OLIGOHYDRAMNIOS 1 Dr Mona Shroff

PHYSIOLOGY OF AMNIOTIC FLUID 2

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

FUNCTIONS OF AMNIOTIC FLUID Shock absorber – protects from external trauma. Shock absorber – protects from external trauma. Protects cord from compression. Protects cord from compression. Permits fetal movements – development of musculoskeletal system, prevents adhesions. Permits fetal movements – development of musculoskeletal system, prevents adhesions. Swallowing of AF enhances growth & development of GIT. Swallowing of AF enhances growth & development of GIT. AF volume maintains AF pressure – reduces loss of lung liquid – pulmonary development. AF volume maintains AF pressure – reduces loss of lung liquid – pulmonary development. Maintenance of fetal body temperature. Maintenance of fetal body temperature. Some fetal nutrition, water supply. Some fetal nutrition, water supply. Bacteriostatic properties – decreases potential for infection Bacteriostatic properties – decreases potential for infection 4 Dr Mona Shroff

5

DEFINITION AMNIOTIC FLUID VOLUME < 5 th percentile for gestational age AMNIOTIC FLUID VOLUME < 5 th percentile for gestational age AMNIOTIC FLUID INDEX < 5 AMNIOTIC FLUID INDEX < 5 SINGLE VERTICAL POCKET < 2 cms SINGLE VERTICAL POCKET < 2 cms 6 Dr Mona Shroff

INCIDENCE 0.5 – 5% 0.5 – 5% 7 Dr Mona Shroff

AETIOLOGY FETAL PROM (50%) PROM (50%) CHROMOSOMAL ANOMALIES CHROMOSOMAL ANOMALIES CONGENITAL ANOMALIES CONGENITAL ANOMALIES IUGR IUGR IUFD IUFD POSTTERM PREGNANCY POSTTERM PREGNANCY MATERNAL PREECLAMPSIA PREECLAMPSIA APLA SYNDROME APLA SYNDROME CHRONIC HT CHRONIC HT PLACENTAL CHRONIC ABRUPTION CHRONIC ABRUPTION TTTS TTTS CVS CVS DRUGS PG SYNTHETASE INHIBITORS PG SYNTHETASE INHIBITORS ACE INHIBITORS ACE INHIBITORS IDIOPATHI C 8 Dr Mona Shroff

DIAGNOSIS SYMPTOMS SYMPTOMS NO SPECIFIC SYMPTOMS H/O leaking p/v Postterm s/o preeclampsia Drugs Less fetal movements SIGNS SIGNS Uterus – small for date Feels full of fetus MalpresentationsIUGR 9 Dr Mona Shroff

USG METHODS MVP <2 cms (<1 severe) (<1 severe) AFI <5 cms (5-8 borderline) (5-8 borderline) 2D pocket <15 sq cms 10 Dr Mona Shroff

COMPLICATIONS FETAL FETALAbortionPrematurityIUFD 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) 11 Dr Mona Shroff

MANAGEMENT DEPENDS UPON AETIOLOGY GESTATIONAL AGE SEVERITY FETAL STATUS & WELL BEING 12 Dr Mona Shroff

DETERMINE AETIOLOGY R/O PROM R/O PROM TARGETED USG FOR ANOMALIES TARGETED USG FOR ANOMALIES R/O IUGR,IUFD when suspected R/O IUGR,IUFD when suspected Amniocentesis if chromosomal anomalies suspected – early symmetric IUGR Amniocentesis if chromosomal anomalies suspected – early symmetric IUGR Tests for APLA Syndrome, if suspected Tests for APLA Syndrome, if suspected 13 Dr Mona Shroff

TREATMENT ADEQUATE REST – decreases dehydration ADEQUATE REST – decreases dehydration HYDRATION – Oral/IV Hypotonic fluids(2 Lit/d) HYDRATION – Oral/IV Hypotonic fluids(2 Lit/d) temperory increase temperory increase helpful during labour,prior helpful during labour,prior to ECV, USG to ECV, USG SERIAL USG – Monitor growth,AFI,BPP SERIAL USG – Monitor growth,AFI,BPP INDUCTION OF LABOUR/ LSCS INDUCTION OF LABOUR/ LSCS Lung maturity attained Lung maturity attained Lethal malformation Lethal malformation Fetal jeopardy Fetal jeopardy Sev IUGR Sev IUGR Severe oligo Severe oligo 14 Dr Mona Shroff

AMNIOINFUSION AMNIOINFUSION INDICATIONS INDICATIONS 1.Diagnostic 1.Diagnostic 2.Prophylactic 2.Prophylactic 3.Therapeutic 3.Therapeutic Decreases cord compression Decreases cord compression Dilutes meconium Dilutes meconium 15 Dr Mona Shroff

TREATMENT ACC. TO CAUSE Drug induced – OMIT DRUG Drug induced – OMIT DRUG PROM – INDUCTION PROM – INDUCTION PPROM – Antibiotics,steroid – Induction PPROM – Antibiotics,steroid – Induction FETAL SURGERY FETAL SURGERY VESICO AMNIOTIC SHUNT-PUV VESICO AMNIOTIC SHUNT-PUV Laser photocoagulation for TTTS Laser photocoagulation for TTTS 16 Dr Mona Shroff

17 Dr Mona Shroff