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Page 1: ultrasonography of amniotic fluid

U/S of Amniotic Fluid Aboubakr Elnashar

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Aboubakr Elnashar

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Amniotic Fluid

• Sources: Early stages: Skin & placenta

12 - 14 W: lung & kidney

20 W: kidney

• Amount: 33 - 34 W: 800-1000 ml

At term: 600 ml

• U/S parameters: I. AFV

II. FFP Aboubakr Elnashar

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I. AFV

• Subjective:

Normal

Absent

Reduced

Increased

• Objective:

1.Maximum vertical pool (MVP)

2.Amniotic fluid index (AFI)

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1. Maximum vertical pool

(minimum of 1cm width)

* How ?

•Oligohyd: <2 cm

•Reduced: 2-3 cm

•Normal: 3 - 8 cm

•Polyhyd: >8cm

Mild 8-12 cm

Severe > 16

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2. Amniotic fluid index

•How ?

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Interpretation:

•Oligohyd: < 5 cm

Reduced: 5-10 cm Normal: 10- 20 cm More than average: 20-25 cm Polyhyd: > 25 cm

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AFI & gestational age

Ges age (W) 5th 50th 95th

28 94 mm 146 mm 228 mm

32 86 mm 144 mm 242 mm

36 77 mm 138 mm 249 mm

38 73 mm 132 mm 239 mm

40 71 mm 123 mm 214 mm

42 69 mm 110 mm 175 mm

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Causes of polyhydramnios

1. Idiopathic

2. D. M.

3. Isoimmunization

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4. Foetal anomalies:

• CNS: Hydrocephaly, Anencephaly, S.

bifida

• Neck &face: Cystic hygroma.

• Pulmonary: Diaphragmatic hernia.

• GIT: Oesophygeal atresia, Dud. atresia,

Omphalocele

• Other: Cong. infection, Chromosomal

anomalies

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Causes of oligohydramnios

1. Spontaneous ROM.

2. Placental insufficiency.

3. IUGR.

4. Renal agenesis, uretheral stenosis.

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Keyhole bladder, posterior urethral valve

Cystic hygroma, olighyd, Turner s synd

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Fetal biophysical profile

Score 2 Score 0

CTG >2acc./40 min <

F. movements >3/30 min <

F.br. movements 30 sec sustained

fbm /30 min

<

F.tone closed fist or

flex .to ex.

movement

Neither

AFV >1 cm pocket <

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Interpretation:

If all parameters detected by U/S are

normal, no need to perform NST

8: reassuring.

6 or 7: equivocal, and must be repeated

within 24 hours.

4 or less: a positive test and strongly

suggests preparing the patient for delivery.

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•Modifications:

Manning (1990)

NST

MVP

Fetal breathing.

More recently

NST

AFI

It is less cumbersome than the original BPP

and its results are just as predictive. AFI is the

indicator of long term uteroplacental function

and the NST is the short term indicator of fetal

acid-base status.

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II. Free floating particles

•What: Multiple linear densities, 1- 5 mm

suspended, but gradually settling

•Significance: * No

* F. maturity

* F. distress.

* LFGA.

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