Why is amniotic fluid called "amniotic fluid" and not "cow's fluid", "pig's fluid" or "dog's fluid"? "water of the gods"?
Explanation 1:
"Amniotic fluid" is an ancient term.
In the ancient word "sheep" and "Yang" is common, both homophonic. It represents the beginning of human life, so it is called amniotic fluid, which is the source of the beginning of human life.
"Sheep" means "to raise" and "to raise" means to nurture, to give birth to, and to have children. Originally, it should be "养水", but it was simplified by later generations and became "羊水" (amniotic fluid) for ease of writing!
Explanation 2:
The word "amniotic fluid" was first used in Greek legend.
The ancient Greeks believed that the baby was born wrapped in the body of the layer of membrane and the sheep's intestines are very similar, so that layer of membrane for the amniotic membrane, and amniotic membrane inside the liquid is called "amniotic fluid".
To date, the root word for amniotic fluid is still the name of a Greek goat.
No matter how many ways there are to explain it, amniotic fluid is just a name, and it is the fluid itself that we really need to understand.
We all know that the fetus is soaked in amniotic fluid in the womb. And what does it do for the fetus? How much amniotic fluid is normal?
How does amniotic fluid come about?
Amniotic fluid refers to the fluid inside the amniotic cavity of the uterus during pregnancy, and it is an indispensable ingredient in maintaining the life of the fetus.
Early pregnancy: the fluid that leaks into the amniotic cavity from the mother's blood flow through the fetal membranes.
Mid-gestation: the fetus produces amniotic fluid through urination and also swallows it through the digestive tract, keeping the amount of water in dynamic balance.
Late pregnancy: In addition to the excretion of fetal urine and the swallowing of amniotic fluid, the fetal lungs breathe amniotic fluid as a new route of operation.
The amniotic fluid is clear in the early and middle stages, but in the later stages it becomes alkaline, white and slightly turbid, with small pieces of suspended material. This is because the fetal fat attached to the fetal body surface will gradually fall off after 38 to 39 weeks of pregnancy and enter the amniotic fluid, which is also a sign that the fetus has matured.
The role of amniotic fluid
A, to protect the fetus
1, shock: amniotic fluid is the fetus of the shock device, can buffer the abdomen external pressure or impact, so that the fetus is not directly affected by the damage.
2, constant temperature: amniotic fluid can ensure that the temperature in the amniotic cavity is always in a constant state, so that the metabolic activities of the fetus in a normal and stable environment.
3, antibacterial: amniotic fluid contains some antibacterial substances, can protect the fetus from infection.
4, conducive to growth and development: through swallowing or inhalation of amniotic fluid, can promote the development of fetal digestive tract and lungs.
5, regulating the balance of body fluids: when the baby's body has too much water, it can be discharged into the amniotic fluid by urination; when it is short of water, it can be supplemented by swallowing amniotic fluid.
6, other: amniotic fluid can also prevent fetal limb adhesion; when the fetus is breech or foot position, it can also avoid umbilical cord prolapse.
Two, protect the mother
Amniotic fluid can protect the baby in addition to the mother also has a protective effect Oh. For example, amniotic fluid can reduce the discomfort to the mother when the fetus moves in the womb. During labor, the amniotic sac can dilate the cervical opening and vagina, facilitating birth. After the water breaks, amniotic fluid lubricates the birth canal, making it easier to deliver the fetus.
How much amniotic fluid is normal?
In general, the amount of amniotic fluid changes with the weeks of pregnancy.
It averages 500 ml at 20 weeks of pregnancy, increases to 700 ml at about 28 weeks, and is highest at 1,000 to 1,500 ml at 32 to 36 weeks, and then decreases gradually.
Therefore, the normal range of amniotic fluid is clinically 300 to 2000 ml. Above or below this range, it is called too much amniotic fluid (>2000ml) or too little amniotic fluid (<300ml).
But since the amniotic fluid is in the mother's stomach, there is no way to measure it with a measuring cup, so the doctor will use ultrasound to find out how much amniotic fluid is present. Usually, the ultrasound will show the amniotic fluid index or the depth of amniotic fluid.
Depth of amniotic fluid (dvp): is the vertical depth of the pool of amniotic fluid that the ultrasound indicates as the maximum. The normal reference value is between 3 and 8cm, less than 3cm indicates too little amniotic fluid, and more than 8cm indicates too much amniotic fluid.
Amniotic fluid index (AFI): the uterus is divided into four quadrants at right angles to the umbilical level and the white line of the abdomen, and the vertical diameter of the largest amniotic pool in each quadrant is measured, and the sum of the four is the amniotic fluid index.
Normal values range from 5 to 18 cm, less than 5 cm for amniotic fluid is too little, less than 8 for amniotic fluid is low, between 18 and 24 cm for suspected amniotic fluid or amniotic fluid is too much, if it is greater than 24 cm, then the diagnosis of amniotic fluid is too much.
Some key words related to amniotic fluid
01
Excessive amniotic fluid
The cause of excessive amniotic fluid is unknown, although 26% of cases of excessive amniotic fluid result in congenital malformations of the fetus.
Therefore, it is important to consider both the fetus and the mother together in cases of excess amniotic fluid.
1. Fetal aspect:
Possible causes include fetal congenital malformations (e.g., anencephaly, severe defects of the central nervous system, digestive system, occlusion of the gastrointestinal tract, etc.), obstruction of the circulatory system of the fetus, blood stagnation, and multiparity.
2. Maternal:
Possible causes are metabolic disorders of the mother (e.g. gestational diabetes mellitus), abnormal obesity or syphilis.
In addition, pregnant women with heart, liver, kidney, etc., are also prone to excessive amniotic fluid.
Serious complications of excess amniotic fluid include premature rupture of membranes, preterm labor, placental abruption, and postpartum hemorrhage due to weak contractions. In most cases, amniotic fluid does not require intervention if there is no other maternal or fetal evidence. If there is a significant increase in the amount of amniotic fluid over a short period of time, resulting in severe discomfort and respiratory distress for the mother, amniocentesis may be considered to release the amniotic fluid.
For most mothers-to-be with amniotic fluid, there is no need to worry too much, because the prognosis for babies with unexplained amniotic fluid, mild amniotic fluid, and amniotic fluid with no fetal abnormality is good.
02
Low amniotic fluid
Currently, the common clinical causes of decreased amniotic fluid are divided into five categories:
(1) Fetal structural anomalies: this is the most common cause of low amniotic fluid in early and mid-pregnancy, malformations to the urinary system malformations are predominantly chromosomal abnormalities to the 21-trimester, trimester 13, trimester 18, etc., so the When encountering an abnormal amount of amniotic fluid, it is important to consider amniocentesis to rule out chromosomal abnormalities.
(2) Placental hypoplasia: a common cause of low amniotic fluid in middle and late pregnancy, mostly related to placental microthrombosis, and more common in pregnant women with fetal growth restriction, expired pregnancy, or placental degenerative changes.
(3) Amniotic membrane lesions: inflammation, intrauterine infection caused by changes in the permeability of the amniotic membrane, resulting in an abnormal amount of amniotic fluid.
(4) Maternal factors: maternal comorbidities, such as hypertensive disorders of pregnancy, gestational diabetes mellitus, intrahepatic cholestasis in pregnancy, maternal blood volume insufficiency, premature rupture of membranes, etc. pregnant women are prone to low amniotic fluid.
(5) Drug factors: pregnant women taking oral diuretics, angiotensin-converting enzyme inhibitors (such as captopril), prostaglandin synthetase inhibitors (such as indomethacin), angiotensin receptor antagonists (such as chlorthalidomide) and so on.
Pregnant women with low amniotic fluid often feel abdominal pain when the fetus moves, and the examination found that the abdominal circumference and uterine height are smaller than those of the same period of pregnancy, and the uterus is highly sensitive, and the slightest stimulation can cause uterine contractions, and the labor pains are severe, and the contractions are uncoordinated, and the uterine mouth is slowly dilated, and the duration of the labor is prolonged.
The fetus with too little amniotic fluid can suffer from pulmonary hypoplasia, growth restriction, intrauterine distress, and even neonatal asphyxia. Therefore, pregnant mothers must not take it lightly.
How to deal with low amniotic fluid? It's not just about "drinking more water"!
If it's the baby's fault, it's time to find out if the baby is likely to have birth defects and what the prognosis is. If it's the mom, find ways to improve it.
If the amniotic fluid is low due to maternal hypovolemia or hypoxia, drinking lots of water, intravenous fluids, and oxygen can indeed help. "Drinking lots of water" is pretty much the easiest way to do this.
So if you follow your doctor's advice to drink more water and then check back, and if your water really has improved, then your previous low water levels may have been caused by you drinking too little water. Of course, if your doctor only recommended that you drink water, it also means that the low amniotic fluid is not too serious.
If the situation is more serious, then it may be time to consider something more complicated, such as amniocentesis. This is because a prolonged period of low amniotic fluid may result in the baby's development being stunted and showing signs of malformations.
Here is also a reminder that if you have low amniotic fluid, it is best to consult your doctor's advice, do not look at other pregnant mothers drinking water, you also follow the water, your situation may not be the same.
03
Premature rupture of amniotic fluid
When labor is imminent, as the uterus continues to contract, the fetal membranes at the opening of the uterus are unable to withstand the greater pressure and rupture, so that the amniotic fluid flows out of the vagina, a situation known as rupture of water.
If amniotic fluid ruptures without regular uterine contractions and vaginal redness, meaning that the membranes rupture before labor, this is called premature rupture of the amniotic fluid, which is a common complication in obstetrics.
Preterm rupture of amniotic fluid is a critical condition that can easily lead to infection and affect the health and well-being of the mother and baby.
Causes:
1. The cervix of the pregnant woman is loose, which causes premature rupture of amniotic fluid due to irritation of the fetal membranes.
2, poor development of the fetal membranes, such as the presence of amniotic membrane - chorioamnionitis, resulting in excessive pressure in the amniotic cavity, causing premature rupture of amniotic fluid.
3. Fetal malposition, pelvic stenosis, cephalopelvic disproportion, excessive amniotic fluid, multiple pregnancies, etc. can increase the pressure in the amniotic cavity and cause premature rupture of the amniotic fluid.
4, inadvertent sexual intercourse during pregnancy causes amnion-chorionic villus infection, especially the prostaglandins in semen can induce uterine contraction, leading to uneven pressure in the amniotic cavity, triggering premature rupture of amniotic fluid.
5, some other factors can also cause premature rupture of amniotic fluid, such as coughing during pregnancy, violent laughter or anger, and heavy physical activity, etc., can make the pressure in the abdominal cavity increased dramatically, resulting in rupture of the fetal membranes, the amniotic fluid out of the vagina.
When amniotic fluid breaks prematurely, it is common for women to think that they have wet their underwear and are unaware that their water has broken prematurely. However, it is very important to recognize premature rupture of the water as soon as possible to prevent bacteria from traveling up the vagina into the uterus and infecting the fetus, and to avoid complications such as umbilical cord prolapse.
Emergency treatment:
In the event of premature rupture of amniotic fluid, the mother and her family should not panic too much, and it is easy to act inappropriately when you don't know what to do.
In order to prevent the umbilical cord from prolapsing, immediately have the mother lie down and adopt the position of elevating the breech position.
Place a clean sanitary towel on the vulva and keep the vulva clean and out of the bath.
Whenever your water breaks, you must go to the hospital immediately, regardless of whether you are in labor or not, and whether or not you are having uterine contractions. Even on the way to the hospital, you need to lie in a hip-high position.
04
Amniotic fluid embolism
Amniotic fluid embolism refers to the syndrome in which amniotic fluid enters the mother's bloodstream during labor and delivery, causing a series of critical symptoms such as pulmonary embolism and shock, which is acute in onset, with a mortality rate as high as 70%-80%, and poses a serious threat to the mother's life.
The occurrence of amniotic fluid embolism usually have the following triggers:
① advanced maternal age: the age of more than 35 years of age, the older the mother, the greater the likelihood of occurrence;
② the birth of a number of mothers: the more the number of fetuses, the higher the probability of occurrence of amniotic fluid embolism;
③ placental abruption of the mother: in the process of delivery, if the occurrence of placenta Early abruption of the placenta: during labor, if the placenta is abrupted, the possibility of fetal cells, fetal fat or fetal stools in the amniotic fluid entering the mother's bloodstream through the placental vein will increase;
4) Pregnant women with fetal demise in the uterus: the longer the fetus is dead in the uterus, the higher the probability of amniotic fluid embolism;
5) Fetal distress: the probability of amniotic fluid embolism is also higher. This is because when the fetus is in distress, there is often fetal stool in the amniotic fluid, and the labor pains are usually very strong at this time, which makes it easier for amniotic fluid embolism to occur.
In actual labor, contact between amniotic fluid and blood is inevitable, but amniotic fluid embolism still occurs in a very small percentage of people. There are still some unclear mechanisms involved.
05
Cloudy amniotic fluid
is a thick, dense spot of light that can be seen on ultrasound. It is usually caused by the accumulation of fetal fat, meconium or bile in the amniotic fluid. Of these, 12%-22% are due to contamination by fetal stool.
Clinical studies have shown a relationship between fetal stool contamination and fetal hypoxia, which is one of the diagnostic criteria for fetal distress.
The common causes of amniotic fluid turbidity are as follows:
1. Fetal fat is mixed in the amniotic fluid, and if this is the cause of amniotic fluid turbidity, it will not harm the fetus, so there is no need to worry too much.
2, fetal feces mixed in the amniotic fluid, if this situation may lead to fetal hypoxia in the uterus, the need for oxygen, the specific treatment measures should be carried out after the diagnosis of a professional doctor.
3, the bile is mixed in the amniotic fluid, amniotic fluid in the main substances have fetal water, brittle hair, simple turbidity generally have no effect. If it's cloudy, it's a sign that the fetus is in an abnormal condition and needs to be delivered immediately.
Because amniotic fluid is the environment in which the fetus lives, the presence of turbidity should not be taken lightly, and the cause should be identified at the hospital as soon as possible.
Based on the degree of contamination of amniotic fluid, medical amniotic fluid contamination is divided into three degrees:
Amniotic fluid I degree of contamination manifested as amniotic fluid is light green, commonly found in the fetus of chronic hypoxia;
Amniotic fluid II degree of contamination manifested as amniotic fluid dark green or yellowish green, suggesting that the fetus of acute hypoxia;
Amniotic fluid III degree of contamination manifested as amniotic fluid brownish-yellow color, thick, suggesting that the fetus of severe hypoxia. This suggests that the fetus is suffering from severe hypoxia.
If the amniotic fluid is cloudy, the mother is most worried about the safety of the fetus. Mild turbidity in amniotic fluid at the end of pregnancy is due to the presence of fetal metabolites in the amniotic fluid, which is normal.
If there is an infection in the amniotic cavity, too much fetal fat, maternal cholestasis, intrauterine fetal hypoxia, etc., the amniotic fluid will be obviously turbid.
And the choice of delivery method, need to be analyzed on a case-by-case basis, amniotic fluid turbidity need to closely observe the intrauterine condition of the fetus, go to the hospital for a detailed examination, to clarify the cause, symptomatic treatment.