POLYHYDRAMNIOS AND OLIGOHYDRAMNIOS.ppt
- 1. DR. NABEEL S. BONDAGJI, MD, FRCSC Department of Obstetrics and Gynecology Feto-Maternal Unit
- 2. PHYSIOLOGY OF AMNIOTIC FLUID Early pregnancy: composition of AF similar to ECF. Transfer of water across amnion and through fetal skin. By second trimester: fetus begins to urinate swallow, and inspire AF During last 2/3 of pregnancy, AF is principally comprised of fetal urine.
- 3. NORMAL AMNIOTIC FLUID VOLUME Weeks Gestation Fetus Amniotic Fluid Placenta (g) (ml) (g) 16 28 36 40 100 200 100 1000 1000 200 2500 900 400 3300 800 500
- 5. DEFINITIONS: Polyhydramnios: 2000 cc amniotic fluid Amniotic Fluid Index = largest vertical pocket in 4 quadrants polyhydramnios 24 cm.
- 7. ETIOLOGY OF POLYHYDRAMNIOS Idiopathic Fetal Anomalies Diabetes Multifetal gestation Immune/Non-immune hydrops Fetal infection Placental haemangiomas
- 8. Etiology of Polyhydramnios: Fetal Anomalies Problems with swallowing and GI absorption Increased transudation of fluid: anencephaly, spina bifida Increased urination: anencephaly (lack of ADH, stimulation of urination centers) Decreased inspiration
- 9. SYMPTOMS Dyspnea Abdominal pain Venous stasis Contractions preterm labor Decreased Perception of Fetal Movements
- 10. DIAGNOSIS Fundal height > gestational age Difficulty palpating fetal parts/hearing heart tones Tense uterine wall ***Sonography
- 11. (fetus)? Fetal prognosis worsens with more severe hydramnios and congenital anomalies 15-20% fetal malformations Preterm delivery Suspect diabetes Prolapse of cord Abruption
- 12. (Mother)? Dyspnea Venous Stasis Placental abruption Uterine dysfunction Post-partum hemorrhage Abnormal presentation -- C/S
- 13. TREATMENT Mild to Moderate hydramnios: rarely requires treatment Hospitalization, bed rest Amniocentesis Non-steroidal anti-inflammatory analgesia Blood sugar control
- 14. OLIGOHYDRAMNIOS
- 17. ETIOLOGY Postdate Fetal Anomalies: obstruction of fetal urinary tract/renal agenesis IUGR ROM Twin/Twin transfusion Exposure to ACE inhibitors, and Non-steroidal anti-inflammatory
- 18. SIGNS/SYMPTOMS Fundal height < gestational age Decreased fetal movement Fetal Heart Rate tracing abnormality Diagnosis: Ultrasound
- 20. Extremely poor fetal prognosis, especially in early pregnancy Adhesions between amnion and fetal parts - --malformations and amputations Musculoskeletal deformities Pulmonary hypoplasia
- 21. Cord Compression -- >fetal hypoxia Passage of meconium into low AF volume: thick particulate suspension -->respiratory compromise