in obstetrics and gynecology ultrasound, especially researched and trained in pregnancy ultrasound – pre-birth diagnosis. Dr. Tu has completed courses on ultrasound – pre-birth diagnosis of the FMF International Society of Fetal Medicine; be trained in consulting and implementing diagnostic intervention techniques in fetal medicine and participate in many in-depth conferences and seminars on Fetal Medicine
Currently a doctor at Obstetrics and Gynecology Department of Share99 Hai Phong International Health Hub
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