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Question about Amniotic Fluid Levels

post #1 of 8
Thread Starter 
From time to time I hear of women who had to be induced because of amniotic fluid levels that were too low or too high.

Can anyone impart some wisdom on this because it doesn't make sense to me. If the placenta is supplying the baby with all the necessary oxygen and nutrients through the umbilical cord, then why would low or high amount of amniotic fluid be a reason for induction? Or is an abnormal fluid level not the problem, but an indicator of another problem? If so, what problems?

Thanks in advance for helping me understand this.
post #2 of 8
Now that's a good question! Since I'm bored and trying to kill my last half hour at work I did some checking...here's what I found.

First on low fluid level:
Oligohydramnios is often the result of a tear or rupture in the amniotic membrane, causing it to leak amniotic fluid and thus lower the level of fluid still surrounding the baby. If the low fluid levels are caused by a membrane leak, there is an increased risk of infection to both mother and baby, Roberts says. For baby, too little fluid can mean a tangle with an umbilical cord; without fluid to float in, a baby may sit on the cord and cut off its own blood supply. The mother also is vulnerable to bacteria that enter the uterus through the tear causing the fluid leak.
And high:
Most cases of polyhydraminios are mild and result in few, if any complications. Those with higher levels of fluid could experience one or more of the following risks:

Premature rupture of the membranes (PROM)
Placental abruption
Preterm labor and delivery (approximately 26%)
Growth restriction (IUGR) resulting in skeletal malformations
Stillbirth occurs in about 4 in 1000 pregnancies that suffer from polyhydramnios vs. about 2 in1000 pregnancies with normal fluid levels.
Cesarean delivery
Postpartum hemorrhage
I think I'd read that high levels can be indicative of a congenital problem with the baby.

Interesting stuff. I did get most of that info from seemingly mainstream sites though; if I thought I had these issues I would definitely look for more alternative sites to make sure I was getting balanced info.
post #3 of 8
Thread Starter 
Wow, thanks for searching!

So, it does seem that in most cases the low or high levels could lead to other problems, and it's not necessarily the low or high level that is the problem.

So then, low or high levels don't necessarily REQUIRE and induction, but could just be a sign that the mom and baby should be monitored closely? Any midwives or nurses who can elaborate on this?

I was just curious because an acquaintance was recently induced at 38 weeks for low levels. She said it HAD to be done or her baby would have died because they need the fluid to survive. I'd never given it much thought, so wanted to learn a little more about it.
post #4 of 8
The low or high fluid is not the problem, but abnormal fluid levels may indicate that there is a bad reason behind the problem. For example, low fluid... it could mean nothing, it could mean your friend was about to go into labor, or it could mean her placental was failing... the risk of the latter being the actual cause of the low fluid is lower than the risk of it meaning nothing... but the docs point of view is that if they didn't induce, and the baby was born still due to placental insufficiency, then they are at risk for a lawsuit...
you know, they always operate under the assumption of worse-case scenario.
post #5 of 8
Hi--thought I could shed some light. My ds (now 9 mos.) was delivered at 37 weeks b/c of low fluid.
Low fluid is more serious the earlier it occurs in pregnancy. Very early on, it can be a sign of very serious things, like PROM, or Potter's syndrome (baby has no functioning kidneys, therefore does not produce urine, therefore fluid is low). Late in pregnancy, fluid naturally decreases, which may mean as little as the body is just preparing for birth. At any point it can indicate that mom is dehydrated or that there are stomach or bladder problems with the baby.

My low fluid was discovered at 30 weeks. I started to measure small, so I had an u/s where my fluid level was assessed at 2cm. I was sent for an IV and my fluid was then assessed at 6cm (still low). For the next 3 weeks I had 2x weekly NST and u/s. They assess fluid in each of the 4 quadrants of the uterus, and some drs will only give you "credit" for fluid found in pockets with no cord. So throughout this time I had some drs. who said I had 0 fluid,because there was cord in each pocket, and some were saying I had 7 or 8 centimeters. Sometimes I was told I should deliver immediately, sometimes I was told it would be better to hold off. Since u/s showed a normal baby, the main concern was cord accident, which was really terrifying to me. From 33 weeks on I had N/S tests every day, u/s every other day. My fluid levels were between 0 and 4. At 37 weeks I decided to deliver. Baby had stopped growing and I had previously delivered a 35-weeker and 36-weeker twins without any "prematurity" complications, so I felt in my heart that this one would do ok at 37 weeks. Also, the fear of a cord accident was getting to be too much for me, so I felt it was time.

Not sure about your friend's situation, but I think it usually comes down to a risk/benefit ratio. I didn't "have to" deliver my son at 37 weeks. He was doing fine on NST. But I was comfortable with the risks of delivering a 37 weeker, and not with the risk of a cord accident. However, when I was first presented the option of delivery at 30 weeks, I felt the risks of prematurity were far greater than the other risks associated with low fluid, so I chose to hold off.
post #6 of 8
Forgot to mention--
drs. can check placental sufficiency through ultrasound, by looking at the blood flow on doppler, which can be very reassuring in cases of low fluid.
post #7 of 8
Most of the diagnoses of low fluid are bunk. It's an Ob myth that it means that baby is in trouble. Generally women's level of fluid drops in the last weeks of pregnancy so obviously it's a sign that the baby is coming soon. Instead of panicking about it when it's occurring in a term baby, it should just be a sign of impending labour. Too many women are given this excuse to induce. Oligo- and poly- are diagnosed way too readily when the true states of both of those are quite extreme - many litres one way or the other.
Try this for a really good explanation about the current obsession with it.
Suspect Diagnoses Come with Biophysical Profiling
post #8 of 8
Low fluid too can be a sign of maternal dehydration. It wasn't in my case though as I was already on restricted activity and knew to drink a lot, especially if I started to have ctxs. Evan was born w/ no water as far as we know. I never had that water breaking moment, it didn't break at home, not at the hospital and wasn't there when I delivered so the only assumption is I didn't have any. Which is totally different from #1, I had a TON of fluid. When they broke my water (dumb me) it just came and came and came and I was huge w/ him! I wasn't near as big w/ Evan, but still plenty big. I plan on having my DR monitor my fluid levels during my next pgcy so I can at least try to drink more water at the end if needed in hopes of having better levels this next time. I did abrupt during my last labor, but that was under the polyhydraminos risk list so I'm not sure if they're connected or not.
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