POLYHYDRAMNIOS AND OLIGOHYDRAMNIOS edited.pptx

Medical topic related to gynea

1. POLYHYDROMINOS AND OLIGOHYDROMINOS DR. ZUBI NA A DNAN Assistant Professor Classified Gynaecologist

2. Early pregnancy : composition of AF similar to ECF. Transfer of water across amnion and through fetal skin. By Second Trimester: fetus begins to urinate, swallow, and inspire AF During last 2/3 of pregnancy, AF is principally comprised of fetal urine. PHYSIOLOGY OF AMNIOTIC FLUID

3. PO LYHYDROMINOS Normal range= 5 - 25 cm / MVP = 2-8 cm Amniotic Fluid Index = largest vertical pocket in 4 quadrants polyhydramnios 2 5 cm and MVP > 8cm

4. Classification of Polyhydramnios Mild AFI = 25 - 29.9 cm / MVP = 8 - 11 cm Moderate AFI = 30 - 35 cm / MVP = 11 - 15 cm Severe AFI >35 cm / MVP > 15 cm

5. ETIOLOGY OF POLYHYDRAMNIOS Poor Disposal Over Production CNS lesions Maternal DM Chromosomal abnormalities TTTS Muscular dystrophies Fetal DI oesophageal atresia Fetal anemia ( immune hydrops) Duodenal atresia sacrococcygeal teratoma pharyngeal or esophageal tumours CMV, Toxoplasmosis, Syphilis Diaphragmatic hernia Idiopathic hyperextension of head

6. Maternal Risks respiratory embarrasment abdominal discomfort pressure symptoms PPROM and PTL Unstable lie and Malpresentations cord prolapse placental abruption PPH due to atony Venous stasis

7. Fetal Risks 30% perinatal mortality 50% congenital malformations 22% PTL

8. Management History General Physical Examination mild poly ...normal findings mod to severe poly ... SOB Anxious look BP, Weight, pallor and legs for varicosities

9. Abdominal Examination Abdominal wall: stretched & shiny Uterus: globular & tense, fundal height: large for dates Fetal parts: ballotable, malpresentation, fluid thrill + FHS: not readibly audible

10. Investigations Ultrasound (confirmation and severity of polyhydramnios, Malformations, rule out other DD’s,chorionicity in case of multiple pregnancy) Blood group and Rh factor of couple Maternal glucose challenge test Viral antibody titres fetal karyotyping from blood, tissue or amniotic fluid

11. DD’s Mistaken dates Macrosomia Multiple pregnancy Placental abruption Uterine Fibroid Ovarian Cyst

12. TREATMENT Mild to Moderate hydramnios: rarely requires treatment General Measures Hospitalization, bed rest, prop up, left lateral,analgesia, no role of fluid & salt restriction, Tocolysis for PTL Drugs NSAID ( Indomethacin) PG synthetase inhibitor ( Sulindac) Therapeutic Amniocentesis Treat the Cause e.g, diabetes, rhesus isoimunization,

13. Time & Mode of delivery delivery once maturity is reached VD preferred, LSCS when other obs complications associated

14. OLIGOHYDRAMNIOS

15. DEFINITION MVP < 2cm, AFV < 200ml or 500 ml, AFI < 5cm, AFI 5t h percen tile for Gestati onal age

16. Reduced production Cotinuous drainage of liquor IUGR PPROM Prolonged Pregnancy Idiopathic Fetal renal agenesis fetal polycystic kidney urethral obstruction Maternal drugs like NSAID Twin Twin Transfusion post dates

17. SIGNS/SYMPTOMS Fundal height < gestational age Decreased fetal movement Fetal Heart Rate tracing abnormality

18. Limb Contractures Postural Deformities like talipes,scoliosis,hip dislocation Potter syndrome Amniotic Band Syndrome Pulmonary hypoplasia Fetal hypoxia Perinatal mortality Fetal Complications

19. Maternal Risks No physical distress Increased risk of malpresentation, IOL, fetal distress in labour, chorioamnionitis, LSCS

20. Management History GPE Abdominal examination Per speculum examination Investigations ultrasound, CBC, GTT, RFT’s, fetal karyotyping

21. TREATMENT Delivery (at term, or with other complications like IUGR, Chorioamninitis) Conservative to prolong pregnancy as close to term as possible hospitalization for maternal and fetal monitoring Amnioinfusion with NS via transcervical catheter Maternal hydration cervical occlusion with fibrin gel...not recommended antenatal vesicoamniotic shunting in obstructive uropathies

22. PROGNOSIS Depending o n th e ca us e If e xc es s or r ed uc ed A FI i s th e re su lt o f an u nd er ly in g fe ta l ab no rm al it y th en n at ur e of a bn or ma li ty w il l de te rm in e the pr og no si s

23. THANK YOU