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

2. PHYSIOLOGY OF AMNIOTIC FLUID

3. 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

4. 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

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

7. INCIDENCE
0.5 – 5%

8. 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

9. 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

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

11. 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)

12. MANAGEMENT DEPENDS UPON AETIOLOGY GESTATIONAL AGE SEVERITY
FETAL STATUS & WELL BEING

13. 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

14. 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

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

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