oligohydramnios.pptx

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1. Normal amniotic fluid

2. ⦿ 1 2 we e ks: 50ml ⦿ 2 w e e k s: 400ml ⦿ 36- 38we e ks: 1litre

3. ⦿ Fetal uri n e ⦿ Fetal lu n g sec r etion ⦿ O r a l nasa l sec r etion

4. ⦿ Fetal swall o wing ⦿ Intramembraneou s transfer ⦿ T ransmembraneous transfer

5. ⦿ 8- 24cm

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

7. ⦿ M a tern a l Condi t ions Hypertensive disorders Uteroplacental insufficiency Dehydration Idiopathic Post term pregnancy Prelabour rupture of membranes

8. ⦿ F etal condit i ons ⦿ R ena l agenesis ⦿ Urin ary tra c t o bstruction ⦿ Sp o nta n e o u s rupture of memb r anes ⦿ Intrauterin e i nfe c tion ⦿ IUGR ⦿ Drugs: PG inhibitors, ACE inhibitors ⦿ Fetal chr o mos o ma l an d structural abnormalities ⦿ Amn i on nodosum

9. ⦿ Smaller uterin e size ⦿ Les s fetal mo v ements ⦿ The uteru s i s “ full o f fetu s ” ⦿ Malpr e sentat i on ⦿ Evidenc e s of IUGR

10. ⦿ History ⦿ W atery / blo o d stai n e d vaginal discharge ⦿ Hypertension ⦿ P r e e c lampsia ⦿ P r e gestat i onal hy p e r tension ⦿ APLA syndrome ⦿ Family history Congenital anomalies Chromosomal abnormalities ⦿ Medications

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

12. ⦿ M a tern a l ⦿ P r o longed lab o u r du e t o i n e r tia ⦿ Incr e ase d o perativ e i n ter f e r enc e du e to malpresentations ⦿ C ho r ioamnioni t is

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

14. Due to reduced amniotic fluid volume ⦿ S k eleta l def o rmities ⦿ Contractures ⦿ Amniotic band s an d autoamputat i on ⦿ Pulmonary hy poplasia ⦿ Umb i lical c o rd c o mpression ⦿ Me c onium aspirati o n ⦿ FHR abno r malities ⦿ Lo w APGAR s c o r e s ⦿ Intrapartu m death

15. Management

16. ⦿ Cou nselling ⦿ Se r ia l USG

17. ⦿ Cou nselling ⦿ Conside r Amnioi n fusion ⦿ Se r ia l USG ⦿ Ex c lude PP R OM ⦿ T e r mi n atio n of pregnanc y SOS

18. ⦿ Deliv e r pos t t e rm c ases ⦿ Se r ia l US G an d Dopple r i n IUGR ⦿ Conser v ativ e ma n agemen t f o r pret e rm prelabor rupture of membranes till 34 weeks ⦿ Idiopathi c cases : N S T , serial US G & B PP

19. ⦿ Materna l hy dration : 1 50 - 2 000ml / day ( oral/ IV) ⦿ Amn i o i nfusion Abdominally/ trans cervically

20. ⦿ US G t o exclud e placenta ⦿ P ai n ti ng an d draping ⦿ 2 G n eedle ⦿ Connected to sterile tubing, 3 way stopcock and a 50ml syringe ⦿ N S i s in j e c te d u n de r USG ⦿ Anti D SOS

21. ⦿ Consent ⦿ Baseline FHR, vital signs, uterine activity ⦿ Monito r FHR an d uterin e activity ⦿ Measure and mark fundal height and reassess every hour ⦿ N o tif y i f non resolving variable deceleration even with 800ml of solution infused Non reassuring maternal/fetal response Intrauterine pressure> 25mmHg

22. According to ⦿ fetal condition and specific conditions such as ⦿ preeclampsia ⦿ growth restriction ⦿ fetal anomaly

23. ⦿ Clos e monitorin g b y EFM ⦿ R up t ur e th e membrane s i n a c tiv e ph ase of labor ⦿ Amnioinfusion i n c as e of me c onium staini n g ⦿ I f FHR abnormality : immediat e CS

24. ⦿ DFMC ⦿ Left lateral position ⦿ FHR monitoring ⦿ Administration of fluids ⦿ Anti D after amnioinfusion SOS ⦿ Close monitoring during labour

25. ⦿ Ris k f o r fetal c o mpr o mis e r e lated t o reduced amniotic fluid volume ⦿ Risk for prolonged labor r/t uterine inertia ⦿ Ris k f o r i nfe c tio n r e lated t o premature rupture rupture of membranes ⦿ An x iety ⦿ Inef f e c tiv e c o pi n g

26. THANK YOU