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Oligohydramnios & Polyhydramnios (:large_blue_circle:Oligohydramnios…
Oligohydramnios & Polyhydramnios
:large_blue_circle:
Oligohydramnios
Def
:koala:
Def of
An
hydramnios (rare):
complete absence
of AF
Def: Amniotic fluid volume < 500 ml at GA 32-36 wks
Dx
:sunrise_over_mountains: by U/S
Amniotic fluid volume < 5th percentile for GA
Amniotic fluid index < 5 (
Sum
of 4 quadrants)
Single vertical pocket < 2 cms
Etiology
:ear_of_rice:
Placental insufficiency (รกเสื่อม)
Severe preeclampsia
Post-term preg
Urinary tract malformations
Renal agenesis
(detected by Empty fetal bladder on Serial u/s scanning)
Obstruction of urinary tract
Clinical picture
:frame_with_picture:
Uterus: small for date
Fetus (common)
Hyperflexed attitude
Breech presentation
Investigations
:male-scientist::skin-tone-4:
U/S
: Small (< 1x1 cm) Amniotic fluid locules
:black_small_square: important to
exclude
congenital anomalies, growth retardation, and
identifies fetal presentation
Mx
:leaves:
Delivery
During labor ➭ Observe for
fetal distress
(more common)? ➭ If yes,
Immediate vaginal or abdominal delivery
Post-term: Termination of preg is I/C
Adequate rest
( :arrow_down: dehydration)
Hydration
via Oral/IV Hypotonic fluids (2 L/day) (temporarily :arrow_up: fluid)
Serial U/S
to monitor growth, AFI, BPP
Induction of labor
in
Lung maturity attained
Lethal malformation
Fetal jeopardy
Severe IUGR
Severe oligo
Assessment
:grapes:
Complications
:explode:
Pulmonary hypoplasia (as AF is needed for
lung distension
)
Abnormal fetal development (due to
Compression of uterine wall
➭
Fetal distress
and adherent fetal parts)
Abnormal presentation (eg. ไม่กลับหัว ➭ Breech presentation)
Normal Amniotic fluid
:green_apple:
Volume Development
17 wks
: 250 ml (:arrow_up: 50 ml)
28-38 wks
: 750 - 1000 ml (:arrow_down: after
34 wks
)
8 wks
: 15 ml (:arrow_up: 10 ml/wk)
42 wks
: < 500 ml
GA 16-19 wks
นิยมเจาะดูหน้าท้องแม่ เพราะน้ำมันเยอะ เจาะไปก็ไม่โดนตัวเด็ก
Physiology of AF
INFLOW
(1000 ml/day)
Fetal urine
Lung liquid
OUTFLOW
(1000 ml/day)
Fetal swallowing
Intramembranous (placenta, cord)
Transmembrane (Amniotic membranes)
:red_circle:
Polyhydramnios
Def
:koala:
Amniotic fluid
> 2000 ml
Incidence
:chestnut:
~ 1:200
Etiology
:ear_of_rice:
Mech
:arrow_down:
consumption
of AF
:arrow_up:
production
AF
Causes
Fetal
:baby::skin-tone-3:
1. Congenital anomalies
Anencephaly
Transduction of CSF fr the exposed meninges
Absence of swallowing of the liquor
Lack of antidiuretic hormone or irritation of the exposed centres ➭ Fetal polyuria
DA or EA
(duodenal or esophagus atresia)
cuz กินไม่ได้
2. Uniovular twins
Due
to Interconnecting vascularity in the placenta
➭ 1 fetus obtains more circulation so its heart & kidney hypertrophy
➭ :arrow_up: Urine production (so only 1 amniotic sac is affected)
3. :arrow_up: Placental mass
Chorio-angioma
➭ Large placenta
Edema of the placenta
due to
Hydrops fetalis
resulting fr:
Rh - incompatibility
Severe anemia
Hemoglobinopathies (particularly alpha- major)
CMV infection
True knot of cord
➭ Obstruction of venous return with Placental congestion
Fetal liver cirrhosis
as in syphilis
Maternal
:mother_christmas::skin-tone-3:
1. DM
due to
High sugar content AF ➭ :arrow_up: Osmotic pressure of liquor amniotic
Hyperglycemia ➭ Fetal polyuria
2. Preg-induced HT
due to
Edema of placenta
3. Severe generalized edema
due to
Cardiac
Hepatic
Renal
Clinical pictures
:frame_with_picture:
Acute
hydramnios
Very rare
Rapid
accumulation of liquor
Occurs
before 20 wks
Common causes: Uniovular twins, Fetal anomalies
Chronic
hydramnios
More common
Gradual
accumulation of liquor
Occurs in
late pregnancy
Condition may end by Preterm labor
:fishing_pole_and_fish:
S&S
Abdominal discomfort & pain
in
acute
hydramnios
Pressure
symptoms
Dyspnea
Palpitation
Indigestion
Hemorrhoids
Edema
Varicosities of lower limbs
General examination: may reveal PIH
Abdominal examination
Inspection: overdistended abdomen
Palpation:
Fundal height > GA
Cystic tense uterus
Difficult to feel fetal parts by dipping
Fluid thrill (mayb)
Malpresentation & Nonengagment r common
Ddx
:candy:
Causes of Oversized pregnant uterus
Ovarian cyst with preg
Ascites
(From U/D: heart, kidney, liver *uses U/S to ddx)
Mx
:leaves:
Acute hydramnios
Terminate preg by High artificial rupture of membranes ➭
Gradual
escape of liquor ➭ can
avoid Shock
and
Seperation of placenta
Sudden drop of intrauterine pressure & Shrinkage of Placental site ➭ Seperation of the placenta
➭ Drew Smythe catheter: used for rupture of hind water in such conditions
:warning: after
sudden
drop of intrauterine pressure ➭ Rapid accu of Blood in splanchnic area ➭ Shock
Chronic hydramnios
:alarm_clock:During Pregnancy
Death fetus or Malformation ➭
Termination of preg
by High artificial rupture of membranes
Healthy fetus ➭
Expectant Rx
Rest
Sedative
Salt restriction
Rx of U/D causes — DM & toxo
Condition not improved or get worse ➭ Terminate
Premature fetus with Marked pressure symptoms ➭
Repeated amniocentesis
—aspirated 1.5-2 L in rate < 500 ml/hr under U/S control
:warning: AF is rapidly acc & there’s risk of premature labor/injury to fetus/umbilical cord vessels
:alarm_clock:During Labor
Malpresentation, Cord presentation and/or Cord prolapse should be detected ➭ Mx according to conditions
Half dilated Cx ➭ pass Symthe catheter to rupture hind water ➭ this will initiate UCs (can be enchanted by Oxytocin)
Active Mx of 3rd stage — carried out to guard against PPH
Complications
:explode:
Maternal
During labor
PROM (premature rupture of membranes)
Cord prolaspe
Abruptio placenta
Shock
PPH
During preg
Preterm labor
PIH
Pressure symptoms
Malpresentation
Abortion
Fetal
Prematurity
Asphyxia due to Cord prolapse or Placental Seperation