Amniotic Fluid Problems: All You Should Know

Amniotic fluid is the medium in which the baby develops and is therefore of utmost importance. Sometimes, there are problems in this fluid, which can be solved on their own or with treatment.

Reviewed and approved by the nurse Leidy Mora Molina.

Written by Edith Sánchez

Last update: 08 November, 2022

Amniotic fluid problems can be of 3 types:

1. Too much fluid.
2. Too little fluid.
3. An infection of the amniotic fluid

The problems sometimes affect the mother, sometimes the fetus, and sometimes both. They can occur at different times during pregnancy and are usually detected by clinical assessment or ultrasound.

Amniotic fluid problems

1. Too much amniotic fluid

Too much amniotic fluid is called hydramnios or polyhydramnios. It’s estimated to be present in 1 in 100 pregnancies. In most cases, this problem is mild and appears in the second half of gestation.

In more than half of the cases, the cause is unclear. In the others, the reason could be one or more of the following:

• A multiple pregnancy
• Gestational diabetes
• Anemia in the fetus
• Congenital anomalies
• Infections in the fetus

Symptoms

In some cases, increased fetal fluid doesn’t cause any symptoms. If the excess is significant, it could generate the following signs:

• A rapid growth of the uterus
• Early contractions
• An upset stomach (the mother)
• Shortness of breath or trouble breathing in the mother

Complications

Although most cases of excess amniotic fluid can be treated without problems, complications with varying levels of severity sometimes occur:

• Premature labor
• Premature rupture of membranes
• Severe breathing problems in the mother
• Heavy vaginal bleeding after delivery
• Uterine atony: the uterus stretches and cannot return to its original shape
• Placental abruption: occurs only after premature rupture of the membranes
• Prolapsed umbilical cord: occurs when the umbilical cord comes out of the vagina before the baby does

2. Too little amniotic fluid

Too little amniotic fluid is known as oligohydramnios. It’s estimated that this abnormality affects fewer than 10% of pregnant women, but only 5% of all cases are diagnosed.

This condition is most common in the third trimester, although it can also occur at any time. If it occurs early in gestation, it often leads to more serious consequences.

It isn’t always possible to establish the cause of low amniotic fluid. However, it is usually related to one of the following factors:

• Death of the fetus
• Multiple pregnancy
• Alterations in the placenta: such as premature rupture of membranes
• Maternal diseases: gestational diabetes, preeclampsia, dehydration, lupus
• Fetal abnormalities: congenital malformations, intrauterine growth restriction, infections.
• Post-term pregnancy: when gestation is prolonged beyond the estimated delivery date.

Symptoms

Amniotic fluid shortage rarely causes noticeable symptoms. In any case, the size of the uterus is usually smaller than expected for the gestational age. Also, the mother may feel a decrease in fetal movements.

Complications

A shortage of amniotic fluid can result in problems such as the following:

• Cesarean section: In some cases, the fetus is unable to tolerate vaginal delivery.
• Growth stagnation: With the possibility of fetal death.
• Fetal compression: Causes limb deformities, chin recession, and flattened nose.
• Potter’s syndrome: Occurs when there are malformations and the fetal lungs don’t mature as they should.

3. Intra-amniotic infection

Another potential problem with amniotic fluid is chorioamnionitis or intra-amniotic infection. This can occur in the fluid alone or in combination with a similar condition in the placenta.

The main cause of intraamniotic infection is the presence of pathogens in the mother’s genital tract. These microorganisms can ascend into the uterus. Usually, the body avoids this type of infection, but there are some conditions that favor it:

• Too much touching of the vagina during labor
• Premature rupture of the membranes
• Meconium amniotic fluid
• Prolonged labor

Symptoms

There are no characteristic symptoms of intra-amniotic infection. However, fever, abdominal pain and a purulent discharge from the vagina are common. Also, the heart rate of the mother and fetus are very fast.

Complications

This amniotic fluid problem can lead to complications, such as the following:

• Fetal death
• Septic shock
• Uterine atony
• Premature delivery
• Fetal seizures
• Bacteremia in the mother
• Cerebral palsy in the baby
• Premature detachment of the placenta
• Acute respiratory distress syndrome in the mother

Diagnosis

Amniotic fluid problems often cause no symptoms. Sometimes the only sign is that the uterus is too large or too small. In the case of intra-amniotic infection, a fever is present. It’s very common for these problems to be detected incidentally during an ultrasound. The test can determine the amount of amniotic fluid present.

Other tests are usually done afterwards to determine the specific cause. The most commonly requested are blood tests and amniocentesis.

Treatment of amniotic fluid problems

Treatment of amniotic fluid problems is based on regular ultrasounds to monitor progress. Regular monitoring of the fetal heart rate is also carried out. If there’s too much amniotic fluid, it tends to just be controlled, unless the excess is extreme. If so, the fluid is withdrawn with a needle through the mother’s abdomen.

When there’s too little fluid, delivery may be scheduled for 36 or 37 weeks. If there’s an infection, antibiotic treatment is usually carried out. It’s important to watch for signs, such as the size of the belly, the mother’s breathing difficulties, and the frequency of the baby’s movements.

It’s also essential to keep all follow-up appointments during pregnancy, as well as the ultrasounds prescribed by the doctor.