Download POLYHYDRAMNIOS

OLIGOHYDRAMNIOS
Dr Mona Shroff
www.obgyntoday.info
1
PHYSIOLOGY OF AMNIOTIC
FLUID
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INFLOW
OUTFLOW
(1000 ml/d)
(1000 ml/d)
1.FETAL URINE
2.LUNG LIQUID
1.FETAL
SWALLOWING
INTRAMEMBRANOUS (placenta,cord)
TRANSMEMBRANOUS(amniotic membranes)
RECYCLING – 3hrs
Dr Mona Shroff
www.obgyntoday.info
3
FUNCTIONS OF AMNIOTIC FLUID
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Shock absorber – protects from external trauma.
Protects cord from compression.
Permits fetal movements – development of
musculoskeletal system, prevents adhesions.
Swallowing of AF enhances growth & development
of GIT.
AF volume maintains AF pressure – reduces loss of
lung liquid – pulmonary development.
Maintenance of fetal body temperature.
Some fetal nutrition, water supply.
Bacteriostatic properties – decreases potential for
infection
Dr Mona Shroff
www.obgyntoday.info
4
Dr Mona Shroff
www.obgyntoday.info
5
DEFINITION
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AMNIOTIC FLUID VOLUME < 5 th
percentile for gestational age
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AMNIOTIC FLUID INDEX < 5
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SINGLE VERTICAL POCKET < 2 cms
Dr Mona Shroff
www.obgyntoday.info
6
INCIDENCE
0.5 – 5%
Dr Mona Shroff
www.obgyntoday.info
7
AETIOLOGY
FETAL
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PROM (50%)
CHROMOSOMAL ANOMALIES
CONGENITAL ANOMALIES
IUGR
IUFD
POSTTERM PREGNANCY
MATERNAL
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DRUGS
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PLACENTAL
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CHRONIC ABRUPTION
TTTS
CVS
PREECLAMPSIA
APLA SYNDROME
CHRONIC HT
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PG SYNTHETASE
INHIBITORS
ACE INHIBITORS
IDIOPATHIC
Dr Mona Shroff
www.obgyntoday.info
8
DIAGNOSIS
SYMPTOMS
SIGNS
NO SPECIFIC
SYMPTOMS
H/O leaking p/v
Postterm
s/o preeclampsia
Drugs
Less fetal movements
Uterus – small for
date
Feels full of fetus
Malpresentations
IUGR
Dr Mona Shroff
www.obgyntoday.info
9
USG
METHODS
MVP
AFI
<2 cms
(<1 severe)
<5 cms
(5-8 borderline)
2D pocket
<15 sq cms
Dr Mona Shroff
www.obgyntoday.info
10
COMPLICATIONS
FETAL
MATERNAL
Abortion
Increased morbidity
Prematurity
IUFD
Prolonged labour:
Deformities –
uterine inertia
CTEV,contractures,amputation
Potters syndrome- pulmonary
Increased operative
hypoplasia
intervention
Malpresentations
(malformations,
distres)
Fetal distress
MSAF – MAS
Dr Mona Shroff
Low APGAR
www.obgyntoday.info
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MANAGEMENT
DEPENDS UPON
AETIOLOGY
 GESTATIONAL AGE
 SEVERITY
 FETAL STATUS & WELL BEING
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Dr Mona Shroff
www.obgyntoday.info
12
DETERMINE AETIOLOGY
R/O PROM
 TARGETED USG FOR ANOMALIES
 R/O IUGR ,IUFD when suspected
 Amniocentesis if chromosomal anomalies
suspected – early symmetric IUGR
 Tests for APLA Syndrome , if suspected
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Dr Mona Shroff
www.obgyntoday.info
13
TREATMENT
ADEQUATE REST – decreases dehydration
 HYDRATION – Oral/IV Hypotonic fluids(2 Lit/d)
temperory increase
helpful during labour,prior
to ECV, USG
• SERIAL USG – Monitor growth,AFI,BPP
• INDUCTION OF LABOUR/ LSCS
Lung maturity attained
Lethal malformation
Fetal jeopardy
Sev IUGR
Severe oligo
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Dr Mona Shroff
www.obgyntoday.info
14

AMNIOINFUSION
INDICATIONS
1.Diagnostic
2.Prophylactic
3.Therapeutic
Decreases cord
compression
Dilutes meconium
Dr Mona Shroff
www.obgyntoday.info
15
TREATMENT ACC. TO CAUSE
Drug induced – OMIT DRUG
 PROM – INDUCTION
 PPROM – Antibiotics,steroid – Induction
 FETAL SURGERY
VESICO AMNIOTIC SHUNT-PUV
Laser photocoagulation for TTTS
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Dr Mona Shroff
www.obgyntoday.info
16
Dr Mona Shroff
www.obgyntoday.info
17