Posts Tagged ‘amniotic fluid’

What is twin-to-twin transfusion syndrome?

Friday, December 15th, 2017

Twin-to-twin transfusion syndrome (TTTS) is a serious condition that occurs in about 10-15% of identical twin pregnancies where the babies share a placenta (monochorionic).

In TTTS, the blood vessels in the placenta form abnormal connections and blood does not flow evenly between the babies. One twin becomes a “donor” and the other becomes a “recipient.” The donor twin pumps blood to the recipient twin. This means that the recipient twin is bigger, has more blood, and makes more urine. This results in too much amniotic fluid (polyhydramnios) and an enlarged bladder. The extra fluid can also strain the recipient twin’s heart. However, the donor twin is smaller, has less blood, little to no amniotic fluid (oligohydramnios), and a smaller bladder.

How do you know if your twins have TTTS?

TTTS is usually found during an ultrasound in the second trimester. Once TTTS is identified, your health care providers will evaluate how serious the TTTS is. They will look at how much amniotic fluid is in each sac, how the donor twin’s bladder is working, and they will look at blood flow in both babies. They may also do an amniocentesis and echocardiogram (an ultrasound of the baby’s heart) if needed.

What treatment is available for TTTS during pregnancy?

The treatment plan will depend on how severe the condition is. Options for treatment include:

  • Monitoring with regular ultrasounds: Monitoring allows your providers to regularly check on your twins and look for any signs that TTTS is getting worse.
  • Removing amniotic fluid from the recipient twin: Extra amniotic fluid is removed from the larger (recipient) twin. This is only a temporary option and may need to be repeated.
  • Laser surgery (known as selective fetoscopic laser photocoagulation or SFLP): This procedure uses a laser to stop the transfer of blood between the babies. It is often the

Without treatment TTTS can cause serious problems for both babies. So it is important that you go to all of your prenatal checkups—even when you’re feeling fine. Twins with mild to moderate TTTS may be at increased risk for premature birth.

When your baby is overdue

Monday, September 30th, 2013

bellyThe average healthy pregnancy is around 40 weeks. Some babies come earlier and others run later. A pregnancy that lasts longer than 42 weeks is called a post-term pregnancy.

Dr. Siobhan Dolan discusses overdue pregnancies in the book Healthy Mom Healthy Baby. Here is an excerpt from the book.

“Although many post-term babies are healthy, some risks do start to increase after 41 to 42 weeks. An overdue pregnancy takes a toll on the placenta, amniotic fluid, and umbilical cord. As the baby grows larger, the chances of stillbirth and delivery injuries go up, and there is a greater likelihood that the baby will experience meconium aspiration (inhaling stool from the amniotic fluid into the lungs) or a condition called dysmaturity syndrome (in which the baby is no longer getting enough nourishment because the placenta is aging and becoming calcified).

“When a baby is overdue, the provider may do some tests to check on the baby’s health. They include:
– Ultrasound exam
– Kick count, which is a count of how many times your baby moves or kicks you during a certain period of time
– Nonstress test, in which a fetal monitor measures your baby’s heart rate for a certain amount of time
– Biophysical profile, which uses a fetal monitor and an ultrasound to score a baby on each of five factors (nonstress test, body movements, breathing movements, muscle tone, and the amount of amniotic fluid)
– Contraction stress test, which compares your baby’s heart rate at rest with the heart rate during contractions induced by a shot of oxytocin or nipple stimulation

“If these tests suggest that your baby is in good condition, you can continue to wait for labor to begin naturally. If they raise concerns, your provider may wish to induce labor or perform a c-section. Providers rarely allow a pregnancy to go beyond 42 weeks.”

Amniotic fluid surrounding your baby

Friday, July 26th, 2013

insideWhat is this made of and how much is enough, too much? What’s normal, what’s not?

The amniotic sac that contains your baby begins to form about 12 days after conception. Amniotic fluid begins to form at that time, too. In the early weeks of pregnancy, amniotic fluid is mainly made up of water supplied by the mother. After about 12 weeks, your baby’s urine makes up most of the fluid. The amount of amniotic fluid increases until about 36 weeks of pregnancy. At that time you have about 1 quart of fluid. After that time, the level begins to decrease.

Sometimes you can have too little or too much amniotic fluid. Too little fluid is called oligohydramnios. Too much fluid is called polyhydramnios. Either one can cause problems for a pregnant woman and her baby. Even with these conditions, though, most babies are born healthy.

The amniotic fluid that surrounds your baby plays an important role in her growth and development. This clear-colored liquid protects the baby and provides her with fluids. Your baby actually breathes this fluid into her lungs and swallows it. This helps her lungs and digestive system grow strong. Your amniotic fluid also allows your baby to move around, which helps her to develop her muscles and bones.

Normal amniotic fluid is clear or tinted yellow. Fluid that looks green or brown usually means that the baby has passed his first bowel movement (meconium) while in the womb. (Most babies have their first bowel movement after birth.)

If the baby passes meconium in the womb, it can get into his lungs through the amniotic fluid. This can cause serious breathing problems, called meconium aspiration syndrome, especially if the fluid is thick. Some babies with meconium in the amniotic fluid may need treatment right away after birth to prevent breathing problems. Babies who appear healthy at birth may not need treatment, even if the amniotic fluid has meconium.

Polyhydramnios

Tuesday, December 13th, 2011

ultrasoundWhen a pregnant woman has polyhydramnios, the level of amniotic fluid surrounding her baby is too high. To understand why this can be a problem, it’s important to first understand the basics of amniotic fluid.

The amniotic fluid that surrounds your baby plays an important role in her growth and development. This clear-colored liquid protects the baby and provides her with fluids. Your baby actually breathes this fluid into her lungs and swallows it. This helps her lungs and digestive system grow strong. Your amniotic fluid also allows your baby to move around, which helps her to develop her muscles and bones.

The amniotic sac that contains your baby begins to form about 12 days after conception. Amniotic fluid begins to form at that time, too. In the early weeks of pregnancy, amniotic fluid is mainly made up of water supplied by the mother. After about 12 weeks, your baby’s urine makes up most of the fluid. The amount of amniotic fluid increases until about 36 weeks of pregnancy. At that time you have about 1 quart of fluid. After that time, the level begins to decrease.

Polyhydramnios (too much amniotic fluid) occurs in about 1 out of 100 of pregnancies. Most cases are mild and result from a slow buildup of excess fluid in the second half of pregnancy. But in a few cases, fluid builds up quickly as early as the 16th week of pregnancy. This usually leads to very early birth.

Polyhydramnios is diagnosed with ultrasound. Medical experts do not fully understand what causes this condition. In about half of cases, the cause is not known. Here are some of the known causes:
– Birth defects in the baby that affect the ability to swallow. Normally, when the fetus swallows, the level of amniotic fluid goes down a bit. This helps to balance out the increase in fluid caused by fetal urination.
– Heart defects in the baby
– Diabetes during pregnancy
– Infection in the baby during pregnancy
– Blood incompatabilities between the pregnant woman and the fetus (examples:
– Rh or Kell disease)

Women with mild polyhydramnios may have few symptoms. Women with more severe cases may have discomfort in the belly and breathing problems. That’s because the buildup of fluids causes the uterus to crowd the lungs and the organs in the belly.
Polyhydramnios may increase the risk of pregnancy complications such as:
– Preterm rupture of the membranes (PROM) (breaks or tears in the sac that holds the amniotic fluid)
– Premature birth
– Placental abruption (The placenta peels away from the uterine wall before delivery.)
– Poor positioning of the fetus
– Severe bleeding by the mother after delivery

The best thing you can do is to go to all your prenatal care appointments. Your health care provider can monitor the size of your belly and how much amniotic fluid is in your womb. If you have a problem, your provider can take steps to help prevent complications in you and your baby.

If you have diabetes, talk to your health care provider about your increased risk of polyhydramnios.

If your health care provider thinks you might have polyhydraminos, you will probably need extra monitoring during your pregnancy. In many cases, polyhydramnios goes away without treatment. Other times, the problem may be corrected when the cause is addressed. For example, treating high blood sugar levels in women with diabetes often lowers the amount of amniotic fluid. Other treatments include removing some amniotic fluid or using medication to reduce fluid levels.

Oligohydramnios

Monday, November 8th, 2010

pregnant-bellyWhen a pregnant woman has oligohydramnios, the level of amniotic fluid surrounding the baby is too low. To understand how this can affect your health and the health of your baby, it’s helpful to first understand the function of amniotic fluid in a healthy pregnancy.

The amniotic fluid that surrounds your baby plays an important role in your baby’s growth and development. This clear-colored liquid protects the baby and provides it with fluids. Your baby breathes this fluid into its lungs and swallows it. This helps the lungs and digestive system grow strong. Your amniotic fluid also allows the baby to move around, which helps it to develop its muscles and bones.

The amniotic sac that contains your baby begins to form about 12 days after conception. Amniotic fluid begins to form at that time, too. In the early weeks of pregnancy, amniotic fluid is mainly made up of water supplied by the mother. After about 20 weeks, your baby’s urine makes up most of the fluid. The amount of amniotic fluid increases until about 36 weeks of pregnancy. At that time you have about 1 quart of fluid. After that time, the level begins to decrease.

Oligohydramnios (too little amniotic fluid) occurs in about 4 out of every 100 pregnancies. It is most common in the last trimester of pregnancy, but it can develop at any time in the pregnancy. About 1 out of 8 women whose pregnancies last 2 weeks past the due date develops oligohydramnios. This happens as amniotic fluid levels naturally decline.

Oligohydramnios may affect you, your baby, and your labor and delivery in different ways. The effects depend on the cause (a possible birth defect in the baby affecting urine output, or a health condition with the mother), when the problem occurs, and how little fluid there is.  To read more about possible causes, effects, and treatment options, click on this link.

Chorioamnionitis

Tuesday, November 2nd, 2010

Chorioamnionitis is a bacterial infection of the amniotic fluid and membranes that surround a developing baby. This can cause potentially dangerous infection in both the mother and baby. It is important for a pregnant woman to receive treatment for this infection because it is thought to be a major cause of preterm premature rupture of the membranes (PPROM) and premature birth.

Symptoms of chorioamnionitis include a high fever, uterine pain, rapid heart rate in mother and/or baby, nasty smelling vaginal discharge or leaking amniotic fluid, and increased white blood cell count.  Since there is no simple test to confirm chorioamnionitis, it is important that a pregnant woman report any of these symptoms to her health care provider right away. Diagnosis of this infection may require amniocentesis.    If chorioamnionitis is diagnosed, antibiotics will be given to the mother, delivery may be scheduled immediately and then antibiotics will be given to both mom and baby after delivery.

Chorioamnionitis occurs in roughly 1 to 2 percent of all pregnancies.  Women who have had it in a previous pregnancy are at increased risk of having it again in a future pregnancy.

Meconium aspiration

Tuesday, September 21st, 2010

Meconium is the stuff that first poops are made of. It’s greenish-black, sticky and tar-like, but may be treated as gold because it shows that the baby’s intestines are working.

Sometimes the passing of the first stool happens while the baby is still in Mom’s uterus or during delivery.  Meconium aspiration happens when a newborn inhales (or aspirates) a mixture of meconium and amniotic fluid.  The inhaled meconium can partially or completely block the baby’s airways, making it difficult to breathe and causing meconium aspiration syndrome, or MAS.

If that happens, the doctor will order a number of tests to see how affected a baby might be.  The primary focus is to clear the airway as much as possible to decrease the amount of meconium that is aspirated. This is done by inserting a plastic tube into the baby’s windpipe through the mouth or nose and applying suction as the tube is slowly removed. This allows for suction of both the upper and lower airways. The doctor will continue trying to clear the airway until there’s no meconium in the suctioned fluids.

MAS can affect the baby’s breathing in a number of ways including irritation to the lung tissue, airway obstruction by a meconium plug, infection, and the destruction of surfactant by the meconium (read our previous post on surfactant.)  The severity of MAS depends on the amount of meconium the baby inhales and, generally, the more meconium a baby inhales, the more serious the condition.

Babies with MAS may be sent to a special care nursery or a NICU to be carefully monitored for the next few days. Most babies with MAS improve within a few days or weeks and usually there is not severe permanent lung damage.  These babies, however, may be at a higher risk of having reactive airway disease (lungs that are more sensitive and can possibly lead to an asthmatic condition).  Severe cases may necessitate the baby be given mechanical ventilation, which can increase the risk for bronchopulmonary dysplasia, a lung condition that can be treated with medication or oxygen.  Rarely, MAS can lead to a collapsed lung or pneumonia.

If not at the hospital when her water breaks, it’s important for a pregnant woman to tell her doctor immediately if meconium is present in the amniotic fluid, or if the fluid has dark green stains or streaks. Doctors may use a fetal monitor during labor to monitor the baby’s heart rate for any signs of fetal distress. In some cases they may recommend amnioinfusion, adding saline to the amniotic fluid to wash meconium out of the amniotic sac before the baby has a chance to inhale it at birth.

Although MAS is a frightening complication for parents to face during the birth of their child, the majority of cases are not severe.  Did any of you face this problem?