1 / 24

DR. NABEEL S. BONDAGJI, MD, FRCSC Department of Obstetrics and Gynecology Feto-Maternal Unit

DR. NABEEL S. BONDAGJI, MD, FRCSC Department of Obstetrics and Gynecology Feto-Maternal Unit. PHYSIOLOGY OF AMNIOTIC FLUID. Early pregnancy: composition of AF similar to ECF. Transfer of water across amnion and through fetal skin. By second trimester: fetus begins to

stedman
Download Presentation

DR. NABEEL S. BONDAGJI, MD, FRCSC Department of Obstetrics and Gynecology Feto-Maternal Unit

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. DR. NABEEL S. BONDAGJI, MD, FRCSC Department of Obstetrics and Gynecology Feto-Maternal Unit

  2. PHYSIOLOGY OF AMNIOTIC FLUID • Early pregnancy: composition of AF similar to ECF. Transfer of water across amnion and through fetal skin. • By second trimester: fetus begins to urinate swallow, and inspire AF  During last 2/3 of pregnancy, AF is principally comprised of fetal urine.

  3. NORMAL AMNIOTIC FLUID VOLUME

  4. DEFINITIONS: • Polyhydramnios: 2000 cc amniotic fluid • Amniotic Fluid Index = largest vertical pocket in 4 quadrants polyhydramnios 24 cm.

  5. ETIOLOGY OF POLYHYDRAMNIOS • Idiopathic • Fetal Anomalies • Diabetes • Multifetal gestation • Immune/Non-immune hydrops • Fetal infection • Placental haemangiomas

  6. Etiology of Polyhydramnios: Fetal Anomalies • Problems with swallowing and GI absorption • Increased transudation of fluid: anencephaly, spina bifida • Increased urination: anencephaly (lack of ADH, stimulation of urination centers) • Decreased inspiration

  7. SYMPTOMS • Dyspnea • Abdominal pain • Venous stasis • Contractions  preterm labor • Decreased Perception of Fetal Movements

  8. DIAGNOSIS • Fundal height > gestational age • Difficulty palpating fetal parts/hearing heart tones • Tense uterine wall • ***Sonography

  9. (fetus)? • Fetal prognosis worsens with more severe hydramnios and congenital anomalies • 15-20% fetal malformations • Preterm delivery • Suspect diabetes • Prolapse of cord • Abruption

  10. (Mother)? • Dyspnea • Venous Stasis • Placental abruption • Uterine dysfunction • Post-partum hemorrhage • Abnormal presentation -- C/S

  11. TREATMENT • Mild to Moderate hydramnios: rarely requires treatment • Hospitalization, bed rest • Amniocentesis • Non-steroidal anti-inflammatory analgesia • Blood sugar control

  12. OLIGOHYDRAMNIOS

  13. DEFINITION • AFI 5

  14. ETIOLOGY • Postdate • Fetal Anomalies: obstruction of fetal urinary tract/renal agenesis • IUGR • ROM • Twin/Twin transfusion • Exposure to ACE inhibitors, and • Non-steroidal anti-inflammatory

  15. SIGNS/SYMPTOMS • Fundal height < gestational age • Decreased fetal movement • Fetal Heart Rate tracing abnormality • Diagnosis: Ultrasound

  16. Extremely poor fetal prognosis, especially in early pregnancy • Adhesions between amnion and fetal parts ---malformations and amputations • Musculoskeletal deformities • Pulmonary hypoplasia

  17. Cord Compression -- >fetal hypoxia • Passage of meconium into low AF volume: thick particulate suspension -->respiratory compromise

  18. TREATMENT • Delivery • Amnioinfusion

  19. THANK YOU

More Related