polyhydramnios and oligohydramnios.pptx

A powerpoint presentation to describe the amniotic fluid problems during pregnancy.

1. AMNIOTIC FLUID ABNORMALITIES Dr. Saima Chaudhary

2. AMNIOTIC FLUID What is amniotic fluid?

3. What is the function of amniotic fluid?

4. FUNCTIONS OF AMNIOTIC FLUID Before labour : Protection from external trauma, shock & temperature. Prevention of adhesion between embryo & membranes. Homogenous medium for the growth of the embryo. Permits the free movement of the embryo. Reservoir of water and nutrients.

5. FUNCTIONS OF AMNIOTIC FLUID During labor: Allows regular dilatation of the cervix. Lubricant for fetus descent. Bacteriostatic Avoids compression of fetus and cord

6. PRODUCTION Mother through amnion By 10 weeks transudate of fetal serum via fetal skin and cord. By 16 weeks fetal kidney, lung fluids and oro -nasal secretions

7. Clearance Fetal swallowing AF to fetal circulation AF to maternal circulation

8. MEASUREMENT OF AMNIOTIC FLUID Clinical assessment Ultrasound Single deep pocket (SDP) Amniotic fluid index (AFI)

9. SINGLE DEEP POCKET (SDP) Normal = 2-8 cm

10. AMNIOTIC FLUID INDEX Normal value= 5-24

11. AMNIOTIC FLUID INDEX (AFI)

12. POLYHYDRAMNIOS

13. POLYHYDRAMNIOS Defined as excessive amount of amniotic fluid AFI of ≥ 25 cm Deepest vertical pool of > 8 cm Incidence: 1-3% of pregnancies

14. Severity AFI SDP Mild 25-30 8-11 Moderate 30-35 11-15 Severe More than 35 More than 15 SEVERITY OF POLYHYDRAMNIOS

15. ETIOLOGY Idiopathic Maternal Diabetes Rh alloimmunization Fetal Anomalies Duodenal atresia Oesophageal atresia Anencephaly Neuromuscular fetal condition Fetal chromosomal defects Fetal infection like parvovirus / syphilis Fetal tumors like thoracic tumor TTTS in multifetal gestation Placental haemangiomas / AV fistula

16. SYMPTOMS Abdominal discomfort/pain Dyspnea Preterm labor PPROM Increased / Decreased Perception of Fetal movements E dema of lower extremities

17. SIGNS Uterus : Gestation Difficult to palpate fetal parts. Difficult to hear fetal heart sound. Ballotable fetus. Shiny abdominal skin Varicose veins

18. MATERNAL COMPLICATIONS Preterm labor/ PROM Uterine dysfunction Abnormal lie / presentations Cord prolapse Cesarean section Placental abruption after ruptured membranes A mniotic fluid embolism U terine atony - Post-partum hemorrhage PIH

19. FETAL COMPLICATIONS P rognosis depends upon cause. Fetal malformations Preterm delivery *Fetal distress due to prolapse of cord/ abruption Nuchal cord Neonatal death Intrauterine death

20. DIAGNOSTIC WORKUP Detailed history+ examination Ultrasound Goals Number and chorionicity of fetus Quantitate fluid Look for structural anomalies,anemia , FHR & hydrops Amniocentesis Infection screen Karyotyping Maternal testing for blood sugar & blood group

21. POLYHYDRAMNIOS

22. MANAGEMENT Depends upon Cause Severity Symptoms: yes/no Most effective treatment in DM and TTTS Best outcome in idiopathic polyhydramnios

23. MANAGEMENT Counselling Mild to Moderate hydramnios : Expectant management (counseling + serial AFI) Severe/ symptomatic: Hospitalization Bed rest Blood sugar control Non-steroidal anti-inflammatory analgesia Intravascular fetal transfusion in fetal anemia

24. TREATMENT IN CASE OF TTTS

25. INDOMETHACIN THERAPY Mechanism: Impairs lung liquid production/enhances absorption in renal tubules. ↓Fluid movement across fetal membranes. Dose: 25 mg 6 hourly up to 200mg/day. Complications: premature closure of ductus arteriosus , impairment of renal function,oligohydramnios and cerebral vasoconstriction. So not used after 34 weeks

26. INDOMETHACIN THERAPY Monitoring : weekly fetal echocardiography and AFI. Stopped: if ductal constriction or AFI< 8 Sulindac : another NSAID under research

27. AMNIOREDUCTION BY AMNIOCENTESIS To relieve maternal distress & to test fetal lung maturity

28. AMNIOCENTESIS

29. LABOUR MANAGEMENT Vigilance for cord prolapse Increased chance of cesarean section Vigilance for PPH

30. OLIGOHYDRAMNIOS Defined as reduced amount of amniotic fluid AFI of < 5 cm Deepest vertical pool of <2 cm Incidence: 3-4% of pregnancies

31. OLIGOHYDRAMNIOS

32. ETIOLOGY Fetal PROM (50%) Chromosomal anomalies Structural anomalies IUGR Post term pregnancy Maternal Dehydration Placental •Abruption •TTTS Drugs •PG synthetase inhibitors •ACE inhibitors Idiopathic

33. FETOMATERNAL RISKS* FETAL Abortion Prematurity IUFD Skeletal deformities Contractures Pulmonary hypoplasia Malpresentations Fetal distress Meconium aspiration Low APGAR F etal anomalies MATERNAL Increased morbidity Prolonged labour uterine inertia Chorioamnionitis and p. sepsis in PROM Labor induction Increased chance of cesarean

34. DIAGNOSIS SYMPTOMS No specific symptoms H/O leaking p/v Less fetal movements Post term Preeclampsia Drugs D etected on USG SIGNS Uterus – small for date R educed l iqor on abdominal examination F etal heart rate abnormality may be present L iqor draining on pad/ exam

35. DIAGNOSIS Detailed history to know the cause+ fetal movements Examination Ultrasound goals Quantitate liqor by AFI Look for anomalies Growth deficiency Fetal and uterine blood flow Fetal well being *Karyotyping

36. OLIGOHYDRAMNIOS

37. MANAGEMENT Management depends upon Etiology Gestational age Severity Fetal status & well being

38. MANAGEMENT Counselling : regarding cause and prognosis Adequate rest – decreases dehydration Hydration – oral/iv hypotonic fluids (2 liter/day) Serial USG – monitor growth, AFI, BPP Induction of labour / LSCS once lung maturity attained Lethal malformation- termination of pregnancy

39. MANAGEMENT Treatment acc. To cause Drug induced – omit drug Postdate pregnancy- delivery PROM – induction PPROM – antibiotics, steroid – induction Fetal surgery Vesico amniotic shunt- PUV obstruction Laser photocoagulation for TTTS Vasopressin –experimental

40. MANAGEMENT AMNIOINFUSION Decreases cord compression Dilutes meconium

41. Any Questions