AmnioticFluidLevels

DrinkingextrafluidshasbeenfoundtohelpwithlowAFI.

Source:AmericanJournalofObstetricGynecology,1995Oct,173:4,118691

Acutematernalhydrationinthirdtrimesteroligohydramnios:effectsonamnioticfluidvolume,
uteroplacentalperfusion,andfetalbloodflowandurineoutput[seecomments]

DiscussionGroup
Topic:ScaletodetermineAFI
RegardingtheAFI(amnioticfluidindex)lessthan5cmwouldbesomethingtheywouldwantto
keepaneyeon.Ijusthadthisquestionfromsomeoneelsewiththesamediagnosislastweek.Her
doctorsaidherfluidlevelswerelow..at9.5..

Asfarasthefluidlevels,under78isconsideredlowandunder5isconsidereddangerouslylow.11
isjustaroundnormal.

Remedies:
(fromamidwife)increaseherproteinintakeandstopgettingultrasounds

Drinkwater!Manypeopledonotdrinkenoughwater,butmostpregnantwomenreallydont.Low
amnioticfluidcansignalproblemsbutveryoftenifthemotherjustincreasesherwaterto2liters
ormoreaday,thefluidlevelresolves.Ten8oz.glassesadayisreallyaminimum,andmostpeople
willwrinkletheirnoseandsayIcantpossiblydrinkthatmuchwater!Inhotweatherorwhenthe
motherhasbeenveryactive,itshouldbemore!

Theamnioticfluidisconstantlybeingmadeandevenwhenthemembraneshavebeenrupturedfor
anextendedamountoftime.Thereisusuallyagoodamountoffluidbehindthebaby.Weknowthat
artificiallyreleasingmembranescanleadtocomplicationsandputanaddedstressonthecordetc.,
ascanmembranesthathavereleasedontheirownforextendedperiods.Nobirthisevera
completely"drybirth."

Hereisalinktotheproblemyouareaskingabout:lowamnioticfluidalsoknownas
oligohydramnioshttp://www.wikipregnancy.com/page/Oligohydramnios
TakenoteofwhatthislinkhastosayundertheheadingcalledTREATMENT.Thisinformationis
excellentadvicethatyoucanpassonthenexttimethissubjectcomesup.

Topic:RetestingafterfirstlowAFIreading
Ifthereisanindicationoflowamnioticfluid,themomshouldrequestanotherreadingatanother
time,assometimesthebabyobscuresthetruelevel,dependingupontheangleofthetesting.

Ialsoadvisethatthemomdrinkalotofwaterpriortothesecondoranyreading.

FluidlevelisthemostSUBJECTIVEreadinginthetestitcanchangefromonesonotechtothenext.
Babypositionisahugefactor;mother'sfluidintakeisanother.

WhenIhaveclientsthatgoto41weeksand5days(henceI'mrequiredtogetabiophysicalprofile
Sonoonethatchecks8to10itemsandgetsa'score');Ihavethemomsdrinkagallonofwaterthe

daybeforeandtwoquartsbeforetheactualultrasoundANDhavemomeatacandybarwhileinthe
waitingroomforthesonogram.Atleast2ofthe8or10testswillbeeasytopasswiththismethod
fetalreactivity,thesugarmakessurethebayismovingaroundwell,andthetonsofwaterdoes
increasetheamnioticfluidlevelsoit'seasily'measured'bythetech.Someoftheother'tests'are
placentalgrade9(istheplacentalstilldoingitsjob?)andtheanswerisyes,ifthemomis
continuingtoeatwell.Fetalvariability(howoftenandhowwidearangeofheartrateupsand
downs),placentallocation,andmypersonalfavoritethesizeofthebabyarenotoriously
inaccurateatthislatestageofpregnancy.

Forsizeanddates,anultrasoundpriorto20weeksalongisfairlyaccurateasapieceof
information.Anythingaftergetsvery'unstable'asasourceofinformationfordatesorsizeandis
certainlynothingtobasedecisionson.
Regardinglowamnioticfluid:theplacentamakestheamnioticfluid,andthebabycontributesby
drinkingthefluidandpeeing.LowAFmaybeduetoasmallorpoorlyformedplacentathatis
unabletokeepupasthebabygrows.Itmayalsobeduetoaprobleminthebabyakidneyor
bladdermalfunction(rare.)Theplacentacomesfromthefertilizedegg,justatthebabydoes,and
manyproblems(includingpreeclampsia)areduetoaplacentathathasproblemsrightfromthe
beginning.Itmayfunctionwellforthefirstseveralmonths,andthenjustcan'tkeepup.Somoms
needtobehealthyBEFOREconceivingtoensurethebestchanceofagoodplacenta,healthybaby,
etc.Ofcourseexcellentnutritionandplentyofwaterthroughoutthepregnancyiscrucialtoo,but
eventhatcan'tcureaplacentathatisnotgreatfromthebeginning.Theplaceofimplantationis
key,too.Aplacentaimplantingoverauterinescarmayhavemoretrouble.
Didtheyinfacthave'lowfluid'??Andwhyacesareanbirth.Noopportunityforlabor?Thatseems
likeoverkilltome.Usuallyifitisaseriousconcern,womenareallowedtolabortoseewhat
happens.

TruelowamnioticfluidiscalledOligohydramnios

**JohnsHopkinsresearcherswhostudiedthehealthofmorethan250babiesbornat37weeks
ofgestationsaytheyfoundthatbabieswhosemothershadlowlevelsofamnioticfluidwereof
normalsize.Andthebabieshadnogreaterriskforhealthproblemsthanbabieswhosemothers
hadnormallevelsofamnioticfluid.**

LowLevelofAmnioticFluidNoReasontoInduceLabor

Theconditiondoesn'tjeopardizefetalhealth,studysays
http://www.austin360.com/health/content/sharedauto/healthnews/prer/511660.html
ByJaniceBillingsley
HealthScoutNewsReporter

FRIDAY,Feb.7(HealthScoutNews)Alowlevelofamnioticfluidinthelasttrimesterofa
pregnancy,oftenthoughttobesufficientcausetoinducedelivery,isnotreasonenoughtodoso.

JohnsHopkinsresearcherswhostudiedthehealthofmorethan250babiesbornat37weeksof
gestationsaytheyfoundthatbabieswhosemothershadlowlevelsofamnioticfluidwereof
normalsize.Andthebabieshadnogreaterriskforhealthproblemsthanbabieswhosemothers
hadnormallevelsofamnioticfluid.

"Thisstudyindicatesthatwedon'twanttointervenebecauseofaAmnioticFluidIndex(AFI)of
lessthanfiveifeverythingelseisnormal,"saysstudyauthorDr.ErnestM.Graham,anassistant
professorofgynecologyandobstetricsatJohnsHopkinsUniversity.

GrahampresentedtheresultsofhisstudyonFeb.7attheannualmeetingoftheSocietyfor
MaternalFetalMedicineinSanFrancisco.

Amnioticfluidisaclear,slightlyyellowishliquidthatsurroundsthefetusduringpregnancy;itis
containedintheamnioticsac.Normallevelsoffluidindicateproperfunctioningofthe
developingfetus,whilelowlevelscanbeassociatedwithincompletelungdevelopmentandpoor
fetalgrowth.Measuredbydepthsincentimeters,normalamountsrangefromfiveto25
centimeters;belowthatisconsideredlow.

TheAmericanCollegeofObstetricsandGynecologyrecommendstheAmnioticFluidIndex
shouldbeonlyonemeasureofassessingfetalhealth.Heartmonitorsandsonogramsareothers.

However,doctorsofteninducedeliveryespeciallyat37weeksbasedlargelyonalowAFI,
saysDr.SiobhanDolan,assistantmedicaldirectoroftheMarchofDimes.
Normalgestationlastsapproximately37to40weeks,accordingtotheMarchofDimes,which
lastweeklauncheda$75millioncampaigntoaddressthehighincidenceofprematurebabies
bornbefore37weeks.

"Ingeneral,there'satendency,at37weeks,todeliverthebaby,"Dolansays."Butthisisagood
studybecauseitgivespeoplereassurancetomanagethepregnancywithcarefulmonitoringand
observation.Youdon'thavetogoimmediatelytothelaborroom."

Forthestudy,Grahamandhiscolleaguesstudied262womenwhogavebirthatJohnsHopkins
Hospitalfrom1999to2002,comparingthebabies'healthatbirth.Onehundredthirtyone
womenhadhadalowAFIduringtheirthirdtrimester,aconditioncalledoligohydramnios.The
other131womenhadnormalamountsofamnioticfluidattheendoftheirpregnancies.

WomenwithlowAFIlevelshadtheirlaborinducedsoonerduetotheircondition,butwereless
likelytohaveCaesareansections,Grahamsays.Thebabiesborntothesewomenwerenormal
size,andwereatnoincreasedriskforrespiratoryproblems,immatureintestinesorbrain
disorders,hesays.

"We'vealwaysthoughtthatAFIwascorrelatedwithbloodflowinthefetus,thatalowAFImeant
therewasn'tagoodbloodflow,butwefoundthatAFIisaverypoorindicatorofthat,"Graham
says.ThefindingshouldgivedoctorspausebeforeusingAFItestresultsasareasontoinduce
delivery,headds.

"IfalowAFIistheonlythingdetermininganearlyinterventioninapregnancy,thatisnota
reasontodoso,"hesays.

Moreinformation
Anexplanationofthefetalmonitoringtestsusedduringpregnancy,includingAFIreadings,can
befoundat"http://www.smartmoms.org/prenataltests/test7.html".
"http://www.marchofdimes.com/681_4536.asp"describeswhatamnioticfluidisandwhyitis
importanttothedevelopmentofthefetus.

SOURCES:ErnestM.Graham,M.D.,assistantprofessor,gynecologyandobstetrics,JohnsHopkins
University,Baltimore;SiobhanDolan,M.D.,assistantmedicaldirector,MarchofDimes,White
Plains,N.Y.,andassistantprofessor,gynecologyandobstetrics,AlbertEinsteinCollegeof
Medicine,Bronx,N.Y.;Feb.7,2003,presentation,annualmeeting,SocietyforMaternalFetal
Medicine,SanFrancisco
Copyright2003ScoutNews,LLC.Allrightsreserved.

DiscussionGroup
Topic:InductionforlowAFI
AlsoduringmylastpregnancyIwasinducedforlowfluid.Thistime(20weeks)Iwenttoseethe
consultantandhesaid,afterlookingatmypreviousfluidlevels,thattheyhavealteredthechart
andthattheoldfluidlevelswouldbenothingtoworryaboutandifitwaslikethatagainIcouldgo
aheadwiththehomebirth.Iguessitsprogressandagoodthing,butitsortofmadememad
becauseIalwaysfelttherewasnothingwronglasttime,lasttime,withthedifferentchartthey
madeitsoundlikethingswerereallywrong...Iwishtheyhadthischartthen.

Topic:CaesareanduetolowAFI
"Ihaveaquestioninregardstotheamnioticfluid2mothersendupwithCsectionsbecausethe
Dr's.toldthemthattheiramnioticfluidwaslow.Onemotherwas3weeksfromherEDDandthe
otherwasatherEDD."

Twomothersendedupwithcsectionsaftergoingthroughthewholenineyardsofinterventions,
whichbeganwithinductionsfor"lowamnioticfluid".Thiswasaverydiscouragingsituationfor
thembecausetheyandtheirpartnersallfeltcompelledtolistentotheirdoctor'scautionarytale
aboutthedangersofsuchanindicator.Tome,theincredulousthingaboutthistypeofscenariois
howitunfolds:(doctor)"yourultrasoundindicatesthatyouramnioticfluidisonthelowsideand
wethinkitwouldbeadvisabletogetthebabydeliveredASAPbeforesomedangerouscomplications
cansetin".They(patientandpartner,confused&scared)agree,andthenwhenshegetstothe
hospital,canyouguesswhatisthefirstthingthatthedoctordoes?Heorshebreaksherwater.
ThismakesnosenseDoesn'tthebabyneedthatfluid?
Herearetwolinksthatbasicallystate"babieshadnogreaterriskforhealthproblemsthanbabies
whosemothershadnormallevelsofamnioticfluid."Oneisanannouncementofastudyconfirming
samebyJohnsHopkinsUniversity.
http://www.facebook.com/ext/share.php?sid=100616730350&h=jcJeL&u=EVYO9
http://www.facebook.com/ext/share.php?sid=85728794888&h=SmJik&u=QWsLo

Topic:Howmuchfluidisnormal?
HowmuchfluidshouldIhave?
Terminology:
1. polyhydraminos:toomuchfluid
2. oligohydraminos:toolittlefluid

Undernormalcircumstances,theamountofamnioticfluidyouhaveincreasesuntilthebeginningof
yourthirdtrimesterandgenerallypeaksat34weeks,atwhichpointyoumaycarryaboutaquart..
Afterthat,itgraduallydecreasesuntilyougivebirth.Ifyou'refoundtohavetoomuchfluidatany
pointinyourpregnancy,it'scalledhydramniosorpolyhydramnios.Iftheconditionisnotassociated
withanyotherfindings,theprognosisisusuallygood.

Ifpretermlabor(whichsometimesoccurswiththiscondition)shouldhappen,thisissomethingthey
cantakecareofatthehospital.

Watchingyouclosely&perhapsputtingyouonbedrestifnecessarysoundlikethebestcourseat
thistime.Pleasekeepapositiveframeofmindabouttheoutcomeofallofthis.Iknowthatyoucan
andwilldothat.

Inadditiontothat,IthinkthatIwouldliketorecommendthatyoudosomedailyaffirmationsto
affecttheoutcomeofthisuncertainty:

"Iseemybabygrowinginsideofme.Everythingisasitshouldbe.Heisdeveloping&growingeach
dayandthelevelofamnioticfluidisperfectforhisneeds"

"Iseemybabysurroundedbyandbathedintheperfectamountofamnioticfluid"

"Iseethateverythingisasitshouldbeformetohavetheperfectbirthingformybaby.Heis
growingasheshouldandisthrivingintheperfectamountofamnioticfluidforhisneeds"

"Mybabyknowswhenthetimeisrightforhimtobeborn;hewilldecidewhentoappear,neither
tooearlyortoolate."

And,remembertokeepvisualizinghimintheperfectbirthingpositionandenvironment.

Topic:Drybirth

There'snosuchthingasatrue"drybirth."Inpregnancy,themother'sbodyproducesamnioticfluid
almostcontinuously.Untiltheplacentaisborn,themotherisstillpregnant(orsoherbodythinks)
andcontinuesproducingit.Soevenifawoman'smembranefullyreleasesandit'ssometimeuntil
thebirth,periodicallyshewillfeelagushoffluidasherbodycontinuesdoingwhatitissupposedto
do!

Idon'thavearticlesorstatstoreferencebutwithmyfirstsonIwastoldfluidlevelshaddroppedat
*42*weeks.Afteragelinductionandanight'sworthofsurges(andnocervicalchange)the
midwivesconcededthatthemeasurementoffluidcanberathersubjective(read:Wrong)andby
palpationIhadplentyoffluid.Ileftthehospital,wenttoanotherfacilityforamorethorough
ultrasound(abiophysicalprofile),wenthome,andhadalovelyspontaneousbirth3dayslater.

Topic:Otherevaluationsandconsiderations
PennySimpkinhasabitofinfoonthefactthatinthelastfewweeksofpregnancyitisnormaltosee
theamnioticfluidleveldecreaseabit,oftenbringingonreleaseofmembranes.Imfairlycertain
itsinherbook,Pregnancy,ChildbirthandtheNewborn.Havingsaidthat,Imsuretheresmore
informationthatjustthatasshesnotamedicaldoctorandsharingthissourcewithone
probablywontbeacceptable!Butyoumaybeabletofindhersourcesofinformation.

Isthebaby'sbodyoutlineeasilyseenthrutheabdominalwallwhileshelaysonherback?inother
words,isshestillroundedandfulloffluid?Wouldsomeonehavetopushabittofeelthebodyparts
onfundalpalpation?

Ultrasoundsarenotoriouslyinaccurateforevaluatingfluidlevels.Whilesheisdrinkingsheneedsto
increasesaltandproteinintakeI'dsuggestsheeateverytwoorthreehourssnackingalong.
Increasingherfluidshouldmakethebabypeemorehencebringupthefluidlevelinutero.

Questionstoraisedoesthebabyneedthislevelofintervention?Issomethingtrulygoingon?

Havehereatacandybarordrinkjuicerightbeforethescanwedont'wanttohave'nonreactive'
addedtothelistofthingstheymightfind!

AdditionalResources

WebsitewithagreattablewithAFIindexinformation:
http://www.transitionsdoula.com/downloads/afi.pdf#search='Amniotic%20fluid%20index

MarchofDimesstudyaboutinductionduetoAFIandneonataloutcomes:
WhilemanystudiesdemonstrateanincreaseininductionswhentheAFIisbelow5thesesame
studiesalsoindicatethatattimeofbirthAPGARscores,cordPH,andNICUadmissionswerenot
significantlydifferentbetweenthegroups.

http://www.marchofdimes.com/professionals/681_4536.asp
http://www.marchofdimes.com/pnhec/188_1033.asp

AboutPregnancyWebsiteinformationsheets:
http://pregnancy.about.com/cs/amnioticfluid/a/aaafv.htm
http://pregnancy.about.com/cs/amnioticfluid/a/aaafv_2.htm

UniversityofMichigandefinition:
OligohydramniosWhenawomanissaidtohavetoolittleamnioticfluidshehas
oligohydramnios.Thisisdefinedashavinglessthan200mlofamnioticfluidattermoranAFIof
lessthan5cm.Thismeansthatduringanultrasoundthelargestpocketoffluidfounddidnot
measure1cmorgreateratitslargestdiameter.Itisclinicallyveryhardtoprovepriorto
delivery.Afterthebirth,examiningtheplacentaforthepresenceofamnionnodosumonthe
placentaishighlycorrelatedwitholigohydramnios.

Itisusuallyacombinationoffactors,notjustonethatdeterminesinduction.
http://www.med.umich.edu/1libr/tests/testn05.htm

Inductionriskywithunripecervix
Source:Obstetrics&Gynecology2005;105:6907
Posted:11April2005
http://www.obgynworld.com/international/news/2005/Week_15/Day_1/Induction_risky_with.
asp
Quantifyingriskandriskfactorsforcesareandeliveryafterinductionoflabor.
Innulliparouswomen,bothmedicalandelectiveinductionraisetheriskofcesareansection
comparedwithspontaneouslabor,especiallyincaseswithalowBishopscore,(cervical
readiness)studyfindingsshow.
AteamofresearchersledbyFrancisVrouenraetsfromAcademicHospitalMaastrichtinThe
Netherlandssetouttodeterminetheriskandpredictorsforcesareandeliveryafterinductionof
laborinnulliparouswomen,whoareconsideredtobemostatrisk.

Theyanalyzedobstetricandneonataldataforacohortofnulliparouswomenwithaterm
singletonfetusinthecephalicpositionwhounderwentmedical(n=435)orelectiveinductionof
labor(n=189),orenteredlaborspontaneously(n=765)atoneoftwohospitals.
Theresultsrevealedamorethantwofoldhigherincidenceofcesareandeliveryfollowing
medical(23.4percent)andelective(23.8percent)induction,comparedwiththecontrols(12.0
percent).However,afteradjustingforBishopscoreforcervicalripenessatadmission,the
likelihoodofcesareandeliverybecamecomparableamongallthreegroups.
Theinvestigatorscomment:"Whereasinductionformedicalindicationsisofteninevitable,
inductionforelectivereasonsshouldbediscouragedinthecaseofanunripeBishopscore."

Inductionfailureredefined
Source:Obstetrics&Gynecology2005;105:7059
Posted:12April2005
http://www.obgynworld.com/international/news/2005/Week_15/Day_2/Induction_failure_re.
asp
Researchersdeterminethelengthofthelatentphaseafterinductionthatisassociatedwithalow
likelihoodofvaginaldeliveryandhighriskofmorbidity.
USresearchindicatesthatpermittingalatentphaseofupto18hoursafterinductionoflabor
allowsmostpatientstoprogresstovaginaldeliverywithoutsignificantlyincreasingmaternalor
neonatalrisks.
Ithasbeenpreviouslysuggestedthat"afailedinductionoflabormaybediagnosedinwomen
whosecontinuedlackofprogressionintotheactivephasemakesitunlikelythattheywould
safelyproceedtoavaginaldelivery,"noteCharlaSimonandWilliamGrobmanfrom
NorthwesternUniversityMedicalSchoolinChicago,Illinois.
Inanefforttoidentifythemostclinicallyrelevantdefinitionofafailedinduction,thepairof
researchersanalyzedmedicalrecordsforallnulliparouswomenwhowereinducedattheir
institutionafter36weeks'gestationovera6monthperiod.
Ofthe397womenincludedintheanalysis,26percentunderwentcesareansection.Theriskof
suchdeliveryrosewithincreasinglengthofthelatentphase,exceedingthe50percentmark
whenthelatentphaseexceeded18hours.Theseprotractedinductionswereassociatedwith
increasedfrequenciesofchorioamniotisandpostpartumhemorrhage,butthisdidnottranslate
intohigherrisksoftransfusion,hysterectomy,prolongedhospitalization,oradverseneonatal
outcomes.
SimonandGrobmanconclude:"Theresultssuggestitisnotunreasonabletoallowupto18
hoursoflatentlaborbeforerecommendingacesareanforafailedinduction."