Abstract
Abstract Swallowing of amniotic fluid by late gestation fetuses increases when amniotic fluid volume (AFV) is elevated. Our objectives were to quantitatively characterize fetal swallowing when AFV is elevated above normal to polyhydramniotic levels and to explore the mechanisms that mediate these changes. Late gestation fetal sheep were studied under basal conditions and during intra-amniotic infusion of lactated Ringer's solution. Control AFV averaged 631 ± 214 mL (SE, n = 6), swallowed volume was 299 ± 94 mL/day, and there were 5.7 ± 1.8 bouts/day of rapid swallowing. During intra-amniotic infusion, AFV (3065 ± 894 mL) and daily swallowed volume (699 ± 148 mL/day) increased (P < 0.05) and the number of bouts reached a maximum of 13.7 ± 2.0 bouts/day when AFV exceeded 1500 mL. Unexpectedly, the volume swallowed per bout (57.3 ± 5.8 mL, n = 102) did not vary with AFV (r = 0.023, P = 0.81). Neither the number of swallows/day nor the volume/swallow changed consistently with elevated AFV. Daily swallowed volume increases and reaches a maximum of twice normal as AFV approaches polyhydramniotic levels. Mechanistically, the increase in swallowing was achieved primarily by an increase in the number of bouts of swallowing per day rather than the expected passive increase in volume per bout. This implies changes in fetal behavior as AFV was elevated. Furthermore, swallowed volume was four times more sensitive to increases in AFV than reported previously.