Amniotic fluid is a water-like fluid that helps in the development of the baby. It performs a lot of crucial functions that are important in keeping your baby safe while it grows in your womb, and in its proper development. Amniotic fluid has several functions as follows: When the baby moves around freely in the amniotic fluid, it helps in bone and muscle development. When the baby breathes the amniotic fluid in and out, it helps in the development of lungs. When the baby starts swallowing the fluid and peeing it out later, it helps in the development of the digestive system. Amniotic fluid protects the umbilical cord from getting compressed. As a result, the flow of nutrition from the mother to the baby for its overall development is constant. The amniotic fluid also acts as a lubricant and helps in the development of fragile body parts that grow together like fingers and toes. Low levels of amniotic fluid are most common during the third trimester. The causes for the same could be any of the following: Water-breaking: If your amniotic sac tears off and fluid flows out, it is called water breaking. This usually happens in and around the time of delivery. If you haven’t quite reached the delivery time, then your doctor may give you antibiotics to protect you and your baby from infection while you wait for the delivery date to close in. If you have crossed 38th week of pregnancy, based on your condition, the doctor may also suggest inducing labour. Health hazard: If your baby has some health issues, then the volume of amniotic fluid may become low. Especially during the second-trimester scan, babies are diagnosed with kidney, heart or chromosomal abnormality. This becomes obvious in the scan if your baby is passing very less urine. Your doctor may also suggest another test called amniocentesis, to be sure. Issues with placenta: If you have diabetes, high blood pressure, lupus or pre-eclampsia, then your placenta may fail to supply enough blood and nutrition to your baby. In this case, the volume of amniotic fluid in your baby may fall, and you may have to be under strict supervision. Medication: Some medicines must be avoided during pregnancy as they cause low amniotic fluid. Especially drug for high blood pressure and anti-inflammatory like ibuprofen are not prescribed during pregnancy. Identical twins: If identical twins share a placenta, then sometimes there may be an issue of low amniotic fluid. In this case, the baby with extra blood will get access to the amniotic fluid while the other will not get enough. There are numerous and severe problems associated with low amniotic fluid if it is diagnosed during the first and second trimester. If the same is detected in the third trimester, then the situation can be brought under control as the doctors are well equipped for handling the complications at this stage. The problems associated with low amniotic fluid are as follows: Your baby may be born with severe congenital disabilities like missing internal or external organs or malformation of bones like dysplasia or clubfoot. It can also result in stillbirth or in-utero death of the baby after the 20th week of pregnancy. Some babies die soon after birth. Miscarriage after the 20th week is also one of the complications associated with the low amniotic fluid. Babies are born prematurely before the 37th week with low birth weight and underdeveloped organs. If oligohydramnios is diagnosed during the third trimester, when a baby may be born with limited growth, compressed umbilical cord during labour, and caesarean delivery.
What causes low amniotic fluid during pregnancy
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The amniotic fluid is part of the baby’s life support system. It protects your baby and aids in the development of muscles, limbs, lungs and digestive system. Amniotic fluid is produced soon after the amniotic sac forms at about 12 days after conception. It is first made up of water that is provided by the mother, and then around 20 weeks fetal urine becomes the primary substance.
As the baby grows he or she will move and tumble in the womb with the help of the amniotic fluid. In the second trimester the baby will begin to breathe and swallow the amniotic fluid. In some cases the amniotic fluid may measure too low or too high. If the measurement of amniotic fluid is too low it is called oligohydramnios. If the measurement of amniotic fluid is too high it is called polyhydramnios.
What is oligohydramnios?
Oligohydramnios is the condition of having too little amniotic fluid. Doctors can measure the amount of fluid through a few different methods, most commonly through amniotic fluid index (AFI) evaluation or deep pocket measurements. If an AFI shows a fluid level of less than 5 centimeters (or less than the 5th percentile), the absence of a fluid pocket 2-3 cm in depth, or a fluid volume of less than 500mL at 32-36 weeks gestation, then a diagnosis of oligohydramnios would be suspected.
About 8% of pregnant women can have low levels of amniotic fluid, with about 4% being diagnosed with oligohydramnios. It can occur at any time during pregnancy, but it is most common during the last trimester. If a woman is past her due date by two weeks or more, she may be at risk for low amniotic fluid levels since fluids can decrease by half once she reaches 42 weeks gestation. Oligohydramnios can cause complications in about 12% of pregnancies that go past 41 weeks.
What causes low amniotic fluid?
- Birth defects – Problems with the development of the kidneys or urinary tract which could cause little urine production, leading to low levels of amniotic fluid.
- Placental problems – If the placenta is not providing enough blood and nutrients to the baby, then the baby may stop recycling fluid.
- Leaking or rupture of membranes –This may be a gush of fluid or a slow constant trickle of fluid. This is due to a tear in the membrane. Premature rupture of membranes (PROM) can also result in low amniotic fluid levels.
- Post Date Pregnancy– A post date pregnancy (one that goes over 42 weeks) can have low levels of amniotic fluid, which could be a result of declining placental function.
- Maternal Complications– Factors such as maternal dehydration, hypertension, preeclampsia, diabetes, and chronic hypoxia can have an effect on amniotic fluid levels.
What are the risks of having low amniotic fluid?
The risks associated with oligohydramnios often depend on the gestation of the pregnancy. The amniotic fluid is essential for the development of muscles, limbs, lungs, and the digestive system. In the second trimester, the baby begins to breathe and swallow the fluid to help their lungs grow and mature. The amniotic fluid also helps the baby develop muscles and limbs by providing plenty of room to move around.
If oligohydramnios is detected in the first half of pregnancy, the complications can be more serious and include:
- Compression of fetal organs resulting in birth defects
- Increased chance of miscarriage or stillbirth
If oligohydramnios is detected in the second half of pregnancy, complications can include:
- Intrauterine Growth Restriction (IUGR)
- Preterm birth
- Labor complications such as cord compression, meconium stained fluid and cesarean delivery
What treatments are available if I am experiencing low amniotic fluid?
The treatment for low levels of amniotic fluid is based on gestational age. If you are not full term yet, your doctor will monitor you and your levels very closely. Tests such as non-stress and contraction stress test may be done to monitor your baby’s activity. If you are close to full term, then delivery is usually what most doctors recommend in situations of low amniotic fluid levels.
Other treatments that may be used include:
- Amnio-infusion during labor through an intrauterine catheter. This added fluid helps with padding around the umbilical cord during delivery and is reported to help lower the chances of a cesarean delivery.
- Injection of fluid prior to delivery through amniocentesis. The condition of oligohydramnios is reported to often return within one week of this procedure, but it can aid in helping doctors visualize fetal anatomy and make a diagnosis.
- Maternal re-hydration with oral fluids or IV fluids has shown to help increase amniotic fluid levels.