Hydraminos

Hydraminos

1. Hydramnios Presented by MRS AGNES MAHIMA DAVID Msc nursing Obstertics and gynaecological nursing

2. Definition It is a state where liquor amnii exceeds 2000ml

3. Etiology Fetal anomalies Anencephaly –transudation from the exposed meninges Absence of fetal swallowing reflex Suppression of fetal ADH leading to excessive urination Open spina bifida- increased transudation from meninges Esophageal or duodenal atresia –prevent swallowing of the liquor Facial clefts neck masses Hyrops fetalis

4. Placenta Chorioangioma of the placenta Multiple pregnancy Maternal Diabetes Cardiac or renal disease –edema of placenta lead to increase in transudation

5. Clinical types Chronic –few weeks Acute - few days

6. Acute hydramnios The onset is acute and the fluid accumulates within a few days. It usually occurs before 20 weeks of pregnancy . It is usually associated with uniovular twins or chorioangioma of the placenta

7. Sign and symptoms Signs The patient look ill Edema of the legs Abdomen is hugely enlarged more than the period of amenorrhea Fluid thrill is present Fetal part cannot be felt nor is the FHS audible Internal examination reveals effacement of cervix or dilatation of the os Sonography reveals multiple pregnancy or fetal anomalies

8. Symptom Abdominal pain Nausea and vomiting

9. Chronic polyhydramnios symptom Dyspnea Palpitation Edema of legs,varicosities in the legs or vulva or haemorrhoids

10. Signs the patient may be in a dyspnoeic state in the lying down position Evidence of pre eclampsia

11. Abdominal examination Inspection Abdomen –enlarged ,looks globulars with fullness at the flanks Skin is tense, shiny with large straie Palpation Height of the uterus is more than the period of amneorrhea Girth of the abdomen round the umbilicus is more than normal Fluid thrill can be elicted in all direction over uterus Fetal part are difficult to feel Amniotic fluid index test to estimate the total volume

12. Auscultation –fetal heart rate is difficult to hear internal examination – cervix may be pulled up ,dilated , to admit a finger tip through which tense bulged membranes can be felt

13. Investigation Sonography ABO and RH grouping PP sugar ,GTT AFP

14. Complication Maternal during pregnancy Pre eclampsia Mal-presentation PROM Pre term labor Accidental hemorrhage

15. During labor Early rupture of the membrane Cord prolapse Uterine inertia Operative delivery due to malpresentation Retained placenta, PPH and shock

16. Pueperium Sub involution Increased puerperal morbidity due to infection resulting from operative interference and blood loss Fetal Prematurity Congenital abnormality