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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

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OLIGOHYDRAMNIOS

Dr. Mona Shroff, M.D.Diploma in Obs. & Gynaec UltrasoundEMOC 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)

TRANSMEMBRANOUS(amniotic membranes)

RECYCLING – 3hrs


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

  • AMNIOTIC FLUID VOLUME < 5 th percentile for gestational age

  • AMNIOTIC FLUID INDEX < 5

  • SINGLE VERTICAL POCKET < 2 cms


INCIDENCE

0.5 – 5%


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


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


USG

METHODS

MVP <2 cms

(<1 severe)

AFI <5 cms

(5-8 borderline)

2D pocket <15 sq cms


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

DEPENDS UPON

  • AETIOLOGY

  • GESTATIONAL AGE

  • SEVERITY

  • FETAL STATUS & WELL BEING


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

  • 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


  • AMNIOINFUSION

    INDICATIONS

    1.Diagnostic

    2.Prophylactic

    3.Therapeutic

    Decreases cord compression

    Dilutes meconium


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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