Echogenic Amniotic Fluid on Perinatal Outcome
Condition: Amniotic Fluid; Disorder
Study type: Interventional

Summary: 
      Amniotic fluid is the liquid that surrounds a developing fetus in the amniotic sac and is
      usually clear to pale yellow in color. Amniotic fluid composition is complex with many
      maternal and fetal constituents. It is mainly formed from fetal plasma volume, fetal urine,
      fetal respiratory system, gastrointestinal tract, umbilical cord, and fetal surface of the
      placenta. The composition of the Amniotic fluid changes with the gestational age with an
      average pH of 7.2 and specific gravity of 1.0069-1.008
    

Detailed description: 
      The sonographic appearance of amniotic fluid has been described as both anechoic and
      echogenic. The clinical significance of echogenic amniotic fluid remains undetermined.
      Increased echogenicity of the amniotic fluid may represent meconium. The presence of
      echogenic amniotic fluid at term on sonography is uncommon. The presence of meconium, blood
      or vernix caseosa in amniotic fluid may cause echogenicity.

      The existence of meconium in amniotic fluid raises concerns about fetal well-being, the
      ability of the fetus to tolerate labor, or, most importantly, the risk of fetal/ neonatal
      demise . For these reasons, obstetricians tend to increase the frequency of prenatal visits
      to assess fetal well-being with non-stress tests or biophysical profiles (when there is no
      other indication for them), and even to induce labor when amniotic fluid is echogenic. On the
      other hand, elective induction of labor at term carries risks such as increased rate of
      cesarean section, uterine rupture or unexpected neonatal prematurity.

      The presence of echogenic and dense particles in amniotic fluid on the ultrasound scan
      mimicking the view of a snow-storm in the third-trimester pregnant women is a cause of
      concern in antenatal management. that high-density intra-amniotic particles were possibly
      related to vernix caseosa, intra-amniotic bleeding, and meconium.

      Although the most commonly reported cause of particulate or echogenic amniotic fluid was
      vernix caseosa, the reason for concern for the obstetricians in the case of intra-amniotic
      particles is its potential relationship with meconium as well as fetal compromise

      . Free-floating dense particles in the amniotic fluid were also related to lung maturity and
      it was hypothesized that the source of these particles could be different in each trimester.
      The concerns for the presence of meconium-stained amniotic fluid in the case of an amniotic
      sludge may lead the obstetricians to elective induction in term pregnancies before the labor
      starts spontaneously which also increases the potential complications and caesarean rate
    

Intervention name(s): Significance of Echogenic Amniotic Fluid on Perinatal Outcome
Intervention type(s): Behavioral
Intervention description(s): To estimate the nature of echogenic amniotic fluid.and To overcome unnecessary intervention due to turbid amniotic fluid, assess neonatal outcome and estimate gestational age at time of delivery in patients with echogenic amniotic fluid.
Intervention model: Sequential Assignment
Masking: None (Open Label)
Primary purpose: Supportive Care