In the early part of the second trimester, your baby starts to swallow amniotic fluid and eventually excrete it as urine, which is then swallowed again; the full volume of this fluid is recycled every few hours. Baby hence plays a key role in determining the amount of fluid that should be contained within the sac. However sometimes things can go wrong - either too much or too little fluid accumulates in the sac. Both situations then go on to become problematic pregnancies!

Too much fluid (Polyhydramnios)

Excess fluid has its own share of problems. If your uterus is larger than it should be for its time, you experience unusual pain in the abdominal region, you suffer increased back pain, have shortness of breath and swelling in your lower limbs, your doctor will do an ultrasound to confirm or rule out this possibility. An ultrasound is the only way to check on your fetus since it becomes difficult to feel the baby through all the fluid.

What causes it...

For mild polyhydramnios, the cause cannot be determined but for the more severe version the reasons are several:

• Maternal diabetes

• Carrying more than one baby

• Placental problems

• Baby has certain abnormalities

• Baby is not able to swallow the fluid

A high resolution ultrasound to check for abnormalities and possibly an amnio to test for genetic disorders will be arranged. Regular ultrasounds and nonstress tests becomes mandatory for the remaining part of your pregnancy and even during labor to keep track of mum's and baby's health

What it can lead to...

• Premature labor

• Umbilical cord prolapse (c-section is imminent)

• Baby is not able to stabilize its position due to too much room

• Premature membrane rupture

• Placental abruption when water breaks (c-section is imminent)

• Postpartum hemorrhage or heavy bleeding after delivery

Possible solutions

1. Maternal diabetes can be sorted out by controlling glucose level.

2. Temporary solution is to drain off some of the excess fluid by abdominal amniocentesis but the procedure needs to be repeated

3. If baby does indeed have swallowing problems, your baby may need to undergo corrective surgery to rectify the problem soon after its birth

Too little Fluid (Oligohydramnios)

Insufficient fluid has serious repercussions. It most commonly happens in the final trimester, more so if the woman is overdue. If your uterus is smaller than it should be for its time, your doctor is able to feel your baby very easily, a scan to check on fluid levels and baby will be arranged by your doctor.

What causes It...

The problem, the stage of your pregnancy and the level of fluid will determine your baby's situation. Insufficient fluid may indicate that baby is having problems with its kidneys and bladder and secondly it could also mean your placenta is not functioning to capacity. The causes are several:

• Chronic high blood pressure

• Maternal diabetes

• Lupus

• Preeclampsia

• You had a baby with restricted growth previously

• You are leaking fluid

• Placental problems e.g. partial abruption

• Fetal problems such as poor growth or genetic abnormality

• or if you are past your due date (you will need to be induced)

What it can lead to...

• If you are near term, labor will be induced; low levels of fluid in the last weeks are often given as reasons for inducing labor

• If your pregnancy has not progressed enough, the next step will largely depend on how your baby is faring.

• If you have a severe condition, for example preeclampsia or if your baby is not coping well, you will need to deliver early.

• Otherwise it is considered safer to wait until baby is more mature before inducing the labor

• Baby will be monitored closely via ultrasounds and nonstress tests; you will be advised to do fetal kick counts and to drink plenty of fluids

• If fluid level is very low, warm saline solution will be pumped steadily into the sac through your cervix to reduce cord complications

• For very low level of fluids, you may be given epidural to cope with the very painful contractions

• C-section may be the inevitable route if your baby is not able to cope with the pressures of labor