National Institute of Child Health and Development Conference summary: amniotic fluid biology--basic and clinical aspects.

This report summarizes the National Institute of Child Health and Development sponsored conference on amniotic fluid (AF) biology, held 28-29 September 1999, in Detroit, Michigan. National and international investigators with expertise in AF biology addressed the regulation of AF volume and composition as well as the clinical aspects of interpreting fetal health and well-being from AF indices. A major purpose of the meeting was to consider future directions and opportunities for basic and clinical research which focus on understanding the physiology and pathophysiology and providing therapeutic interventions for abnormalities of AF volume. To achieve this, the workshop participants addressed the current state of knowledge, recent scientific advances and priorities for major questions for which answers must be sought. The fact that it is not known whether AF volume is regulated or what volume-regulatory mechanisms might be involved is a major problem that needs addressing. In the later half of gestation, potential AF volume-regulatory pathways include the two major inflows into the amniotic compartment, i.e. fetal urine and lung liquid, and the two major outflows, i.e. fetal swallowing and intramembranous absorption. If AF volume is regulated, then this must occur through regulation of intramembranous flow, because the other three flows are regulated by the fetus to meet fetal needs. Regulation of AF composition is similarly unknown. In clinical practice, a variety of ultrasonographic indices of AF volume are used, but the relationships of these indices to AF volume have not been determined, nor have their dependency on fetal size, shape or position within the uterus. Further, although aberrations in AF volume both above and below normal are associated with increased fetal and neonatal morbidity and mortality, the predictive utility of the various AF indices remains low and there is little consensus on which is best utilized under conditions of oligohydramnios, normal AF volumes, or polyhydramnios. Further, various clinical AF therapies remain largely experimental and their optimization and utilization need exploration. This report is a condensation of the views presented by the conference participants.