Assessment of Amniotic Fluid Volume in Diabetic Pregnant Women during the second and third trimesters using ultrasound

Abstract 

The objective of this study is to assess the amniotic fluid volume in diabetic pregnant women during the second and third trimesters and to identify the effect of diabetes mellitus on amniotic fluid volume . Fifty diabetic pregnant women in the second and third trimesters which undergoing ultrasound exam in the department at Elskaikh Fadul and Elsoudy hospital at Ommdurman. All diabetic pregnant women were in the second and third trimesters, and were scanned by (3.5 MH) convex probe , using (Sonoscape) machine. Ultrasound assessment of amniotic fluid volume by measuring the amniotic fluid index referring to (Phelan method) and measuring the single vertical pocket referring to (Chamberlian method) . The result showed that (13) noncontrolling diabetic pregnant women which was (26%) had polyhydramnios while (37) controlling diabetic pregnant women which was (74%) got an average amniotic fluid volume . The main finding of the study was the polyhydramnios assosciated with noncontrolling diabetes that mean the diabetes mellitus had an effect on amniotic fluid volume . This research showed that there was a strong correlation between the amniotic fluid volume and glucose level which indicated that the amniotic fluid volume increased as a result of increasing of glucose level directly. Finally this study showed that the measurement of amniotic fluid volume by two methods using ultrasound and compare it with the type and status of diabetes play a great role in explaining the effects of diabetes mellitus on pregnancy 

Table of contents

Dedication………………………………………………………….. i

Acknowledgement…………………………………………………… Ii

Abstract …………………………………………………………… Iii

Abstract in arabic……………………………………………………… V

Abbreviations…………………………………………………….. Vi

List of tables……………………………………………………… viii

List of figures…………………………………………………… Ix

Table of Contents……………………………………………….. X

Chapter one

1-1 Introduction ……………………………………………….. 1

1-2 The problem………………………………………………… 3

1-3 Objectives…………………………………………………… 3

1-3-1 General objectives…………………………………………… 3

1-3-2 Specific objectives…………………………………………… 3

1-4 Overview……………………………………………………… 4

Chapter two

Literature review……………………………………………….. 5

2-1 Anatomy …………………………………………………… 5

2-1-1 Amnion and amniotic cavity ……………………………….. 5

2-1-2 Amniotic fluid(liquor amnii)……………………………….. 5

2-1-3 The amniotic sac………………………………………….. 6

2-1-4 Chorion and chorionic cavity……………………………….. 6

2-2 Physiology……………………………………………………….. 8

2-2-1 Fetal urine…………………………………………………… 8

2-2-2 Lung liquid………………………………………………….. 8

2-2-3 Fetal swallowing……………………………………………….. 8

2-2-4 Intramembranous absorption………………………………… 9

2-2-5 Functions of amniotic fluid ………………………………… 9

2-2-6 Normal amnioticfluidvolume……………………………… 10

2-3 Ultrasound assessment of amniotic fluid volume……………. 11

2-3-1 Subjective assessment………………………………………. 11

2-3-2 Quantitative assessment …………………………………… 11

2-4 Ultrasound technique of amniotic fluid index…………………… 13

2-5 Pathology………………………………………………………. 15

2-5-1 Oligohydramnios ……………………………………………. 15

2-5-3 Birth defects……………………………………………….. 18

2-5-4 The risks of oligohydramnios ……………………………… 20

2-5-5 Amniotic fluid band syndrome(AFBS)………………………… 21

2-5-6 Polyhydramnios ……………………………………………… 21

2-6 Ultrasonography ……………………………………………….. 24

2-7 The maternal signs and symptoms of polyhydramnios……………. 26

2- 8 Complications of high fluid level………………………………… 26

2-9 Congenital anomalies…………………………………………… 27

2-10 Diabetes mellitus…………………………………………………. 30

2-10-1 Insulin deppendant diabetes mellitus…………………………. 30

2-10-2 Non insulin deppendant diabetes mellitus……………………. 30

2-10-3 Gestational diabetes mellitus…………………………………. 30

2-10-3-1 Detection…………………………………………………... 31

2-10-3-2 Glucose tolerance test…………………………………….. 31

2-10-3-3 Risk factors for the development of gestational diabetes mellitus. 31

2-10-3-4 Effects of diabetes on pregnancy………………………….. 31

2-10-3-5 Maternal risks……………………………………………. 31

2-10-3-6 Fetal risks……………………………………………….. 32

2-10-3-7Macrosomia………………………………………………… 32

2-10-3-8 Advantages of ultrasound in diabetic pregnancy………………. 34

2-10-3-9 Amnioreduction…………………………………………………. 35

2-11 Previeus studies…………………………………………….. 36

Chapter three

Methodology……………………………………………………… 39

Chapter four

Results…………………………..…………………………………. 42

Chapter five

Discussion………………………………………………………….. 54

Conclusion…………………………………………………………. 57

Recommendation ……………..……………................................... 58

Data collection sheet……………………………………………. 59

References………………………………………………………. 61

Appendixes……………………………………………………….. 64