Oligohydramnios

Oligohydrmnios
Lower level of amnitic fluid
AFI< 5cm or
amnioticfluid < 200ml at term

1. Oligohydramnios Sharon Treesa Antony Second year M.sc nursing Govt. College of Nursing Kottayam

2. Normal amniotic fluid

3. Volume 12 weeks: 50ml 20 weeks: 400ml 36-38weeks: 1litre

4. Production Fetal urine Fetal lung secretion Oral nasal secretion

5. Clearance Fetal swallowing Intramembraneous transfer Transmembraneous transfer

6. Amniotic fluid index 8-24cm

7. Oligohydramnios It is defined as reduced amniotic fluid volume of < 200ml at term or AFI<5cm at 28-40 weeks.

8. Causes Maternal Conditions Hypertensive disorders Uteroplacental insufficiency Dehydration Idiopathic Post term pregnancy Prelabour rupture of membranes

9. Fetal conditions Renal agenesis Urinary tract obstruction Spontaneous rupture of membranes Intrauterine infection IUGR Drugs: PG inhibitors, ACE inhibitors Fetal chromosomal and structural abnormalities Amnion nodosum

10. Clinical features Smaller uterine size Less fetal movements The uterus is “ full of fetus ” Malpresentation Evidences of IUGR

11. diagnosis History Watery/ blood stained vaginal discharge Hypertension Preeclampsia Pregestational hypertension APLA syndrome Family history Congenital anomalies Chromosomal abnormalities Medications

12. Diagnosis Physical examination Small uterine size Less fetal movements Uterus is full of fetus Malpresentations IUGR USG: AFI< 5cm Speculum examination: watery vaginal discharge

13. Complications Maternal Prolonged labour due to inertia Increased operative interference due to malpresentations Chorioamnionitis

14. Fetal Due to etiology Congenital anomalies Chromosomal abnormalities Fetal growth restriction IUD Intra uterine infection following ROM Prematurity

15. Due to reduced amniotic fluid volume Skeletal deformities Contractures Amniotic bands and autoamputation Pulmonary hypoplasia Umbilical cord compression Meconium aspiration FHR abnormalities Low APGAR scores Intrapartum death

16. Management

17. First trimester Counselling Serial USG

18. Second trimester Counselling Consider Amnioinfusion Serial USG Exclude PPROM Termination of pregnancy SOS

19. Third trimester Deliver post term cases Serial USG and Doppler in IUGR Conservative management for preterm prelabor rupture of membranes till 34 weeks Idiopathic cases: NST, serial USG & BPP

20. Specific measures to increase amniotic fluid volume Maternal hydration :1500-2000ml/day ( oral/ IV) Amnio infusion Abdominally/ trans cervically

21. procedure USG to exclude placenta Painting and draping 20 G needle Connected to sterile tubing, 3 way stopcock and a 50ml syringe NS is injected under USG Anti D SOS

22. Nurse’s role Consent Baseline FHR, vital signs, uterine activity Monitor FHR and uterine activity Measure and mark fundal height and reassess every hour Notify if non resolving variable deceleration even with 800ml of solution infused Non reassuring maternal/ fetal response Intrauterine pressure> 25mmHg

23. Timing of delivEry According to fetal condition and specific conditions such as preeclampsia growth restriction fetal anomaly

24. Management of labour Close monitoring by EFM Rupture the membranes in active phase of labor Amnioinfusion in case of meconium staining If FHR abnormality: immediate CS

25. Nursing management DFMC Left lateral position FHR monitoring Administration of fluids Anti D after amnioinfusion SOS Close monitoring during labour

26. Nursing diagnoses Risk for fetal compromise related to reduced amniotic fluid volume Risk for prolonged labor r/t uterine inertia Risk for infection related to premature rupture rupture of membranes Anxiety Ineffective coping

27. THANK YOU