The document outlines the causes, symptoms, diagnosis, management, and complications of hydramnios (polyhydramnios) and oligohydramnios in pregnancy. It highlights risk factors such as maternal diabetes and fetal malformations, as well as the implications for both maternal and fetal health. The prognosis varies based on the underlying causes, with significant risks of prematurity and congenital abnormalities.

1. HYDRAMNIOS

2. POLYHYDRAMNIOS
RISK FACTIORS
MATERNAL
• Diabetes mellitus, About 50% of diabetic pregnancies have hydramnios.
• Cardiac or renal disease

3. FETAL
• Fetal malformation (eg. Spina bifida, hydrocephaly)
• Hydrops fetalis in Rh- incompatibility
• Multiple pregnancy
• Esophageal or duodenal atresia
• aneuploidy

4. SYMPTOMS
• The maternal symptoms depend on the stage of gestation .
• Mild symptoms include
Abdominal discomfort
Slight dyspnea

5. • IN SEVERE CASES (OVER 4000ML OF FLUID)
 Abdominal pain
 Dyspnea
 Orthopnea
Oedema of the abdomen, legs, vulva
 Nausea and Vomiting

6. TYPES OF POLYHYDRAMNIOS
 Acute polyhydramnios
 Chronic polyhydramnios

7. ACUTE POLYHYDRAMNIOS
This condition is extremely rare. It usually occurs before 20 weeks of
pregnancy.
SYMPTOMS
• Abdominal pain
• Nausea
• Vomiting

8. TREATMENT
 Most often spontaneous abortion occurs
 In case with severe TTT’s (Twin - Twin Transfusion synderome) repetitive
amnioreduction until the AFI is normal, may improve the perinatal
outcome.
 Laser ablation may cure the cause of TTT’s.

9. CHRONIC POLYHYDRAMNIOS
This occurs later in pregnancy usually between 32 and 40 weeks. The
prognosis depends on the underlying causes.
SYMPTOMS
• Respiratory – Dyspnea
• Palpitation
• Edema of the legs , varicositis in the legs or vulva and hemorrhoids.

10. SIGNS
• The patient may be in a dyspneic state in the lying down position
• Evidence of pre- eclampsia (edema, hypertension and proteinuria) may be
present.
MANAGEMENT
• Supportive therapy like bed rest
• Drainage of excess amniotic fluid.

11. DIAGNOSIS
Abdominal Examination
• The uterus is larger than expected
• The fetal parts are difficult to outline.
• The fetal heart rate cannot be heard clerly.

12. Ultra sonography:
• Ultrasonography helps to establish the diagnosis and detect the presence of many fetal
anamolies
• To detect abnormally large echo-free space between the fetus and uterine wall.
• AFI (is more than 25cm is polyhydramnios)
• Detect fetal congenital malformations such as anencephly spina bifida meningocele
• Multiple pregnancy
• Fetal malformation

13. MANAGEMENT
• In mild cases rest and mild sedation is helpful.
• In severe cases the hospitalization is required and removal of fluid it may feel
comfortable to the mother temporarily.
• The fetus is matured, induction of labour and delivery may be recommended.
• Major congenital abnormalities are diagnosed termination of pregnancy is
advisable.

14. COMPLICATION
• Fetal malpresentation
• Premature rupture of membranes
• Prolonged labour
• Amniotic fluid embolism

15. PROGNOSIS
• Major fetal congenital malformations occur in 20%
• Incidence of prematurity is more than twice the general rate.
• Placental abruption due to rapid decomposition of the uterus when the
membranes rupture and result in uncreased morbidity and mortality.

16. POLY HYDRAMNIOS
ETIOLOGY
FETAL
• Fetal chromosomal abnormalities
• Renal agencies
• Obstructed uropathy
• Spontaneous rupture of membrane
• IUGR

17. MATERNAL
• Hypertensive disorder
• Uteroplacental insufficiency
• Dehydration

18. EFFECTS OF OLIGOHYDRAMNIOS
EARLY PREGNANCY
• Pressure deformities, such as club feet
• Pulmonary hypoplacia has been reported
• The skin becomes dry and wrinkled

19. LATE PREGNANCY
• Close adaption between the fetus and the uterine wall can lead to pressure
on the umblical cord and obstruction cord and obstruction to the flow of
blood and from the fetus
• Fetal hypoxia may result
• Meconium passed into an amniotic sac. Aspiration of thick meconium by
the fetus will lead to aspiration pneumonia after birth.

20. DIAGNOSIS
• The uterine size appears smaller than gestational period.
• Fetal malpresentation
• On abdominal palpation
• ULTRSOUND
No pocket of amniotic fluid is greater than 1 cm.

21. HAZARDS
MTERNAL
• There is high incidence of operative because of fetal distress and mal
presentation.

22. FETAL
• Perinatal mortality is high.
• Fetal distress in labor is a common complication
• Skeletal deformities due to compression
Eg: Talipes
• Fetal lung hypoplacia is common when amniotic fluid is scanty.

23. COMPLICATION
FETAL
• Abortion
• Fetal pulmonary hypoplacia
• Cord compression
• High fetal mortality

24. MATERNAL
• Prolonged labor due to inertia.
• Increased operative interference malpresentation

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