Amniotic Fluid - 4 - Consequences of Decreased Amniotic Fluid

Sunday, May 11, 2008

Kenneth F. Trofatter, Jr., MD, PhD

In the last three posts, we have reviewed basic aspects of amniotic fluid production and measurement and common causes of decreased amniotic fluid, or oligohydramnios. Now let’s look at reasons decreased amniotic fluid increases the risk for fetal (and newborn) complications and death. Complications related to decreased amniotic fluid depend on the underlying cause, the degree of the decrease, the timing during pregnancy, and the longevity during fetal development. First, let’s look at the worst case scenario – the baby that has no fluid (anhydramnios) from very early in the pregnancy on…

As mentioned in our last post, the most common conditions that lead to anhydramnios include absence of the fetal kidneys (bilateral renal agenesis), nonfunctional kidneys secondary to bilateral renal dysplasia (polycystic and multicystic kidneys), and complete bladder outlet obstruction (posterior urethral valves, or other anomalies associated with maldevelopment of the fetal bladder or urethra). In rare circumstances, complete bilateral obstruction of the ureters (ureteropelvic or ureterovesical junction obstruction) can also be found. Under these conditions, where the baby has essentially no amniotic fluid from late first trimester on, the outcome is uniformly LETHAL.

Interestingly, it is not the absence of kidney function that kills these babies – it is the fact that in the absence of amniotic fluid, the fetal lungs do not develop sufficiently to support breathing once they are actually born! Any of these conditions associated with early and sustained anhydramnios result in the same outcome secondary to pulmonary hypoplasia and insufficiency, and this has been labeled ‘Potter’s syndrome (or sequence)’ after the physician who first described it. Although, it is not known why the absence of fluid results in Potter’s syndrome, it is thought that the constant compression of the thorax contributes, that the production of fluid by the fetal lungs is suppressed, and even that some movement of amniotic fluid (fetal urine) into the lungs is essential for normal development of functional alveoli. Most babies who are born with Potter’s syndrome cannot even make any kind of respiratory effort at birth, and those that do, cannot get sufficient oxygen into their bodies to allow survival.

If you notice, I did not include premature and prolonged rupture of membranes (PPROM) in this category of inevitable lethal outcome. It is true that if PPROM occurs prior to 20-22 weeks, the baby is at risk for the full consequences of Potter’s syndrome, and the earlier the PPROM and the more severe the oligohydramnios, the greater the likelihood is that this will occur. Indeed, during my training, we were taught simply to offer such women induction of labor, not only because the fetal outcome was expected to be dismal but also because the risk of infection to the mother was so high. (Of course, when I trained, it was the rare baby born before 27 weeks that had any chance of survival anyway). But, I must admit, many patients I have had over the years have proven that old teaching to be incorrect, or at least not a certain death sentence for their babies. Some of these women will carry their babies to a point where there is potential viability (today, 23 weeks and beyond) and, though they are at risk for pulmonary hypoplasia, the degree of this is very difficult to predict and it may not be lethal. However, these babies may also be at increased risk for fetal deformations (particularly of the skeleton, thorax, and head) secondary to compression during development and in its most severe form, a condition termed the fetal akinesia/hypokinesia deformation sequence in which there are not only compression malformations but poor development of muscle, tendons, and enervation secondary to the lack of fetal movement in utero.

Although the above conditions are very serious, they are also all the least common complications related to oligohydramnios. Indeed, most babies will not develop decreased amniotic fluid until beyond 24 weeks gestation, so the issues related to pulmonary hypoplasia and major deformations are, fortunately, rare. The most common reasons for oligohydramnios in the latter part of pregnancy are PROM and placental insufficiency. In the case of the former, this can lead to the acute (sudden) decrease in amniotic fluid and in the latter, a more gradual reduction. Leaving infection out of the equation (as a common cause of PROM and associated with its own morbidity and mortality), the primary cause of fetal complications under these circumstances are related to umbilical cord compromise, and in the case of placental insufficiency, decreased fetal oxygenation (ultimately the cause with its own consequences, not the effect, of decreased amniotic fluid).

Normally, I tell patients that the umbilical cord is a lot like a fire hose. It is a ‘closed system’ and the blood contained within it is under some pressure. In other words, just because it is wrapped around the baby’s neck, or other body parts, or even tied into a knot, does not mean the baby is going to necessarily die as the result – in fact most don’t. At least one-third of all babies are born with the cord looped around the neck (nuchal cord) and most do just fine. However, the blood in the umbilical cord vessels is under differential ‘pressures’ depending on whether it is the poorly oxygenated arterial blood (higher pressure) coming from the baby to the placenta or the well-oxygenated venous blood (low pressure) coming back to the baby from the placenta. Obviously, when there is compression on the umbilical cord, the venous blood flow is much more likely to be impeded than the arterial blood flow.

Even if the blood in the umbilical cord is under pressure, in the presence of decreased or absent amniotic fluid it is possible for the baby to trap the cord in a position where blood flow is significantly reduced and the baby can be damaged or even die as the result of too little oxygen. I always worry about this most when there is sudden rupture of the membranes, or if the cord falls (prolapses) through the cervix, and, particularly, in women who are very heavy. It is also one of the causes of fetal morbidity and mortality in placental insufficiency sequences (accompanied by intrauterine growth restriction) because oftentimes in these circumstances, not only is the placenta poorly developed (and has less ‘reserve’), but the cord is often thinner and smaller and not endowed with adequate cushioning due to a reduction in the amount of Wharton’s jelly surrounding the blood vessels (normally two arteries and one vein) in the umbilical cord and, therefore, more likely to be significantly compromised when compressed.

Intermittent (and incomplete) umbilical cord compression can often be identified by distinct abnormalities of the fetal heart rate (FHR) tracing (most commonly, ‘variable decelerations’). These are quite common in labor, particularly after the membranes have ruptured either spontaneously or as the result of the provider’s intervention (artificial rupture of membranes, or AROM). FHR monitoring is, therefore, one means of identifying the baby ‘at risk’ for umbilical cord compromise. Most babies that have decreased fluid and normal placental function tolerate this type of FHR deceleration quite well, although they are still at increased risk for cesarean delivery if the FHR tracing begins to develop signs of ‘nonreassurance’ and spontaneous vaginal delivery is still remote. Since we seem to have spent a fair amount of time on this topic today, I will reserve further discussion on the evaluation and management of pregnancies with oligohydramnios to our next post…

Labels: amniotic fluid; AFV, anhydramnios, oligohydramnios, Potter's syndrome

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85 Comments:

At Sun May 11, 01:06:00 PM 2008, nina.nunez said…

Hi, my name is Nina.

I know I'm not posting in the right spot, but I hope you don't mind. I've looked over your archive and I'm very grateful that you take the time to address reader concerns. Here's a new one..maybe a bit challenging one for you...

I am 29 years old and have had two successful pregnancies..at 18 years of age and at 21. I am very healthy and active. When I was 24,three hemangiomas were found on my liver incidently after surgery for gallbladder removal. I saw a liver specialist who advised that I stop taking birth control pills, which I did. I recently had a liver resection (my right lobe) due to a growing, symptomatic hemangioma (7cm). It was growing near my diaphragm and caused intense shoulder and sometimes breathing pain. The surgery went very well (It was in Dec 2007). I did not need a blood transfusion and am now just about fully recovered. Prior to surgery, my LFT was completely normal. My Liver Functions are almost completely back to normal now. Of course everything was sky high immediately after surgery. The two I still have two small hemangiomas on the left lobe (1.5 cm and 2cm respectively). I still have a little bit of shoulder pain and we did a recent scan of the liver. The concern is that one of the hemangiomas that are left might still be symptomatic. It is in a subdiaphragmatic location on the left lobe. I recently remarried and would love to have another child or two. My liver surgeon thinks it would be fine with monitoring of the existing hemangiomas. My OB/GYN said he didn' think it was a great idea, but he would send me to a specialist. What are your thoughts/experiences on this? Without empirical evidence that hormones make hemangiomas grow, would pregnancy be a contraindication? How long should you wait after abdominal surgery to get pregnant? My incision ran from my sternum straight down with a slight curve towards my right rib. Approximately 12 inches long.

Thank you for your time and I look forward to hearing from you.
At Tue May 13, 06:12:00 PM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

To Nina: I would tend to agree with your surgeon. The remaining hemangiomas are small and could be easily followed during a pregnancy. I did write a post on March 2, 2008 in which I discuss "Hereditary Hemorrhagic Telangiectasias in Pregnancy." You might want to read that and ask your doctor if he/she thinks you might have this condition! With regard to another pregnancy, the surgery you had should not significantly increase your risk for complications at this point and, in your case, it may be better to try sooner than later while the hemangiomas are still small. Good luck and let us know what you decide to do and how things turn out! Dr T
At Tue May 13, 06:48:00 PM 2008, nina said…

Thank you for your quick response. It is very interesting to read about HHT. I do know my mother had a single hemangioma on her liver. But, beyond that, we don't know of anyone else in the family that has one. I will talk to my liver specialist in Dallas about it. Thank you so much for your insight! I appreciate it!
At Thu May 15, 06:05:00 PM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

To Nina: You're welcome. Please let me know what the liver specialist thinks! Dr T
At Tue May 20, 11:43:00 AM 2008, marti said…

Hi. I have been diagnoised with oligohydraminos at 16 weeks and anhydraminos at 24 weeks, not due to PPROM. The dr's say my baby's chances are poor once he is born. He does have some problems, they can only find one kidney. Is there anything you can do once there is no fluid? I am so devestated.
At Tue May 20, 07:11:00 PM 2008, Anonymous said…

Hi Dr. Trofatter!
Thank you for your thorough responses to everyone's questions. I am 35 yrs old and had a very difficult first pregnancy that ended in miscarriage five weeks ago. I had bleeding at 3-7 weeks, oligohydraminos and severe hyperemesis gradvidarum the entire 4.5 mos resulting in several ER visits and hospitalizations, a CVS at 12 weeks which showed mosaic turner's syndrome, an amnio which confirmed the turner's diagnosis and my water broke at 18 weeks. My OB said it was okay to try after 1 cycle and the geneticist after 2 cycles, yet I am afraid of having another miscarriage and/or another baby with a genetic defect. I have a couple of questions regarding future pregnancies. What is the best time frame to start trying again? I could not take prenatal vitamins or folic acid during my pregnancy (it would make the nausea and hyperemesis even worse), how detrimental is this to the baby? I was taking zofran (once a day) as well as vistaril and reglan (twice a day) could these medications and the severe vomiting led to oligohydraminos.

Thank you for your assistance with my questions.
At Sun May 25, 05:40:00 PM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

To Marti May 20: No, I am afraid that if there is anhydramnios now, either the one kidney is dysplastic and nonfunctional or there is severe placental insufficiency related to whatever problem caused the baby's abnormalities. We cannot replace the fluid and hope for a better outcome under these circumstances. I am so sorry, but we are very limited in terms of being able to help under these circumstances except to pray with you. Best wishes to you, and if you think about it, please let us know what happens. Dr T
At Sun May 25, 05:47:00 PM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

To anonymous May 20: Fortunately, the risk of recurrence of the Turner's is relatively low. You should not get pregnant again until YOU are READY to do so, regadless of when it might be safe to try. That may take some counseling from what you have told me. It is hard to say if the hyperemesis was simply the result of the abnormal fetal karytoype or if this is something you will be at risk for again. I would strongly suggest at leats 2-3 months of supplemental folic acid (4 mg/day) and a multivitamin with extra Vitamin D and calcium in anticipation of the worst from the hyperemesis standpoint. I doubt the medications caused the decreased fluid. More likely there was something innately wrong with the baby and/or the placenta secondary to the chromosomal abnormality. If you do get pregnant again and have problems with hyperemesis, write back and I will give you my thoughts on what you can try. Sorry for your recent loss. Best wishes and thanks for writing! Dr T
At Thu May 29, 02:48:00 PM 2008, Anonymous said…

Hi Doctor,
My name is Tricia and I was looking for information on low amniotic fluid for months to get a better understanding. I got pregnant in August '07 and in November '07 I started bleeding a lot. I went to the emergency room and verified that my child was still alive and that I had a blood clot in my uterus. I bled on and off for three more weeks. When I went to the OB/GYN it was discovered that I had less than 1cm of amniotic fluid (4 1/2 mths). I was put on bed rest immediately with weekly appointments to check if my baby was still alive. I was hospitalised at 23 weeks by my OB so that I could be under 24hr monitoring just in case I went into labor. I went into labor at 28wks and 6 days. Labor & Delivery lasted 2 1/2 hours. she was 2lbs 2ozs and she was not able to breathe on her own and died half an hour after.
I have a 7 year old daughter and that pregnancy went very well - no complications what so ever.
I would like to try again in spring '09. Is there anything that I can do to prevent the anhydramnios. My fluids never went over 2cm. Can this happen again.
Also in the first trimester, I would always feel something sharp stick me in my belly whenever I got up out of a chair, could there have been something inside of me sticking my uterus. I have three very, very small fibroids.
At Thu May 29, 05:47:00 PM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

Hi Tricia: Do you remember the events surrounding the bleeding at 4 and a half months? Was this after intercourse or after having fallen? Are you a smoker? Did you have any pain with the bleeding? Did they find anything wrong with the baby after it was born - abnormalities of the kidneys, heart, face , etc.? Did your doctor suspect you had ruptured the bag of waters along with the bleeding or afterwards?

Regardless, it sounds as if you had an early placental abruption (separation of the placenta from the lining of the uterus). Your baby had decreased fluid because there was not enough blood flow going through the placenta to keep the baby happy - it shut down flow to its kidneys and just stopped making urine. Unfortunately, this occurred at a critical time in the fetal lung development and without the fluid around the baby, the lungs never developed properly (pulmonary hypoplasia). That's why you baby could not breathe after birth.

I do not know if the fibroids contributed to the placental abruption, but they could have. Sometimes fibroids will be a source of inflammation and if they sit right underneath the placenta, they can cause problems, but I suspect something else happened. I am so sorry for your loss and thank you for writing. Best wishes! Dr T
At Fri Jun 06, 10:30:00 AM 2008, Anonymous said…

Hi, my name is Denise:

4.5 years ago I was pregnant with twins. We had twin to twin transfusion. We had considerd the surgery to disconnect to two veins so this wouldn't be a concern. We decided not to and thought that a reduction of amniotic fluid later would be better for us. I was seeing a specialist a couple hours aways from where I live and with the bumps and everything i started having contractions, luckly they stopped with some medicine. My specialist wanted me to spend the rest of my pregnacy up at the hospital, several months. Considering I had a 6 year old son, whom was extremely attached to me and his dad wasn't very close to him and i didn't have anyone to watch him I said no. My husband and I decided to get a dr closer, still being over 1 hour away. I was having pains when i got up so the dr recommended me get a reduction asap, in november. During to reduction I noticed that he was taking alot of fluid 2.5 jars. Is that alot? After, they didn't give my my rh shot right away. Before christmas I told my dr I wanted to have the babies before the new year, he said that it wouldn'd be a good idea to just wait. 1.5 months after the amniotic reduction we found out the donor baby died severy days earlier. We found that out on Jan 9 my babies were 32 weeks they would have been 30 weeks if they were delivered when I wanted them to be. After my daughter was born on that day they asked me if i wanted a otopsy done while the dr was there and he said that there was no need that the baby died from not having enough fluid in her sack. my mind cannot forget and wonder if taking too much fluid from the recipient baby put too much presure on the donor baby and that's why she died. What should i do? should i investigate and find out what happened or should i just let it go?
At Sat Jun 07, 08:38:00 AM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

To Denise: I think you should just let it go, but that is so much easier said than done... I know that. TTTS is a very serious condition and even in the most experienced hands, there is a high rate of fetal loss and/or long-term complications. It sounds like you were in good hands and handled appropriately and despite everyone's best efforts, the rsults were not the best. If you have not done so already, it might be a good idea to get a counselor to hlp you work through these issues. I am sorry for your loss, even that many years ago, it still hurts. Dr T
At Wed Jun 11, 06:06:00 AM 2008, Anonymous said…

hi,My name is lakshmi.i am 12 weeks pragnant.doctor told fluid is less around the baby. i am fearing about it.will it be a problem to the baby?what i need to do.. please advice me.
At Wed Jun 11, 07:08:00 PM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

To lakshmi: I am sorry, but I would need more information first. Why does your doctor think the fluid is too low at 12 weeks?
Dr T
At Wed Jun 11, 10:45:00 PM 2008, Anonymous said…

Hi Doctor,I am Lakshmi....Thank u so much for your time andquick reply.Doctor adviced to take NT scan at 12 week.doctor checked the scan report and said that liquor is less for the gestational age.and also she said that baby is so tiered inside.she has given THRIVE capsules to increse the liquor.asked me to take rest in the afternoon time. But i am working as a software engineer.so if it is compulsary to take rest then i will take. she told that take the tablets and also lots of water,then come for the checkup on 28th so that i will let u know whether rest is need or not.
but i have seen in some sites and some of friends and relatives are saying that baby is not at good condition if there is no fluid at this stage. I wolud like to clear on this.now i am taking that tablet and lots of water.i will wokr for 9 hours in the office.and what could be the resons for less fluid around the baby. can you plz reply me .. and if u need the scanned reports i will attach and send u as a mail.This is my first pragnancy.so i am very fearig about it.please do reply me.
Thank u in advance.
At Sun Jun 15, 02:03:00 PM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

Lakshmi: If there really is no fluid at this point. that is VERY bad. Either the baby has no kidneys (bilateral renal agenesis), or has dysplastic kidneys (polycystic or multicystic), or has urethral obstruction (could they see a fetal bladder), or another anomaly such as a limb-body-wall complex, or such a poor placenta that it cannot support the health of a baby even this early. Have you seen a specialist yet in Maternal-Fetal Medicine? If not, please do. Best of luck to you and let us know what you find out! Dr T
At Sat Jun 21, 12:32:00 AM 2008, shruti said…

Hi doctor,
I am Shruti,age 28 years i had lost my 2 pregnancies due to lesser amnotic fluid.
now i am still pregnenat & Gestational age is 25 weeks 2 days my lmv is 25-12-07
i hav a similar problem in all pregnancy(problem of lessing Amnotic fluid)
Ist pregnancy supervised & detected IUGR & severe oligohydraminos(USG) at 22 weeks and the later IUD at 28 weeks.Birth weight 1.2kg,no obivious congenitial malformations and autopsy was not done.
I was detected PIH at 26 weeks and was on ALPHA METHYL DOPA 250 mg TDS & other investigation was normal.

IInd pregnancy LMP.15.5.2005 detected Hypertension at 20 weeks and is on nifedipine. On evaluation found to hav severe oligohydraminos and IUGR and reffered for targeted anomaly scan to look for the fetal pathology.
Other investigatins done are: Antiphospholipid anti body : Negative,Torch titer:Neagtive, Triple Test: i in 68,karyotype(30-11-05) 44 autosomes&2 sex cromosomes.Fetal karotype:Normal,24 hr urinary protien-203mg/24hrs,Antinuclear Anti body:+++ve Homogenous at 1:10,Anti cardiolipin anti body IgG:0.24 GPL Factor V Ledien mutation: Negative,platelet count: 276,000,APTT:31 SEC
(gone to immunology department for counselling and there was clinically no evidence of SLE.....

and when the Fetus was no more final diagnosis was that:
Fetus with Intrauterine growth retardation due to chronic placental insufficiency? secondray to Maternal Hypertension.Internal examination: there was no abnormality detected in internal organs,Placenta was shrunken, shriveled and hard,Histopathology: Multiple placental infarcts,.....

so now before my 3rd pegnancy some tests as Reproductive Immunophenotype...Natural killer cell Activity: CD3(Pan T Cell) 83.7% (63-86)CD19(B Cells) 8.6*% (3-8) CD56+CD+16+Cell9.4% (3-12) CD56 Cells 23.6* %(3-12) EStimation of CyTOkines: TH1 type cytokine estimation: TNF-594.999pg/ml (high:400-600pg/ml),Interferon assay of Latent tuberculosis: Positive for latent tuberculosis-2.209IU/ml(<0.35 IU/ml)

this is my third Pregnancy now(12.06.08) my weight is 64 kgs. B.P is 140/90, blood group is B+ve,Triple Test- Triple Test-Trisomy21 screen: Negative,NTD screening: positive>=1:50,Trisomy18 screening : Negative on 12.5.08 my AFI was approx 9.0cms but on 19.06.08 my AFI becomes 5.2cms, foetal heart rate is 176b/m.& is regular in rythm.foetal movments r sluggish.gestational age is 24 weeks 3 daysof foetus. weight is 627 gms approx. umblical cord is showing normal Cerbral ventricles r not dilated. postion of the heart within thorax is normal, foetal abdomen is normal, utres & adnexa shows no abnormality.....
But a less liquir makes my pregnancy at high risk.....
please advice me:1. how could the level of amnotic fluid could be increased ???? with the help of any capsules vaccine or any therapy.
2.did maternal hydration therapy work on me??
3. hav u got any conclusion for me that why every time amnotic fluid goes less to me in all of my pregnancy.

Please ans fast I will be thankful to u ...
At Sun Jun 22, 03:02:00 AM 2008, shruti said…

Hi doctor,
I am Shruti,age 28 years i had lost my 2 pregnancies due to lesser amnotic fluid.
now i am still pregnenat & Gestational age is 25 weeks 2 days my lmv is 25-12-07
i hav a similar problem in all pregnancy(problem of lessing Amnotic fluid)
Ist pregnancy supervised & detected IUGR & severe oligohydraminos(USG) at 22 weeks and the later IUD at 28 weeks.Birth weight 1.2kg,no obivious congenitial malformations and autopsy was not done.
I was detected PIH at 26 weeks and was on ALPHA METHYL DOPA 250 mg TDS & other investigation was normal.

IInd pregnancy LMP.15.5.2005 detected Hypertension at 20 weeks and is on nifedipine. On evaluation found to hav severe oligohydraminos and IUGR and reffered for targeted anomaly scan to look for the fetal pathology.
Other investigatins done are: Antiphospholipid anti body : Negative,Torch titer:Neagtive, Triple Test: i in 68,karyotype(30-11-05) 44 autosomes&2 sex cromosomes.Fetal karotype:Normal,24 hr urinary protien-203mg/24hrs,Antinuclear Anti body-+++ve Homogenous at 1:10,Anti cardiolipin anti body IgG: 0.24 GPL Factor V Ledien mutation: Negative,platelet count: 276,000,APTT:31 SEC
(gone to immunology department for counselling and there was clinically no evidence of SLE.....

and when the Fetus was no more final diagnosis was that:
Fetus with Intrautterine growth retardation due to chronic placental insufficiency? secondray to Maternal Hypertension.Internal examination: there was no abnormality detected in internal organs,Placenta was shrunken, shriveled and hard,Histopathology: Multiple placental infarcts,.....

so now before my 3rd pegnancy some tests as Reproductive Immunophenotype...Natural killer cell Activity: CD3(Pan T Cell) 83.7% (63-86)CD19(B Cells) 8.6*% (3-8) CD56+CD+16+Cell9.4% (3-12) CD56 Cells 23.6* %(3-12) EStimation of CyTOkines: TH1 type cytokine estimation: TNF-594.999pg/ml (high:400-600pg/ml),Interferon assay of Latent tuberculosis: Positive for latent tuberculosis-2.209IU/ml(<0.35 IU/ml)

this is my third Pregnancy now(12.06.08) my weight is 64 kgs. B.P is 140/90, blood group is B+ve,Triple Test- Triple Test-Trisomy21 screen: Negative,NTD screening: positive>=1:50,Trisomy18 screening : Negative on 12.5.08 my AFI was approx 9.0cms but on 19.06.08 my AFI becomes 5.2cms, foetal heart rate is 176b/m.& is regular in rythm.foetal movments r sluggish.gestational age is 24 weeks 3 daysof foetus. weight is 627 gms approx. umblical cord is showing normal Cerbral ventricles r not dilated. postion of the heart within thorax is normal, foetal abdomen is normal, utres & adnexa shows no abnormality.....
But a less liquir makes my pregnancy at high risk.....
please advice me:1. how could the level of amnotic fluid could be increased ???? with the help of any capsules vaccine or any therapy.
2.did maternal hydration therapy work on me??
3. hav u got any conclusion for me that why every time amnotic fluid goes less to me in all of my pregnancy.

Please ans fast I will be thankful to u ...
At Tue Jul 29, 10:19:00 PM 2008, Anonymous said…

DR. IS THERE ANYTHING THEY CAN DO TO SUBSITUTE AMNIOTIC FLUID. MY DAUGHTER IS AT 17 WEEKS AND HAS BEEN TOLD THAT SHE HAS LITTLE TO NO FLUID(AT 14 WEEKS) WE HAVE WEEKLY APPTS. BUT WERE TOLD NOTHING COULD BE DONE. I JUST WANT TO MAKE SURE WE HAVE ALL THE INFORMATION. MY DAUGHTER HAS MADE IT KNOWN SHE WILL NOT TERMINATE THE PREGNANCY AS LOG AS THERE IS A HEARTBEAT.
At Mon Aug 04, 02:16:00 AM 2008, noor said…

hi my name is NOOR i am 20 years old i had dilievered an immature 24th week baby just 2 weeks ago the baby only live for an hour this was my first pregnancy my doctor advised me to diliever the baby as the amniotic fluid was too short in my baby bag although i had no infection as emotionaly iam very sad and really want a baby i asked doctor when should i planned to get pregnant again she said just after 1 month so i just want to know how can i prevent my next pregnancy from such n horrible ending
At Wed Aug 06, 07:02:00 PM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

To Shruti June 22: Sorry,but I have just found your comments. No, there is nothing you can do to impove placental growth or function at this point in a pregnancy. I would recommend that you begin therapeutic doses of heparin or lovenox, and possibly a baby aspirin (81 mg) as well early in any subsequent pregnancies. We do NOT understand why these things happen in some patients, but history tends to repaet itself in obsterical complications. Best of luck. Dr T
At Wed Aug 06, 07:04:00 PM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

To anonymous July 29: What do her doctors think is causing the decreased fluid? Once you can tell me that, I might be able to give you my thoughts on things. Dr T
At Wed Aug 06, 07:07:00 PM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

To Noor: I am so sorry for your loss. Under these circumstances, I recommend waiting at least 4-6 months before getting pregnant again. In the meantime, you should be evaluated for the possibility of acquired or genetic thrombphilias, autoimmune disease, and thyroid disease. Recommendations for treatment may depend on the results of those tests. Did you have an autopsy done on the baby? Kind regards. Dr T
At Fri Aug 08, 11:39:00 AM 2008, noor said…

well there was no autopsy done on the baby and i had asked my dotor about what actually cause the amniotic fluid to leak out she didnt give any clear one although she said in the next pregnancy she will goin to give me antibiotics from the begning and also give patch to my baby bag at 14 or 15th week well i am so confused wether this will help me or not kindly give me some advise wether i should change my doctor or follow the same ones instruction
At Sat Aug 09, 06:21:00 PM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

To noor: It sounds like your doctor believes that you have an incompetent cervix and might benefit from a cerclage (stitch around the cervix) early in pregnancy. You might consider, not changing doctors, but getting a 'second opinion' from a specialist in Maternal-Fetal Medicine (high risk obstetrics). Best wishes! Dr T
At Tue Aug 12, 01:18:00 PM 2008, Anonymous said…

Hello Docotor,

I am almost 7 weeks pregnant and my doctor is concerned that their is not a lot of fluid around the baby. There is fluid present but he said he would like to see twice as much. The babies growth is perfect and the heart beat is steady and strong. I go back in on the 20th for a follow up ultrasound. Is there anything I can do to increase the fluids around the baby? Do you think there is any chance that this might turn out to be a normal pregnancy? Thank you in advance, Crissy
At Tue Aug 12, 07:26:00 PM 2008, LL said…

Hi. My name is Laraleigh. I am 31 weeks pregnant with my 3rd child. My oldest was delivered at 36 weeks after 6 weeks of bedrest due to preterm labor, my second was delivered at 33 weeks after 4 weeks hospital bedrest due to unexplained 3rd trimester bleeding and preterm labor. This pregnancy has been a rollercoaster ride to say the least. At 17 weeks my Maternal-Fetal specialist noticed the babies femurs were measuring short. She has continued to measure extremely small since. At 30 weeks she measured 26. Her weight is estimated at 1lb 15ozs. We also noticed that her right femur was starting to bow, although they had previously ruled out dwarfism because her growth was completely proportional, just very slow. I now have decreased fluids as well (from 10.6 to 7.6). I have been on bedrest for 2 weeks and this week have noticed her movements have slowed significantly. In addition to all of this she has a hypoplastic nose bone and some other soft markers for chromosomal abnormalities. I am a realistic person and don't expect any miracles from my doctors but they seem to have really stepped back from my case and are just letting me hang out. I haven't sought a second opinion simply b/c I am already seeing an OB- a specialist- and no one will take me on as a patient this late, even if we do decide to change doctors. I did see another set of specialists at 24 weeks but they could not give me any information other than if I were at their practice they would no longer consider the baby their patient. Anyway, I guess I just want your opinion on what might be going on and whether we should deliver the baby sooner rather than later. I have not had an amnio b/c I am high risk for PTL and don't want to put our baby at further risk. I don't smoke, drink, use drugs or anything else, nor do I live with or see anyone who does. Thanks for having a look.

-Laraleigh Forester
At Thu Aug 14, 03:23:00 PM 2008, Danita said…

Hi, my name is Danita. I am 25 weeks pregnant, and my water broke at 24 weeks. I was told today that there is no fluid around my baby, but that he is doing good. I asked my doctor about the possible complications, and he provided me with some of the same informatiom that you discussed in your postings. I guess my question is since there is no fluid now, and there is no gurantee that his lungs are developing accordingly, why not induce labor so that he can be monitored and given oxygen, etc... to assist with his breating? I am at a very reputable hospital with a level III NICU department, so I am trying to weight my options. As my water has broken I am at an increased risk of infection, so why does my doctor feel it is necessary to keep him incubating inside if it is not going to help him in the end? A friend of mines experienced the same situation and her doctor delivered her baby at 24weeks because of the same concern about his lungs not being able to develop while he was still inside. He is doing okay now, but he has a long road ahead of him in the NICU. I am a little concerned and just need a second opinion.

Thank you,

Danita
At Sat Aug 16, 06:14:00 PM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

To crissy: At 7 weeks, there is nothing you can do to affect the fluid around the baby. Find out what the next ultrasound shows and then let us know. Best of luck. Dr T
At Sat Aug 16, 06:19:00 PM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

To Laraleigh: My suggestion would have been to do the amnio despite the risk of preterm labor. The baby could have a chromosomal, syndromic, or genetic problem or simply be a normal baby with a very poor placenta. At this point we will not know until the baby is born. I doubt you will carry the baby to term because it will either put you into early labor or make you preeclamptic because it is unhappy, or develop evidence of distress and need to be delivered early. Please let us know how things turns out and sorry I cannot be of more help. Best wishes! Dr T
At Sun Aug 17, 01:14:00 PM 2008, LL said…

I was put in the hospital on Thursday for contractions and a positive fetal fibronectin. I will be here for the duration of the pregnancy most likely. My amniotic fluid is fluctuating from 10.6 all the way down to 6.6 and then back up again. So far there are no plans to deliver, but any significant change could push them either way. We won't be having an amnio simply because of the fluid and contracting. Thanks for your comment. We are waiting until her birth to find out anything else.
At Sun Aug 17, 01:43:00 PM 2008, Anonymous said…

Hi, my name is Laura and I am 37 years old. I am expecting twins via IVF. (this was our only option)I am 18w4days. I had the Quad test and it came out to 1-54 for Down Syndrome. I went in August 15th to have an Amnio done to check for sure, however during the 2nd level sono the Perinal Doctor advised that baby B had no amniotic fluid and his heart was hardened with fluid surrounding it. He advised that the baby would not survive. He advise that baby A looked healthy and did not think an amnio was needed. He advised that because of baby B condition this was probably the cause of the quad testing results. We were shocked and did not know what to ask at the appointment. Now that I have had a few days. I am worried if anything will happen to me or baby A while we wait to go to term since baby B will most likley not miscarry because of his position in the uterus.
At Fri Aug 22, 06:14:00 PM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

To Laura: You have a very good chance of carrying Baby A to good viability if not to term. The other baby probably did have a chromosomal abnormality or a major malformation that caused the demise. I am sorry for the loss and wish you the best for the rest of the pregnancy. Let us know how things turn out. Dr T
At Fri Aug 22, 06:18:00 PM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

To LL: Hang in there. It sounds like you are in good hands. I am sure your doctors will keep a very close eye on the baby and deliver if there is any evidence of fetal compromise. By the way, have you had Doppler flow studies done on the baby? Please let us know how things turn out.
Dr T
At Sat Aug 23, 07:32:00 PM 2008, Marti said…

Dr T. An update...
I posted to you back in May about my situation. I was just looking through my browers marked favorites and came across this blog again all these months later.
Shortly after posting to you, my membranes ruptured, so what very little fluid my placenta had produced leaked out. I did not however go into labor and decided against delivery at that point.
After a short stay in the hospital, I was allowed to go home and come in for weekly visits at my MFM office. My MFM dr wanted to induce at 35 weeks.
However, I went into labor on my own at 33 wks, something we were not expecting due to all my conditions. At 31 wks my baby turned head down from breech, also something we thought wouldn't happen as I had NO fluid at that point.
My son weighed 2lb 12 oz and was 14 1/2 in long. It was discovered at birth that he had 5 of 8 characteristics of VACTERLS association, but inevidably, he died after living 5 hours 43 min from pulmonary hypoplasia.
At Tue Aug 26, 05:54:00 PM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

To Marti: I am so sorry about the baby, but thank you for the update. Did the genetic counselor think this was a 'chance' event or an inheritable disorder? If they haven't given you an opinion, ask them! Kind regards,
Dr T
At Tue Aug 26, 06:59:00 PM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

To Danita Aug 14: For some reason I just got you comment today. My first question back is are you still pregnant. I acctually hope you are. There is not a week that goes by that we don't have a patient in your situation. It is a very delicate balance regarding when to deliver and when to wait. One thing we are all agreed upon is if there is clear evidence of infection, you should be delivered. However, if there is not, the baby is much better off inside of you than in the NICU. Days can sometimes make the difference between survival and not or between with few complications of prematurity and terrible long-term complications. If you are still pregnant, I hope you get another few weeks at least. And, if you have delivered, please let us know how things turned out. Best wishes! Dr T
At Wed Aug 27, 10:32:00 AM 2008, Danita said…

Update-Dr. T, it's me Danita, thank you so much for your response. I actually delivered our son on Saturday, August 23, 2008. I was 26 weeks, 6 days and I delivered due to an infection. Our son weighed 2 lbs. 9oz. and came out fighting. He has been stable since the delivery, and things are going in his favor. Of course his lungs were small in comparison to his body, so he is on a ventilator. My doctor said each day I remained pregnant gave our son a better chance of survival. We are just taking things day by day, but so far he has been a champion and is hanging in there. Again, I appreciate your response and will keep you updated.

Warm Regards,
Danita
At Wed Sep 03, 06:27:00 AM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

To Danita: I know you have lots of other things on your mind, so thank you so much for updating us. We will be pulling for all of you! Please let us know how things turn out. Dr T
At Tue Sep 30, 09:02:00 AM 2008, Anonymous said…

hi; my name is ana and i am 20 weeks pregnant; at 18 wk the dr found that i have low fluid (3 cm)and told me about all the risks; because i keep leaking, dr said it is probably a case of pprom, as the baby;s kidneys and bladder seems to be just fine; the baby is moving alot, his heart rate is good, his growth is good...; i have to make a decision this week, if to terminate or not, but i just dont know what to do; i dont want my baby to spent his childhood in the hospitals...; please help me with an advice
At Sun Oct 05, 06:41:00 PM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

To Ana: I am so sorry. This is a very difficult situation. If there is little or no fluid at this time in the pregnancy, the baby's lungs may not develop enough to be able to support itself after birth. This is called pulmonary hypoplasia. There is also a very high risk of infection for both you nad the baby. There are rare circumstances where the baby will turn out alright when this happens, but chances for that are not very good. Kind regards, Dr T
At Wed Oct 08, 04:32:00 PM 2008, Kristin Campbell said…

Hi, My name is Kristin. Last week during an ultrasound to determine the size/age of my baby (because I was measuring big) they found that I was very low on amniotic fluid. 2.5. They immediately put me in the hospital for bed rest. Over that week I went from that small amount of fluid to without any anhydramnios. Later in the week the moved me to the University of WA hospital and told me that my son has proterior urethra valve. They were going to try and do a bladder tap with a needle to check kidney function but he is in the wrong possition to do that. I know that at 20 weeks he had enough fluid but somewhere inbetween that time and 29-30 weeks the fluid went away. They have told me that the biggest concern is lung developement so they are trying to keep him in me as long as possible. I on the other hand am more worried at this point about saving his kidneys as the fluid is backing up now and compressing the kidneys. Are there any know treatments that can be done inutero? I have had atleast 9 miscarrys between weeks 4 and 8 of pregnancy. This baby is a miracle baby...and I so much do not want to lose him over have him suffer a life of dialysis, pills and kidney transplants and pain. Any information would be helpfull. Thank you so much for your time. If you need more information about his case I have some at babynels.buildingahealthylivingtemple.com
At Thu Oct 09, 09:10:00 PM 2008, Anonymous said…

Hi Dr
I am Evia....Havejust went through just went through my week 25....doc briefly said my baby is pretty "small"...weight 705g..length about 19.5cm... However,I read books and thought that weight wise is quite ok and not seems like falling into the lower 10% percetile..thus, very confusing....However, she did mentioned that there is sign a reduction in my fluid ( not abruptly though)......Things are normal during my week 21 scan...My gyane just prescribed asprin and ask me back for 2 weeks time to review.. i am sacred since my gyane like to use " harsh " words whenever explaining

Many thanks and My questions as follow:
1) chances of baby suriving assumpting i have to do an induction labour ( around week 30)
2) is this quite common?
3) I was busy moving around ( without much rest)prior to my week 25 scan.can it be one of the reasons?
4) any chances the fuld to increase-like taking more rest, more water...increase iron intake and/or take asprin to improve the blood flow.?
At Fri Oct 10, 03:03:00 PM 2008, Anonymous said…

hi, my name is lissette and my water broke at 15 weeks due to a cvs. my doctor put me in bedrest and i have been resting for 2 weeks his heart is good and he is growing ok even though there's is very little amniotic fluid around the baby. but a friend of mine was in the same situation as iam and went to tampa general hospital for a amniotic patch, a procedure in which they put a patch where the membrane has ruptured.After one week the the membrane was sealed and she regained the fluid.she gave birth at 31 weeks. so my question is that if i have the same procedure done and my membrane seals up his organs would develop fine for the rest of the pregnancy even if he was without enough liquid for 2 weeks?please let me know as soon as possible.
At Wed Oct 15, 06:02:00 AM 2008, Anonymous said…

Hi my name is Christi and I'm currently 19 wks pregnant. At 17 wks my water suddenly broke, I was immediately admitted to the hospital put on anitiobiotics and brethine. My OB/GYN has placed me on complete bedrest after 4 days hospitilization. He has since diagnosed me with an incompetent cervix. He is hopeful that if I can make it to an age of viability, 24-28 wks, the chances for baby's survival is higher. Since there is little to no amniotic fluid and an apparent weak cervix, what's the likelihood baby can survive and be healthy under such conditions.
Thanks in advance for your time. I look forward to hearing from you.
At Fri Oct 17, 07:56:00 PM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

To Christi: Carefully read my response to another reader's comment just above yours. The same concerns apply. If your baby really has no fluid around it during this very critical stage of lung develop, even if you get to a range of potential viability, the baby may not have the lung tissue to survive - this is called pulmonary hypoplasia. If you have an incompetent cervix, there is probable less than a 5% chance you will carry that far now that you have ruptured membranes and if you do, a 90+% chance the baby will have pulmonary hypoplasia. The terbutaline may also not be a safe drug to take under these circumstances because of your very high risk for infection. Best wishes to you. Dr T
At Wed Oct 22, 07:40:00 PM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

To Kristen: You might consider asking your doctors to arrange for a second opinion consultation with specialists at an institution such as the University of San Francisco who have a specialty interest in fetal surgery. Best wishes and thank you for writing. Dr T
At Tue Oct 28, 01:02:00 PM 2008, Anonymous said…

I'm sorry I did know how to get to another board other then this one. My case is a lot different from many women on here. At 21 years old I was pregnant with a little girl and everything seemed to be going well. Things sadly took a turn for the worst and my daughter Natalie was born at 23 weeks gestation. Apperantly due to an infection called ureaplaisma. (sorry if i miss spelled that.) Anyways she was born weighing only 1 pound and 8 oz. Natalie at only a day of life was breathing over the vent settings they had her on. Things for my tiny baby were go well until we got a call saying my husband needed to come in and speak to the doctor taking care of our daughter. My husband did. The doctor took him into a room and told him they had mistakenly given Natalie an overdose, but that she should be fine and that this had happend before and they just keep a close eye on the babies when something like this happends. Later on w found out that they overdosed her on Indocin. 10 times more than then what should have been given. 0.1 ml was what it should have been and it was 10 ml that was given. Things just kept getting worse and we were brought in for a small surgery. Natalie had a hole in her small intestins. (prifation of the bowel.) an infection of some kind caused her poor belly to become black. they put a line in her to drain it out. Things just didn't get any better and we were called in to Riley hospital for childern on dec 24 2006. A doctor took us into a room showing us a head scan. Natalie had IVH. A grade 4 and her outcome for her life was worse than anything we could put her through. We decided to take Natalie off life support on dec 25 2006 and she died in are arms. The hospital had admitted they are wrong for the overdose, but refuse to say it was the cause of death. I think to myself an overdose on a premature baby would kill it. it's crazy to think one day she was breathing and the next she was a blue as the sky. Natalie was my baby girl and now the doctor that wrote the order wrong gets to live his life like nothing every happend. I wonder if he even thinks about my little girl and the effect of his actions have costed us. anyway I don't know all the medical terms for the things Natalie had. I'm sorry those things are just hard to think of. Doctors try to tell you the best they can without making to confusing. I just want to know if indocin could have been the cause of everyhing and the brain bleed that ended her life. I just want some answers and I guess I'll never get it from the doctor who overdosed her. I have a lot of anger built up, although I do know doctors are human and make mistakes. it bothers me he never called, never said sorry, nothing. I tried filling a lawsuit against the hospital for wrongful death, but it would stick up. Just breaks my heart everyday. I'm sorry I just really needed someone to listen for once. My daughter lived and was a human and now that she's gone no one cares, but me. Well I'm pregnant with my 6th pregnacy. I've had 3 misscarriges and 2 premature births. my son Daniel was a 28 weeker and is 3 years old and doing great. I'm 27 weeks today. Can my new baby girl get IVH if she born now. And why would they use indocin on babies? your not suppose to take if in the third trimester. Says it's not been studied on childern under 12 years old. I'm sorry I'm done now.

Ashley Neal
At Thu Oct 30, 07:15:00 PM 2008, Mysticaldragon1 said…

Hi, my name is Lis,

I am now just 34 weeks in my pregnancy and my fluid level has been steadily decreasing in the past 6 weeks. Ultrasound 6 weeks ago showed 14cm of fluid, 2 weeks ago 8.9cm, and today 6.3 cm. Testing has been done with nitrazine strips but nothing conclusive has been found. I do have periodic feelings of fluid gushing. My OB sent me to the hospital to be induced, but the doctors on staff at the hospital didn't agree. I am also 3.5cm dilated and 70% enfaced. I am considered high risk beacause of being over 40 years of age. All these factors are seriously concerning me and I was wondering if you have any words of advice.

Thank you
At Tue Dec 02, 01:35:00 AM 2008, Anonymous said…

Hi DR,
I am bina .I am in my 36 week. during ultrasound scan and doppler they told amniotic fluid is less (2.5cm, 2.8cm)top and bottom nil. baby is 64.7mm length. they told heart is good blood flow is good. baby is in breech presentation. i would like to know about complications of delivery.??
At Tue Dec 09, 12:33:00 PM 2008, Neeru said…

Hi Doctor, Im Neeru. Im pregnant by 35 weeks and iam diagnosed with mild oligohydraminos with AFI value 8.9.Foetal measurements are BPD- 89.2, Abd circum - 285, Femoral length - 66.3 and heart rate - 140/min, foetal weight is 2254+/- 338gms. What is the significance of the following parameters? whether my baby will do fine and what should be the line of the treatment if at all required?
At Wed Dec 17, 07:50:00 AM 2008, bmoreno@bulloch.k12.ga.us said…

Hello, my name is Bobbi.

I am almost 23 weeks, and my doctor says that my little boys right kidney has a blockage, and for some reason he cannot see the left kidney. He said it could be fetal positioning. I have a normal level of amniotic fluid, and I have to go back in 2 more weeks so that the doctor can see if he sees the left kidney. He would not tell me worst case scenario, but I feel like I need to know so that I can be prepared. I have one 3 year old daughter with no problems during or after that pregnancy. What may have caused this, and what happens now?
At Wed Dec 17, 07:20:00 PM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

To Ashley: I am not sure how to respond to this because there are so many things that need an explanation and so many questions I would have myself that not even you can answer at this point. I will say this, I am very sorry for all you have been through. Unfortunately, little babies such as Natalie are at risk for ALL of the complications you described even if she had not gotten an "overdose" of indomethacin. Survival under the best of circumstances at 23 weeks is no more than 30-50% and more than half of those babies who do survive will have very serious complications related to prematurity the rest of their lives. Regardless, the indocin was probably used because she had a condition called "patent ductus arteriosus." The ductus arteriosus is a blood vessel that helps the baby bypass blood from the lungs while it is in the womb. Babies obviously do not need their lungs to work while they are inside anyway. Normally, shortly after birth, the ductus arteriosus closes on its own and the blood that should go from the heart to the lungs begins to do that. Very premature babies like Natalie usually have a very hard time pushing blood through their lungs so the ductus wants to stay open, worsening the condition for the baby. Your baby also developed a condition called necrotizing enterocolitis (the black bowel you mentioned). This is also a very common condition in extremely premature babies who cannot handle the colonization of the bowel with bacteria that normally occurs after birth or the food they are given because of the immaturity of the bowel. This resuklts in blood vessels to the bowel that may become clotted off, killing that protion of the bowel they were supposed to be carrying oxygen to. It is possible this was aggravated by the indocin, but there is no way to be sure of that at this time. Your baby also had a severe intraventricular hemorrhage. These occur because the blood vessels in the fetal brain are also very fragile and can rupture easily in very premature babies. This condition could have also occurred spontaneously or been the result of the other complications that she had. With all the terrible complications Natalie had, if she had survived, she probably would have suffered the rest of her life, but even knowing that does not make her loss any easier under the circumstances.

I just wanted to say that with your history of recurrent premature deliveries, you should be evaluated for cervical incompetence if you have not already been. Any baby born prematurely is at increased risk for the problems Natalie had, but the earlier, the greater that risk is. My heart goes out to you and best wishes for your current pregnancy. Dr T
At Thu Dec 25, 05:02:00 PM 2008, Anonymous said…

Dear Doctor T,

This is Ashley again Natalie's mom and I wanted to say think you for the note. things have been going well and I thought you might like an update on my current pregnancy. I do have weak cervix and a cerclage was placed at 18 weeks. I have been doing well up until last night when I started having contractions 6 minutes apart. I was taken to the hospital where they gave my tribluten. Or however you spell it anyways it work and stopped the contrations. I am now 35 weeks and 3 days. My ob Doctor says she will deliver baby at 36 weeks if I can just hold on for 4 more days. Not to sure why she won't let me deliver seeing as I'm this far along and I was given a shot at 31 weeks to help with the lungs. Anyways other than that today I've been having a horrible pain down there and am not sure whats going on since I have never been this far before. Oh did i get to tell you that we are having a girl!! How sweet is that. anyways just wnated to update you and I'll be sure to check back here and there. Thank you for you time.

Sincerely, Ashley Neal
At Wed Jan 14, 09:41:00 AM 2009, Anonymous said…

Hi my name is noor

i am 19wk pregnant and by an ultrasound my doc came to know that i have less than adequate amniotic fluid and in the end she written on my ultrasound card APPEARS S.F.D fetus, ADV: FOLLOW UP AFTER 2-3 WKS for E.D.D+ doppler for further evaluation

i am very confused tell me is this somthing very serious
At Sat Jan 24, 04:17:00 PM 2009, Angela said…

Hi, my name is Angela.

Im 18 and Im 31 weeks pregnant. When I was about 24 weeks pregnant I took the quad Screening test and it came out abnormal. when they look at it more closly they didnt see anything worng. and scedualed me for another ultasoud a few week later. When I went for the ultrasoud they said i had low fluid at about a 6-7. 2 weeks later it went to about 10 and stayed there. my doctor still keeps a close eye on my fulid. she tells me it in the normal range but low normal. She has now schedualed my appointment for twice a week and nonstress test every visit. yesterday on my appointment she put me on bed rest but not restricted jus as much as possible. She tells me that there is a chance that i will have to have a cesearn, depending on the fluids. i just need some advice. Is thIs something really dangerouse I should really be worring on? and If I do have a cesarean what can be wrong with my baby?
At Sat Jan 31, 04:27:00 AM 2009, Anonymous said…

Hi Dr. Trofatter,
Can I get some advice from you regarding a complicated amnio I had Wednesday, 1/28? I saw you answer the questions on this board and my doctor won't call me back. I was wondering...Should I just wait and rest and not worry about the pain in my lower abdomen or should I get it checked out immediately? I have read that women with an amnio like mine, where the doctor does multiple needle insertions and their uterus contracts during the procedure have a higher risk of miscarriage after the procedure. Is this true and should I be extra vigilent since this happened to me? I'm scared too that the baby might have been poked by the needle and injured. Is there a chance that infection can occur inside the sack without a fever, and just abdominal pain? The doctor jabbed me three times with the same needle, with my uterus contracting, and I'm just freaking out. This seems to be very rare, since all I see and hear about are people that say how painless and easy the amnio is, that's why I decided to do it in the first place, even though my risk for a baby with a chromosomal defect was extremely small. I only did this because of my age, 36, and am now regretting my decision. I'm so scared for my baby because until I had the amnio, my pregnancy was going great, and the measurements were all normal. Now after the amnio I've been feeling pain in my lower abdomen, inside, for two days. I'm scared too because I've seen women who have miscarried up to a week after having an amnio due to complications from the procedure.
I hope you're able to see this and answer my questions. Thank you so much for your help and I look forward to hearing from you. Take care, Stephanie
At Sat Feb 07, 02:37:00 AM 2009, chandy said…

Hi, my name is chandy and i am 29 years old. Recently my baby girl was stillborn at 40 weeks and 6 days. I was being monitored by the hospital's fetal-maternal unit in the last week as I felt less fetal movements on a couple of days. I had three CTGs in the last week, the first two were normal but in the last one the following was noted:

Baseline 150bpm.
Variability - Normal
Accelerations - Present
Decelerations - Occasional variable down to 140 bpm lasting up to 90 sec associated with uterine activity. Biophysical and API attended.

The following were also noted in the Biophysical profile :
Breathing - Seen
Movements - Seen
Tone - Present
AFI - 4.07

I was sent home after being told the baby was fine. I never got a proper explanation of these finidings. Could you please explain these and should I have been immediately induced due to these findings? My baby died on the night of this abnormal CTG. We are completely devastated.

An autopsy revealed that there were no abnormalities but there was evidence of hypoxia. The following comment was made about the placenta:

"Poorly vascularised, immature placenta. Old infarct with old intervillous thrombus at placental margin. No evidence of inflammation."

Could you please explain what this means? Could this have contributed to my baby's death? Is this likely to occur in future pregnancies? Is there any precautions (medicines etc.) we can take to ensure a healthy placenta?

Thanks.
At Thu Feb 12, 11:51:00 AM 2009, dottie47591 said…

Hi my name is Dottie and my step daughter is 19 weeks pregnant and her water broke last night they said that the sack is completely empty she has had 2 miscarriages due to her cervix not being thick enough they have her on bed rest and the babies heart rate is been 132 to 142 just wondering if there is anything to suggest to the doctors or what to do she started bleeding real bad last night and it has slowed down any suggestions would be greatly appreciated!!!!
At Wed Mar 04, 04:50:00 PM 2009, Stephanie said…

Hi my name is Stephanee - I'm currently 24 wks pregant and have almost no fluid. My baby suffers from LUTO with cyst on his kidneys. His blocked bladder is now producing little or no urine. My dr. has stopped the wkly bladder taps and amnio infusions, based on the last urine results and the cystic kidneys. The explained that it was not safe to go in and infuse fluid wkly for such a poor probablity for a baby born with severe renal failure. Is this true??
At Tue Mar 31, 01:14:00 PM 2009, Anonymous said…

I am 29 years old. At the onset of my second trimester I started experiencing headaches. At first they were manageable but they began to grow progressively worse. When I was 18 weeks pregnant I "got sick." I was achey and was running a fever that avaraged 101. I was given a Z-Pak perscription and my symptoms went away; however my headache bcame so severe that I could not even go to work. By the following Thursday my headache was so bad my husband took me to the emergency room. I was also again running a fever that averegared 101. At that time they gave me pain medicing and told me my LFTs were very high and to follow up with my obgyn. The next day I went to see my ob and she referred me to a general practitioner to see if they could figure out what was wrong with me. It seemed that I had a "virus" but it wasn't flu. The general practitioner admitted me to the hospital and ordered a neuro consult for the headaches. For the the next 7 days I remained in the hospital and received IV fluids, antibiotics, steroids. My headaches were so bad that I was put on a pin patch which did not releive the pain so I was also given other narcotics orally and through an IV. On the day I was admitted a sonograph was performed and I was told that the baby was fine. THroughout my hospitalization the baby ms moving around and continued to have a normal heart rate. During the hospitalization 2 spinal taps were performed and countless blood tests were performed. At no point could any doctor tell me what was wrong. THe most anyone could say was that I was suffering from pregnancy related migraines and I had some unknown virus. I was released from the hospital on a Friday. The following Wednesday i went to my ob for a follow up and sonogram. After the sonogram I was told I had little to know amniotic fluid and that I would have to deliver my baby. I was 21 weeks at this point. Labor was induced and my baby was stillborn two days later.

Do you have ANY ideas as to why I lost all of my amniotic fluid. Do you have ANY ideas as to what was affecting me or if the baby was infecting me? You comments are greatly appreciated.
At Thu Apr 02, 07:58:00 AM 2009, Rex said…

We are 18 weeks pregnant and just told yesterday that there is an absence of amniotic fluid around the baby except for a small pocket of fluid. Everything else seems fine - the heart rate is good, there are 2 kidneys, a bladder, lungs, the placenta is doing what its suppose to do. the Dr. did an amniotest and from that does not think the water broke. We have 2 doctors recommending termination of the pregnancy to minimize the health risks to my wife and they are saying that there is next to zero chance of the baby's survival even if we continue with the pregnancy - mainly because the lack of fluid would hinder the baby's ability to breath on its own.
We are obviously going through a difficult time of what to do. What could happen to my wife if we continued the pregnancy? If the water didn't break and the baby's kidneys seem fine, why would this be happening? Is there any chance of fluid being produced later? Are there other tests that can be done to confirm how or why the amniotic fluid has gone? We are so at a loss of what to do. We just keep asking ourselves - what if we've missed something?
At Fri Apr 10, 08:11:00 AM 2009, Chit V said…

hi dr, my name is chit. i am not sure if you have replied to lissette oct 10 post. i am 40 yrs old and in an almost similar situation as hers. this is my 4th pregnancy and the first 3 were delivered ok via caesarean section.

my water bag broke at 18 weeks and doctor advised full bed rest. i have done just that and am now in my 21st week. my husband and i want to continue with the pregnancy since my son's heartbeat has been very normal throughout, but we are aware of all the complications that may occur with my son's development and outcome at 1.5cm fluid thickness.

i had read in your previous posts that my baby at this stage is a lot better off inside me than in an incubator. my question is if there is such a thing as using an amniotic membrane patch thru surgery to seal off the hole in the amniotic sac and refill the bag with fluid, and if there is, how effective is it in normalizing my pregnancy and baby's development?

thank you very much and more power to you!
At Wed May 20, 08:57:00 AM 2009, Anonymous said…

Hi Doc, my name is Gigi, I was just told this morning my sack is smaller than the baby. I am 33 years old I have a five year old son. This is my second pregnancy. I have slight bleeding the last two days, the doctor said its old bleeding no fresh new bleeding. I asked if I had an infection or something he did'nt think so. I don't know if he'll send out my urine for testing, he didn't check with me on that. Is this the same problem I've been reading about low amniact fluid? I also had the the IUD no hormone for 10 years, cooper, for abou four years I took it out in January and got pregnant March 23 or about that. How serious is this I am having more testing at 12 weeks,Which will test for abnormalities, which is in two weeks from now. Thank you for your time.
At Wed May 27, 10:06:00 AM 2009, Anonymous said…

Hello Dr. Trofatter,
I was 20 weeks when I found out that my amniotic fluid was 9 to which I was prescribed bed rest. I quit my job and started staying at home. I also started drink 5 liters of water every day till my next ultra sound which was last week (I am 24 weeks now). I was disappointed to find out that the fluid levels had dropped to 7.6. The baby’s vital organs were fine but I was asked to come again in 2 weeks. I have also been advised to take a low dosage of aspirin to increase the blood flow to the placenta (my internet research tells me aspirin is not good for pregnancy). My question to you is how can I make amniotic fluid go back up again? I want to travel back to the USA? How risky is traveling in my current state? Is safe to take aspirin? What’s the worst I can expect? Thank you for your articles, they have helped me a lot
At Thu May 28, 07:54:00 PM 2009, Danita said…

Hello Dr. T--it's Danita. I originally posted a comment on your blog on August 14, 2008. I just wanted to give you a quick update. My son who was born at 26 weeks 6 days, and weighed 2 lbs. 9 oz. is now a healthy 9 month old. I was told like many of the other women that my baby probably wouldn’t make it. I was admitted to the hospital at 23 weeks after my water broke, and I was immediately placed on bed rest. I continued to leak fluid, and eventually after a week I did not have any fluid surrounding my baby. I was nervous, scared, and honestly confused by all of the facts that were being presented to me. I just wanted to let you know that I truly appreciate the encouragement that you provided to me as well as the other women that have, or are experiencing these difficult times during what is supposed to be the happiest time of our lives. You were honest, and gave me a sense of hope. After spending 4 long months in the NICU we finally got to bring him home in December of 2008. My son left the hospital a healthy baby with no medication, no oxygen--nothing. This is the same baby that I was told probably would not make it…I just had to share my journey, and my experience. I would like to send my condolences to the women on this blog who have experienced a loss. I have experienced that pain, and I know it is a very emotional time. I want to tell those same women along with all the other women on the blog to keep their faith strong. I know it is hard--- I’ve been there…but I wanted to share my story with all of you. I am not here to give you false hope, but maybe I can give you hope period. Dr. T— keep doing your thing!

Thank you again,

Danita
At Sat May 30, 01:16:00 PM 2009, Anonymous said…

Hello Dr. T,
My name is Jazmime. I am 27 yrs old and I am currently 22 weeks pregnant. I was diagnosised with no amniotic fluid at 18 weeks. My doctor offered to do a blue dye test to determinet the cause but I declined that since it would not change the prognosis he gave me or the condition of the baby. My doctor provided me the following options: induce my labor, go to a clinic for a D&E, or c-section at 24 weeks to see if the baby could make it on it's own. He gave my baby less than a 5% chance of making it and if for some reason she did make it, she would suffer from major health issues/deformaties. I do not want my baby to suffer or have a low quality of life. I lost my first child to anacephaly and remember how difficult of a labor that was. I had a horrible reaction to the drug they gave me to induce and was running so high of a temp that they had to put ice packs all over me. I was in labor for 16-18 hrs. I thought that since the first time the process was so difficult that I would opt for a D&E procedure. Well I went to the clinic and could not go through the procedure. My intution and conscious would not let me carry out the procedure. I was so upset at the thought of what they may do to me and my baby that I started to an anxiety attack and threw up. I went back to my doctor and ask that he induce me at 23 wks. He is no refusing to deliver me stating that I am too close to 24 weeks and hospital policy will not allow him to induce me. Do you have any suggestions for me? I am worried about my health and what will happen to me baby. I feel VERY strong about not returning to the abortion clinic and allowing them to take away my baby's diginity. Can I let nature take it's course without putting my life at danger? Please help
At Sun May 31, 01:13:00 PM 2009, Anonymous said…

dear Doc T,

my name is mya and I lose my fluid about 2 weeks ago. I am very upset because everyone keeps telling me to terminate at 22 weeks. However, he has a heartbeat, a working bladder, two kidneys and his lungs are going I can also feel him moving. Please, please give me some advice of what I should do. I refuse to terminate at this time as long as he's willing to live inside I will give him a chance. Tell me my options and defects that I'm in store for.
At Tue Jun 30, 08:54:00 PM 2009, Mary said…

Howdy, I am a 42 yr old mother of three awsome kids. I am currently 24wks by LMP with my 4th pregnancy. Last pregnancy was 10 yrs ago.

Early screen came back with very poor scores for Downs. An amniocentis with "fish" was performed at 14 wk based on lmp of 1/09/09. "She" was found to be genetically normal - no Downs! She looked very healthy on ultrasound on exam immediately prior to amnio with ample fluid for the test and kidneys were confirmed to be normal and functional. Ultrasounds since have continued to confirm proper growth and no physical abnormalities. Her heart rate holds steady at 155. My BP holds constant at 120/70. (I'm normally 110/70) I have no cramping or bleeding.

Complications of anyhydraminos set in almost but not quite immediately following the amnio and continued according to ultrasound from week 15 - week 19, Slow leak from rip during amnio is presumed but not confirmed. OB has performed visual exam but no nitrozine strip test. At week 20 fluid unexplicably returned. By 21 weeks it was just above olioghydraminos levels and holding.

Although everyone said I would miscarry during those anhydraminos weeks and explained the fatal nature of lung damage from lack of fluid, same specialist are now indicating there is some chance of survival. Either she will breath and be fine or she will lack airsack in the lungs and just not breath, dying within minutes to hours after birth. (Don't get me started on my story about trying to find a late term abortionist that I could get access to, there arent any in the DFW area!) Do you have any ideas why the fluid came back or what the chances are it will just disappear again? I do not have the amnio on cd/tape and couldn't see the screen well while I held still for the procedure. Could this have been more than just a rip in the uterine wall, could a needle puncture to the fetus cause this? Could the removal of an incorrect level of fluid cause this. Could contamination of my blood into the amniotic sack cause this ( I am O neg. and there looked like there was some blood in the sample collected) I was told I should not take preventative antibiotics as there was no proof of infection, but I know I have had infections in the past that didn't make me sick... I lived with nasty tonsils for years without being sick.... I have basic test for auto immune disorders and hormone imbalances during first 6 weeks but no problems found, should those be retested? Do you have any odds for survival at this point?

THANK YOU FOR THIS ADVISE COLUMN... it is the best of so very few sources of information on this problem.

Mary
At Thu Jul 23, 05:53:00 AM 2009, amanda said…

hi my name is amanda and i am now 2days from being 28 weeks pregnant. at 20 weeks my doctor couldn't see the sex of the baby and sent me to a high risk doctor. the high risk doctor found that i had low amniotic fluid AFI=0.9 due to the baby having cysts on the kidney. they found very little fluid around the heart but heartbeat and chambers are great looking. there is an echogenic bowel. they had told me that it didn't look to good for my baby right about now. when i went back to the doctor at 27 weeks my amniotic fluid had rose to an AFI=3.2 he didn't seem concerned anymore about the kidneys now he is just concerned that the lungs are a little bit to small. i am getting admitted to the hospital next week. i was just wondering even with steroid injections is it possible that my baby will have a good outcome of all this?? please answer!
At Thu Aug 06, 03:01:00 PM 2009, Skd004 said…

Hi, my name is Samantha and I am currently 19 weeks pregnant and about a week ago the doc told me that I had little to no fluid around my baby and they suggested that I terminate my pregnancy and I really want my baby, is there anything that I can do and also they refuse to admit me in the hospital until I am at least 23 weeks. They think that I have a small leak. What should I do?
At Tue Sep 15, 11:15:00 AM 2009, Nelly said…

i know i am not posting it in the right place,but hope its ok. here is my story.

I am 20 yrs. old, my husband and I had been trying to have a baby for a year and half...then we became pregnant with clomid. Everything looked great, the baby was growing and we were both healthy. Never had any bleeding or cramps.Even got to find out we were expecting a baby BOY...we were really excited! Then at 5 1/2 months...I had started to feel like i had a stomach bug...just upset stomach, and had to go to the restroom, slight backache(have good tolerance to pain)...on a friday night, but then it went away after a couple of hours. I fell asleep, saturday nothing, sunday nothing, sunday night,...the same thing came back again...same symptoms...so I thought i would go in to the hospital, better be safe than sorry. When I got there they checked me and apparently I was 4 to 5 cm dialated. The pain started to become little by little more and more pain. They tried to stop the contractions with all the meds they had, they even gave me a steroid shot. After 4 hours I was already 10cm and in major pain, i gave birth to my 22week old son. He, the water bag still intact, and the placenta all came off together at once...I delivered everything...then the babys bag was broken once he was out.

I thought that I just had a stomach bug becuz my husband had that like 4 to 5 days before this happened. The only thing i had when I was pregnant was always a low backache, heavy normal discharge, heavy feeling of hips, the baby was always really low, sometimes felt like the baby would come out. The doctor said it could have been a placental abruption, incompetent cervix, or an infection that they couldnt detect. They checked for infection but nothing. My high blood pressure was normal, just a slight fever(nothing to worry), no bleeding. He said that he thought that it was more than likely a placental abruption...since the placenta came off, but i never had any symptoms of placental abruption, and when he checked the placental, it was normal...there were no traces that an abruption occured. As for an incompetent cervix, he told me there could be a little chance, but that he dosent think so cuz typically women with that dont contract or feel contractions and when they come to the hospital they are already 10cm. So what do you think it could possibly be....a PLACENTAL ABRUPTION(even though i had no symptoms,no bleeding and placental analysis came back normal)? An INCOMPETENT CERVIX? An INFECTION? Or just a FLUKE? Sorry for the long story.
At Thu Oct 01, 05:11:00 AM 2009, Kenneth F. Trofatter, Jr., MD, PhD said…

To Nelly: Your story is MOST consistent with an incompetent cervix. You may have had an underlying bladder infection that was not detected that initiated cervical change, but most women with even that will not have the rapid cervical change you describe. MOST women with cervical incompetence WILL have contractions, especially after the cervix has dilated and effaced so that cannot be used to rule out the diagnosis in your case. I would strongly recommend a consultation with a specialist in MFM before you get pregnant again so that you are aware of your options for evaluation and treatment during pregnancy. You might also consider having a sonohysterogram done as well to look for evidence of uterine anomalies. I am sorry for your loss and best wishes.
Dr T
At Thu Oct 01, 08:53:00 AM 2009, Nelly said…

Thank you Dr. for writing back to me. I think that it is an incompetent cervix too cuz during all my pregnancy i had alot of discharge,i mean a lot, always had a low backache,heavy feeling of the hips, and baby was really low, sometimes it felt like his feet were out of my cervix,literally, and those are all the symptoms for an incompetent cervix. The doc said that all that is normal for a pregnancy!?!?!?! I didnt seem to think so! They had checked me and said i did not have any symptoms indicating a bladder infection so they had ruled that out. The doc thinks it is placental abruption cuz the placenta came out prematurely, but i did not have no symptoms of placental abruption. Plus, i dont know if my doc knows or not cuz he was not there for the delivery, he got there after everything happened. Well, my baby came out so quickly except his head, he came out feet first. The nurses were trying to get his head out, i didnt know at first, but my husband said his head was stuck for like a minute.So, i have read that when you have hard and fast contractions like that and when the uterus gets small so quickly cuz the baby came out with a full bag of water(not popped), the placenta comes of as soon as the baby gets out....so that could have been the reason the placenta came off. The uterus could have thought that the whole baby came out and cuz of all the rapid contractions, caused the placenta to come off as soon then, when they got to take the baby's head out, the placenta came with it. Yet, the doc was not there and i dont think he knows that so then he probably thinks it is a placental abruptionm but he gets baffeld becuz the placenta looked normal no abruptions....the only thing he mentioned was that it seemed(cant remember if he said for sure or seemed) like there were tiny blood clots in the placenta, but nothing of concern to have caused me to go into preterm labor that quick and like that. I dont think it was preterm labor, cuz preterm labor causes you to contract a lot then causes u to dilate, when i got to the hospital i was barely starting to have contractions that i could feel, like only 45min that i had weird discomfort and pain in the house til i went to the hospital, and when they checked me i was already 3-5cm...(i say 3-5 cuz when two nurses checked me they said i was 4-5 somewhere there,but the doc said he has in his papers 3, yet he was not there during none of that time). I wasnt in major pain when i got there, yet i was already dilated that much!?!?!?!Once i was there the pain was starting to get more intense.... So do you think it could have even remotely possible been placental abruption(even though i had no symptoms, normal lookin placental)(the only basis of my doc to determine that, was the placenta came off prematurely, but does not know that my child's head was stuck!)?
At Sun Oct 11, 09:44:00 AM 2009, justmike2880 said…

My girlfriend is a diebetic and pregnant she has other medical issues such as kidney and heart disease as well. Her doctor told her last week that since her previous c section 2 years aga has still not healed all the way that there may be a promblem since she has low amniotic fluid. What could happen if the amniotic sac were to break before she was at full term or like right now? The doctor put her on bed rest but she wont slow down and I am concerend thst if something were to happen that it could kill her and/or the baby. What are all the heath risks that this could potentially take affect in this situation. Please help me.
At Sun Oct 18, 06:26:00 PM 2009, Kenneth F. Trofatter, Jr., MD, PhD said…

To Nelly: It could have been an abruption primarily, or secondarily as the result of an ascending infection as a consequence of premature cervical change associated with an incompetent cervix.
Dr T
At Sun Oct 18, 06:32:00 PM 2009, Kenneth F. Trofatter, Jr., MD, PhD said…

To justmike: You didn't tell me how far along she is and if she is having any other problems such as superimposed preeclampsia. The c/section from two years ago has to be "healed" as much as it is ever going to heal, so I am not sure why the doctor thinks that is related to the decreased amniotic fluid (unless he/she suspects a placenta accreta at the site of the previous uterine scar. I am more worried that your girlfrined has a poorly vascularized placenta as the result of her long-standing, poorly-controlled diabetes and subsequent kidney and heart disease. The doctors might be able to determine this by Doppler flow studies if they haven't already. If the baby is having to shunt blood to its brain to survive, it will shut down blood flow to its kidneys, thereby making less urine (that's what most of the amniotic fluid is). Please let us know what you find out and how she does. Best wishes.
Dr T
At Sat Oct 31, 12:05:00 PM 2009, Anonymous said…

Hi my name is Jennifer.

I am 20wk 6 days pregnant and have been diagnosed with oliohydramnios. I had a fluid level a week ago of 2cm when they were doing an initial ultrasound. I was transferred to a perinatologist where we did an amnio four days later with almost no fluid accountable. They amnioinfused 240cc of saline in and took out 60cc for testing. I went back in two days later to find out we only have 1cm of fluid left out of all that placed in. I believe i am leaking fluid as does my doctor, but he says there is nothing we can do at this time. I also found out the two sac layers that are supposed to fuse have not and there is fluid in between them. This is my third pregnancy with the first two perfect all the way to the due date. I am confused, scared and wondering what to expect in the future to come..
At Sat Nov 07, 12:32:00 PM 2009, Anonymous said…

Hi, I'm Laura. I'm 40 years old and pregnant with my second child.

When I went in for an ultrasound at approx. 18 weeks gestation, it was determined that my baby was measuring small and I was dispatched to a prenatal specialist. I saw them at about 20 weeks gestation with the following results from their ultrasound:
*Low amniotic fluid (I wasn't told how low)
*Hyperechoic bowel
*Smaller than expected fetal size

An amnio was done and the two viruses tested for (toxiplamosis and something else) both came back negative. Also negative for Trisomy 13, Trisomy 18 & Trisomy 21. What other conditions should I ask my doctor about? I'm going back to the prenatal specialist on Monday and would like to be prepared with as much information as possible.
At Wed Jan 13, 05:07:00 PM 2010, Rob Volmer said…

My wife was diagnosed with Anhydramnios or no Amniotic fluid when she was 13 weeks pregnant. Despite undergoing numerous experimental procedures including trying to afix an amniopatch, there was never a significant reaccumulation of fluid. Today we was a beautiful and healthy 3 year old boy despite what the doctors said! There is hope, I am happy to walk you through the different options that are out there and share best practices with you. Feel free to email me at rvolmer@crosbyvolmer.com and take a look at our web site that shares Sebastian's story www.godsmiracleofsebastian.com
At Thu Jan 14, 04:26:00 PM 2010, Kenneth F. Trofatter, Jr., MD, PhD said…

To Rob Jan 13: Thanks for sharing your story. The key to your child's survival was that there was some fluid - not complete anhydramnios - and he continued to void throughout the pregnancy. I am very glad things turned out well. Under those conditions, I always tell folks I do not have a crystal ball! Many times the outcome is poor, but miracles do happen. Thanks again!
Dr T
At Tue Jan 19, 08:48:00 AM 2010, Blue Moon Technologies said…

HiDear Doc T,

My name is Pooja, I m 30 years old, 14 weeks pregnent, my ultrasound reports says, the

amniotic fluid volume is decreased (the sac volume is smaller than the size of the embryo),

rest the growth of the fetus is corresponding to 14 weeks pregnancy. First i had mis-

abortion in 8weeks due to no fetal activity. Doctor says to follow up ultrasound in 18-20

weeks. Please advice how the fluid gets increased, what can be done..

Eagerly waiting for your valuable advice.
At Wed Jan 20, 06:44:00 PM 2010, Kenneth F. Trofatter, Jr., MD, PhD said…

To Pooja Jan 19: The most common reasons for very decreased fluid are premature rupture of membranes, a poor placenta (either small or separated from the wall of the uterus - a placental abruption), or a fetal urinary tract abnormality preventing the production or egress of urine. Was there any fluid present?
Dr T
At Thu Jan 21, 11:13:00 AM 2010, Blue Moon Technologies said…

Hi Dear Doc T,
Thanks for your reply. yes ultrasound report says fluid is not absent but its very less. The doctor has prescribed me to take ARG 9, asprin, sustain and to follow up in 18 weeks ultrasound. As according to the doctor the growth of the fetus is corresponding to 14 weeks pregnancy but the amniotic fluid volume is decreased (the sac volume is smaller than the size of the embryo). According to them its a rare case of pregnancy. Pls. suggest what test or any other thing can be tried out.

Regards pooja
At Sat Jan 30, 04:14:00 PM 2010, Kenneth F. Trofatter, Jr., MD, PhD said…

To Pooja: i would suggest a MSAFP test at about 16 weeks and then the careful ultrasound your doctor has recommended at 18-20 weeks. They might also consider Doppler flow studies on the uterine arteries at that time. Further evaluation will depend on findings at that point so let us know and then I might have some other thoughts. Best wishes again!
Dr T

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Amniotic Fluid - 4 - Consequences of Decreased Amniotic Fluid

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