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Oligohydramnios - Coggle Diagram
Oligohydramnios
Nursing care
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.
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Instruct her about signs and symptoms of labor, including those she’ll need to report immediately.
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Note the development of any uterine contractions, notify the health care provider, and continue to monitor closely.
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Aetiology
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Placental insufficiency
resulting in the blood flow being redistributed to the fetal brain rather than the abdomen and kidneys. This causes poor urine output.
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Non-functioning fetal kidneys, e.g. bilateral multicystic dysplastic kidneys
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Pathophysiology
The volume of amniotic fluid increases steadily until 33 weeks of gestation. 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 (e.g. respiratory).
The fetus breathes and swallows the amniotic fluid. 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.
Clinical Assessment
History
Inquire about symptoms of leaking fluid and feeling damp all the time (often described as new urinary incontinence).
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Ultrasound
Assess for liquor volume, structural abnormalities, renal agenesis and obstructive uropathy.
Measure fetal size. Small babies can result from placental insufficiency, which also causes oligohydramnios. There may also be a rise in pulsatility index of the umbilical artery Doppler in placental insufficiency.
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