OBG

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