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Oligohydramnios

This document discusses oligohydramnios, which is defined as a low amniotic fluid volume. It describes the normal physiology of amniotic fluid, including inflow from fetal urine and lung liquid and outflow from fetal swallowing. The key functions of amniotic fluid are also outlined. The document then covers the incidence, causes, diagnosis, complications, and management of oligohydramnios, noting it can be caused by fetal or maternal factors and that treatment depends on the etiology, gestational age, severity, and fetal status and well-being. Serial ultrasounds and tests are used to determine the cause, and management may include hydration, monitoring, induction of labor, or am

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967 views17 pages

Oligohydramnios

This document discusses oligohydramnios, which is defined as a low amniotic fluid volume. It describes the normal physiology of amniotic fluid, including inflow from fetal urine and lung liquid and outflow from fetal swallowing. The key functions of amniotic fluid are also outlined. The document then covers the incidence, causes, diagnosis, complications, and management of oligohydramnios, noting it can be caused by fetal or maternal factors and that treatment depends on the etiology, gestational age, severity, and fetal status and well-being. Serial ultrasounds and tests are used to determine the cause, and management may include hydration, monitoring, induction of labor, or am

Uploaded by

Nina
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PPT, PDF, TXT or read online on Scribd
  • Oligohydramnios Introduction: Introduces the topic of oligohydramnios, setting the stage for the detailed exploration that follows.
  • Physiology of Amniotic Fluid: Discusses normal amniotic fluid volume during pregnancy and its physiological relevance.
  • Inflow and Outflow: Explains the mechanisms of amniotic fluid inflow and outflow.
  • Functions of Amniotic Fluid: Details the protective and developmental roles of amniotic fluid in gestation.
  • Definition of Oligohydramnios: Provides the clinical definition and criteria for diagnosing oligohydramnios.
  • Incidence: Presents the incidence rates of oligohydramnios in pregnancies.
  • Aetiology: Explores potential causes of oligohydramnios including fetal, maternal, placental, and idiopathic factors.
  • Diagnosis: Discusses symptoms and signs for diagnosing oligohydramnios.
  • Ultrasound (USG) Methods: Describes ultrasound methods used to assess amniotic fluid levels.
  • Complications: Enumerates fetal and maternal complications arising from oligohydramnios.
  • Management: Outlines management strategies based on aetiology, severity, and fetal status.
  • Determine Aetiology: Focuses on determining the cause of oligohydramnios with various diagnostic tests.
  • Treatment: Explains treatment options including rest, hydration, and procedures to manage oligohydramnios.
  • Amnioinfusion: Details the procedure and indications for amnioinfusion in oligohydramnios.
  • Treatment According to Cause: Explores tailored treatment approaches depending on the specific cause of oligohydramnios.

OLIGOHYDRAMNIOS

Dr Mona Shroff 1

[Link]
PHYSIOLOGY OF AMNIOTIC
FLUID

2
INFLOW OUTFLOW
(1000 ml/d) (1000 ml/d)

[Link]
[Link] URINE
SWALLOWING
[Link] LIQUID

INTRAMEMBRANOUS (placenta,cord)
TRANSMEMBRANOUS(amniotic membranes)
RECYCLING – 3hrs
Dr Mona Shroff 3

[Link]
FUNCTIONS OF AMNIOTIC FLUID
 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 4

[Link]
Dr Mona Shroff 5
[Link]
DEFINITION

 AMNIOTIC FLUID VOLUME < 5 th


percentile for gestational age

 AMNIOTIC FLUID INDEX < 5

 SINGLE VERTICAL POCKET < 2 cms

Dr Mona Shroff 6

[Link]
INCIDENCE

0.5 – 5%

Dr Mona Shroff 7

[Link]
AETIOLOGY
FETAL
 PROM (50%) MATERNAL
 CHROMOSOMAL ANOMALIES  PREECLAMPSIA
 CONGENITAL ANOMALIES  APLA SYNDROME
 IUGR  CHRONIC HT
 IUFD
 POSTTERM PREGNANCY
DRUGS
 PG SYNTHETASE INHIBITORS
PLACENTAL  ACE INHIBITORS
 CHRONIC ABRUPTION
TTTS
IDIOPATHIC

 CVS

Dr Mona Shroff 8

[Link]
DIAGNOSIS
SYMPTOMS SIGNS

NO SPECIFIC Uterus – small for


SYMPTOMS date
Feels full of fetus
H/O leaking p/v
Postterm Malpresentations
s/o preeclampsia IUGR
Drugs
Less fetal movements
Dr Mona Shroff 9

[Link]
USG
METHODS

MVP <2 cms


(<1 severe)

AFI <5 cms


(5-8 borderline)

2D pocket <15 sq cms


Dr Mona Shroff 10

[Link]
COMPLICATIONS
FETAL MATERNAL
Abortion
Prematurity Increased morbidity
IUFD
Deformities – Prolonged labour:
CTEV,contractures,amputation uterine inertia

Potters syndrome- pulmonary


Increased operative
hypoplasia
intervention
Malpresentations (malformations,
Fetal distress distres)
MSAF – MAS
Low APGAR Dr Mona Shroff 11

[Link]
MANAGEMENT
DEPENDS UPON

 AETIOLOGY
 GESTATIONAL AGE
 SEVERITY
 FETAL STATUS & WELL BEING

Dr Mona Shroff 12

[Link]
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

Dr Mona Shroff 13

[Link]
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

Dr Mona Shroff 14

[Link]
 AMNIOINFUSION

INDICATIONS
[Link]
[Link]
[Link]

Decreases cord
compression
Dilutes meconium

Dr Mona Shroff 15

[Link]
TREATMENT ACC. TO CAUSE
 Drug induced – OMIT DRUG
 PROM – INDUCTION
 PPROM – Antibiotics,steroid – Induction
 FETAL SURGERY
VESICO AMNIOTIC SHUNT-PUV
Laser photocoagulation for TTTS

Dr Mona Shroff 16

[Link]
Dr Mona Shroff 17
[Link]

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