2. Varies with the duration of pregnancy.Average of amniotic fluid volume 12 weeks : 50 ml; 24 weeks : 500 ml; 36 weeks : 1000 ml & decreases thereafter. At term: The normal range in a singleton pregnancy is large: 500-2000 ml

3. DEFINITION Amniotic fluid volume (AFV) >2 L. INCIDENCE 1:25 pregnancies.

4. TYPES CHRONIC: ACUTE Excess fluid accumulates gradually & it is only noticed after the 30 th week of pregnancy. It is 10 times more common than acute polyhydramnios. Excess fluid accumulates more quickly & it occurs earlier in pregnancy. It is usually associated with uniovular twin pregnancy.

5. CAUSES FETAL ANOMALIES AnencephalyDuodenal atresia Thoraco- oesophageal fistula Spina bifidaHydrops fetalis MULTIPLE PREGNANCY MATERNALDiabetes mellitusPre-eclampsiaHeart or renal failureIDIOPATHIC

8. SYMPTOMS Unusually enlarged abdomen & less felt fetal movements. Abdominal discomfort. Dyspnea, dyspepsia, leg edema.

9. SIGNS The patient will be dyspnic state at lying down position Evidences of preeclampsia(edema, HTN and proteinuria)may be present

10. Abdomen is markedly enlarged, looks globular with fullness at the flanks. The skin is tense, shiny with large striae. INSPECTION: Abdominal girth is more than normal. Fluid thrill can be elicited in all directions over the uterus. Fetal parts cannot be well defined PALPATION: Fetal heart sound is not heard distinctly although its presence can be picked up by Doppler. AUSCULTATION:

11. INVESTIGATION USG Confirm diagnosis Vertical pocket > 8cm OR AFI >24 cm Detect the degree Vertical pocket: 8-11 cm (mild); 12-15 (Moderate) & >16 (severe) Detect the cause

12. DIFFERENTIAL DIAGNOSIS Twins :- No fluid thrill.Ovarian cystFull bladderMaternal ascitis Hydatiform mole:- H/O bleeding in early pregnancy and passage of vesicle per vagina.

13. Complications MATERNAL FETAL Malpresentation and unstable lie. Preterm labour :- due to over distension of membrane stretch muscle causes PG E2 secretion leads to contraction and labour. PROM : -cord prolapse, hand prolapse Abruptio placental :- over stretching in placenta leads to separation of placenta. Postpartum hemorrhage :- due to uterine inertia and retained tissue. Perinatal mortality high due to :- preterm labor, congenital malformation & cord prolapse.

14. MINOR DEGREE Additional rest in semi-reclining position. Sedation. MAJOR DEGREE 1 ) HOSPITALIZATION:- If there is dyspnoea or abdominal pain or ambulation is difficult. Bed rest rarely has any effect & diuretics, water & salt restriction are likewise ineffective.

15. 2. Amniocentesis To relief maternal distress. Technique:1500 is removed gradually (500 ml /hr)

16. SCHEME OF MANAGEMENT OF CHRONIC POLYHYDRAMNIOS No fetal abnormalityFetal abnormality Responsive to treatment Distress ++ Less than 37 weeks Pregnancy 38 weeks ++ Amnioreduction Correction of lie Stabilizing oxytocin drip A.R.M. Amnioreduction

17. DEFINITION Marked deficiency of the amniotic fluid volume below the normal limits (400ml) INCIDENCE0.5-5% of all pregnancies

18. A. Fetal:- 1. Spontaneous rupture of the membranes2. IUGR: 60%3. Post-term pregnancy 4. Congenital anomalies of the urinary tract: obstructive lesions or agenesis

19. B. Maternal:- 1. Utero-placental insufficiency. 2. Drugs: Prostaglandin synthetase inhibitors, Angiotensin converting enzyme inhibitors 3. Placental abruption C. Idiopathic

20. 1. Uterus is small for date2. Fetus: a. Easily felt & immobile b. FHS: easily heard 3. USG: Vertical pocket <1cm or <2cm; AFI <5 cm

21. AMNIO INFUSION: Infusion of saline into the uterine cavity through the abdominal wall by a spinal needle to increase the AFV & dilute any meconium.

22. DURING PREGNANCYDURING LABOR 1. Fetal hypoxia: {cord compression}2. Persistent position of the fetus 3. Limb deformities: talipes (clubfoot) & ankylosis of joints. 4. Pulmonary hypoplasia: {failure to retain amniotic fluid or increased outflow with impaired lung development & growth} 1. Increased cesarean section rate