Amniotic Fluid Disorders: From Prenatal Management to Neonatal Outcomes

Abstract

Amniotic fluid volume assessment has become standard in the surveillance of fetal well-being, especially in high-risk pregnancies. Amniotic fluid disorders are a frequent and important topic in fetal and perinatal medicine. However, although important advances have been achieved, many important and challenging questions remain unanswered to date. An abnormally low amniotic fluid volume, referred to as oligohydramnios, has been traditionally considered a possible indicator of placental insufficiency or fetal compromise and is associated with an increased rate of obstetric interventions. An excess of amniotic fluid, referred to as polyhydramnios, may be secondary to fetal or maternal conditions and has been associated with a variety of adverse pregnancy outcomes, especially when it is severe. The ultrasonographic detection of an amniotic fluid disorder should prompt a proper workup to identify the underlying etiology. Data on the association of isolated oligohydramnios or idiopathic polyhydramnios with adverse obstetric and perinatal outcomes are conflicting. While the management of secondary oligohydramnios is usually guided by the underlying condition, the management of isolated oligohydramnios is poorly defined. Similarly, the management of idiopathic and secondary polyhydramnios is not yet standardized. There is an urgent need for randomized clinical trials to provide stronger recommendations on the management of these two common conditions.

Keywords: amniotic fluid; amniotic fluid volume; fetal medicine; neonatal outcome; oligohydramnios; polyhydramnios; ultrasound.

Figure 1

Oligohydramnios. Q: quadrant. AFI: Amniotic Fluid Index.

Figure 2

Diagnostic workup for cases of oligohydramnios.

Figure 3

Polyhydramnios. Q: quadrant. AFI: Amniotic Fluid Index.

Figure 4

Diagnostic workup for cases of polyhydramnios.