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Amniotic Fluid: Function, Volume and Abnormalities

Amniotic fluid is the protective liquid surrounding the unborn baby inside the amniotic sac. It plays a vital role in fetal development throughout pregnancy.

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Things worth knowing about "Amniotic fluid"

Amniotic fluid is the protective liquid surrounding the unborn baby inside the amniotic sac. It plays a vital role in fetal development throughout pregnancy.

What is Amniotic Fluid?

Amniotic fluid is a clear to slightly yellowish liquid that surrounds the unborn baby throughout pregnancy within the amniotic sac. It is essential for the healthy development of the fetus and serves multiple critical physiological functions.

Composition and Formation

In the early stages of pregnancy, amniotic fluid is primarily produced by the mother. From approximately week 20 of pregnancy, the majority of the fluid originates from the fetal urine. The baby continuously swallows amniotic fluid, processes it through the kidneys and lungs, and excretes it back – forming a natural circulatory cycle.

Amniotic fluid is composed of:

Water and electrolytes
Proteins and carbohydrates
Fatty acids and hormones
Fetal skin cells and lanugo hair
Antibodies that support immune defense

Functions of Amniotic Fluid

Amniotic fluid performs numerous vital functions for the unborn child:

Cushioning and protection: It protects the baby from physical shocks and external pressure.
Temperature regulation: It maintains a stable and warm environment for the baby.
Freedom of movement: It allows the baby to move, which is essential for the development of muscles and the skeletal system.
Lung development: The baby breathes in and out amniotic fluid, which promotes the maturation of the fetal lungs.
Infection protection: Antibodies within the fluid help protect the baby from infections.
Umbilical cord protection: It prevents compression of the umbilical cord.

Volume of Amniotic Fluid During Pregnancy

The amount of amniotic fluid changes throughout the course of pregnancy:

16th week of pregnancy: approximately 200 ml
Around week 34: maximum volume of approximately 800–1,000 ml
Toward the end of pregnancy: slight decrease to approximately 600–800 ml

Abnormalities in Amniotic Fluid Volume

Polyhydramnios (too much amniotic fluid)

Polyhydramnios refers to an excessive accumulation of amniotic fluid, typically above 2,000 ml. Possible causes include:

Gestational diabetes
Fetal malformations of the digestive tract or nervous system
Multiple pregnancies (twins, triplets)
Infections during pregnancy

Oligohydramnios (too little amniotic fluid)

Oligohydramnios occurs when the volume of amniotic fluid falls significantly below normal levels. Possible causes include:

Fetal kidney malformations
Placental insufficiency
Post-term pregnancy
Premature rupture of membranes

Rupture of Membranes

At the end of pregnancy or at the onset of labor, the amniotic sac breaks – this is called the rupture of membranes or water breaking. The amniotic fluid then flows out through the vagina. A premature rupture of membranes before week 37 of pregnancy requires immediate medical evaluation.

Diagnostic Use of Amniotic Fluid

Amniotic fluid can also be used for diagnostic purposes. In a procedure called amniocentesis, a small sample of amniotic fluid is extracted to analyze fetal cells. This test can detect:

Chromosomal abnormalities (e.g., Trisomy 21 / Down syndrome)
Genetic disorders
Infections
Fetal lung maturity

When to Seek Medical Advice

The following signs require prompt medical attention:

Fluid leaking from the vagina (possible rupture of membranes)
Changes in amniotic fluid color (greenish or brownish fluid may indicate meconium passage)
Severe abdominal pain or pressure
Reduced fetal movement

References

Moore, K.L.; Persaud, T.V.N.; Torchia, M.G.: The Developing Human – Clinically Oriented Embryology. 11th edition. Elsevier, 2019.
Magann, E.F. et al.: Amniotic fluid and the clinical relevance of the sonographically estimated amniotic fluid volume. Journal of Ultrasound in Medicine, 2011. Available at: https://pubmed.ncbi.nlm.nih.gov/21876098/
World Health Organization (WHO): WHO Recommendations on Antenatal Care for a Positive Pregnancy Experience. WHO Press, Geneva, 2016. Available at: https://www.who.int/publications/i/item/9789241549912

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