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Pregnancy and Childbirth: The answers

Reduced amniotic fluid volume

 

In general, reduced amniotic fluid volume is a matter of concern. Even though, in a good number of cases, no cause for the reduction of the volume is ever established, reduced fluid volume may signal such problems as fetal abnormality, sub­optimal placental function, unrecognized rupture of mem­branes or even wrong dates. Reduced amniotic fluid volume always calls for closer monitoring of the pregnancy.

 

Fetal abnormalities and reduced fluid volume

The main concern is kidney or other urinary tract abnormalities.

 

If the baby has one of the few serious kidney abnormalities that make them unable to produce urine, then there will be very little - almost undetectable - amniotic fluid. This is usually apparent very early, probably around twenty weeks of gestation. An ultrasound scan will go a long way in establishing the diagnosis but this is not always the case.

 

If there is a condition that obstructs the flow of the urine, again there will be reduced fluid volume.

As a rule, the defects have to be bilateral (affecting both kidneys) to produce this effect.

 

Renal (kidney) abnormalities and amnitic fluid

Some kidney abnormalities are incompatible with life outside the womb. Most obstructive conditions can be relieved before delivery, if this is found to be necessary. This is usually a stop-gap measure. Definitive surgical treatment will be carried out after delivery.

 

Sub-optimal placental function and reduced fluid

If the placenta, for whatever reason, is not functioning efficiently, this may be reflected in reduced amniotic fluid volume. There will also be restricted growth of the fetus.

 

If these features are apparent, the progress of the pregnancy will be monitored closely and there is a high possibility of delivery before term, either via induction of labor or caesarean section as deemed appropriate. Each case is obviously assessed on its own merit, and there is no hard and fast rule.

 

Genetic or chromosomal abnormality as a cause of reduced fluid volume

Some chromosomal abnormalities are characterized by a chronically reduced amniotic fluid volume, almost always accom­panied by fetal growth restriction.

 

Because many of these abnormalities occur with other physical anomalies, the diagnosis is likely to be suspected before delivery as a result of detailed ultrasound scanning.

 

If that is the case, fluid could be taken from around the baby (by a procedure called amniocentesis) for analysis, to establish the diagnosis.

 

Effects of reduced fluid volume on the growing fetus

The most feared effect is poor lung development. Normal lung development depends on the presence of adequate amniotic fluid.

 

If the reduced volume starts very early and does not improve, lung development could be very poor and this is an extremely difficult problem to overcome.

The severity of this problem also depends on the degree of reduction in the fluid volume.