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    Amniotic Fluid Disorders

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    victor onapa
    Polyhydramnios and oligohydramnios refer to excessive or insufficient amniotic fluid, respectively. Polyhydramnios occurs in about 1% of pregnancies and is associated with fetal abnormalities and maternal diabetes. Oligohydramnios can lead to fetal lung hypoplasia and limb deformities. Management may include bed rest, hydration, amnioinfusion, and monitoring fetal well-being. The amount of amniotic fluid normally increases throughout pregnancy until 38 weeks.

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    Amniotic Fluid Disorders

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    victor onapa
    50 views22 pages
    Polyhydramnios and oligohydramnios refer to excessive or insufficient amniotic fluid, respectively. Polyhydramnios occurs in about 1% of pregnancies and is associated with fetal abnormalities and maternal diabetes. Oligohydramnios can lead to fetal lung hypoplasia and limb deformities. Management may include bed rest, hydration, amnioinfusion, and monitoring fetal well-being. The amount of amniotic fluid normally increases throughout pregnancy until 38 weeks.

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    Polyhydramnios and oligohydramnios refer to excessive or insufficient amniotic fluid, respectively. Polyhydramnios occurs in about 1% of pregnancies and is associated with fetal abnormalities and maternal diabetes. Oligohydramnios can lead to fetal lung hypoplasia and limb deformities. Management may include bed rest, hydration, amnioinfusion, and monitoring fetal well-being. The amount of amniotic fluid normally increases throughout pregnancy until 38 weeks.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    50 views22 pages

    Amniotic Fluid Disorders

    Uploaded by

    victor onapa
    Polyhydramnios and oligohydramnios refer to excessive or insufficient amniotic fluid, respectively. Polyhydramnios occurs in about 1% of pregnancies and is associated with fetal abnormalities and maternal diabetes. Oligohydramnios can lead to fetal lung hypoplasia and limb deformities. Management may include bed rest, hydration, amnioinfusion, and monitoring fetal well-being. The amount of amniotic fluid normally increases throughout pregnancy until 38 weeks.

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    © All Rights Reserved
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    Download as pptx, pdf, or txt
    of 22

    Abnormal 

    Midwifery
    Amniotic Fluid Disorders
    BY
    REBECCA & BARBARA
    Learning objectives
    • Define terms polyhydramnios and oligohydramnios
    • Explain the management of a pregnant woman with polyhydramnios
    • Explain the management of a pregnant woman with
    oligohydramnios

     
    Why is Amniotic Fluid Important?
     
    • Bathes the fetus to allow for proper growth and development of
    the lungs
    • Allows freedom of fetal movement and symmetrical musculoskeletal
    development
    • Barrier against infection & cushion against trauma
    • Provides a constant temperature, protecting fetus from heat loss
    Levels vary, increasing with gestational age

    – 50ml  at 12 weeks


    – 400ml at 20 weeks
    – 800ml at 34
    – 1000ml at 36­‐38 weeks
    at term there is 500–1000cc of fluid
    Amniotic fluid increases throughout pregnancy up to 38weeks of
    gestation when it is greatest at about 1 litre, from then it starts
    diminishing up to about 800 mls by the time of delivery and if
    pregnancy goes beyond term this volume continues to decrease.
    Polyhydramnios
    • Defined as an excessive amount of amniotic fluid; aka Hydramnios
    • Quantified as more than 1500mL of amniotic fluid
    – may not be apparent clinically until 3000ml
    • Identified in about 1% of pregnancies or 1/250 pregnancies
    • Associated with fetal malformations (especially of CNS and GI tract),
    maternal diabetes, monozygotic twin pregnancy
    Causes of Polyhydramnios
    • congenital anomalies 20% time
      – esophageal atresia or other GI tract blockage
    – open neural tube defect, anencephaly, meningomyelocele
    •  multiple gestation, especially with monozygotic twins
    •  maternal diabetes mellitus
    •  Rarely iso-­‐immunization and chorioangioma 'a rare tumor of the placenta’
    Idiopathic  80 – 90% of the time

     
    Types: Chronic versus Acute
    •  Chronic– gradual onset after 30 weeks of pregnancy
    This is the most common type
    •  Acute  –occurs suddenly about  20 weeks; uterus reaches
     the xiphisternum in about 3-­‐4 days
    – rare; associated with monozygotic twins and/or severe fetal abnormalities
    – poor prognosis– can be managed with amniocentesis to remove fluid
     
     
     
    Polyhydramnios
    Complications:
    • Maternal complaints of abdominal pain, dyspnea, edema, and possible
    oliguria
    • Unstable lie    -­‐>malpresentations
    • Cord prolapse
    • Premature  rupture of the membranes (PROM)
    • Preterm labor & delivery≈ ¼ of time  Increased
    • Incidence of caesarean section
    • Postpartum hemorrhage  
    Polyhydramnios
    Complications:
    • Abruptio placenta
    • Associated with pre-­‐eclampsia
    • Obstruction of maternal ureters
    • Increased perinatal mortality
    Diagnosis: History
     
    • Maternal complaints of:
      – breathlessness & discomfort
    – abdominal pain
      – exacerbation of symptoms (indigestion, heartburn, constipation)
    – edema and varicosities of the vulva & lower extremities
     
     
    Diagnosis: Examination
    •  Inspection  – size greater than date
      – globular shape
      – stretched and shiny skin with striae gravidarum
      – superficial blood vessels
    •  Palpation
      –  tense uterus
      – difficult to feel fetal parts
      – ballottable
      – fluid thrill
    •  Auscultation  of  FHTs may  be difficult
    •  -­‐>Ultrasound to confirm
     
    Polyhydramnios
    • Management:
    Goal– relieve symptoms and  optimize length of gestation, prevent complications
    •  Work-­up to  identify cause
      •  Bed  rest to decrease risk of  preterm labor
      •  Admit to consultant obstetrical unit
    •  Be prepared for complications
      – cord prolapse
      – pp hemorrhage
    •  Closely examine baby  for abnormalities
     
     
    Management cont

    • Amniocentesis- to relieve maternal discomfort, test for FLM


    • Amniotomy- slow removal of fluid recommended to avoid cord
    prolapse or placental abruption
    • Indomethacin Therapy- Dosing at 1.5 to 3mg/kg/day
    Oligohydramnios
    • Defined as: Abnormally small amount of amniotic fluid index, AFI of
    5cm or less
    • At term volume may  be 300–500ml or less
    • Etiology not completely understood
    • Conditions associated with oligohydramnios include: chromosomal
    abnormalities, congenital anomalies, IUGR, PROM, post-term
    pregnancy, fetal demise, placental abruption, twin-to-twin
    transfusion, uteroplacental insufficiency, maternal HTN, preeclampsia,
    DM, Indomethacin or other NSAID drug use, ACE inhibitor use
    CAUSES
    • Early ruptured of membranes is most common cause
    • Fetal urinary tract anomalies
      – renal agenesis (absence of kidneys),Potter’s Syndrome(pulmonary
    hypoplasia in addition to renal agenesis)
    • Intrauterine growth retardation due to placental insufficiency associated with
    maternal hypertension, diabetes.
    Reduction in placental function causes inadequate perfusion of fetal organs
    including the kidneys.
    The decrease in fetal urine formation leads to oligohydramnios, as the major
    component of amniotic fluid is fetal urine.
    CAUSES
    • Postmature pregnancy or Postdates pregnancy (>42weeks)
    •  Some maternal medications–ACE inhibitors 
    Complications
    • Poor development of lung tissue
      – broncho-­‐pulmonary dysplasia
      – pulmonary  hypoplasia
    • Poor tolerance of labor  – cord compression
    • Limb deformities, e.g. talipes
    • A squashed looking face, flattering of the nose and micrognathia (small
    jaw)
    • Dry, leathery skin.
    • Fetal death
    Potters Syndrome
    Technically Potter sequence
    • Incompatible with life due to pulmonary hypoplasia
    • Results from oligohydramnios due to multiple causes
    – bilateral renal  agenesis, obstruction of urinary tract, polycystic
    kidney disease, renal hypoplasia, placental insufficiency
    – may have genetic component
    •  Appearance: flat face, low set ears, clubbed feet, beaked nose
    Diagnosis
     

    •  History
    – mother may notice decreased fetal movements compared to previous
    normal pregnancies
    •   Uterus measures size <dates, the uterus is small and compact.
    •   Fetal parts are easily felt
    • The fetus is not ballotable
    • Auscultation is normal
    •   Malposition
     Amniotic fluid volume detection is done by ultrasonography
    Management of Oligohydramnios
    • Maternal bed rest
    •  Hydration
    •  Monitor fetal well-­‐being
    •  Amnio-­‐infusion
    cont
    • Fetal outcome poor with early-onset oligohydramnios; pulmonary
    hypoplasia is common in these cases and can be lethal
    • Late onset oligohydramnios can be complicated by cord compression
    during labor.
    • Amnioinfusion is the intrauterine infusion of crystalloid during labor
    to prevent umbilical cord compression and has been proven to lead to
    a reduced cesarean delivery rate
    • Amnioinfusion can also be used for intrapartum management of
    meconium-stained fluid (often associated with oligohydramnios) with
    markedly reduced incidence of meconium aspiration
    Bibliography
    • Cunningham, F. Gary. Williams Obstetric, 21st ed. McGraw-Hill Medical
    Publishing Division, 2001.
    • Gabbe, Steven G. Obstetrics Normal & Problem Pregnancies, 3rd ed.
    Churchill Livingstone Inc., 1986.
    • Gordon, John David. Obstetrics Gynecology & Infertility, 5th ed. Scrub
    Hill Press, Inc., 2001.

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