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Problems With Amniotic Fluid

By Antonette T. Dulay, MD, Attending Physician, Maternal-Fetal Medicine Section, Department of Obstetrics and Gynecology;Senior Physician, Main Line Health System;Axia Women’s Health

Amniotic fluid is the fluid that surrounds the fetus in the uterus. The fluid and fetus are contained in membranes called the amniotic sac. There may be too much or too little amniotic fluid. The fluid, amniotic sac, and/or placenta may become infected (see Intra-Amniotic Infection).

Too much amniotic fluid (polyhydramnios or hydramnios) stretches the uterus and puts pressure on the diaphragm of pregnant women. This complication can lead to severe breathing problems for women or to labor that begins early—before 37 weeks of pregnancy (preterm labor).

Too much fluid may accumulate because of the following:

  • Diabetes in the pregnant woman

  • More than one fetus (multiple births)

  • Rh antibodies to the fetus’s blood produced by the pregnant woman (Rh incompatibility)

  • Birth defects in the fetus, especially a blocked esophagus or defects of the brain and spinal cord (such as spina bifida)

However, about half the time, the cause is unknown.

Too little amniotic fluid (oligohydramnios) can also cause problems. If the amount of fluid is greatly reduced, the fetus may be compressed, resulting in deformities. When oligohydramnios is present, the lungs may not mature normally. This combination of immature lungs and deformities is called Potter syndrome.

There tends to be too little amniotic fluid in the following situations:

  • The fetus has birth defects in the urinary tract, particularly in the kidneys.

  • The fetus has not grown as much as expected.

  • The fetus has died.

  • The fetus has a chromosomal abnormality.

  • The placenta is not functioning normally (as a result, the fetus may not grow as much as expected).

  • The pregnancy has lasted too long (42 weeks or more).

Taking certain drugs such as angiotensin-converting enzyme (ACE) inhibitors (including enalapril or captopril) during the 2nd and 3rd trimesters can result in too little amniotic fluid. These drugs are usually avoided during pregnancy. However, rarely, they are used to treat severe heart failure. Taking nonsteroidal anti-inflammatory drugs (NSAIDs, such as aspirin or ibuprofen) late in pregnancy can also reduce the amount of amniotic fluid.

Doctors may suspect too much or too little amniotic fluid when the uterus is too large or too small for the length of the pregnancy. Sometimes the problem is incidentally detected during ultrasonography.