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Oligohydramnios, polyhydramnios and intrauterine growth retardation

Oligohydramnios, polyhydramnios and intrauterine growth retardation. elaboration: Piotr Uzar Department for Pathology of Pregnancy and Labour PAM. Amniotic fluid volume during pregnancy.

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Oligohydramnios, polyhydramnios and intrauterine growth retardation

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  1. Oligohydramnios, polyhydramnios and intrauterine growth retardation elaboration: Piotr Uzar Department for Pathology of Pregnancy and Labour PAM

  2. Amniotic fluid volume during pregnancy Amniotic fluid volume is in a dynamic balance state and it is determinated by: placental, fetal and maternal factors.

  3. Oligohydramnios • Definition: Considerable deficiency of amniotic fluidvolume< 200ml, 0,5%- 5,5% of all pregnancies • Reasons: fetal diseasies (malformations, hypotrophia, TTTS, acardiacus); maternal diseasies (diabetes with microangiopathy, gestosis, ); PROM; bad hydration;post-term pregnancy • Symptoms: SF,  fetal movements,  circumference of the abdomen, too littleweight, easy to feel fetus parts, hard to move presenting part

  4. Oligohydramnios • USG estimation:- difficult anatomy estimation- AFI < 5cm (amniotic fluid index by Phelan) -  biophysical profil and  fetal movements -  biometrics values (compression of fetus) - disturbances of blood flow in AU and AA

  5. Oligohydramnios • Complications: IUGR, hypoplasia of fetuses lungs, deformations fetus syndrome, amniotic bands syndrome, intrauterine infections, poor general condition of fetus, fetal necrosis or perinatal death, umbilical cord compression, meconium aspiration syndrome (MAS), brady- and tachycardia of fetus, inconstant decelerations, intrauterine fetal anoxia

  6. Oligohydramnios • Prophylaxis and treatment:- preconception care: hypertension, nephropathy, systemic disease, diabetes with microangiopathy - prenatal care: - treatment above mentioned diseases, detection of malformations, treatment of infections and ionic disorders; - conservative therapy (diet, rest); - operative therapy (amnioinfusion)- during labour: CTG, intranatal amnioinfusion- in case of green amniotic fluid

  7. Polyhydramnios • Definition: Pathologic increase of amniotic fluid volume, volume > 2 l ; 0,1%- 3,5% of all pregnancies • Reasons:

  8. Polyhydramnios • Symptoms: weak sensation of fetal movements, fetal pulse ausculation with difficulty, excessive diaphragm elevation, pain, pregnant circulatory-respiratory system disorders • USG estimation: AFI > 20cm • Complications: PROM, prolapse of the umbilical cord, premature placental ablation, intrauterine fetal anoxia, premature labour, incorrect lie, weak labour activity, postpartum uterine atonia and hemorrhage in the immediate postpartum period

  9. Polyhydramnios • Prophylaxis and treatment:-preconception care: malformations prophylaxis and diabetes control - prenatal care: - primary disease treatment (diabetes, infections, Rh isoimmunization) - symptomatic treatment- amnioreductions; take care!- premature labour, premature placental ablation, PROM and intrauterine infection; Indomethacin- fetal membranes permeability, fetus miction, resorption of amniotic fluid by lungs;take care!-narrowing of Botall’s duct

  10. Intrauterine growth retardation • Definition:Type I - IUGRofweight and height of the fetus or newborn <10 centile for gestational age Type II - IUGR of weight of the fetus or newborn <10 centile for gestational age; SGA (small for gestational age) • Clinical classification of hypotrophia:- Type I - symmetrical: 20%,low weight and height -reasons: smaller genetic potential, race, chromosome aberrations, hypovitaminosis, intrauterine infections, drugs

  11. IUGR - Type II - asymmetrical: 80%,low weight with normal height and head circumference, „brain sparing efect”- brain and heart without lesions-reasons: uteroplacental insufficiency, smoking, drinking, multiple pregnancy, diabetes, chronic hypertension with proteinuria, bleeding in the III period of pregnancy, malnutrition hypovolemia placental blood flow  size of placenta

  12. IUGR • USG estimation • Complications: of: IQ, activity, attention, tension, behaviour; short stature; slim body build • Treatment: primary disease, uteroplacental insufficiency, rest

  13. Rh Isoimmunization elaboration: Piotr Uzar Department for Pathology of Pregnancy and Labour PAM

  14. Rh Isoimmunization • Pathomechanism: a women immunization by erythrocytic Agtransmision of antierythrocytic Ig by placenta Ig bindings with fetus blood cells Ig damages blood cells haemolysis (hyperbilirubinemia) anaemiatissue hypoxia damage of: heart (circulatory insufficiency), epithelium, liver oedema and transudate in the body cavities, hypoalbuminemia fetal death • 0,2ml shunt is enough to immunize (labour, abortion) • Reasons: pregnancy, transfusion of incompatible blood group, drug addicts

  15. Rh Isoimmunization • Diagnostics:- blood group and Coombs test- a) if negative then tests in I, II, III trimester; b) if positive then once a month+ USG-USG estimation: hyperplacentosis (>4,5cm, in I trim. only), hepatosplenomegaly,  umbilical v., cardiomegaly (surface of the heart> 1/3 of breast), transudate in the peritoneum, oedema ( >0,5cm), transudate in the pleura and pericardium- Invasive diagnostics- cordocentesis- indications: Rh isoimmunization in anamnesis, Ig anti D1:16 or Ig anti D<1:16 with USG symptoms

  16. Rh Isoimmunization • Determination of: blood group and Rh, direct Coombs test, blood cell count (estimation of anaemia), serum protein, bilirubin, gasometry • CTG monitoring 1hafter procedure (FHR- small shunt, FHR- reaction after puncture of artery, if long-lasting then big blood loss) • Start of diagnostics: after 28Hbd if Ig anti D1:16 or Ig anti D<1:16 with USG symptoms of oedema of fetus or 4 weeks before the term fetal oedema appeard during the last pregnancy

  17. Rh Isoimmunization • Treatment:- earlier pregnancy termination (36-38Hbd)- Sandoglobulin (0,4mg/kg i.v.)- intrauterine transfusions (triple the survival rate) • transfusion indications:- grave anaemia of fetus- fetal hydrops- the only treatment- anamnesis- several fetal necrosis and father DD • transfusion complications: bleeding, fetus infection, premature labour, umbilical cord tamponade, umbilical venous thrombosis

  18. Rh Isoimmunization • Prophylaxis: intramuscular administration of Ig anty-D results in 96-98% effectivness if indirect antiglobulin reaction is negative • 150g:after -abortion, -missed labour, -ectopic pregnancy, -intrauterine procedure, -labour, -bleeding (imminent abortion, placenta praevia) • 300g:after -multiple pregnancy, cesarean section, -instrumental delivery, - manual removal of placenta • Gestational administration of150g Ig anty-D about 28Hbd effectivness to 99%

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