Amniotic fluid

The amniotic fluid is that fluid surrounding the developing fetus that
is found within the amniotic sac contained in the mother's womb.
It is clear pale yellow fluid.
- pH of is around 7.2.

- Specific gravity of 1.0069 1.008.

Amniotic fluid origin
As a transudate from maternal serum across the fetal membranes. OR
From the maternal circulation in the placenta
transudate across the umbilical cord or fetal circulation in the
placenta.
Contribution from the fetal urine; the fetus drinks about 400 ml of
liquor every day at term and equal amount excreted in the urine.
Secretion from tracheobronchial tree.
 Amniotic Fluid: Circulation
The water content of the amniotic fluid changes every three hours
Large volume moves in both directions between the fetal & maternal
circulations mainly through the placental membrane
It is swallowed by the fetus, is absorbed by respiratory & GIT and
enters fetal circulation. It then passes to maternal circulation through
placental membrane. During final stages of pregnancy fetus swallows
about 400ml of amniotic fluid per day
Excess water in the fetal blood is excreted by the fetal kidneys and
returned to the amniotic sac through the fetal urinary tract
 Amniotic fluid measures about

50 ml at 12 weeks
400 ml at 20 weeks or
midpregnancy
800 ml 34 weeks
1000ml 36-38 weeks
At full term, there is between
500-800 ml of amniotic fluid.
Post term 43 weeks 200ml
 Colour :- in early pregnancy colourless but near term it become pale
straw coloured due to presence of exfoliated lanugo and epidermal
cells from the fetal skin
Abnormal colour:-
Meconium stained (green)
Golden colour:- in Rh incompatibility is due to excessive haemolysis.
Greenish yellow :-in post maturity
Dark coloured:- in concealed accidental haemorrhage.
Dark brown:- amniotic fluid found in IUD.
 COMPOSITION
In the first half of pregnancy, the fluid is almost identical to a
transudate of plasma.
In late pregnancy the composition is altered mainly due to
contamination of fetal urinary metabolites.
The composition includes:-
A) water 98-99%
B) solid (1-2%)
 Solid constituents: a) Organic
Protein-0.3gm%
Glucose-20mg %
Urea-30mg%
Uric acid 4mg%
Creatinine 2mg%
Total lipids-50mg%
NPN :-30mg%
 Inorganic :- the concentration of the sodium, chloride and potassium
is almost the same as that found in maternal blood.
As pregnancy advances, there is slight fall in the level of Na+ and
chloride conc. Due to dilution of hypotonic fetal urine, where as K
conc. Remains unaltered.
C) suspended particles include:- lanugo, exfoliated squamous epithelial
cells from fetal skin, vernix caseosa, cells from respiratory tract , urinary
bladder and vagina of the fetus
Function
Cushions the fetus against injury
Allows for the free movement of the fetus
Essential for the fetal lung development
A source of fetal nutrition
Aids in maintaining fetal temperature

During labour
The amnion and chorion are combined to form a
hydrostatic wedge which helps in dilatation of the cervix.
It flushes the birth canal at the end of first stage of labour
and by its aseptic and bactericidal action protects the
fetus and prevents ascending infection to the uterine
cavity.
 Clinical importance of liquor amnii study
Foetal well being is determined by adequate liquor volume appropriate for
duration of pregnancy
Foetal maturity is determined by foetal lung surfactants (phospholipids)
lecithin and sphingomyellin obtained in liquar amnii by amniocentesis.
Excess bilirubin in liquor amnii can detect Rh blood group isoimmunisation.
Foetal malformation. 16-18 weeks cell culture of amniotic fluid obtained by
amniocentesis can identify chromosomality defective babies
Amniotic fluid excess alpha-fetoprotein can identify foetus with open
neural tube defects (anencephaly)
 Abnormalities in volume
Oligohydraminos
1) < 500ml between 32-36 weeks
2) Common causes
a) amniotic leakage
b) Abnormalities of the fetal kidneys
3) Primary oligohydramnios is associated with fetal abnormalities
a) Renal agenesis
b) Polycystic kidneys
c) Urinary tract obstructions
Hydraminos
1) Excess 2 litres of liquid between 32and 36 weeks
2) Is often associated with poor fetal outcomes because of
a)preterm delivery
b) Fetal malpresentation
c) Cord prolapse