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

PHYSIOLOGY OF AMNIOTIC FLUID

INTRAMEMBRANOUS (placenta,cord) TRANSMEMBRANOUS(amniotic membranes) 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. 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 MATERNAL DRUGS PLACENTAL IDIOPATHIC PROM (50%) CHROMOSOMAL ANOMALIES CONGENITAL ANOMALIES IUGR IUFD POSTTERM PREGNANCY MATERNAL PREECLAMPSIA APLA SYNDROME CHRONIC HT DRUGS PG SYNTHETASE INHIBITORS ACE INHIBITORS IDIOPATHIC PLACENTAL CHRONIC ABRUPTION TTTS CVS

DIAGNOSIS Uterus – small for date Feels full of fetus Malpresentations 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

USG METHODS MVP <2 cms (<1 severe) AFI <5 cms (5-8 borderline) 2D pocket <15 sq cms

COMPLICATIONS FETAL Abortion MATERNAL 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)

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