Amniotic Fluid and Its Mechanics

By
Samyuktha Raj
Rahul Bommaraju

Aim
Main aim of this project is to study the
development of amniotic fluid and its
mechanics.

What is amniotic fluid?

Amniotic fluid is a clear, slightly yellowish liquid
present in the amniotic sac which is very critical
for the fetal growth and development.

The amniotic fluid helps in

The

developing baby to move in the womb,

which allows for proper bone growth

The

lungs to develop properly

Keep

a relatively constant temperature around

the baby, protecting from heat loss

Protect

the baby from outside injury by

cushioning sudden blows or movements

Formation of amniotic fluid

The blastocyst is an initial structure formed after
fertilization.
Inner cell mass
Embryo
Outer layers

Trophoblast

Trophoblast

Placenta

Amniotic fluid volume

The volume of amniotic liquid is absolutely
associated with the development of baby.

The normal pregnant lady encounters an

increment in plasma volume totaling more than a
liter by mid-incubation. At 30 weeks the measure
of water in the human fetal compartments,
including baby, placenta and amniotic liquid may
approach five liters.

Mechanics involved in amniotic fluid

production
AF circulation
Placental water flux
Calculation of membrane water flow
Fetal membrane (IM) water flow
Placental water flow
Measurement and analysis of amniotic fluid

AF circulation
As we have seen how amniotic fluid is initially formed
during the first half of the gestation period, during the
next half the primary sources of AF include fetal urine
production and fluid secreted by the fetal lungs.
Urine production
Lung fluid production
Fetal swallowing
Intramembranous flow

Urine production:
The mature fetus can respond to changes in fluid status by
modulating urine flow. . These findings indicate that AF
volume may be regulated through the mechanism of
altered fetal urine flow.
Lung fluid production:
It appears that all mammalian fetuses secrete fluid from
their lungs. Under physiological conditions, half of the fluid
exiting the lungs enters the AF and half is swallowed.
Therefore, the total lung fluid production approximates
one-third that of urine production with the net AF fluid
contribution only one-sixth of urine.
Increased arginine vasopressin (AVP) decrease lung fluid
production.

Fetal swallowing
Human fetus swallows an average of 210e760 ml/day.Fetal
swallowed volume is subject to periodic increases as
mechanisms for thirst and appetite develop
functionality.

Intramembranous (IM) flow

The IM pathway refers to the route of absorption from
the amniotic cavity directly across the amnion into the
fetal vessels.

Placental water flux

Fetal hydration is ultimately dependent on the flow of water

from the maternal .circulation across the placenta.

The total water exchanged between the fetus and mother is

much larger, up to 70 ml/min.

Diffusional flow occurs in both directions across the

membrane, and results in no net accumulation of water.

In mid-gestation, the placenta increases in size, but in late

gestation, the growth of the fetus is exponential, while the
placenta grows slowly.

Calculation of membrane water flow

Five major routes of membrane transfer can be distinguished as
follows.

Simple diffusion of lipophilic substances (for

example, oxygen).

Diffusion of hydrophilic substances through

transmembrane channels (the common mechanism
for membrane water flow).

Facilitated diffusion (as occurs with D-glucose).

Active transport (as for certain electrolytes).

Receptor-mediated endocytosis (a mechanism of

transfer of large molecules).

simple diffusion of any compound (mol/s) across the

membrane along physical gradients is given by

c1 andc2 in mol/m3 represent the unbound solute concentrations

on opposite sides of the membrane.
P represents the solute permeability of the membrane in m/sec
S stands for the surface area for diffusion in m2.
Sigma is the reflection coefficient
Jv is the volume in m3/sec.
I as the electrical
current in Coulomb/sec

volume flow is given by

Lp

is the hydraulic conductance.

DetP is the hydrostatic pressure difference.
R is the gas constant.
Tis temperature in degrees Kelvin.
PE is the electric osmotic pressure coefficient.
K is defined as electrical current.

Fetal membrane (IM) water flow

In fetus an extensive network of microscopic
blood vessels is located between the outer surface
of the amnion and the chorion providing the surface
area for IM flow.
Diffusional permeability

2.2*10-4cm/sec.

Osmotic permeability of

1.5*10-2 cm/sec.

Placental water flow

Human placenta is known as Hemochorial
placenta.
The placenta is a complex organ.
In hemochorial placentae, the maternal blood is
contained in sinuses in direct contact with one or
more layers of fetal epithelium.

Measurement and analysis of amniotic fluid

Amniotic fluid index
Measure the depth of the largest visible pocket
of fluid.

Amniotic fluid index is an ultrasound procedure used

to asses the amount of amniotic fluid.
The normal range for the deepest vertical pocket is 2
cm to 8 cm.

Disorders in amniotic fluid

Disorders in amniotic fluid volume are of two
types
Polyhydramnios

Main causes of Polyhydramnios

Congenital
Rh

defects

factor
Maternal Diabetes:
Twin-to-twin transfusion syndrome:

Oligohydramnios

Main causes of Oligohydramnios

Birth

defects
Placental problems
Leaking or rupture of membranes
Post Date Pregnancy
Maternal Complications

Amniotic fluid embolism

The disastrous entry of amniotic fluid into
the maternal circulation leads to dramatic squeal
of clinical events called as Amniotic fluid embolism
AFE can occur during labor, caesarean
section, dilatation and evacuation or in the
immediate postpartum period.

There are two phases of AFE

First phase
The patient experiences acute shortness of
breath and hypotension. This rapidly progresses
to cardiac failure leading to a reduction of
perfusion to the heart and lungs

Second phase
This is known a the hemorrhagic phase
and may be accompanied by severe shivering,
coughing, vomiting, and the sensation of a bad
taste in the mouth.

Collapse of the cardiovascular system

leads to fetal distress and death unless the
child is delivered swiftly

Symptoms
Prodromal symptoms in AFE are sudden
chills, shivering, sweating, anxiety, and coughing
followed by signs of respiratory distress, shock,
cardiovascular collapse, and convulsions.

Respiratory difficulty, evidenced by cyanosis,

tachypnea, and bronchospasm, frequently
culminates in fulminant pulmonary edema.

Conclusion
The developing pregnancy requires large
volumes of water, which are obtained from the
maternal circulation through the placenta

AF volume is therefore affected by both

placental water flow and by the balance between
production and absorption.

References
(1)M.H. Bealla,*, J.P.H.M. van den Wijngaardb, M.J.C. van Gemertb, M.G.
Ross Amniotic Fluid Water Dynamics.
(2) http://en.wikipedia.org/wiki/Amniotic_fluid_embolism
(3) Amniotic fluid embolism
A. Rudra, S. Chatterjee, S. Sengupta, B. Nandi, and J. Mitra Amniotic Fluid
Embolism. Retrieved from
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2823093/
(4)http://www.jaypeejournals.com/eJournals/ShowText.aspx?ID=59&Type=
FREE&TYP=TOP&IN=_eJournals/images/JPLOGO.gif&IID=7&isPDF=YES
(5) M.H. Bealla, J.P.H.M. van den Wijngaardb, M.J.C. van Gemertb, M.G.
Rossa. Regulation of Amniotic Fluid.
(6) Barker G, Boyd RD, DSouza SW, Donnai P, Fox H, Sibley CP. Placental
water content and distribu.tion. Placenta 1994;15:47e56