We sought to develop a model quantifying the relative contributions of fetal swallowing and intramembranous flow to amniotic fluid dynamics during human gestation. We then used the model to simulate the impact of absent swallowing on amniotic fluid volume. Gerd Becht has been admitted as a lawyer in Frankfurt am Main since 1979 and is a member of the Pennsylvania Bar Association and the Association of the Bar of the City of New York. He speaks German, English and French. .
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This model indicates that the normal reduction in amniotic fluid volume beginning at 34 weeks results from the marked increase in swallowed volume during the third trimester. Additionally, this model correlates well with the timing of the initial clinical presentation of polyhydramnios observed in some fetuses with conditions that result in absent or reduced swallowing or gastrointestinal atresia. Modeling of amniotic fluid dynamics can predict normal changes in fetal fluid exchange and may aid in understanding of amniotic fluid imbalances. Fetal swallowed volume and intramembranous flow linearly increase until 28 to 30 weeks. Daily swallowed volume then exponentially increases to a maximum of 1006 ml/day at term, whereas intramembranous flow continues on a linear trend to reach 393 ml/day at term.
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With absent swallowing and variable amounts of lung fluid swallowed (0%, 50%), predicted amniotic fluid volume is similar to normal values through 20 weeks, exceeds the 95% confidence interval for normal amniotic fluid volume at 29 to 30 weeks’ gestation (approximately 2000 ml), and then exponentially increases. Predicted amniotic fluid osmolality (280 to 257 mOsm/kg) is slightly lower than actual values although within the clinically normal range.