Amniotic fluid and pregnancy: everything you need to know

Amniotic fluid is a sterile substance in which the baby bathes throughout pregnancy. It is essential to the development and growth of lthe embryo, and later the fetus. This precious fluid not only protects it from temperature variations, external shocks and infections, but also enables it to move and develop its lungs and muscles. But what is amniotic fluid? What role does it play? And what to do if the quantity is too low or too high? Here's everything you need to know.

What is amniotic fluid?

Amniotic fluid is the biological fluid surrounding the fetus in the uterine cavity. It is contained in the amniotic sac, also known as the "sac of waters", which is made up of two membranes: the amnion and the chorion.

Throughout pregnancyThis liquid, 97% water, enables the baby to develop normally, while being protected from external aggressions (blows, sudden movements, noise, temperature changes, bacteria, etc.).

How is amniotic fluid formed during pregnancy?

Amniotic fluid appears rapidly after fertilization, during the creation of the amniotic sac, which begins around day 7 of pregnancy.

During the first weeks, it is mainly produced by the embryo, thanks to the phenomenon of extracellular expansion. It is then secreted by transudation through the membranes and epidermis of the fetus until the 4th month of gestation. Between 20 and 25 weeks of amenorrhea (SA), the baby's skin becomes keratinized and no longer allows water to pass through. This fluid is then formed from urine, pulmonary secretions and cells from the amniotic cavity. The fetus swallows and expels it constantly, contributing to its circulation and renewal.

The composition of amniotic fluid remains quite complex. It consists mainly of water and electrolytes (99%), but also contains mineral elements (calcium, sodium, potassium, trace elements, etc.), amino acids and fetal epithelial cells.

What is the role of this fluid during pregnancy?

Amniotic fluid plays a vital role during pregnancy. It is essential to the healthy development of the fetus and is a valuable indicator of the baby's health.

From fetus to baby

In order for the fetus to develop into a baby, the amniotic fluid keeps it at an ideal temperature of 37.5 degrees, while protecting it from external shocks. This fluid also enables the fetus to make active movements in the womb, thus stimulating its motor skills.

By swallowing and expectorating it, the fetus develops its lungs while absorbing the water and nutrients it needs. It also experiences flavour, a sensation produced by the smell and taste of the food the pregnant woman consumes during pregnancy.

Finally, the antibacterial properties of amniotic fluid protect lthe child from most infections, with the exception of toxoplasmosis and cytomegalovirus (CMV). cytomegalovirus (CMV) which can cross the placental barrier.

Fetal health index

The amount of amniotic fluid is a valuable indicator of fetal well-being. By means of an ultrasound scan, a gynecologist or midwife can determine whether the volume is normal, insufficient (oligohydramnios) or too great (hydramnios). There are two ways of doing this:

• Chamberlain's large vertical tank (LVC) method;
• the Phelan method, which uses an amniotic index (ILA).

Large vertical tank (CGV)

Lhe Chamberlain assessment is an ultrasound examination designed to explore the entire amniotic sac in order to calculate the depth of the largest vertical cistern of fluid (VGC). A diagnosis can be made on the basis of the measurement obtained:

• a value of less than 2 cm may indicate oligohydramnios ;
• a value between 2 and 8 cm indicates a normal volume;
• a value greater than 8 cm suggests hydramnios.

Amniotic index (ILA)

Phelan's method is based on the evaluation of the amniotic index (ILA). During this examination, the sonographer virtually divides the uterus into four parts (quadrants) intersecting at the umbilicus. He then measures and adds up the depth (vertical diameter) of the fluid cisterns identified:

• if the measurement is less than 5 cm, there is a risk of oligohydramnios ;
• if it is between 5 and 18 cm, the amount of liquid is normal;
• if it's over 18 cm, then the pregnant woman may be suffering from hydramnios.

How much amniotic fluid is in the uterine cavity?

The amount of amniotic fluid present in the uterine cavity varies throughout pregnancy. Sometimes, however, it is too little (oligohydramnios) or too much (hydramnios). We tell you more!

Normal amniotic fluid volume

As the weeks go by, the amniotic fluid sadapts to the weight and development of the fetus, following a precise cycle:

• Before 20 weeks' amenorrhea, its volume increases progressively in the uterine cavity (from 20 ml to around 200 ml between 7 and 16 SA).
• It then stabilizes at around 980 ml between 20 and 34 SA.
• Finally, from 34 SA onwards, the quantity of amniotic fluid decreases, reaching around 800 ml at term.

However, this amount varies from pregnant woman to pregnant woman l. It is generally between 250 ml and 2 liters for a normal pregnancy.

Insufficient fluid: oligohydramnios

Loligohydramnios refers to a lack of amniotic fluid. This is the most common anomaly, affecting between 0.4% and 4% of pregnancies. Pregnant women suffering from oligohydramnios have an amniotic fluid volume of less than 200 ml. This may be due to a cracked water sac, placental anomaly, maternal anomaly or fetal anomaly.

Loligohydramnios can occur at any stage of gestation and can lead to complications of varying severity, depending on the child's stage of development: pulmonary hypoplasia, musculoskeletal anomalies, etc. This is why it must be promptly treated and monitored by a doctor or gynecologist. For this reason, it must be promptly treated and monitored by a doctor or gynecologist. Treatment depends on the origin and severity of the condition.

If you suffer from temporary oligohydramnios, you'll need to rest and probably be confined to bed. SIn the case of premature oligohydramnios occurring before the 5th month due torupture of the amniotic sac, the medical profession will be obliged to propose termination of the pregnancy. After the 5th month, however, antibiotic treatment may be prescribed. Finally, if the rupture occurs at the end of the pregnancy or shortly afterwards, delivery will be induced.

Too much: hydramnios

Lhydramnios or polyhydramnios refers to an excess of amniotic fluid in the uterine cavity (more than 2 liters). This anomaly has various causes: gestational diabetes, preeclampsia and infection in the mother-to-be, or anemia and congenital malformations in the fetus.

Two types of hydramnios have been identified by doctors:

1. Lchronic hydramnios (which develops slowly towards the 3rd trimester of pregnancy and remains fairly controllable);
2. Lacute hydramnios (which appears suddenly in the 2nd trimester of pregnancy, causing a range of symptoms that are difficult to tolerate: contractions, uterine pain, breathing difficulties, etc.).

Like oligohydramnios, hydramnios carries a number of risks: premature delivery, rupture of the water sac, procidence of the cord, developmental abnormalities and more. Hydramnios therefore requires rapid treatment, which varies from case to case. For example, medical treatment may be recommended to reduce the baby's urine output. Sometimes, punctures are also necessary to prevent premature birth.

How can I control the amount of fluid in a pregnant woman's pouch?

The amount of amniotic fluid in a pregnant woman can be checked by clinical examination or ultrasound. In the first case, the doctor or gynaecologist may suspect that the volume is too large or too small, if lthe mother-to-be 's uterus is too large or too small for the stage of pregnancy.

In the second case, the sonographer observes the distribution of fluid around the baby on the screen and measures the cisterns formed. An amniotic index is obtained, which determines whether the quantity is normal, too low or too high.

What is the usual color of amniotic fluid?

The color of the amniotic fluid should be clear. This means it is still sterile and free of bacteria. However, the fluid may have other hues.

A greenish or cloudy appearance is generally due to the emission of meconium (the baby's first stool), revealing that the fetus is suffering. The medical profession can then induce ldelivery.

A red color often indicates the presence of a retroplacental hematoma, requiring an emergency cesarean section.

What are the problems associated with fetal fluid?

Problems related to amniotic fluid include infections of the fluid, membranes and placenta (intra-amniotic infection), as well as partial loss of fluid at l.

Fetal infection

An intra-amniotic infection occurs when bacteria from the vagina enter the uterine cavity and contaminate the fluid, amniotic sac or placenta. These germs can seriously harm lthe child and cause severe complications for the mother.

Once the water has broken, creating a sterile environment for the fetus, bacteria can more easily enter the uterus. The risk of infection therefore increases with duration. Gynaecologists and doctors therefore do their utmost to ensure that delivery takes place within 24 hours of the rupture of the membranes.

Partial loss of liquid

In some cases, the membranes making up the amniotic cavity partially rupture, and the fluid sdrips out continuously. This rupture of the amniotic sac most often occurs towards the end of pregnancy, but can occur well before term.

Partial loss of amniotic fluid can increase the risk of fetal infection. So, if in doubt, go to the maternity hospital. If fissuring is confirmed, it will be treated according to the stage of pregnancy. Before 22 weeks' amenorrhea, the volume of the liquid will be measured, and antibiotics and an infectious work-up will be prescribed. Between 22 and 35 weeks' gestation, the pregnant woman will be hospitalized and cared for until delivery.

Why test amniotic fluid?

Lamniocentesis is a medical examination that removes a small quantity of amniotic fluid (between 10 and 20 ml). It is performed by a doctor during an ultrasound scan. A very fine needle connected to a syringe is gently inserted into the womb of the mother-to-be.

This test is used to detect chromosomal abnormalities (such as trisomy 21), toidentify genetic diseases (such as cystic fibrosis) and to diagnose parasitic (toxoplasmosis) or viral (cytomegalovirus) infections.

Lamniocentesis is not compulsory, but is recommended for women over 38 or with a Down's syndrome child. It may also be prescribed when the prenatal blood test for trisomy 21 proves positive.

A relatively rare procedure,amnioscopy is performed at the end of pregnancy, when the term has passed. A lighted tube is inserted into the cervix to check the appearance and color of the fluid passing through the amniotic sac.

When does the amniotic fluid sdrain from the uterine cavity?

The amniotic fluid s'evacuates from the uterine cavity at the moment of rupture of the water sac, also known as "water breaking". The two membranes (amnion and chorion) rupture, releasing this fluid.

When it occurs around term, it indicates that the child is ready to be born and that delivery is imminent. Labour usually begins a few hours later.

If the amniotic sac ruptures prematurely (before 22 weeks of amenorrhea), the pregnant woman is placed under close surveillance in hospital and receives numerous tests and treatments to delay delivery as long as possible.

Amniotic fluid FAQ

What is the procedure lfor measuring the amount of amniotic fluid?

Can the baby swallow amniotic fluid?

Does drinking lots of water help increase fluid intake?

Does a pregnant woman's food pass into the amniotic fluid?

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