POLYHYDRAMINOS

OBG

1. polyhydramnios Presented By: SNEHLATA PARASHAR

2. POLYHYDRAMNIOS INTRODUCTION DEFINITION INCIDENCE ETIOLOGY CLINICAL TYPES INVESTIGATIONS COMPLICATIONS MANAGEMENT

3. INTRODUCTION Amniotic fluid normally increase in amount throughout pregnancy from a few milliliters to a liter at 38 th week. The fluid is not static ; the water and solutes in it are change every few hours. There are two chief abnormalities of amniotic fluid. Polyhydramnios Oligohydramnios Polyhydramnios is a medical condition excess of amniotic fluid in the amniotic sac. There are 2 clinical varieties of polyhydramnios . Chronic Acute The opposite to Polyhydramnios is Oligohydramnios a deficiency of amniotic fluid.

4. Definition Polyhydramnios is defined as a state where liquor amnii exceeds 1500 to 2000 ml. Clinical Definition : The excessive accumulation of liquor amnii causing discomfort to the patient or when a imaging help needed to substantiate the clinical diagnosis of the lie and presentation of foetus. The incidence varies from 1-2% of the cases. it is more common of multipare than the premigravidae. it occurs 1 in 1000 pregnancies. INCIDENCE

5. ETIOLOGY Fetal Anomalies: Congenital fetal malformation is associated with polyhydramnios in about 20% cases. A nencephaly O pen S pina B ifida E sophageal or Duodenal A tresia F acial C left H ydrops Fetalis Placenta: Chorioangioma of the placenta. Multiple Pregnancies : H ydromnios is more common in uniovular twins, usually affecting the second sac. Maternal : D iabetis C ardiac or Renal D isease

6. CLINICAL TYPES Depending on the rapidly of onset, hydramnios may be: Chronic: It is the commonest onset in insidious taking few weeks. Acute: It is extremely rare acutely on pre-existing chronic variety. The chronic variety is 10 times commoner than the acute one.

7. Chronic polyhydramnios Symptoms: Dyspnoea. Palpitation. Oedema of legs. Signs: The patient may be dyspnoea state in the lying down position. Evidence of pre- eclampsia ( edema , hypertension & protenuria ) may be present.

8. Abdominal examination Inspection: Abdominal marked enlarge. The skin is tense shiny with large straiae . Palp at ion: Height of the uterus is more than the period of amenorrhoea. Girth of the abdomen round the umbilicus more than the normal. Foetal parts can’t be well defined: so also the presentation or the position. Auscultation: Foetal heart sound is not heard easily.

9. investigation USG : Amniotic fluid index is more than 25cm. To note the lie and presentation of the foetus. To diagnose any foetal congenital malformation.

10. complication Maternal : During P re gnancy: Pre eclampsia . Malpresentation . Pre rupture of the membrane. Pre term labour. During Labour: Early rupture of the membrane. Cord prolaps . Increase operative delivery due to malpresentation . Puerperium : Sub involuation Increase puerperial morbidity due to infection resulting from increase operative interpherence and blood loss. Foetal Complication: Foetal death are mostly due to prematurity & congenital abnormalities.

11. management Principles Of Management: To relieve the symptoms. To find out the causes. To avoid and to deal with the complication. Supportive Therapy: Bed rest, treatment associate with condition like preeclampsia. Investigation are done to exclude congenital foetal malformation. Further management depends on Response to treatment. Period of gestation. Presence of foetal malformation. Associated complicating factors.

12. Response to treatment is good means pregnancy is continued. Unresponsive: Pregnancy less than 37 weeks – Amniocentesis Pregnancy more than 37 week – Induction of labour is done. Amniocentesis, termination of pregnancy. During Labour : Usual management is followed. If the uterine contration become sluggish, oxytocin infusion may be started. To prevent post partum haemorrhage . IV administraion of methergin .