Prepared by : Hamzah Qarawi To: Miss Mahdia Kony

Outline Defenition Diagnosis Sign &symptoms Complication treatmen t

Description Amniotic fluid is the liquid that surrounds the developing fetus during pregnancy. It is contained within the amniotic membrane that forms the amniotic sac (bag of waters).

NORMAL AMNIOTIC FLUID VOLUME

INFLOW (1000 ml/d) 1.FETAL URINE 2.LUNG LIQUID INTRAMEMBRANOUS (placenta,cord) TRANSMEMBRANOUS(amniotic membranes) RECYCLING – 3hrs OUTFLOW (1000 ml/d) 1.FETAL SWALLOWING

FUNCTIONS OF AMNIOTIC FLUID *Shock absorber – protects from external trauma. *Protects cord from compression. *Permits fetal movements – development of musculoskeletal system, prevents adhesions. *Maintenance of fetal body temperature. *Some fetal nutrition, water supply. *Bacteriostatic properties – decreases potential for infection. 10

Definition - Polyhydramnios : A condition in which there is too much fluid around the fetus in the amniotic sac.

Causes and symptoms 1.Fetal causes. 2.Maternal causes. 3.Placental causes. 4.Idiopathic ( in two third of the cases the cause is unknown.

Infections passed from mother to fetus can also result in damage to the fetus and elevated amniotic fluid levels. Fetal abnormalities, including many that are life-threatening or lead to a significant impairment in the quality of life, are found in up to a quarter of all patients. For this reason, the initial finding of excess amniotic fluid should be followed by thorough diagnostic studies to determine the cause and the prognosis.

Because fetal swallowing is a major factor in amniotic fluid removal, fetal abnormalities that prevent fluid uptake should be investigated. These include gastrointestinal obstructions such as esophageal atresia and duodenal atresia, as well as neurological conditions that affect swallowing including anencephaly. Certain cardiac abnormalities, kidney disorders, and genetic conditions such as myotonic dystrophy and alpha- thalassemia can also cause polyhydramnios

Fetal chromosome abnormalities are frequently associated with elevated amniotic fluid levels. The more severe the polyhydramnios the more likely it is that fetal abnormalities will be present. In addition, there are other, infrequent causes, and in a number of cases, no cause can be found. Polyhydramnios can lead to maternal abdominal discomfort and respiratory difficulties as well as preterm labor. When polyhydramnios is associated with fetal abnormalities, perinatal mortality is significantly increased

Complication of polyhydramnios 1.Preterm labour. 2.Preterm premature rupture of membranes. 3.Placental abruption especially when there is sudden rupture of membranes which cause sudden release of pressure. 4.Higher incidence of Malpresentations and unstable lie. 5.Higher risk of developing postpartum haemorrhage due to uterine inertia. 5.Higher incidence of C/S due to the above complications.

Fetal risks: High perinatal mortality rate ranging from 10%- 30% which is largely due to: 1.Congenital malformations. 2.Prematurity. 3.Fetal hypoxia secondary to cord prolapse, placental abruption and uteroplacental dysfunction

Management All woman with polyhydramnios should have: 1.Ultrasound examination to assess: - the degree of polyhydramnios. -presence of multiple pregnancy. -Any fetal abnormalities. 2.Fetal specimens for karyotyping and viral infections. 3.Maternal blood sugar assessment

Treatment:  There is no known method of controlling the production or absorption of amniotic fluid,  except that strict control of diabetes may reduced the prevalence of polyhydramnios in diabetic women. The therapeutic aims are to:  Relieve symptoms.  Prolong pregnancy

20 Oligohydramnios: is a condition in pregnancy characterized by a deficiency of amniotic fluid in the amniotic sac

FETAL PROM (50%) CHROMOSOMAL ANOMALIES CONGENITAL ANOMALIES IUGR IUFD MATERNAL PREECLAMPSIA APLA SYNDROME CHRONIC HT PLACENTAL CHRONIC ABRUPTION TTTS CVS DRUGS PG SYNTHETASE INHIBITORS ACE INHIBITORS IDIOPATHI C AETIOLOGY

Oligohydramnios is most commonly associated with abnormalities of the fetal kidneys. Since fetal urine is the main source of amniotic fluid in the latter two-thirds of pregnancy, any condition that interferes with fetal urine production can lead to oligohydramnios

Renal agenesis, cystic kidneys, and bladder outlet obstructions are common. Meckel-Gruber syndrome, a lethal autosomal recessive genetic disorder featuring brain and kidney abnormalities and extra digits is one specific cause. Placental insufficiency and fetal growh retardation can also result in oligohydramnios.

Premature rupture of membranes, especially between 16 and 24 weeks is another cause and, because amniotic fluid is important in lung growth, it can lead to underdevelopment of the lungs (pulmonary hypoplasia). In general, regardless of the cause, oligohydramnios that arises early in a pregnancy,

can cause hypoplastic lungs. It can also result in space limitations within the amniotic sac that cause fetal compression and orthopedic abnormalities such as clubbed feet in the newborn. In general, oligohydramnios that begins near the time of delivery is associated with a better outcome than cases than have an onset earlier in pregnancy.

Diagnosis In current obstetrical practice, polyhydramnios and oligohydramnios are usually detected during a routine prenatal ultrasound. If the ultrasonographer suspects that excess or reduced fluid is present, it is customary to take measurements of pockets of fluid visualized around the fetus

The mother should be counseled about the possible complications and offered additional testing as necessary.

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

According - GestationalAge - Severty -Fetal status & well being MANAGEMENT

TREATMENT - ADEQUATE REST – decreases dehydration - HYDRATION – Oral/IV Hypotonic fluids(2 Lit/d) temperory increase helpful during labour 30

Amnioinfusion is a procedure in which normal saline or lactated Ringer's solution is placed into the uterus after sufficient cervical opening and rupture of membranes. Amnioinfusion can treat problems associated with decreased intra- amniotic volume, including: prophylactic treatment of oligohydramnios, treatment of severe variable decelerations during labor, and to reduce the risk of meconium aspiration during labor in patients with moderate or thick meconium fluid. Amnioinfusion is, therefore, performed during intense situations and the benefits often outweigh the risks AMNIOINFUSION

 AMNIOINFUSION INDICATIONS 1.Diagnostic 2.Prophylactic 3.Therapeutic Decreases cord compression Dilutes meconium 32

Prognosis  The prognosis for both polyhydramnios and oligohydramnios depends on the cause. If excess or reduced amniotic fluid is the result of an underlying fetal abnormality, the nature of that abnormality will determine the prognosis.

This is one reason why it is important to perform the necessary follow-up studies. A woman who has been diagnosed with polyhydramnios or oligohydramnios needs to be made fully aware of the types of testing available and carefully counseled about the diagnosis and its impact on the chance for a successful pregnancy outcome and a healthy infant

Prevention In order to prevent polyhydramnios or oligohydramnios, it would be necessary to prevent the underlying cause. Good control of maternal diabetes and the prevention of infections transmittable from mother to fetus are two approaches for a subset of cases, but, in general, prevention is not possible.

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