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Abstract

Anomalies of amniotic fluid

Anomalies of amniotic fluid, i.e. polyhydramnios or oligohydramnios, are associated with increased rates of pregnancy complications and an increased perinatal morbidity and mortality. In most of the cases polyhydramnios are the consequence of diabetes in pregnancy and of fetal malformations, mainly of the gastrointestinal tract. Direct complications of polyhydramnios are lie anomalies, umbilical cord complications such as cord around the neck or body or prolaps of the umbilical cord in (preterm) prelabor rupture of membranes (P)PROM due to increased intrauterine space and therefore increased fetal mobility on the one hand, preterm labor, (P)PROM, and preterm birth due to increased intrauterine volume and pressure on the other hand. In cases of oligohydramnios placental insufficiency and (P)PROM are the leading causes. In the evaluation of oligohydramnios it is important to rule out (P)PROM reliably (bedside tests for PAMG-1 [placental alpha-microglobulin-1] or npIGFBP [non-phosphorylated insulin-like growth factor binding protein-1]). Furthermore fetal Doppler sonography and cardiotocography with or without biophysical profile play an essential role in managing placental insufficiency. Ideally anomalies of amniotic fluid should be treated causally, i.e. by intensive treatment of gestational diabetes by diet or insuline. In some cases only symptomatic treatment is possible while neither amnioinfusion nor serial punction are currently viewed as standard procedures in Germany well knowing that both are well established and quite well evaluated treatment options under certain conditions with proven benefits for mother and child. In most of the cases however the only way is intensive pregnancy and especially peripartum surveillance.

CME Prakt Fortbild Gynakol Geburtsmed Gynakol Endokrinol 2011; 7(2): 138–148

Keywords
Amniotic fluid, polyhydramnios, oligohydramnios, pregnancy, abnormality

Bernd C. Schmid, Holger Maul
Katholisches Marienkrankenhaus Hamburg
Reviewer: Stephan Henschen, Schwerin
und Isabel Grochla, Köln

Maul H. Anomalien ... Gynakol Geburtsmed Gynakol Endokrinol 2011; 7(2): 138–148 publiziert 31.07.11 www.akademos.de/gyn ©akademos Wissenschaftsverlag 2011 ISSN 1614-8533