This document discusses normal amniotic fluid levels at different gestational ages and the causes and effects of oligohydramnios, or low amniotic fluid. It notes that oligohydramnios can be caused by maternal or fetal conditions and leads to risks for the fetus like skeletal deformities, contractures, and pulmonary hypoplasia. The management of oligohydramnios involves counseling, serial ultrasounds, amnioinfusion if needed, monitoring for signs of fetal distress, and delivery according to the specific conditions and gestational age.

1. Sharon Treesa Antony
Second year M.sc nursing
Govt. College of Nursing Kottayam

2. Normal amniotic fluid

3. ⦿12 weeks:
50ml
⦿20 weeks:
400ml
⦿36-38weeks:
1litre

4. ⦿Fetal urine
⦿Fetal lung secretion
⦿Oral nasal secretion

5. ⦿Fetal swallowing
⦿Intramembraneous transfer
⦿Transmembraneous transfer

6. ⦿8-24cm

7. ⦿It is defined as reduced amniotic fluid
volume of < 200ml at term or AFI<5cm at 28-
40 weeks.

8. ⦿Maternal Conditions
 Hypertensive disorders
 Uteroplacental insufficiency
 Dehydration
 Idiopathic
 Post term pregnancy
 Prelabour rupture of membranes

9. ⦿Fetal conditions
⦿Renal agenesis
⦿Urinary tract obstruction
⦿Spontaneous rupture of membranes
⦿Intrauterine infection
⦿IUGR
⦿Drugs: PG inhibitors, ACE inhibitors
⦿Fetal chromosomal and structural
abnormalities
⦿Amnion nodosum

10. ⦿Smaller uterine size
⦿Less fetal movements
⦿The uterus is “ full of fetus”
⦿Malpresentation
⦿Evidences of IUGR

11. ⦿History
⦿Watery/ blood stained vaginal discharge
⦿Hypertension
⦿Preeclampsia
⦿Pregestational hypertension
⦿APLA syndrome
⦿Family history
Congenital anomalies
Chromosomal abnormalities
⦿Medications

12. Physical examination
⦿ Small uterine size
⦿ Less fetal movements
⦿ Uterus is full of fetus
⦿ Malpresentations
⦿ IUGR
⦿ USG: AFI< 5cm
⦿ Speculum examination: watery vaginal discharge

13. ⦿Maternal
⦿Prolonged labour due to inertia
⦿Increased operative interference due to
malpresentations
⦿Chorioamnionitis

14. ⦿ Fetal
Due to etiology
⦿ Congenital anomalies
⦿ Chromosomal abnormalities
⦿ Fetal growth restriction
⦿ IUD
⦿ Intra uterine infection following ROM
⦿ Prematurity

15. Due to reduced amniotic fluid volume
⦿Skeletal deformities
⦿Contractures
⦿Amniotic bands and autoamputation
⦿Pulmonary hypoplasia
⦿Umbilical cord compression
⦿Meconium aspiration
⦿FHR abnormalities
⦿Low APGAR scores
⦿Intrapartum death

16. Management

17. ⦿Counselling
⦿Serial USG

18. ⦿Counselling
⦿Consider Amnioinfusion
⦿Serial USG
⦿Exclude PPROM
⦿Termination of pregnancy SOS

19. ⦿Deliver post term cases
⦿Serial USG and Doppler in IUGR
⦿Conservative management for preterm
prelabor rupture of membranes till 34 weeks
⦿Idiopathic cases: NST, serial USG & BPP

20. ⦿Maternal hydration :1500-2000ml/day
( oral/ IV)
⦿Amnio infusion
Abdominally/ trans cervically

21. ⦿USG to exclude placenta
⦿Painting and draping
⦿20 G needle
⦿Connected to sterile tubing, 3 way stopcock
and a 50ml syringe
⦿NS is injected under USG
⦿Anti D SOS

22. ⦿Consent
⦿Baseline FHR, vital signs, uterine activity
⦿Monitor FHR and uterine activity
⦿Measure and mark fundal height and reassess
every hour
⦿Notify if
• non resolving variable deceleration even
with 800ml of solution infused
• Non reassuring maternal/fetal response
• Intrauterine pressure> 25mmHg

23. According to
⦿ fetal condition and
specific conditions such as
⦿ preeclampsia
⦿ growth restriction
⦿ fetal anomaly

24. ⦿Close monitoring by EFM
⦿Rupture the membranes in active phase of
labor
⦿Amnioinfusion in case of meconium staining
⦿If FHR abnormality: immediate CS

25. ⦿ DFMC
⦿ Left lateral position
⦿ FHR monitoring
⦿ Administration of fluids
⦿ Anti D after amnioinfusion SOS
⦿ Close monitoring during labour

26. ⦿Risk for fetal compromise related to reduced
amniotic fluid volume
⦿Risk for prolonged labor r/t uterine inertia
⦿Risk for infection related to premature
rupture rupture of membranes
⦿Anxiety
⦿Ineffective coping

27. THANK YOU