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 mldayFetal

swallowed volume is subject to periodic increases as

mechanisms for lsquolsquothirstrsquorsquo and lsquolsquoappetitersquorsquo 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 mlmin

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 (mols) across the

membrane along physical gradients is given by

c1 andc2 in molm3 represent the unbound solute concentrations

on opposite sides of the membrane

P represents the solute permeability of the membrane in msec

S stands for the surface area for diffusion in m2

Sigma is the reflection coefficient

Jv is the volume in m3sec

I as the electrical

current in Coulombsec

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 2210-4cmsec

Osmotic permeability of 1510-2 cmsec

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 defects

Rh 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)MH Bealla JPHM van den Wijngaardb MJC van Gemertb MG Ross Amniotic Fluid Water Dynamics

(2) httpenwikipediaorgwikiAmniotic_fluid_embolism

(3) Amniotic fluid embolism

A Rudra S Chatterjee S Sengupta B Nandi and J Mitra Amniotic Fluid Embolism Retrieved from

httpwwwncbinlmnihgovpmcarticlesPMC2823093

(4)httpwwwjaypeejournalscomeJournalsShowTextaspxID=59ampType=FREEampTYP=TOPampIN=_eJournalsimagesJPLOGOgifampIID=7ampisPDF=YES

(5) MH Bealla JPHM van den Wijngaardb MJC van Gemertb MG Rossa Regulation of Amniotic Fluid

(6) Barker G Boyd RD DrsquoSouza SW Donnai P Fox H Sibley CP Placental water content and distribution Placenta 19941547e56

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 mldayFetal

swallowed volume is subject to periodic increases as

mechanisms for lsquolsquothirstrsquorsquo and lsquolsquoappetitersquorsquo 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 mlmin

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 (mols) across the

membrane along physical gradients is given by

c1 andc2 in molm3 represent the unbound solute concentrations

on opposite sides of the membrane

P represents the solute permeability of the membrane in msec

S stands for the surface area for diffusion in m2

Sigma is the reflection coefficient

Jv is the volume in m3sec

I as the electrical

current in Coulombsec

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 2210-4cmsec

Osmotic permeability of 1510-2 cmsec

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 defects

Rh 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)MH Bealla JPHM van den Wijngaardb MJC van Gemertb MG Ross Amniotic Fluid Water Dynamics

(2) httpenwikipediaorgwikiAmniotic_fluid_embolism

(3) Amniotic fluid embolism

A Rudra S Chatterjee S Sengupta B Nandi and J Mitra Amniotic Fluid Embolism Retrieved from

httpwwwncbinlmnihgovpmcarticlesPMC2823093

(4)httpwwwjaypeejournalscomeJournalsShowTextaspxID=59ampType=FREEampTYP=TOPampIN=_eJournalsimagesJPLOGOgifampIID=7ampisPDF=YES

(5) MH Bealla JPHM van den Wijngaardb MJC van Gemertb MG Rossa Regulation of Amniotic Fluid

(6) Barker G Boyd RD DrsquoSouza SW Donnai P Fox H Sibley CP Placental water content and distribution Placenta 19941547e56

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 mldayFetal

swallowed volume is subject to periodic increases as

mechanisms for lsquolsquothirstrsquorsquo and lsquolsquoappetitersquorsquo 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 mlmin

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 (mols) across the

membrane along physical gradients is given by

c1 andc2 in molm3 represent the unbound solute concentrations

on opposite sides of the membrane

P represents the solute permeability of the membrane in msec

S stands for the surface area for diffusion in m2

Sigma is the reflection coefficient

Jv is the volume in m3sec

I as the electrical

current in Coulombsec

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 2210-4cmsec

Osmotic permeability of 1510-2 cmsec

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 defects

Rh 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)MH Bealla JPHM van den Wijngaardb MJC van Gemertb MG Ross Amniotic Fluid Water Dynamics

(2) httpenwikipediaorgwikiAmniotic_fluid_embolism

(3) Amniotic fluid embolism

A Rudra S Chatterjee S Sengupta B Nandi and J Mitra Amniotic Fluid Embolism Retrieved from

httpwwwncbinlmnihgovpmcarticlesPMC2823093

(4)httpwwwjaypeejournalscomeJournalsShowTextaspxID=59ampType=FREEampTYP=TOPampIN=_eJournalsimagesJPLOGOgifampIID=7ampisPDF=YES

(5) MH Bealla JPHM van den Wijngaardb MJC van Gemertb MG Rossa Regulation of Amniotic Fluid

(6) Barker G Boyd RD DrsquoSouza SW Donnai P Fox H Sibley CP Placental water content and distribution Placenta 19941547e56

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 mldayFetal

swallowed volume is subject to periodic increases as

mechanisms for lsquolsquothirstrsquorsquo and lsquolsquoappetitersquorsquo 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 mlmin

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 (mols) across the

membrane along physical gradients is given by

c1 andc2 in molm3 represent the unbound solute concentrations

on opposite sides of the membrane

P represents the solute permeability of the membrane in msec

S stands for the surface area for diffusion in m2

Sigma is the reflection coefficient

Jv is the volume in m3sec

I as the electrical

current in Coulombsec

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 2210-4cmsec

Osmotic permeability of 1510-2 cmsec

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 defects

Rh 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)MH Bealla JPHM van den Wijngaardb MJC van Gemertb MG Ross Amniotic Fluid Water Dynamics

(2) httpenwikipediaorgwikiAmniotic_fluid_embolism

(3) Amniotic fluid embolism

A Rudra S Chatterjee S Sengupta B Nandi and J Mitra Amniotic Fluid Embolism Retrieved from

httpwwwncbinlmnihgovpmcarticlesPMC2823093

(4)httpwwwjaypeejournalscomeJournalsShowTextaspxID=59ampType=FREEampTYP=TOPampIN=_eJournalsimagesJPLOGOgifampIID=7ampisPDF=YES

(5) MH Bealla JPHM van den Wijngaardb MJC van Gemertb MG Rossa Regulation of Amniotic Fluid

(6) Barker G Boyd RD DrsquoSouza SW Donnai P Fox H Sibley CP Placental water content and distribution Placenta 19941547e56

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 mldayFetal

swallowed volume is subject to periodic increases as

mechanisms for lsquolsquothirstrsquorsquo and lsquolsquoappetitersquorsquo 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 mlmin

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 (mols) across the

membrane along physical gradients is given by

c1 andc2 in molm3 represent the unbound solute concentrations

on opposite sides of the membrane

P represents the solute permeability of the membrane in msec

S stands for the surface area for diffusion in m2

Sigma is the reflection coefficient

Jv is the volume in m3sec

I as the electrical

current in Coulombsec

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 2210-4cmsec

Osmotic permeability of 1510-2 cmsec

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 defects

Rh 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)MH Bealla JPHM van den Wijngaardb MJC van Gemertb MG Ross Amniotic Fluid Water Dynamics

(2) httpenwikipediaorgwikiAmniotic_fluid_embolism

(3) Amniotic fluid embolism

A Rudra S Chatterjee S Sengupta B Nandi and J Mitra Amniotic Fluid Embolism Retrieved from

httpwwwncbinlmnihgovpmcarticlesPMC2823093

(4)httpwwwjaypeejournalscomeJournalsShowTextaspxID=59ampType=FREEampTYP=TOPampIN=_eJournalsimagesJPLOGOgifampIID=7ampisPDF=YES

(5) MH Bealla JPHM van den Wijngaardb MJC van Gemertb MG Rossa Regulation of Amniotic Fluid

(6) Barker G Boyd RD DrsquoSouza SW Donnai P Fox H Sibley CP Placental water content and distribution Placenta 19941547e56

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 mldayFetal

swallowed volume is subject to periodic increases as

mechanisms for lsquolsquothirstrsquorsquo and lsquolsquoappetitersquorsquo 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 mlmin

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 (mols) across the

membrane along physical gradients is given by

c1 andc2 in molm3 represent the unbound solute concentrations

on opposite sides of the membrane

P represents the solute permeability of the membrane in msec

S stands for the surface area for diffusion in m2

Sigma is the reflection coefficient

Jv is the volume in m3sec

I as the electrical

current in Coulombsec

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 2210-4cmsec

Osmotic permeability of 1510-2 cmsec

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 defects

Rh 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)MH Bealla JPHM van den Wijngaardb MJC van Gemertb MG Ross Amniotic Fluid Water Dynamics

(2) httpenwikipediaorgwikiAmniotic_fluid_embolism

(3) Amniotic fluid embolism

A Rudra S Chatterjee S Sengupta B Nandi and J Mitra Amniotic Fluid Embolism Retrieved from

httpwwwncbinlmnihgovpmcarticlesPMC2823093

(4)httpwwwjaypeejournalscomeJournalsShowTextaspxID=59ampType=FREEampTYP=TOPampIN=_eJournalsimagesJPLOGOgifampIID=7ampisPDF=YES

(5) MH Bealla JPHM van den Wijngaardb MJC van Gemertb MG Rossa Regulation of Amniotic Fluid

(6) Barker G Boyd RD DrsquoSouza SW Donnai P Fox H Sibley CP Placental water content and distribution Placenta 19941547e56

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 mldayFetal

swallowed volume is subject to periodic increases as

mechanisms for lsquolsquothirstrsquorsquo and lsquolsquoappetitersquorsquo 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 mlmin

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 (mols) across the

membrane along physical gradients is given by

c1 andc2 in molm3 represent the unbound solute concentrations

on opposite sides of the membrane

P represents the solute permeability of the membrane in msec

S stands for the surface area for diffusion in m2

Sigma is the reflection coefficient

Jv is the volume in m3sec

I as the electrical

current in Coulombsec

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 2210-4cmsec

Osmotic permeability of 1510-2 cmsec

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 defects

Rh 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)MH Bealla JPHM van den Wijngaardb MJC van Gemertb MG Ross Amniotic Fluid Water Dynamics

(2) httpenwikipediaorgwikiAmniotic_fluid_embolism

(3) Amniotic fluid embolism

A Rudra S Chatterjee S Sengupta B Nandi and J Mitra Amniotic Fluid Embolism Retrieved from

httpwwwncbinlmnihgovpmcarticlesPMC2823093

(4)httpwwwjaypeejournalscomeJournalsShowTextaspxID=59ampType=FREEampTYP=TOPampIN=_eJournalsimagesJPLOGOgifampIID=7ampisPDF=YES

(5) MH Bealla JPHM van den Wijngaardb MJC van Gemertb MG Rossa Regulation of Amniotic Fluid

(6) Barker G Boyd RD DrsquoSouza SW Donnai P Fox H Sibley CP Placental water content and distribution Placenta 19941547e56

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 mldayFetal

swallowed volume is subject to periodic increases as

mechanisms for lsquolsquothirstrsquorsquo and lsquolsquoappetitersquorsquo 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 mlmin

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 (mols) across the

membrane along physical gradients is given by

c1 andc2 in molm3 represent the unbound solute concentrations

on opposite sides of the membrane

P represents the solute permeability of the membrane in msec

S stands for the surface area for diffusion in m2

Sigma is the reflection coefficient

Jv is the volume in m3sec

I as the electrical

current in Coulombsec

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 2210-4cmsec

Osmotic permeability of 1510-2 cmsec

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 defects

Rh 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)MH Bealla JPHM van den Wijngaardb MJC van Gemertb MG Ross Amniotic Fluid Water Dynamics

(2) httpenwikipediaorgwikiAmniotic_fluid_embolism

(3) Amniotic fluid embolism

A Rudra S Chatterjee S Sengupta B Nandi and J Mitra Amniotic Fluid Embolism Retrieved from

httpwwwncbinlmnihgovpmcarticlesPMC2823093

(4)httpwwwjaypeejournalscomeJournalsShowTextaspxID=59ampType=FREEampTYP=TOPampIN=_eJournalsimagesJPLOGOgifampIID=7ampisPDF=YES

(5) MH Bealla JPHM van den Wijngaardb MJC van Gemertb MG Rossa Regulation of Amniotic Fluid

(6) Barker G Boyd RD DrsquoSouza SW Donnai P Fox H Sibley CP Placental water content and distribution Placenta 19941547e56

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 mldayFetal

swallowed volume is subject to periodic increases as

mechanisms for lsquolsquothirstrsquorsquo and lsquolsquoappetitersquorsquo 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 mlmin

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 (mols) across the

membrane along physical gradients is given by

c1 andc2 in molm3 represent the unbound solute concentrations

on opposite sides of the membrane

P represents the solute permeability of the membrane in msec

S stands for the surface area for diffusion in m2

Sigma is the reflection coefficient

Jv is the volume in m3sec

I as the electrical

current in Coulombsec

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 2210-4cmsec

Osmotic permeability of 1510-2 cmsec

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 defects

Rh 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)MH Bealla JPHM van den Wijngaardb MJC van Gemertb MG Ross Amniotic Fluid Water Dynamics

(2) httpenwikipediaorgwikiAmniotic_fluid_embolism

(3) Amniotic fluid embolism

A Rudra S Chatterjee S Sengupta B Nandi and J Mitra Amniotic Fluid Embolism Retrieved from

httpwwwncbinlmnihgovpmcarticlesPMC2823093

(4)httpwwwjaypeejournalscomeJournalsShowTextaspxID=59ampType=FREEampTYP=TOPampIN=_eJournalsimagesJPLOGOgifampIID=7ampisPDF=YES

(5) MH Bealla JPHM van den Wijngaardb MJC van Gemertb MG Rossa Regulation of Amniotic Fluid

(6) Barker G Boyd RD DrsquoSouza SW Donnai P Fox H Sibley CP Placental water content and distribution Placenta 19941547e56

Fetal swallowing

Human fetus swallows an average of 210e760 mldayFetal

swallowed volume is subject to periodic increases as

mechanisms for lsquolsquothirstrsquorsquo and lsquolsquoappetitersquorsquo 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 mlmin

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 (mols) across the

membrane along physical gradients is given by

c1 andc2 in molm3 represent the unbound solute concentrations

on opposite sides of the membrane

P represents the solute permeability of the membrane in msec

S stands for the surface area for diffusion in m2

Sigma is the reflection coefficient

Jv is the volume in m3sec

I as the electrical

current in Coulombsec

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 2210-4cmsec

Osmotic permeability of 1510-2 cmsec

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 defects

Rh 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)MH Bealla JPHM van den Wijngaardb MJC van Gemertb MG Ross Amniotic Fluid Water Dynamics

(2) httpenwikipediaorgwikiAmniotic_fluid_embolism

(3) Amniotic fluid embolism

A Rudra S Chatterjee S Sengupta B Nandi and J Mitra Amniotic Fluid Embolism Retrieved from

httpwwwncbinlmnihgovpmcarticlesPMC2823093

(4)httpwwwjaypeejournalscomeJournalsShowTextaspxID=59ampType=FREEampTYP=TOPampIN=_eJournalsimagesJPLOGOgifampIID=7ampisPDF=YES

(5) MH Bealla JPHM van den Wijngaardb MJC van Gemertb MG Rossa Regulation of Amniotic Fluid

(6) Barker G Boyd RD DrsquoSouza SW Donnai P Fox H Sibley CP Placental water content and distribution Placenta 19941547e56

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 mlmin

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 (mols) across the

membrane along physical gradients is given by

c1 andc2 in molm3 represent the unbound solute concentrations

on opposite sides of the membrane

P represents the solute permeability of the membrane in msec

S stands for the surface area for diffusion in m2

Sigma is the reflection coefficient

Jv is the volume in m3sec

I as the electrical

current in Coulombsec

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 2210-4cmsec

Osmotic permeability of 1510-2 cmsec

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 defects

Rh 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)MH Bealla JPHM van den Wijngaardb MJC van Gemertb MG Ross Amniotic Fluid Water Dynamics

(2) httpenwikipediaorgwikiAmniotic_fluid_embolism

(3) Amniotic fluid embolism

A Rudra S Chatterjee S Sengupta B Nandi and J Mitra Amniotic Fluid Embolism Retrieved from

httpwwwncbinlmnihgovpmcarticlesPMC2823093

(4)httpwwwjaypeejournalscomeJournalsShowTextaspxID=59ampType=FREEampTYP=TOPampIN=_eJournalsimagesJPLOGOgifampIID=7ampisPDF=YES

(5) MH Bealla JPHM van den Wijngaardb MJC van Gemertb MG Rossa Regulation of Amniotic Fluid

(6) Barker G Boyd RD DrsquoSouza SW Donnai P Fox H Sibley CP Placental water content and distribution Placenta 19941547e56

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 (mols) across the

membrane along physical gradients is given by

c1 andc2 in molm3 represent the unbound solute concentrations

on opposite sides of the membrane

P represents the solute permeability of the membrane in msec

S stands for the surface area for diffusion in m2

Sigma is the reflection coefficient

Jv is the volume in m3sec

I as the electrical

current in Coulombsec

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 2210-4cmsec

Osmotic permeability of 1510-2 cmsec

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 defects

Rh 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)MH Bealla JPHM van den Wijngaardb MJC van Gemertb MG Ross Amniotic Fluid Water Dynamics

(2) httpenwikipediaorgwikiAmniotic_fluid_embolism

(3) Amniotic fluid embolism

A Rudra S Chatterjee S Sengupta B Nandi and J Mitra Amniotic Fluid Embolism Retrieved from

httpwwwncbinlmnihgovpmcarticlesPMC2823093

(4)httpwwwjaypeejournalscomeJournalsShowTextaspxID=59ampType=FREEampTYP=TOPampIN=_eJournalsimagesJPLOGOgifampIID=7ampisPDF=YES

(5) MH Bealla JPHM van den Wijngaardb MJC van Gemertb MG Rossa Regulation of Amniotic Fluid

(6) Barker G Boyd RD DrsquoSouza SW Donnai P Fox H Sibley CP Placental water content and distribution Placenta 19941547e56

simple diffusion of any compound (mols) across the

membrane along physical gradients is given by

c1 andc2 in molm3 represent the unbound solute concentrations

on opposite sides of the membrane

P represents the solute permeability of the membrane in msec

S stands for the surface area for diffusion in m2

Sigma is the reflection coefficient

Jv is the volume in m3sec

I as the electrical

current in Coulombsec

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 2210-4cmsec

Osmotic permeability of 1510-2 cmsec

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 defects

Rh 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)MH Bealla JPHM van den Wijngaardb MJC van Gemertb MG Ross Amniotic Fluid Water Dynamics

(2) httpenwikipediaorgwikiAmniotic_fluid_embolism

(3) Amniotic fluid embolism

A Rudra S Chatterjee S Sengupta B Nandi and J Mitra Amniotic Fluid Embolism Retrieved from

httpwwwncbinlmnihgovpmcarticlesPMC2823093

(4)httpwwwjaypeejournalscomeJournalsShowTextaspxID=59ampType=FREEampTYP=TOPampIN=_eJournalsimagesJPLOGOgifampIID=7ampisPDF=YES

(5) MH Bealla JPHM van den Wijngaardb MJC van Gemertb MG Rossa Regulation of Amniotic Fluid

(6) Barker G Boyd RD DrsquoSouza SW Donnai P Fox H Sibley CP Placental water content and distribution Placenta 19941547e56

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 2210-4cmsec

Osmotic permeability of 1510-2 cmsec

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 defects

Rh 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)MH Bealla JPHM van den Wijngaardb MJC van Gemertb MG Ross Amniotic Fluid Water Dynamics

(2) httpenwikipediaorgwikiAmniotic_fluid_embolism

(3) Amniotic fluid embolism

A Rudra S Chatterjee S Sengupta B Nandi and J Mitra Amniotic Fluid Embolism Retrieved from

httpwwwncbinlmnihgovpmcarticlesPMC2823093

(4)httpwwwjaypeejournalscomeJournalsShowTextaspxID=59ampType=FREEampTYP=TOPampIN=_eJournalsimagesJPLOGOgifampIID=7ampisPDF=YES

(5) MH Bealla JPHM van den Wijngaardb MJC van Gemertb MG Rossa Regulation of Amniotic Fluid

(6) Barker G Boyd RD DrsquoSouza SW Donnai P Fox H Sibley CP Placental water content and distribution Placenta 19941547e56

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 2210-4cmsec

Osmotic permeability of 1510-2 cmsec

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 defects

Rh 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)MH Bealla JPHM van den Wijngaardb MJC van Gemertb MG Ross Amniotic Fluid Water Dynamics

(2) httpenwikipediaorgwikiAmniotic_fluid_embolism

(3) Amniotic fluid embolism

A Rudra S Chatterjee S Sengupta B Nandi and J Mitra Amniotic Fluid Embolism Retrieved from

httpwwwncbinlmnihgovpmcarticlesPMC2823093

(4)httpwwwjaypeejournalscomeJournalsShowTextaspxID=59ampType=FREEampTYP=TOPampIN=_eJournalsimagesJPLOGOgifampIID=7ampisPDF=YES

(5) MH Bealla JPHM van den Wijngaardb MJC van Gemertb MG Rossa Regulation of Amniotic Fluid

(6) Barker G Boyd RD DrsquoSouza SW Donnai P Fox H Sibley CP Placental water content and distribution Placenta 19941547e56

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 defects

Rh 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)MH Bealla JPHM van den Wijngaardb MJC van Gemertb MG Ross Amniotic Fluid Water Dynamics

(2) httpenwikipediaorgwikiAmniotic_fluid_embolism

(3) Amniotic fluid embolism

A Rudra S Chatterjee S Sengupta B Nandi and J Mitra Amniotic Fluid Embolism Retrieved from

httpwwwncbinlmnihgovpmcarticlesPMC2823093

(4)httpwwwjaypeejournalscomeJournalsShowTextaspxID=59ampType=FREEampTYP=TOPampIN=_eJournalsimagesJPLOGOgifampIID=7ampisPDF=YES

(5) MH Bealla JPHM van den Wijngaardb MJC van Gemertb MG Rossa Regulation of Amniotic Fluid

(6) Barker G Boyd RD DrsquoSouza SW Donnai P Fox H Sibley CP Placental water content and distribution Placenta 19941547e56

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 defects

Rh 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)MH Bealla JPHM van den Wijngaardb MJC van Gemertb MG Ross Amniotic Fluid Water Dynamics

(2) httpenwikipediaorgwikiAmniotic_fluid_embolism

(3) Amniotic fluid embolism

A Rudra S Chatterjee S Sengupta B Nandi and J Mitra Amniotic Fluid Embolism Retrieved from

httpwwwncbinlmnihgovpmcarticlesPMC2823093

(4)httpwwwjaypeejournalscomeJournalsShowTextaspxID=59ampType=FREEampTYP=TOPampIN=_eJournalsimagesJPLOGOgifampIID=7ampisPDF=YES

(5) MH Bealla JPHM van den Wijngaardb MJC van Gemertb MG Rossa Regulation of Amniotic Fluid

(6) Barker G Boyd RD DrsquoSouza SW Donnai P Fox H Sibley CP Placental water content and distribution Placenta 19941547e56

Disorders in amniotic fluid

Disorders in amniotic fluid volume are of two

types

Polyhydramnios

Main causes of Polyhydramnios

Congenital defects

Rh 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)MH Bealla JPHM van den Wijngaardb MJC van Gemertb MG Ross Amniotic Fluid Water Dynamics

(2) httpenwikipediaorgwikiAmniotic_fluid_embolism

(3) Amniotic fluid embolism

A Rudra S Chatterjee S Sengupta B Nandi and J Mitra Amniotic Fluid Embolism Retrieved from

httpwwwncbinlmnihgovpmcarticlesPMC2823093

(4)httpwwwjaypeejournalscomeJournalsShowTextaspxID=59ampType=FREEampTYP=TOPampIN=_eJournalsimagesJPLOGOgifampIID=7ampisPDF=YES

(5) MH Bealla JPHM van den Wijngaardb MJC van Gemertb MG Rossa Regulation of Amniotic Fluid

(6) Barker G Boyd RD DrsquoSouza SW Donnai P Fox H Sibley CP Placental water content and distribution Placenta 19941547e56

Main causes of Polyhydramnios

Congenital defects

Rh 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)MH Bealla JPHM van den Wijngaardb MJC van Gemertb MG Ross Amniotic Fluid Water Dynamics

(2) httpenwikipediaorgwikiAmniotic_fluid_embolism

(3) Amniotic fluid embolism

A Rudra S Chatterjee S Sengupta B Nandi and J Mitra Amniotic Fluid Embolism Retrieved from

httpwwwncbinlmnihgovpmcarticlesPMC2823093

(4)httpwwwjaypeejournalscomeJournalsShowTextaspxID=59ampType=FREEampTYP=TOPampIN=_eJournalsimagesJPLOGOgifampIID=7ampisPDF=YES

(5) MH Bealla JPHM van den Wijngaardb MJC van Gemertb MG Rossa Regulation of Amniotic Fluid

(6) Barker G Boyd RD DrsquoSouza SW Donnai P Fox H Sibley CP Placental water content and distribution Placenta 19941547e56

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)MH Bealla JPHM van den Wijngaardb MJC van Gemertb MG Ross Amniotic Fluid Water Dynamics

(2) httpenwikipediaorgwikiAmniotic_fluid_embolism

(3) Amniotic fluid embolism

A Rudra S Chatterjee S Sengupta B Nandi and J Mitra Amniotic Fluid Embolism Retrieved from

httpwwwncbinlmnihgovpmcarticlesPMC2823093

(4)httpwwwjaypeejournalscomeJournalsShowTextaspxID=59ampType=FREEampTYP=TOPampIN=_eJournalsimagesJPLOGOgifampIID=7ampisPDF=YES

(5) MH Bealla JPHM van den Wijngaardb MJC van Gemertb MG Rossa Regulation of Amniotic Fluid

(6) Barker G Boyd RD DrsquoSouza SW Donnai P Fox H Sibley CP Placental water content and distribution Placenta 19941547e56

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)MH Bealla JPHM van den Wijngaardb MJC van Gemertb MG Ross Amniotic Fluid Water Dynamics

(2) httpenwikipediaorgwikiAmniotic_fluid_embolism

(3) Amniotic fluid embolism

A Rudra S Chatterjee S Sengupta B Nandi and J Mitra Amniotic Fluid Embolism Retrieved from

httpwwwncbinlmnihgovpmcarticlesPMC2823093

(4)httpwwwjaypeejournalscomeJournalsShowTextaspxID=59ampType=FREEampTYP=TOPampIN=_eJournalsimagesJPLOGOgifampIID=7ampisPDF=YES

(5) MH Bealla JPHM van den Wijngaardb MJC van Gemertb MG Rossa Regulation of Amniotic Fluid

(6) Barker G Boyd RD DrsquoSouza SW Donnai P Fox H Sibley CP Placental water content and distribution Placenta 19941547e56

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)MH Bealla JPHM van den Wijngaardb MJC van Gemertb MG Ross Amniotic Fluid Water Dynamics

(2) httpenwikipediaorgwikiAmniotic_fluid_embolism

(3) Amniotic fluid embolism

A Rudra S Chatterjee S Sengupta B Nandi and J Mitra Amniotic Fluid Embolism Retrieved from

httpwwwncbinlmnihgovpmcarticlesPMC2823093

(4)httpwwwjaypeejournalscomeJournalsShowTextaspxID=59ampType=FREEampTYP=TOPampIN=_eJournalsimagesJPLOGOgifampIID=7ampisPDF=YES

(5) MH Bealla JPHM van den Wijngaardb MJC van Gemertb MG Rossa Regulation of Amniotic Fluid

(6) Barker G Boyd RD DrsquoSouza SW Donnai P Fox H Sibley CP Placental water content and distribution Placenta 19941547e56

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)MH Bealla JPHM van den Wijngaardb MJC van Gemertb MG Ross Amniotic Fluid Water Dynamics

(2) httpenwikipediaorgwikiAmniotic_fluid_embolism

(3) Amniotic fluid embolism

A Rudra S Chatterjee S Sengupta B Nandi and J Mitra Amniotic Fluid Embolism Retrieved from

httpwwwncbinlmnihgovpmcarticlesPMC2823093

(4)httpwwwjaypeejournalscomeJournalsShowTextaspxID=59ampType=FREEampTYP=TOPampIN=_eJournalsimagesJPLOGOgifampIID=7ampisPDF=YES

(5) MH Bealla JPHM van den Wijngaardb MJC van Gemertb MG Rossa Regulation of Amniotic Fluid

(6) Barker G Boyd RD DrsquoSouza SW Donnai P Fox H Sibley CP Placental water content and distribution Placenta 19941547e56

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)MH Bealla JPHM van den Wijngaardb MJC van Gemertb MG Ross Amniotic Fluid Water Dynamics

(2) httpenwikipediaorgwikiAmniotic_fluid_embolism

(3) Amniotic fluid embolism

A Rudra S Chatterjee S Sengupta B Nandi and J Mitra Amniotic Fluid Embolism Retrieved from

httpwwwncbinlmnihgovpmcarticlesPMC2823093

(4)httpwwwjaypeejournalscomeJournalsShowTextaspxID=59ampType=FREEampTYP=TOPampIN=_eJournalsimagesJPLOGOgifampIID=7ampisPDF=YES

(5) MH Bealla JPHM van den Wijngaardb MJC van Gemertb MG Rossa Regulation of Amniotic Fluid

(6) Barker G Boyd RD DrsquoSouza SW Donnai P Fox H Sibley CP Placental water content and distribution Placenta 19941547e56

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)MH Bealla JPHM van den Wijngaardb MJC van Gemertb MG Ross Amniotic Fluid Water Dynamics

(2) httpenwikipediaorgwikiAmniotic_fluid_embolism

(3) Amniotic fluid embolism

A Rudra S Chatterjee S Sengupta B Nandi and J Mitra Amniotic Fluid Embolism Retrieved from

httpwwwncbinlmnihgovpmcarticlesPMC2823093

(4)httpwwwjaypeejournalscomeJournalsShowTextaspxID=59ampType=FREEampTYP=TOPampIN=_eJournalsimagesJPLOGOgifampIID=7ampisPDF=YES

(5) MH Bealla JPHM van den Wijngaardb MJC van Gemertb MG Rossa Regulation of Amniotic Fluid

(6) Barker G Boyd RD DrsquoSouza SW Donnai P Fox H Sibley CP Placental water content and distribution Placenta 19941547e56

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)MH Bealla JPHM van den Wijngaardb MJC van Gemertb MG Ross Amniotic Fluid Water Dynamics

(2) httpenwikipediaorgwikiAmniotic_fluid_embolism

(3) Amniotic fluid embolism

A Rudra S Chatterjee S Sengupta B Nandi and J Mitra Amniotic Fluid Embolism Retrieved from

httpwwwncbinlmnihgovpmcarticlesPMC2823093

(4)httpwwwjaypeejournalscomeJournalsShowTextaspxID=59ampType=FREEampTYP=TOPampIN=_eJournalsimagesJPLOGOgifampIID=7ampisPDF=YES

(5) MH Bealla JPHM van den Wijngaardb MJC van Gemertb MG Rossa Regulation of Amniotic Fluid

(6) Barker G Boyd RD DrsquoSouza SW Donnai P Fox H Sibley CP Placental water content and distribution Placenta 19941547e56

References (1)MH Bealla JPHM van den Wijngaardb MJC van Gemertb MG Ross Amniotic Fluid Water Dynamics

(2) httpenwikipediaorgwikiAmniotic_fluid_embolism

(3) Amniotic fluid embolism

A Rudra S Chatterjee S Sengupta B Nandi and J Mitra Amniotic Fluid Embolism Retrieved from

httpwwwncbinlmnihgovpmcarticlesPMC2823093

(4)httpwwwjaypeejournalscomeJournalsShowTextaspxID=59ampType=FREEampTYP=TOPampIN=_eJournalsimagesJPLOGOgifampIID=7ampisPDF=YES

(5) MH Bealla JPHM van den Wijngaardb MJC van Gemertb MG Rossa Regulation of Amniotic Fluid

(6) Barker G Boyd RD DrsquoSouza SW Donnai P Fox H Sibley CP Placental water content and distribution Placenta 19941547e56