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Oligohydramnios, image, image, นางสาวพรรณธิวา สิ่วสำแดง
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Oligohydramnios
Nursing care
1.Monitor maternal and fetal status closely, including vital signs and fetal heart rate patterns.
- Monitor maternal weight gain pattern, notifying the health care provider if weight loss occurs.
- Provide emotional support before, during, and after ultrasonography.
- Inform the patient about coping measures if fetal anomalies are suspected.
- Instruct her about signs and symptoms of labor, including those she’ll need to report immediately.
- Reinforce the need for close supervision and follow up.
- Encourage the patient to lie on her left side.
- Continuously monitor maternal vital signs and fetal heart rate during the amnioinfusion procedure.
- Note the development of any uterine contractions, notify the health care provider, and continue to monitor closely.
Pathophysiology
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It plateaus from 33-38 weeks, and then declines with the volume of amniotic fluid at term approximately 500ml.
It is predominantly comprised of the fetal urine output, with small contributions from the placenta and some fetal secretions.
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It gets processed, fills the bladder and is voided, and the cycle repeats. Problems with any of the structures in this pathway can lead to either too much or too little fluid.
Anything that reduces the production of urine, blocks output from the fetus, or a rupture of the membranes (allowing amniotic fluid to leak) can lead to oligohydramnios.
Causes
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Fetal chromosomal abnormalities (eg, aneuploidy)
Uteroplacental insufficiency (eg, due to preeclampsia, chronic hypertension, abruptio placentae, a thrombotic disorder, or another maternal disorder)
Diagnosis
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Comprehensive ultrasonographic examination, including evaluation for fetal malformations
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Oligohydramnios may be suspected if uterine size is less than expected for dates or if fetal movements are decreased; it may also be suspected based on incidental ultrasonographic findings.
If oligohydramnios is suspected, amniotic fluid should be assessed quantitatively using the amniotic fluid index (AFI).
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Signs and Symptoms
Oligohydramnios itself tends not to cause maternal symptoms other than a sense of decreased fetal movement.
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