Polyhydramnios

This ppt includes meaning,definition, clinical features,types, complications, causes, risk factors, management, surgical, nursing management, pathophysiology .explained with images in details .

1. SEMINAR ON POLYHYDRAMNIOS PRESENTED BY - PREETI KULSHRESTHA M. SC. NURSING FINAL YEAR

2. MEANING Poly - Excessive Hydramnios - Amniotic fluid

3. DEFINITION Polyhydramnios is a state where the amount of amniotic fluid exceeds 1500-2000ml. (or) An amount of amniotic fluid more then 2000 ml.

4. INCIDENCE Polyhydramnios occurs in 1-2% of pregnancies. It is more common in multipara than in primipara.

5. ETIOLOGY Fetal Anomalies Maternal Causes Placental Factors Multiple Pregnancies

6. FETAL ANOMALIES 1) Anencephaly. 2) Open Spina Bifida

7. 3) Esophageal or Duodenal atresia . 4) Facial Clefts And Neck Masses .

8. 2) MATERNAL CAUSES Diabetes mellitus. cardiac or renal diseases.

9. 3) Placental factors Choriocarcinoma of the placenta - Choriocarcinoma is  a fast-growing cancer that occurs in a woman's uterus (womb) .

10. 4) Multiple pregnancies Multiple pregnancies especially with monozygotic twins usually affecting the second sac.

11. SIGNS AND SYMPTOMS Uterine enlargement. Mechanical problems such as- - Severe Dyspnea. -Lower extremity and Vulvar e -Pressure pains in the back abdomen and thighs. -Nausea & Vomiting Frequent change of fetal lie (unstable lie). Auscultation of the fetal heart is difficult .

12. CLINICAL TYPES

13. Acute polyhydramnios DEFINITION Acute polyhydramnios- it is extremely rare and occurs at about 20 th week and come on suddenly. OR It amniotic fluid increase rapidly over days can cause severe symptoms is known as acute polyhydramnios .

14. SIGNS AND SYMTOMS OF ACUTE POLYHYDRAMNIOS Abdomen pain. Nausea or vomiting. Fluid thrill may be present. Abdomen in hugely enlarged. Fetal parts cannot be felt normal but the fetal heart sound is audible.

15. Chronic polyhydramnios DEFINITION This is the most common type which is gradual in onset , usually from about 30 th week of pregnancy. OR If amniotic fluid volume increase progressively over months the symptoms are usually milder is known is chronic polyhydramnios.

16. SIGN AND SYMPTOMS OF THE CHRONIC POLYHYDRAMNIOS Dyspnoea is more common in supine position. Oedema in legs. Uterine contractions. Uterine discomfortness.

17. DIAGNOSTIC TESTS Ultrasonographic measurement of AFI >25c.m. SDP=>8C.M. Comprehensive ultrasonographic examination for fetal malformations. Maternal glucose challenge test Amniocentesis

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19. COMPLICATIONS Preterm contractions and possibly  preterm labour Premature rupture of membranes Fetal malposition Maternal respiratory compromise Umbilical cord prolapse Uterine atony Postpartum haemorrhage Fetal death

20. MANAGEMENT Principles Of Management - To relieve the symptoms. To avoid and to deal with the complication.   To find out the causes.

21. Contd.  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.

22. Response to treatment is good means pregnancy is continued  Unresponsive: Pregnancy less than 37 weeks – Amniocentesis   Pregnancy more than 37 week – Induction of labor is done  Usual management is followed.  If the uterine contraction become sluggish, oxytocin infusion may be started.   To prevent post partum hemorrhage.  IV administration of methergine. 

23. NURSING DIAGNOSIS Risk for Maternal and Fetal Injury related to polyhydramnios   Activity Intolerance related to maternal discomfort and dyspnea.  Deficient fluid volume & imbalance nutrition less than the body requirements to meet metabolic demand (nausea/vomiting). Fatigue related to the disease condition. Pain related to the disease condition.

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