Nishimwe was almost six months pregnant when she suddenly experienced severe swelling of her entire body. At first, she ignored the signs mistaking them for normal pregnancy changes, but she later went to see a doctor when the swelling persisted. “The doctor said I didn’t have enough blood and gave me pills to boost my blood count. He was wrong about the diagnosis because my condition only worsened and a few days later, my baby stopped kicking,” the mother-of-two narrates. She had to seek additional consultation and her state became an emergency when the doctors discovered that her amniotic fluid had dried up. An emergency C-section was recommended — a procedure that almost cost her her life but consequently, claimed that of her newborn baby. Amniotic fluid is the liquid that surrounds and protects an embryo while it is growing in the uterus. However, when this fluid is low or dries up, it can cause grave effects for the mother and the unborn baby. WHAT CAUSES THE CONDITION? Dr Pasteur Mberimbere, a gynaecologist/ obstetrician at University Teaching Hospital of Kigali, says that foetal urine is the major source of amniotic fluid production, and foetal swallowing is the major mode of resorption. Initially, the fluid is comprised of water produced by the mother at around 20 weeks’ gestation, however, this is entirely replaced by foetal urine, as the foetus swallows and excretes the fluid. Mberimbere says the foetal kidneys produce 1 to 1.2L of urine per day (when the woman is about to deliver) and that foetal lungs also produce a small amount of liquid that contributes to the amniotic fluid volume. What leads to low amniotic fluid, or for the fluid to dry up, however, is a state caused by a number of factors. Low amniotic fluid volume, also termed as oligohydramnios, is caused by pathologies that affect foetal kidneys and, therefore, impair the foetal urine production (renal or urologic abnormalities), according to the gynaecologist. He, however, notes that one can think of fluid leakage or increased vaginal discharges, or maternal dehydration as some of the other factors. Medics warn that when amniotic fluid begins to leak during pregnancy, it can increase the baby’s risk of experiencing a birth injury. And that although it can at times be difficult to determine if a woman is really leaking amniotic fluid or another substance (such as urine or vaginal discharge), it is important to consult a doctor if this happens. Dr Yvonne Butler Tobah, a gynaecologist, indicates that when one has a low amniotic fluid, what happens next will depend on the cause, severity, the baby’s gestational age, the mother’s health and that of the baby. She notes, a mother’s water breaking, the placenta peeling away from the inner wall of the uterus (either partially or completely before delivery), certain health conditions in the mother, such as chronic high blood pressure, use of certain medications, are some of the factors that can induce low amniotic fluid. Mberimbere supplements her view saying that foetal anomalies, on the other hand, can cause excessive amniotic fluid volume (polyhydramnios). These can interfere with swallowing and the major mode of resorption. These anomalies, he says, can include neurologic or gastrointestinal anomalies, upper gastrointestinal obstruction (oesophagus, duodenal, or small bowel atresia, central nervous system abnormalities, and other genetic conditions that cause hypotonia). POSSIBLE EFFECTS When an expectant mother experiences a leakage or loss of amniotic fluid, there is a possibility of a miscarriage, it can also result into slowed foetal growth, premature birth or in worst-case scenarios, a stillbirth. Mberimbere reveals that because foetal lung development requires a sufficient amount of amniotic fluid, the absence of amniotic fluid leads to pulmonary hypoplasia — incomplete development of the lungs. The baby, hence, may experience abnormal foetal heart rate activity. When it comes to the signs and symptoms that one can look out for, he says there are no specific signs for this condition apart from those detailed on ultrasound. It is the ultrasound machine used to clinically determine amniotic fluid volume. With it, the abdomen of a pregnant mother is divided into four quadrants, and the depths (measured in centimetres) of the deepest pocket are added together, he explains. Tobah notes that no treatment has been proved effective long term. But the short-term improvement of amniotic fluid is possible and might be done in certain circumstances. She also highlights that if one has a low amniotic fluid and they are 36 to 37 weeks pregnant, the safest treatment might be delivery. If a woman is less than 36 weeks pregnant, their health care provider will review the baby’s health, discuss the cause of low amniotic fluid and recommend monitoring the pregnancy with foetal ultrasounds. “If the mother is about to deliver, the treatment would be delivery. Correction of the condition may be achieved by amnioinfusion (infusion of normal saline solution into the uterine cavity through a catheter), this practice is not universal,” Mbarimbere says.
