1. OLIGOHYDRAMNIOS

3. PHYSIOLOGY OF AMNIOTIC FLUID

6. Amniotic fluid volume 8 weeks : 15 ml,increases 10 ml/wk
17 wks :250 ml ,increases 50 ml/wk
28-38 wks : ml (decreases after 34 wks)
42 wks<500ml

7. 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

8. Definition
It is an extremely rare condition where the liquor amnii is deficient in amount to the extent of less than 200ml at term.(D.C.Dutta) Sonographically, it is defined when the maximum vertical pool of liquor is less than 2cm or when amniotic fluid index(AFI)is less than 5cm.

9. INCIDENCE
0.5 – 5%

10. Etiology Fetal chromosomal anomalies Intrauterine infection
Drugs-PG inhibitors, ACE inhibiters
Renal agenesis or obstruction of the urinary tract of the fetus preventing micturition
IUGR associated with placental insufficiency
Amnion nodosum-Failure of secretion by the cells of amnion covering the placenta.
Post-maturity
Early rupture of fetal membrane

11. FETAL MATERNAL DRUGS PLACENTAL IDIOPATHIC PROM (50%)
CHROMOSOMAL ANOMALIES
CONGENITAL ANOMALIES
IUGR
IUFD
POSTTERM PREGNANCY
MATERNAL
PREECLAMPSIA
APLA SYNDROME
CHRONIC HTN
DRUGS
PG SYNTHETASE INHIBITORS
ACE INHIBITORS
IDIOPATHIC
PLACENTAL
CHRONIC ABRUPTION
CVS

12. Diagnosis Uterine size is much smaller than the period of amenorrhea
Less fetal movements
The uterus is “full of fetus” because of scanty liquor
Malpresentation (breech) is common
Evidences of intrauterine growth retardation of the fetus
Sonographic diagnosis is made when largest liquor pool is less than 2cm.Ultrasound visualization is done following amnio infusion of 300 ml of warm saline solution.
Visualization of normal filling and emptying of fetal bladder essentially rules out urinary tract abnormality.
Oligohydramnios with fetal symmetric growth retardation is associated with increased chromosomal abnormality.

13. Diagnosis SIGNS Uterus – small for date Feels full of fetus
SYMPTOMS
NO SPECIFIC SYMPTOMS
H/O leaking p/v
Post term
s/o preeclampsia
Drugs
Less fetal movements
SIGNS
Uterus – small for date
Feels full of fetus
Malpresentations
IUGR

14. USG
AFI <5 cm
(5-8 borderline)

15. Complications Abortion
Fetal:
Abortion
Deformity due to intra-amniotic adhesions or due to compression
Fetal pulmonary hypoplasia
Cord compression
High fetal mortality
Potter’s syndrom
Malpresentations
Foetal distress-low apgar

16. Maternal :
Prolonged labor due to inertia
Increased operative interference due to malpresentation. The sum effect may lead to increased maternal morbidity.
Increased operative intervention

17. Management DEPENDS UPON AETIOLOGY GESTATIONAL AGE SEVERITY
FETAL STATUS & WELL BEING

18. Determine Etiology R/O PROM, h/o medical illness TARGETED USG FOR
ANOMALIES
R/O IUGR ,IUFD when suspected
Amniocentesis if chromosomal
anomalies suspected – early
symmetric IUGR
Tests for APLA Syndrome , if
suspect

20. Management Patient will be admitted to the hospital Do ultra sound
If renal agenesis is not present ,placental
Function tests should perform
In order to prevent compression deformities and hypo plastic lung disease amnio infusion with normal saline or ringer’s lactate may be performed.
Induce labor because of placental insufficiency

21. Epidural anesthesia may be indicated to reduce the painful uterine contractions
Continuous fetal monitoring to prevent fetal hypoxia due to cord compression or placental insufficiency

22. Treatment ADEQUATE REST – decreases dehydration
HYDRATION – Oral/IV Hypotonic fluids(2 Lit/d)
temporary increase
helpful during labour,
USG
SERIAL USG – Monitor growth, AFI, BPP
INDUCTION OF LABOUR/ LSCS
Lung maturity attained
Lethal malformation
Fetal jeopardy
Severe IUGR
Severe oligohydramnios

23. Amnio infusion AMNIOINFUSION INDICATIONS 1.Diagnostic 2.Prophylactic
3.Therapeutic
Decreases cord compression
Dilutes meconium

24. There appears to be no advantage of prophylactic amnioinfusion over therapeutic amnioinfusion carried out only when fetal heart rate decelerations or thick meconium-staining of the liquor occur.

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

26. Nursing diagnosis
Anxiety related to the outcome Inadequate knowledge related to the condition Potential for maternal and fetal complications

28. Thank you