Twin Amniotic Fluid Levels – How To Asses It In Twin Pregnancy
Birth defects and other complications in twin pregnancies have been linked to variations in twin amniotic fluid levels. Sonographers do not have a universally accepted technique for measuring amniotic fluid. The amniotic fluid index, greatest vertical pocket, and two-diameter pocket approaches are generally agreed upon as the most practical and accurate ways for sonographers to utilize them.
Author:Suleman ShahReviewer:Han JuAug 22, 20227 Shares762 Views
Birth defects and other complications in twin pregnancies have been linked to variations in twin amniotic fluid levels.
The amniotic fluid index, greatest vertical pocket, and two-diameter pocket approaches are generally agreed upon as the most practical and accurate ways for sonographers to utilize them.
When the normal amniotic fluid volume is beyond the subjective normal limits and either oligohydramnios or polyhydramnios is present, only the dye-determined methodology is 100% correct, notwithstanding the speed, non-invasiveness, and consistency with which the other methods evaluate the relative quantity of normal amniotic fluid volume.
What Is Amniotic Fluid?
The fluid that surrounds a fetus during pregnancy is called amniotic fluid.
Amniotic fluid composition in the first trimester of pregnancy is similar to protein-free fetal serum due to fluid transudation through the fetal skin or the maternal decidua.
Amniotic fluid at around 11 weeks of pregnancy is almost all fetal urine with a small quantity of fluid produced by the lungs.
Amniotic fluid content seems to be regulated by a balance between the inflows from fetal urine and outflows of fetal swallowing and intramembranous water flow (from amniotic fluid over the amnion into the fetal-placental vasculature).
During the first and second trimesters of pregnancy, amniotic fluid builds up, with its maximum amount occurring between weeks 33 and 34.
Ultrasound of Amniotic Fluid
What Is Polyhydramnios?
A condition known as polyhydramnios occurs when there is an abnormally high volume of amniotic fluid around the fetus.
In the womb, your baby is surrounded by amniotic fluid.
Excessive amniotic fluid is often detected during a routine checkup in the third trimester.
Not necessarily indicative of anything dire, but you should expect to undergo some further monitoring as a precaution.
Having a hospital delivery is the standard recommendation.
Women with polyhydramnios often have a healthy pregnancy and infant.
However, the womb's thinning from stretching increases the mother's chance of preterm delivery (before 37 weeks) and postpartum hemorrhage.
It is common and not cause for alarm if polyhydramnios patients have an excessive fluid loss during labor.
If you or your baby are in danger, your doctor may recommend inducing labor (kicking off the birthing process with medication) or performing a cesarean section.
Your baby will be checked for healthimmediately after delivery, and they may have specific testing to identify any digestive issues.
What Is Oligohydramnios?
If you have this issue, your baby has too little amniotic fluid around it during pregnancy.
Only approximately 4% of pregnancies experience this.
Your infant's lungs and kidneys produce this fluid.
Your infant will drink the liquid and then urinate it out.
The placenta removes the waste from your body.
Half a quart and one quart (500 ml and 1,000 ml) of amniotic fluid are typical for pregnant women.
An abundance of amniotic fluid or a deficiency might harm the developing baby.
These conditions may hamper your child's growth.
Further, they may have a role in creating difficulties during pregnancy.
Alternatively, an abnormally high amniotic fluid volume might indicate a more severe problem.
It may be brought on by either a lack of fluid production or a decrease in the body's fluid stores.
The treatment's objective is to help you stay pregnant for as long as possible.
Your symptoms, as well as your pregnancy and overall health, will determine the course of treatment.
If your amniotic fluid levels were low during pregnancy, a condition known as oligohydramnios might have developed.
Too much gestational age beyond the due date, or early onset of labor and delivery, may also lead to this complication.
Your baby's lungs may not grow normally if they go too long without enough fluids.
The umbilical cord may be compressed as a result of this situation.
Normal Amniotic Fluid Volume (AFV)
Several studies have shown that the amniotic fluid volume in each sac during a twin pregnancy is statistically similar to that of a singleton pregnancy.
Because of this, diamniotic-dichorionic (di-di) twin gestations have often been evaluated using the standard ranges of normal amniotic fluid volume for singleton pregnancies.
Traditional methods for assessing normal volumes in diamniotic-dichorionic (di-di) twin pregnancies have relied on the normal amniotic fluid volume normal ranges for singleton pregnancies.
The vast majority of research in this area has been undertaken by obstetricians and published in obstetrical publications as opposed to sonographic journals.
How Is Amniotic Fluid Volume Assessed?
Evaluation of normal amniotic fluid volume is a standard and crucial element of prenatal treatment.
Amniotic fluid composition in the first trimester of pregnancy is similar to protein-free fetal serum due to fluid transudation through the fetal skin or the maternal decidua.
Amniotic fluid at around 11 weeks of pregnancy is almost all fetal urine with a small quantity of fluid produced by the lungs.
Amniotic fluid content seems to be regulated by a balance between the inflows from fetal urine and outflows of fetal swallowing and intramembranous water flow (from amniotic fluid over the amnion into the fetal-placental vasculature).
During the first and second trimesters of pregnancy, amniotic fluid builds up, with its maximum amount occurring between weeks 33 and 34.
An obstetrician may tell whether there is too little or too much fluid in the amniotic sac based on the amniotic fluid index (AFI), the biggest vertical pocket (LVP), and the two-diameter pocket (2DP), and the patient's subjective visual data.
Sonographers and their medical interpreters use the data to evaluate systemic issues related to amniotic fluid quantities.
Fetal death, renal agenesis, intrauterine growth restriction (IUGR), postdates, premature rupture of the membranes (PROM), and chromosomal defects are all conditions that may occur in conjunction with oligohydramnios.
Gingival abnormalities and neural tube problems have all been linked to pregnancy with polyhydramnios.
Amniotic fluid may be measured in a number of ways, each having its own normal, oligohydramnios, and polyhydramnios ranges with varying degrees of accuracy as judged by comparison to the dye-determined technique.
Four-Quadrant Summated AFI Method
The linea nigra divides the uterus into right and left halves, while the umbilicus splits it in two.
To calculate the total AFI, we need to measure the greatest vertical pocket of fluid in each quadrant without including any fetal limbs or the umbilical cord.
The index of the total amount of fluid in the uterus is calculated by adding together all of the measurements and recording the result in centimeters.
The numbers will differ if the fetus moves about in each sac while the AFI is assessed.
The quantity of fluid in any given quadrant of the uterus is dynamic since the fetus may shift an arm or leg or roll over at any time, causing fluid to be moved to another location inside the sac.
The usual range is between 5 and 20 cm, with 0–5 cm indicating oligohydramnios and >20 cm indicating polyhydramnios.
These intervals will change from one location to the next based on the personal preferences of the doctors interpreting.
The summated four-quadrant approach was compared to the dye-determined method for yielding these precision intervals.
There is a 93% to 100% success rate for normal fluid, a 7% success rate for oligohydramnios, and a 0% success rate for polyhydramnios.
The AFI technique is very effective, with a sensitivity of 13% and a specificity of 100%.
Largest Vertical Pocket
To get this number, we consider the membrane separating each fetal sac and measure the greatest vertical pocket of fluid perpendicular to the uterine contour.
Evaluating fluid levels in each amniotic cavity requires first locating the dividing membrane.
If the amniotic fluid level is less than 2 centimeters, it is termed oligohydramnios; between 2 and 8 centimeters is regarded normal, and more than 8 centimeters is labeled polyhydramnios.
For normal amniotic fluid volumes, the LVP technique had an accuracy of 81% to 98% compared to volumes obtained by the dye-determined technique; however, when oligohydramnios or polyhydramnios was present, the LVP technique overestimated the lower volumes by 89% and underestimated the higher volumes by 54%.
Since the total amniotic fluid volume in diamniotic twin pregnancies cannot be correctly estimated using the LVP technique alone, another approach must be used.
In the opinion of both sonographers and interpreting doctors, this is the quickest and most reliable procedure.
Two-Diameter Pocket
The transducer is angled perpendicular to the uterine contour, and the depth and width of the biggest pocket are measured.
While this approach was more effective than othersin identifying oligohydramnios (57%), it incorrectly labeled a higher percentage of normal AVFs as oligohydramnios (83%).
Those with oligohydramnios have a uterine volume of less than 15 centimeters, those with normal uterine volumes of 15 to 50 cm, and those with polyhydramnios have a uterine volume of more than 50 cm, with a corresponding 0% accuracy rate.
In diamniotic twin pregnancies, the total amniotic fluid volume cannot be reliably assessed using the two-diameter approach since it is a qualitative, two-dimensional evaluation of a three-dimensional volume.
Subjective Visual Evaluation
The fluid levels in the sacs are visually evaluated, but not quantified in this procedure.
Accordingly, the subjective visual accuracy rate is comparable to the sonographically measured AFI and LVP techniques, with a range of 93% to 97% for normal and 7% to 29% for oligohydramnios and polyhydramnios, respectively.
When one sac's membrane bulges into (toward) another, it visually evaluates the hydrostatic pressure in both sacs.
Because it is a subjective estimate of the relative amount of fluid and the accuracy relies on the sonographer's and interpreting physician's expertise, measuring amniotic fluid volume in this way is often reserved for more seasoned sonographers and sonologists.
Dye-Determined Method
The dye-determined approach is the most widely employed to assess amniotic fluid volume (AVF) in di-di twin gestations.
When injected into a sac, the dye spreads rapidly, stays inside the sac, and does not cross the placenta, making it safe for the developing baby.
It has a perfect rate of accuracy of one hundred percent.
The dye dilution procedure is time-consuming and needs an amniocentesis of each sac to screen for lung maturity and to identify chorioamnionitis.
Due to its invasive nature and substantial loss risks, this approach is rarely favored in practical practice.
People Also Ask
How Can I Increase Amniotic Fluid In Twins?
There are a few possible approaches to boosting amniotic fluid levels, such as:
- Drinking more water every day
- Supplementation
- Rest
- Amnioinfusion
- Intrauterine preterm birth
Do You Have More Amniotic Fluid With Twins?
Because carrying more than one baby again will create more fluid than a single kid, having multiples puts you at risk for excessive fluid levels.
How Do You Calculate The Twin Amniotic Fluid Index?
Amniotic fluid volume is calculated by identifying the membrane that separates the twins, dividing the amniotic fluid sac in half using the fetal diaphragm, and measuring the largest pocket free of the umbilical cord in centimeters, and summing the measurements to create a two-quadrant amniotic fluid index.
Do Twins Have Less Amniotic Fluid?
The amniotic fluid level of the regularly developing twin is usually adequate to large (but not excessive).
One twin may be smaller than the other because their placental share is lower.
Conclusion
The health and safety of a growing fetus rely on adequate quantities of amniotic fluid.
The dividing membrane must always be considered no matter what technique is employed to assess amniotic fluid volume.
Sonographers and interpreting doctors do not yet have a definitive-standard approach for determining twin amniotic fluid levels.
The dye dilution approach is the only current method that reliably assesses the fluid in each sac, but it is quite intrusive and hence involves significant risk of loss.
The pregnant woman or her medical care providers may increase the amniotic fluid level if it is lower than normal.
Increase your amniotic fluid levels by relaxing, minimizing physical activity, and drinking more water.
Suleman Shah
Author
Suleman Shah is a researcher and freelance writer. As a researcher, he has worked with MNS University of Agriculture, Multan (Pakistan) and Texas A & M University (USA). He regularly writes science articles and blogs for science news website immersse.com and open access publishers OA Publishing London and Scientific Times. He loves to keep himself updated on scientific developments and convert these developments into everyday language to update the readers about the developments in the scientific era. His primary research focus is Plant sciences, and he contributed to this field by publishing his research in scientific journals and presenting his work at many Conferences.
Shah graduated from the University of Agriculture Faisalabad (Pakistan) and started his professional carrier with Jaffer Agro Services and later with the Agriculture Department of the Government of Pakistan. His research interest compelled and attracted him to proceed with his carrier in Plant sciences research. So, he started his Ph.D. in Soil Science at MNS University of Agriculture Multan (Pakistan). Later, he started working as a visiting scholar with Texas A&M University (USA).
Shah’s experience with big Open Excess publishers like Springers, Frontiers, MDPI, etc., testified to his belief in Open Access as a barrier-removing mechanism between researchers and the readers of their research. Shah believes that Open Access is revolutionizing the publication process and benefitting research in all fields.
Han Ju
Reviewer
Hello! I'm Han Ju, the heart behind World Wide Journals. My life is a unique tapestry woven from the threads of news, spirituality, and science, enriched by melodies from my guitar. Raised amidst tales of the ancient and the arcane, I developed a keen eye for the stories that truly matter. Through my work, I seek to bridge the seen with the unseen, marrying the rigor of science with the depth of spirituality.
Each article at World Wide Journals is a piece of this ongoing quest, blending analysis with personal reflection. Whether exploring quantum frontiers or strumming chords under the stars, my aim is to inspire and provoke thought, inviting you into a world where every discovery is a note in the grand symphony of existence.
Welcome aboard this journey of insight and exploration, where curiosity leads and music guides.
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