HYDRAMNIOS poly and oligohydramnios.pptx

Obg

1. HYDRAMNIOS

2. POLYHYDRAMNIOS RISK FACTIORS MATERNAL Diabetes mellitus, About 50% of diabetic pregnancies have hydramnios. Cardiac or renal disease

3. Fetal Fetal malformation ( eg. Spina bifida, hydrocephaly) Hydrops fetalis in Rh- incompatibility Multiple pregnancy Esophageal or duodenal atresia aneuploidy

4. symptoms The maternal symptoms depend on the stage of gestation . Mild symptoms include Abdominal discomfort Slight dyspnea

5. IN SEVERE CASES (OVER 4000ML OF FLUID) Abdominal pain Dyspnea Orthopnea Oedema of the abdomen, legs, vulva Nausea and Vomiting

6. Types of polyhydramnios Acute polyhydramnios Chronic polyhydramnios

7. Acute polyhydramnios This condition is extremely rare. It usually occurs before 20 weeks of pregnancy. SYMPTOMS Abdominal pain Nausea Vomiting

8. treatment Most often spontaneous abortion occurs In case with severe TTT’s (Twin - Twin Transfusion synderome ) repetitive amnioreduction until the AFI is normal, may improve the perinatal outcome. Laser ablation may cure the cause of TTT’s.

9. Chronic polyhydramnios This occurs later in pregnancy usually between 32 and 40 weeks. The prognosis depends on the underlying causes. SYMPTOMS Respiratory – Dyspnea Palpitation Edema of the legs , varicositis in the legs or vulva and hemorrhoids.

10. signs The patient may be in a dyspneic state in the lying down position Evidence of pre- eclampsia (edema, hypertension and proteinuria) may be present. MANAGEMENT Supportive therapy like bed rest Drainage of excess amniotic fluid.

11. Diagnosis Abdominal Examination The uterus is larger than expected The fetal parts are difficult to outline. The fetal heart rate cannot be heard clerly .

12. Ultra sonography: Ultrasonography helps to establish the diagnosis and detect the presence of many fetal anamolies To detect abnormally large echo-free space between the fetus and uterine wall. AFI (is more than 25cm is polyhydramnios) Detect fetal congenital malformations such as anencephly spina bifida meningocele Multiple pregnancy Fetal malformation

13. Management In mild cases rest and mild sedation is helpful. In severe cases the hospitalization is required and removal of fluid it may feel comfortable to the mother temporarily. The fetus is matured, induction of labour and delivery may be recommended. Major congenital abnormalities are diagnosed termination of pregnancy is advisable.

14. Complication Fetal malpresentation Premature rupture of membranes Prolonged labour Amniotic fluid embolism

15. prognosis Major fetal congenital malformations occur in 20% Incidence of prematurity is more than twice the general rate. Placental abruption due to rapid decomposition of the uterus when the membranes rupture and result in uncreased morbidity and mortality.

16. Poly hydramnios ETIOLOGY FETAL Fetal chromosomal abnormalities Renal agencies Obstructed uropathy Spontaneous rupture of membrane IUGR

17. MATERNAL Hypertensive disorder Uteroplacental insufficiency Dehydration

18. Effects of oligohydramnios EARLY PREGNANCY Pressure deformities, such as club feet Pulmonary hypoplacia has been reported The skin becomes dry and wrinkled

19. Late pregnancy Close adaption between the fetus and the uterine wall can lead to pressure on the umblical cord and obstruction cord and obstruction to the flow of blood and from the fetus Fetal hypoxia may result Meconium passed into an amniotic sac. Aspiration of thick meconium by the fetus will lead to aspiration pneumonia after birth.

20. Diagnosis The uterine size appears smaller than gestational period. Fetal malpresentation On abdominal palpation ULTRSOUND No pocket of amniotic fluid is greater than 1 cm.

21. Hazards MTERNAL There is high incidence of operative because of fetal distress and mal presentation.

22. FETAL Perinatal mortality is high. Fetal distress in labor is a common complication Skeletal deformities due to compression Eg : Talipes Fetal lung hypoplacia is common when amniotic fluid is scanty.

23. complication FETAL Abortion Fetal pulmonary hypoplacia Cord compression High fetal mortality

24. maternal Prolonged labor due to inertia. Increased operative interference malpresentation

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