this presentation highlights the abnormalities in liquor around the fetus in utero, good for undergraduates and postgraduates of obstetrics and gynaecology.

2. AMNIOTIC FLUID
• AMNIOTIC FLUID PROVIDES CUSHION TO THE FETUS FROM PHYSICAL TRAUMA, PERMITS FETAL LUNG GROWTH, AND
PROVIDES A BARRIER AGAINST INFECTION.
• NORMAL AMNIOTIC FLUID VOLUME VARIES OVER THE PREGNANCY.
• AMNIOTIC FLUID VOLUME INCREASES THROUGHOUT MOST OF PREGNANCY, WITH A VOLUME OF ABOUT 30 ML AT 10 WEEKS
OF GESTATION AND A PEAK OF ABOUT 1 L AT 34-36 WEEKS OF GESTATION. AFV DECREASES TOWARDS TERM, WITH A MEAN
AFV OF 800 ML AT 40 WEEKS.
• A NEAR TERM FETUS PRODUCES 500-1200 ML OF URINE AND SWALLOWS BETWEEN 210 AND 790 ML OF AMNIOTIC FLUID
PER DAY.
• THE AVERAGE VOLUME INCREASES WITH GESTATIONAL AGE, PEAKING AT 800-1000 ML, WHICH COINCIDES WITH 36-37
WEEKS' GESTATION.

3. DEFINITION
• OLIGOHYDRAMNIOS IS DEFINED AS AN AFI LESS THAN 5 CM OR THE ABSENCE OF A FLUID POCKET 2 CM IN
DEPTH.
• POLYHYDRAMNIOS IS USUALLY DEFINED AS AN AFI OF MORE THAN 25 CM OR A SINGLE POCKET OF FLUID
AT LEAST 8 CM IN DEPTH.

4. DEFINITION
• AN INADEQUATE VOLUME OF AMNIOTIC FLUID, OLIGOHYDRAMNIOS , RESULTS IN POOR DEVELOPMENT OF
THE LUNG TISSUE AND CAN LEAD TO FETAL DEATH.
• AN ABNORMALLY HIGH LEVEL OF AMNIOTIC FLUID, POLYHYDRAMNIOS, ALERTS THE CLINICIAN TO
POSSIBLE FETAL ANOMALIES.
• OLIGOHYDRAMNIOS OCCURS IN ABOUT 1-2 % OF PREGNANCIES.
• POLYHYDRAMNIOS OCCURS IN 1% OF PREGNANCIES.

5. OLIGOHYDRAMNIOS - CAUSES
• FETAL URINARY TRACT ANOMALIES, SUCH AS RENAL AGENESIS, POLYCYSTIC KIDNEYS, OR ANY URINARY
OBSTRUCTIVE LESION (POSTERIOR URETHRAL VALVES), IUD
• PREMATURE RUPTURE OF MEMBRANES, CHORIOAMNIONITIS.
• PLACENTAL INSUFFICIENCY, AS SEEN IN PREGNANCY-INDUCED HYPERTENSION, MATERNAL DIABETES, OR
POSTMATURITY SYNDROME.
• MATERNAL USE OF PROSTAGLANDIN SYNTHASE INHIBITORS OR ANGIOTENSIN-CONVERTING ENZYMES.
• MATERNAL DEHYDRATION.
• IDIOPATHIC

6. OLIGOHYDRAMNIOS- PROGNOSIS
• OLIGOHYDRAMNIOS WITH RENAL AGENESIS, MORTALITY IS 100%.
• OLIGOHYDRAMNIOS IS ALSO ASSOCIATED WITH:
MECONIUM STAINING OF THE AMNIOTIC FLUID
FETAL HEART CONDUCTION ABNORMALITIES
UMBILICAL CORD COMPRESSION.
POOR TOLERANCE OF LABOR.
LOWER APGAR SCORES.
FETAL ACIDOSIS.

7. OLIGOHYDRAMNIOS- PROGNOSIS
• IN CASES OF INTRAUTERINE GROWTH RESTRICTION (IUGR), THE DEGREE OF OLIGOHYDRAMNIOS IS OFTEN
PROPORTIONAL TO GROWTH RESTRICTION, IS FREQUENTLY REFLECTIVE OF THE EXTENT OF PLACENTAL
DYSFUNCTION, AND IS ASSOCIATED WITH A CORRESPONDING INCREASE IN THE PMR.
• OBSTRUCTIVE UROPATHIES/RENAL AGENESIS CAUSE POTTER’S SYNDROME; INCLUDING EXTERNAL
COMPRESSION WITH A FLATTENED FACIES AND EPICANTHAL FOLDS, HYPERTELORISM, LOW-SET EARS, A
MONGOLOID SLANT OF THE PALPEBRAL FISSURE, A CREASE BELOW THE LOWER LIP, AND MICROGNATHIA.

8. OLIGOHYDRAMNIOS- DIAGNOSIS
• CLINICAL PRESENTATION AND EXAMINATION.
• OBSTETRIC ULTRASONOGRAPHY.
VISUALIZE THE FETAL KIDNEYS, COLLECTING SYSTEM, AND BLADDER.
PLACENTAL MATURITY.
GROWTH PARAMETERS AND DOPPLER.

9. OLIGOHYDRAMNIOS-TREATMENT
• TREATMENT OF UNDERLYING CAUSE.
• MATERNAL BED REST.
• INCREASED ORAL HYDRATION. USE OF L-ARGININE.
• DELIVERY SHOULD BE IN TERTIARY LEVEL HOSPITAL.
• THE TRANSCERVICAL INSTILLATION OF ISOTONIC SODIUM CHLORIDE SOLUTION , AMNIOINFUSION AT THE
TIME OF DELIVERY REDUCES THE RISK OF CORD COMPRESSION, FETAL DISTRESS, AND MECONIUM . IT
ALSO REDUCES THE POTENTIAL NEED FOR CESAREAN DELIVERY.

10. POLYHYDRAMNIOS-CAUSES
• TWIN GESTATION WITH TWIN-TO-TWIN TRANSFUSION SYNDROME ,MULTIPLE GESTATIONS.
• FETAL ANOMALIES, INCLUDING ESOPHAGEAL ATRESIA, TRACHEAL AGENESIS, DUODENAL ATRESIA.
• CENTRAL NERVOUS SYSTEM ABNORMALITIES AND NEUROMUSCULAR DISEASES THAT CAUSE SWALLOWING DYSFUNCTION.
• CONGENITAL CARDIAC-RHYTHM ANOMALIES ASSOCIATED WITH HYDROPS, FETAL-TO-MATERNAL HEMORRHAGE, AND
PARVOVIRUS INFECTION.
• CHROMOSOMAL ABNORMALITIES, TRISOMY 21, FOLLOWED BY TRISOMY 18 AND TRISOMY 13.
• FETAL AKINESIA SYNDROME WITH ABSENCE OF SWALLOWING.
• POORLY CONTROLLED MATERNAL DIABETES MELLITUS.

11. POLYHYDRAMNIOS-PROGNOSIS
• IDIOPATHIC POLYHYDRAMNIOS - THE PROGNOSIS IS GOOD.
• ABOUT 20% OF INFANTS WITH POLYHYDRAMNIOS HAVE SOME TYPE OF AN ANOMALY; IN THESE CASES, THE PROGNOSIS DEPENDS
ON THE SEVERITY OF THE ANOMALY.
• POLYHYDRAMNIOS IS ASSOCIATED WITH :
PROLONGED FIRST STAGE OF LABOUR
NONVERTEX PRESENTATION AND CESAREAN DELIVERY.
PRETERM LABOR.
PREMATURE RUPTURE OF THE MEMBRANES.
ABRUPTIO PLACENTA.
POSTPARTUM HEMORRHAGE.

12. POLYHYDRAMNIOS-DIAGNOSIS
• CLINICAL PRESENTATION AND EXAMINATION.
• OBSTETRICAL ULTRASONOGRAPHY.
HYDROPS WITH ANASARCA, ASCITES, PLEURAL OR PERICARDIAL EFFUSIONS
GASTROINTESTINAL TRACT OBSTRUCTION , ABSENCE OF THE STOMACH BUBBLE (WHICH IS ASSOCIATED
WITH ESOPHAGEAL ATRESIA). THE DOUBLE-BUBBLE SIGN OR A DILATED DUODENUM SUGGESTS THE
POSSIBILITY OF DUODENAL ATRESIA.
ECHOCARDIOGRAPHY, FETAL ARRHYTHMIAS AND MALFORMATIONS .
FETAL BIOMETRY, DOPPLER, PLACENTA.

13. POLYHYDRAMNIOS-DIAGNOSIS
• SCREENING FOR MATERNAL ANTIBODIES TO D, C, KELL, DUFFY, AND KIDD ANTIGENS TO DETERMINE
MATERNAL ANTIBODY PRODUCTION AGAINST THE FETAL RED BLOOD CELLS.
• VENEREAL DISEASE RESEARCH LABORATORIES.
• IGG AND IGM TITERS RUBELLA, CMV, TOXOPLASMOSIS, AND PARVOVIRUS.
• KLEIHAUER-BETKE TEST TO EVALUATE FETAL-MATERNAL HEMORRHAGE
• FETAL KARYOTYPING FOR TRISOMY 21, 13, AND 18.
• OGTT.

14. POLYHYDRAMNIOS- TREATMENT
• BED REST.
• TREAT DIABETES MELLITUS IF DETECTED.
• IN CASES OF FETAL ANEMIA, INTRAUTERINE PCV TRANSFUSION MAY BE DONE.
• REDUCTIVE AMNIOCENTESIS MAY BE PERFORMED. IF TOO MUCH FLUID IS REMOVED, PLACENTAL
ABRUPTION MAY OCCUR AND EVEN INFECTION, BLEEDING, AND TRAUMA TO THE FETUS.
• LASER ABLATION OF PLACENTAL VESSELS MAY BE EFFECTIVE IN CASES OF TWIN-TO-TWIN TRANSFUSION
SYNDROME.

15. POLYHYDRAMNIOS- TREATMENT
• MOST CASES OF POLYHYDRAMNIOS RESPOND IN THE FIRST WEEK OF TREATMENT WITH INDOMETHACIN.
WHEN ADMINISTERED TO PREGNANT WOMEN WITH POLYHYDRAMNIOS, THESE DRUGS CAN REDUCE FETAL
URINARY FLOW, DECREASING THE VOLUME OF AMNIOTIC FLUID.
• CONSULTATION WITH A NEONATOLOGIST, PEDIATRIC SURGEON, PEDIATRIC CARDIOLOGIST, PEDIATRIC
NEPHROLOGIST, PEDIATRIC INFECTIOUS DISEASE SPECIALIST, OR OTHER GENETICS SPECIALISTS AS
REQUIRED TO CARE FOR THE INFANT.