Abnormality of amniotic fluid and cord
- 1. Amniotic fluid and umbilical cord
- 2. Amniotic fluid Origin : the sources of amniotic fluid is thought to be both fetal and maternal . It is secreted by the amnion , especially the part covering the placenta and umbilical cord. Some fluid is exuded from maternal vessels in the decidua and some fatal vessels in the placenta .fetal urine also contributes at the 10 wks.
- 3. water exchanged The water in amniotic fluid is exchanged at 3 hours.
- 4. color Colorless , near term , pale straw due to lanugo and Epithelial cell from skin . Abnormal Me conium stained – green Golden – heamolysis of RBC. Bilirubin , in Rh negative mother . Green yellow in post maturity
- 5. Composition Protein 0.3 gm % glucose20 gm % urea 30 gm % Uric acid 4 gm % creatinine 2 gm % Hormones – insulin , renin . Prolactin Sodium , chloride , potassium lanugo and Epithelial cell from skin,vernix , cell of RS , urinary bladder and vagina .
- 6. FUNCTIONS DURING PREGNANCY : Shock absorber Temperature Prevent adhesion Freely movement Nutrition small amount
- 7. DURING labour Dilatation of cervix . Mambrane intact . Aseptic and bactericidal action .
- 8. Clinical importance Method if induction Dignosis amniocentesis
- 9. Volume 50ml – 12 weeks 400ml 20 weeks 1000ml 36 - 38 weeks At term 600-800ml At 43 weeks about 200ml
- 10. abnormality Exceeds 1500ml – polyhydramnios Less than 300ml oligohydramnios
- 11. polyhydramnios hydramnious Definition : Exceeds 2000ml or excessive accumulation of liquor amni causing discomfort to the patient and or when an imaging help is needed to substantiate the clinical diagnosis of the lie and presentation of the fetus .
- 12. Etiology 1. Fetal anencephaly production of liquor amni may be due to absence of fetal swallowing reflex and possible suppression of fetal ant diuretic hormone leading to excessive urination . Open spin bifida Esophageal or duodenal Artesia and facial clefts and neck masses –prevent of fetal swallowing reflex Hydrops fetalis due to isoimmunization , cardiothoracic anomalies and fetal cirrhosis are often associated this .
- 13. 2- placenta 2- placenta Chorioangioma of the placenta – tumor growing from a single villus consisting of hyperplasia of blood vessels . 3 multiple pregnancy – 4 maternal - - diabetes – raised blood sugar – raised fetal blood sugar – fetal diuresis – hydramnios
- 14. Clinical types May be acute or chronic The patient may suffer dyspnea or even in the sitting position for easier breathing. Oedema of the legs Evidence of pre- eclamsia
- 15. Abdominal examination INSPECTION Markedly enlarged , looks globular with fullness at the flanks . The skin is tense . Shiny with large striae Palpation – height of the uterus is more than the period A.G is more than normal Fluid thrill Fetal part cannot well defined External ballottement can be elicited more easily .
- 16. AUSCULTATION – FHS can not heard easily or need use of Doppler INTERNAL EXAMINATION The cervix is pulled up may be partially taken up or at time dilated to admit a finger tip
- 17. INVESTIGATIONS Sonography – the large eco- free space between fetus and uterine wall [ single pool > 8 cm – multiple fetus – position – congenital anomalies . Blood – Rh factors Amniotic fluid – estimation of AFI – HIGH IN OPEN NEURAL TUBE DEFECT
- 18. COMPLICATION MATRNAL PRE-ECLAMPSIA MALPRESENTATION PROM PRETERM LABOUR ACCIDENTAL HAEMORRHAGE CORD PROLAPSE UTERINE ATONY RETAINED PLACENTA FETAL PREMATURITY CONGINATAL ANOMALY PERINAL MORTALITY
- 19. PRINCIPLE OF MANEGAMENT TO relive symptoms To find out cause To avoid complication
- 20. TRETMANT Bed rest only for minor hydramnios For severe – patient may hospitalization and deal as HIGH RISK Supportive therapy Amniocentesis – less than 37 weeks for amnio reduction 1-1.5 liter –not exceed Induction of labour – more than 37 weeks with oxyticin infusion . Termination if congenital abnormality .
- 21. During labour Assess for cord prolapsed Uterine contraction may sluggish - oxyticin infusion may be started Inj –oxytocin 10 unit IM with delivery of anterior shoulder prevent PPH. WATCH FOR RETAINED PLACENTA OESOPHAGEAL ATRESIA OF THE BABY SHOULD BE EXCLUDED.
- 22. OLIGOHYRAMNIOS Definition : it is an extremely rare condition where the liquor amnii is deficient in amount to the extent of less than 200 ml at term . Sonographically it is defined vertical pool is less than 2 cm .
- 23. ETIOLOGY UNKNOWN Amnion nodosum – failure of secretion by the cell of the amnion covering the placenta . Associated with fetal chromosomal anomalies Intrauterine infection Drugs Renal agenesis or obstruction IUGR Post maturity
- 24. Diagnosis Markedly smaller size uterus looks fullness of fetus . Fetal movement less Malpresentation - breech is common height of the uterus is less than the period A.G is less than normal Fetal part can well defined USG – FETAL BLEDDER FILLING ANE EMTYING FERQUTELY INDICATED ANOMALY
- 25. COMLICATION MATERNAL PPROLONGED LABOUR MALPRESENTATION PROM CORD COMPRSSION UTERINE INERTIA INCREASED MMR FETAL PREMATURITY CONGINATAL ANOMALY- SHAPE OF SKULL, WRY NECK , CLUB FOOT OR AMPUTATION OF LEG HIGH FETAL MORTALITY ABORT ION
- 26. TREATMENT PROM is common . Contraction may be painful. Fetal distress occurs . Vaginal delivery is favored .
- 27. The umbilical cord or funis From the fetus to placenta . It is developed from the connective or body stalk . With enlargement of amniotic cavity , elongation of the connective stalk , form cord. .
- 28. Structure 1. Covering epithelial cell 2. Wharton's jelly : protective 3. Blood vessels 2 arteries and 2 vein – at 4 month – 1 vein 4. If 1 arteries – fetal abnormality- down syndrome / twins / renal and genital abnormality –Heart anomalies 5. Yock sac – near attachment cord
- 29. Characteristics Length – 50cm normaly Short less than 20 cm True note Falls note Cord prolapse Compression
- 31. Abnormality Placenta accreta : Placenta attached to the uterine wall muscle. Placenta increta : Placenta extends into the uterine muscles Placenta percreta : Placeta extends through the entire wall of the uterus
- 32. Bipartiate Placenta : Placenta containing 2 or more lobes
- 34. Succenturiate Placenta : small accessory lobes develop at a small distance from the main placenta
- 35. Circumvellete placenta : fetal surface has a central depression surrounded by thickened grey white ring composed of a double fold of chorion, amnion, degenerated decidua and fibrin deposits
- 36. Battledore placenta : Cord is attached to the edge of placenta
- 37. THANK YOU