Oligohydramnios
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OLIGOHYDRAMNIOS. Dr. Mona Shroff, M.D. Diploma in Obs. & Gynaec Ultrasound EMOC Clinical Trainer (JHPIEGO). PHYSIOLOGY OF AMNIOTIC FLUID. OUTFLOW (1000 ml/d) 1.FETAL SWALLOWING. INFLOW (1000 ml/d) 1.FETAL URINE 2.LUNG LIQUID INTRAMEMBRANOUS (placenta,cord)

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Oligohydramnios

OLIGOHYDRAMNIOS

Dr. Mona Shroff, M.D.Diploma in Obs. & Gynaec UltrasoundEMOC Clinical Trainer (JHPIEGO)


Physiology of amniotic fluid

PHYSIOLOGY OF AMNIOTIC FLUID


Oligohydramnios

OUTFLOW

(1000 ml/d)

1.FETAL SWALLOWING

INFLOW

(1000 ml/d)

1.FETAL URINE

2.LUNG LIQUID

INTRAMEMBRANOUS (placenta,cord)

TRANSMEMBRANOUS(amniotic membranes)

RECYCLING – 3hrs


Functions of amniotic fluid

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


Definition

DEFINITION

  • AMNIOTIC FLUID VOLUME < 5 th percentile for gestational age

  • AMNIOTIC FLUID INDEX < 5

  • SINGLE VERTICAL POCKET < 2 cms


Incidence

INCIDENCE

0.5 – 5%


Aetiology

AETIOLOGY

FETAL

PROM (50%)

CHROMOSOMAL ANOMALIES

CONGENITAL ANOMALIES

IUGR

IUFD

POSTTERM PREGNANCY

MATERNAL

PREECLAMPSIA

APLA SYNDROME

CHRONIC HT

PLACENTAL

CHRONIC ABRUPTION

TTTS

CVS

DRUGS

PG SYNTHETASE INHIBITORS

ACE INHIBITORS

IDIOPATHIC


Diagnosis

SYMPTOMS

NO SPECIFIC SYMPTOMS

H/O leaking p/v

Postterm

s/o preeclampsia

Drugs

Less fetal movements

SIGNS

Uterus – small for date

Feels full of fetus

Malpresentations

IUGR

DIAGNOSIS


Oligohydramnios

USG

METHODS

MVP <2 cms

(<1 severe)

AFI <5 cms

(5-8 borderline)

2D pocket <15 sq cms


Complications

FETAL

Abortion

Prematurity

IUFD

Deformities –CTEV,contractures,amputation

Potters syndrome- pulmonary hypoplasia

Malpresentations

Fetal distress

MSAF – MAS

Low APGAR

MATERNAL

Increased morbidity

Prolonged labour: uterine inertia

Increased operative intervention

(malformations,

distres)

COMPLICATIONS


Management

MANAGEMENT

DEPENDS UPON

  • AETIOLOGY

  • GESTATIONAL AGE

  • SEVERITY

  • FETAL STATUS & WELL BEING


Determine aetiology

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


Treatment

TREATMENT

  • BED REST – decreases dehydration

  • HYDRATION – Oral/IV Hypotonic fluids

    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


Oligohydramnios

  • AMNIOINFUSION

    INDICATIONS

    1.Diagnostic

    2.Prophylactic

    3.Therapeutic

    Decreases cord compression

    Dilutes meconium


Treatment acc to cause

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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