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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)

slide3
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
slide10
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

slide15
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