Understanding Low Amniotic Fluid In Late Pregnancy

My last two doula clients were both induced due to a diagnosis of Oligohydramnios – low amniotic fluid. I have heard many of my students report that they were induced for the same reason, or that it was a very big concern for their care provider. I decided it was time to really understand the ins and outs of this condition.

What is amniotic fluid?
By the 12th day after conception, the amniotic sac will start to form. Within this protective barrier lives the baby, the placenta, the umbilical cord and the baby’s amniotic fluid. The amniotic fluid is a clear, slightly yellowish, odorless substance. At the onset of pregnancy, as the amniotic fluid starts to build in the amniotic sac, it comes from the mother. Over time, the fetus adds to the supply of amniotic fluid through a shedding of skin cells, along with floating stem cells and the baby’s own urine. As the baby breathes in and ingests the fluids, it urinates them out, and this is the basic cycle that continues until the baby is born.

What is the importance of the amniotic fluid?

The amniotic fluid has many roles. For one, it acts as a buffer or cushion should the mother slip or experience jerky, jarring movements. The baby is basically floating around in this big sac of fluid, so should the mother stumble, the baby will not likely feel the impact. This “floating” idea also helps protect the baby from compressing its umbilical cord, which would deprive the baby of oxygen and put the baby in distress. This pool of fluid also gives the baby room to move, which helps the baby build muscle tone and a strong skeleton, protecting it against infection.

Amniotic fluid is also important with regard to the healthy development of the lungs and gastrointestinal system. When there’s little fluid (in the case of a congenital abnormality of the bladder or missing kidneys, for example) the trachea and other respiratory structures don’t mature, indicating that the pressure and nature of the fluid is important in these organs’ growth. Because the lungs are one of the last systems to emerge in fetal development, fluid levels may be a greater concern earlier in pregnancy, especially when there is a premature rupture of the membranes.

What are the concerns with “low fluids”?

Low fluids can be of concern because there will be a higher likelihood of cord compression during labor. As discussed above, the fluid helps keep the baby buoyant.

Low fluids can be an indication of other problems, such as:

*Kidney or urinary tract issues for the baby
*Pre-eclampsia, diabetes, or high blood pressure for the mother
*Partial abruption of the placenta
*PROM – Premature Rupture of the Membranes
*Intrauterine Growth Restriction (IUGR)

How is it measured?

Amniotic fluid is measured with an ultrasound. The technician measures the fluids in 4 quadrants of the uterus and adds the measurements together to see how many centimeters of fluid are in the uterus. The AFI or Amniotic Fluid Index rates the fluids, with 5 cm being too little fluid and 25 cm being too much.


What can be done if this condition is suspected?

In the US, oligohydramnios is a complication in 0.5-5.5% of all pregnancies, and severe oligohydramnios (meaning less then 400 ml of fluids) is a complication in 0.7% of pregnancies. Oligohydramnios is more common in pregnancies beyond term because the AFV (Amniotic Fluid Volume) normally decreases at term. It complicates as many as 12% of pregnancies that last 41 weeks and longer. According to Anne Frye, in Holistic Midwifery “If abnormal quantities of fluid is suspected, assess the situation over the course of several prenatal visits; fetal growth spurts and lags as well as fluid volume are not always consistent from week to week in normal pregnancy” The “wait, see and re-asses” approach may be helpful in determining what kind of reaction is necessary.

Also, since dehydration may be a cause for the low fluid levels, you might ask your care practitioner if you can hydrate and return the next day to be retested.

Another option is an amnio-infusion, which reintroduces fluids into the amniotic sac. During labor, the doctor can pass a catheter through the cervix and add a warm saline solution. This is helpful if the concern is cord compression.

A similar approach can be used if the mother is not already in labor and it is too early to induce her. The doctor can perform an amniocentesis to reintroduce fluid into the amniotic sac. Although oligohydramnios often returns soon after this procedure, it can help your doctor visualize the fetal anatomy and accurately determine fetal development.

The final solution for oligohydramnios is to induce labor.

Final food for thought: a study from The Johns Hopkins Hospital which discusses the outcome of births with suspected low fluids.

Low Levels of Amniotic Fluid No Risk To Normal Birth

Doctors may not have to deliver a baby early if it has low levels of amniotic fluid surrounding it, Johns Hopkins obstetricians report.

In a study to be presented Feb. 7 [2003] at the annual meeting of the Society for Maternal-Fetal Medicine in San Francisco, researchers show that babies born under such conditions fared similarly to those born to women whose wombs held normal amounts of amniotic fluid. No significant differences were found in the babies’ birth weights, levels of acid in the umbilical cord blood, or lengths of stay in the hospital.

Typically, doctors have been concerned about women with low levels of amniotic fluid during the third trimester – a condition called oligohydramnios – because too little fluid can be associated with incomplete development of the lungs, poor fetal growth and complications with delivery. Amniotic fluid is measured by depth in centimeters. Normal amounts range from 5 to 25 centimeters; any amount less than 5 centimeters is considered low.

“These study results are very surprising – they go against the conventional wisdom,” says Ernest M. Graham, M.D., senior author of the study and assistant professor of gynecology and obstetrics. “Amniotic fluid stems from the baby’s urine, and the urine results from good blood flow, so if we see low fluid we assume there probably is not good blood flow and the fetus is compromised. This study shows the fluid test is not as good as we thought, and there is most likely no reason to deliver the baby early if other tests are normal.”

The researchers studied 262 women (131 with oligohydramnios and 131 with normal amounts of amniotic fluid) who gave birth at The Johns Hopkins Hospital between November 1999 and July 2002, comparing the babies’ health at birth. Patients with oligohydramnios were delivered sooner, but were less likely to need Cesarean sections. Babies born to moms with isolated low amniotic fluid were normal size and were at no increased risk of respiratory problems, immature intestines or brain disorders.

Study co-authors were Rita Driggers, Karin Blakemore and Cynthia Holcroft.

Abstract # 318: Driggers, R. et al, “Are Neonatal Outcomes Worse in Deliveries Prompted by Oligohydramnios?”

This entry was posted in Understanding Low Amniotic Fluid In Late Pregnancy and tagged by Deb. Bookmark the permalink.

About Deb

Debra is a graduate of the Boston Conservatory of Music with a degree in Musical Theater. She has spent most of her life performing and was introduced to yoga through a choreographer in 1997. After several years as a yoga student, she decided to continue her education and became certified as a Bikram Yoga instructor. In 2001 Debra headed out to Seattle to study with renowned prenatal yoga teacher Colette Crawford, R.N., at the Seattle Holistic Center. Debra has received a certificate for Vinyasa Yoga from Shiva Rea, with whom she continues to study. Debra has also been certified in the Maternal Fitness Method with Julie Tupler. In 2004, Debra completed the OM Yoga advanced teacher training with Cyndi Lee. Debra currently studies with Cyndi Lee, Genevieve Kapular, and Susan "Lip" Orem. After being witness to several "typical" hospital births, Debra felt it was important to move beyond the yoga room and be present in the birthing room. In 2003, Debra attended her first birth as a DONA certified labor support doula. In that short period of time, Debra has attended about 40 births. She is continuously in awe of the beauty and brilliance of birth. Most recently, Debra received her certification as a Lamaze Certified Childbirth Educator. Drawing on her experience as a prenatal yoga teacher, labor support doula and childbirth educator, Debra looks to establish a safe and effective class for pregnancy and beyond.

30 thoughts on “Understanding Low Amniotic Fluid In Late Pregnancy

  1. I was diagnosed as having oligohydramnios because my unborn baby girl has one kidney and it’s cystic. If you know of a perinatologist that is willing to perform an amnioinfusion during the 20th week of pregnancy in the Washington, DC metro area please contact me at 240-401-2627 her life depends on it. Thanks so much

  2. Hi Melissa

    I am very sorry to hear about your situation with your baby. I have a colleague in the DC area that may be able to help you. She is studying to be a midwife and has been a doula and prenatal yoga teacher in that area.

    Here is her info:
    Kathryn Haines
    Certified Doula
    Certified Prenatal Yoga Instructor
    Website: http://empoweredbirth.typepad.com/
    Email: diamou@earthlink.net
    Cell: 202-257-8007

    I hope everything works out for you and your family.

    Most sincerely,
    Deb

  3. Amniotic fluid levels can be determined in the second trimester. Your care provider will likely not show much concern about the fluid levels unless you are measuring small, have a leakage of fluid or a decreased awareness of your baby’s movement.

  4. Hi my name is Kristiana. I had a amniocentesis done when I was 17 weeks. I started leaking fluid. I am 22 weeks and still leaking. I am on bed rest and the dr gave me two options. To continue pregnancy or to terminate it. My reading for my fluid was at 2cm. Then a week later went up to 6cm. Our concerns are if there was any damage done because of the low fluid readings.

  5. Hi my name is Kimberly. Im seven weeks pregnant and i have low amniotic fluids does my fluids have a chance of being increaseing and should i be relly concern. And i have one question at what stage during pregnancy does the fetus kidneys start to grow. I know the are seen on and ultrasound around twenty weeks.

  6. I was looking up information about insufficient amniotic fluid because today is my youngest son’s 21st birthday. I was unaware until after delivery that I didn’t have any amniotic fluid. My son was born around 32 weeks, but he was 7 lbs. and 2 ounces without any complications, other than jaundice.

    I was on Breathine,(unsure of the spelling), on the early onset of my pregnancy and a previous C-section.

  7. Hi …Even i had a amniotic fluid less issue but with god’s grace,i am mother of beautiful daughter now…We found amniotic fluid when we went for scan after 20 weeks.Fact is ,when we hear about this issue ,i was shocked,depressed and i was not aware what to do …( i think every one feels same when you hear bad news) … As every one does , i checked all internet sites ,blogs etc etc but rather than
    reducing my worry ,most of content increased my worry.Hence , today i thought to comment on such issues first time so that i can give little courage and reduce tention of pregnantladies facing same issue. If you are readin my comment now then i “assume”,you may have read reason for amniotic fluid issue on other websites too.so i’ll not discuss reasons here.Below is my experience/suggestions which i would like to shares with all pregnant ladies who has less amniotic fluid issue

    * First thing to remember is stop worrying and try to concerntrate on happy moments.Your baby will be healthy even in amniotic fluid issue but something worst will happen to baby due to your worries/tentions/sadness.
    * My amniotic fluid was always less than 10 (below 5th percentile) from 20weeks onwards .Doctor told me not to worry and adviced me to take lot of water ( i used to drink 1 glass after every 1-2 hour) and take healthy food.
    * Also doctor adviced me to do bed rest ,avoid walking/excercise..If you are in sitting on chair then try to keep your legs on table or other chair.
    * Doctor told me to go for scan every month to keep an eye on amniotic fluid.As per doctor , it will temporarily increase amniotic fluid.My doctor told , at any stage if fluid become less than 4 then she would perform delivery.In 8th month, my fluid became very low around 7 Since My doctor did not want to risk baby’s development due to less amniotic fluid issue,doctor recommended to take amino acid through vein (just like glucose) for 5 days (means one bottle every day) .
    * I read on one web site that taking non-veg items like eggs /meat (type of meat which are recommended in pregnancy) will also increase amniotic fluid.It worked for me ..my level did not increase but it became stable at 11.May be it is co-incidence but there is no harm in trying.

    Friends, at last i would like to say that I am not a doctor, i am just like you all.Keep in touch with your doctor regularly for this issue (rather than blogs/websites) .For any doubt ,don’t hesitate to consult doctor .STOP worrying, it will affect your baby.Less amniotic fluid does not mean that something bad/worst will happen to your baby,there are lot of ladies out there which had same issue but now they are celebrating life everyday with their healthy babies.Soon you will be one of those !!!

  8. Ok I love the comment above because today I received news that my amniotic fluid was at level 7. I recently began a steroid for hyperemesis and it has worked but now im wondering if taking the steroid caused me to leak because its only been a month since my last u/s nd there wasn’t any concern. Now im concerned about preterm labor nd what this means. What causes u to leak nd how fast does it usually occur. I all ready intake a lot of water nd fluids… please someone help trying not to stress but my concern for the safe arrival of my second born is really important.

  9. I am almost 38 weeks pregnant and have been closely monitored my entire pregnancy for fetal growth restriction. My last ultrasound they said my fluid was 5.23. Now my doctor wants to induce me saturday. I was planning for a natural birth. My doctor now wants to use pitocin to induce and refuses to use a more natural, less invasive approach. I just feel so unsettled because everything else during my ultrasound looked great, dopplers and the baby has grown nearly 2 lbs in one week. Can you give me any advice?

  10. Hi Cailey,

    Thank you so much for reaching out and asking your question. I can hear your frustration with the situation. Can you ask your doctor for a bit more time and to retest you the next day? In that time. try to hydrate as best you can. You can keep using the questions- Am I ok Is the baby ok? Can we have more time? If either you or baby is not ok. I would recommend following the advice of your care provider.

    Hope this helps and you have a wonderful birth!

    Sincerely
    Deb

  11. Hi ladies!
    unkown housewife yur suggestins r good, bt plz can anyone tell me … Im 36 week pregnant, n my amniotic fluid is 3.5 , now my doc is talking about c-section, im really afraid of operation…can anyone help me??

  12. Hi, I’m currently 38 weeks and 2 days. I found out today that my amniotic fluid levels are at 5. I was advised to drink plenty of water and come back in 5 days time for a check up. I was planning on a natural birth so needless to say I would prefer to not get induced.
    Is there any other advise that you have for me? Do I need to limit moving around i.e. stop working (I have a desk job so not physically draining at all)?
    Thank you in advance,
    Jenny

  13. Hi Jenny

    While a 5 for amniotic fluid is rather low and I can understand you concern. I think the advise you were given is on target- keep hydrated and then get reevaluated. I don’t think you need to limit your movement. But what does your care provider think?

    I sincerely hope your fluid levels rise and you can have the birth you desire.

    Most sincerely
    Deb

  14. I am 34 weeks and have been on an amniotic fluid roller coaster for two weeks. My fluid dropped to 5 at first I was admitted and out in IVs and strict bed rest. My fluid went up to 9 so they released me. Next day next ultrasound 3.1 level of fluid back in the hospital this time for two days of strict bed rest and 5/6 liters of IVs. Tomorrow I go back again for measurement and at some point I just want to meet my little princess and get off this rollercoaster. Drained from it all. The baby is strong in all her testing can they just induce her? I am worried that there maybe something working with her gastrointestinal organs and we can’t tell because there isn’t enough fluid in ther to see accurately! What should I say to my dr?

  15. Hi Maria,

    I hear your concern and frustration and am truly sorry you are going through this. I would have to say, that I understand why your doctor has not induced you and is keeping a close eye on your fluids. While it may seem logical to want your daughter out so you can see what is happening with her development, it is really the most beneficial to her to continue to let her gestate in your body for as long as possible.

    I recommend speaking to your doctor about your concern and let him/her explain the thought process behind his/her choices so that you can feel better about the care you are receiving.

    I hope the rest of your pregnancy can be more easeful.

    Most sincerely
    Deb

  16. hi i am 29 weeks and have this problem 2 weeks ago my level was 6.1 this week 5.2 got another scan in 2 weeks but worried it will drop again i am being moniterd tho as babys heart is dipping now and then really hope to reach a 36 plus week mark before induction :(

  17. My wife was 9 days past due when we had her levels tested 5.4
    Dr. reading test told me that was low and he would have induced a week ago. When or Dr. got report She told my wife that level was ok and would induce by Wed. two days away. Well the next morning my wife woke up and did not feel baby moving. We where in car and at birth center within 20 mins. No Heart beat from baby. We crossed street to hosptial, same no heart beat. My wife hade lost or son that night.

  18. I lost my baby nearly birth. Dr. said, due date will be in 3rd week of Jan 2013, before due date, i can make normal birth. Regular checked up on 1st Jan, Dr. said Ok, but on 2nd Jan, in the morning, I felt that no movement, I seem that my baby is sleeping cause morning time, he sleep regularly and the other things I was thought that nearly deliver, movement will be less. But I checked with Dr. again on that day. When I was clinic Dr. heard the heart beat but make sure to take ultrasound. But ultrasound results was no heart beat. So shocked for me. Check again ultrasound the next day, its show lack of amniotic. Why happen like that? I have so many questions. Why there is lack of amniotic fluid during 3 weeks. Cause I took last ultrasound on 19th Nov 2012. Its showed normal . Regularly check up with Dr. on every week. Why Dr. can’t know if there is less or no fluid. Can Dr. know or nor while she check and listen the heart beat of baby in my regularly check up.

  19. Hi,

    Thank you for the article. I was at the doctors office today who said my fluids were very low (5,5) and that I should be induced today. During the physical exam she was also moving around her finger which hurt quite a bit, I wasn’t sure what that was for since my last appointment where I met my other doctor, he did not do the same movements. When I got up I felt a trickle of water but didn’t think much of it until I got home and I noticed blood tinged mucus. I’m 37+4 weeks into my pregnancy and I really want to have a natural birth, with no induction. I told her I would think about it, my husband was there as well. She said I could have another ultrasound in two days to check the fluids but I have a really bad feeling about my appointment today, I feel like the doctor wants to push me into having an induction and whatever she did during the examen felt really wrong. After having read a lot about low amniotic fluids I feel like being at 5,5 isn’t really an emergency since I have had a very uncomplicated pregnancy in general with no diabetes or pre-eclampsia or anything like that, that might cause issues to the baby or me. What would you advise me to do at this point?

    • Hi Maria

      I understand your concern about not wanting to be induced. I would advise keeping an eye on the fluid you are leaking. It is not uncommon after vaginal exams to have some bloody discharge. However, if it continues, you should notify your care provider. She can check to make sure your membranes are not ruptured. I would also suggest hydrating very well for the next two days and seeing if that changes your amniotic fluid levels at the next ultrasound. This is often a good solution for low fluid since dehydration can be a cause of a low fluid reading.

      It sounds like today’s visit was very disappointing in terms of your care providers support. I am sorry to hear that. You can also request not to have more vaginal exams prior to labor since they don’t really reveal that much useful information. Even if the doctor discovers your cervix is or is not dilated, that is not going to change things or predict when labor will start.

      Hope all turns out how you want it to.

      Happy birthing! :)

      Deb

  20. Hi, the Dr told me today that my fluid was was low, it’s 5.2, I bursted in tears, its all too much to handled, I was just told 2days ago there was fluid around my baby heart. Going for fetal echo tomorrow. I just want everything to be right for me and my baby. I just pray all is still well till tomorrow when I go for my appointment. Am really scared

  21. Hi,

    All throughout my pregnancy I was measuring small, but this did not overly concern me as my mother was told the same with me and I was just fine. (She too had low amniotic fluid an had a c section with me). At 37 weeks I had an ultrasound which showed that my baby was small but my fluid levels were “normal”. I was told to return in 2.5 weeks for a second ultrasound just to be sure everything was fine and that the baby was growing. At my second ultrasound, it was discovered that I had “no” fluid left and that my baby had not grown since the last ultrasound. Thankfully I was already 2 cm, having some contractions and my baby passed the stress test, allowing me to have him naturally. The pediatrician checked him over at birth and he seemed to e just fine. A few days after we took him home, we noticed that his left arm and cheat muscle had less muscle tone and his left had was skeletally smaller than his right… The rest of his body is symmetrical. He also has vitiligo which is a white patch of skin/hair on his head. My limited research showed that vitiligo can happen due to stress… We have also recently discovered and are now actively massaging to correct, that he has congenital torticollis. Having explained all of this, my question is “could all of these symptoms be related? Could they have happened due to low amniotic fluid during those last few weeks?” His left hand looks like it is only a few weeks behind in development from his righ hand…

  22. My wife is 33 weeks, and at two separate u/s’s this week, 5 days apart, had 5.5 cm AFI and one pocket over 2×2. The Dr. is saying he wants to give the baby steroids and deliver this week. We of course said no. The baby is otherwise healthy. The issue is not the kidneys or bladder. He is unsure why she has low AF, but wants to induce and c/s now. The baby is also still breech. We want to take the baby to term, but are scared about defects or death due to cord compression. Thoughts?

    • Hi Erik

      I am so sorry to hear you are in this position. It is no doubt scary to face such decisions. Usually I follow the three question rule when it comes to asking for more time on any given issue. Is mom ok? Is baby ok? If so- can we have more time? Given there is a concern if baby is ok because of low fluid on two separate checks, I would have to say it may be time to trust your doctor. You did choose this person because you believed that if things strayed of the “normal” path that this person had the expertise you were looking for. I know this is a hard decision. I will be thinking of you and your family and sending loving energy your way.

      Most sincerely
      Deb

  23. Ok I’m 32 wks and on friday my af was 8. I went to l&d this morning and my af was 5.3. I feel that is a big change in 2 days. I Drink 16 glasses of water per day. Now dr. Wants me to double my intake of fluids. I see my doc again next friday. While i was at l&d. They had me Drink 2 quarts of water. I’m confused because i should not be dehydrated. Doc let me go home saying my levels had increased. Plus I’ve been on bedrest since 21 wks due to cerlage placement. I’ve had highblood pressure occasionally and gestional diabetes. At least I’ve had the steroids shots for lung development.

  24. Hi, m 29 weeks, n AFI 6.6 doc told me complete bed rest n take water like crazy..l m too afraid that could complete my days of pregnency? :( suggest me if I could do something else for improvement of fluid? N m still leaking once in a day… Thnksss …

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