Polyhydramnios and Oligohydramnios topic presented in detail. Causes maternal and fetal risks, antenatal care, intrapartum and postpartum care, maternal and fetal complications and management, pathophysiology

1. Polyhydramnios
and
Oligohydramnios

2. Professor Umar Model of Integrated Lecture
60%
CORE SUBJECT
20%
HORIZONTAL
INTEGRATION
Physiology
biochemistry
8%
VERTICAL
INTEGRATION
Pathology
pharmacology
7%
VERTICAL
INTEGRATION
Clinical integration
5%
VERTICAL
INTEGRATION
Research,
professionalism
Ethics
Digital library

3. Wisdom
Truth
Motto Vision; The
Dream/Tomorrow
 To impart evidence based
research oriented medical
education
 To provide best possible
patient care
 To inculcate the values of
mutual respect and ethical
practice of medicine

4. Polyhydramnios
and
Oligohydramnios

5. Learning Objectives
 to enable students understand importance
of amniotic fluid for fetal well being
Causes of liquor abnormalities
Complications associated with
oligohydramnios and polyhydramnios
Management of liquor abnormalities


6. Amniotic fluid
Early pregnancy: Amnion
10th
week: Transudate of the fetal serum
via skin & umbilical cord
 From 16th
week: Fetal skin becomes
impermeable to water
Contribution of fluid through
the kidneys & lungs and
removal by fetal swallowing

7. Composition
Growth factors
Multipotent stem cells

8. Amniotic fluid volume
Progressive increase from 10-38th
week
10 weeks: 30 ml
20 weeks: 300 ml
30 weeks: 600 ml
38 weeks: 1000ml
From 38th
week onwards: rapid fall
40 weeks: 800 ml
42 weeks: 350 ml

9. Measurement
Two ways
1. The maximum vertical pool (MVP)
2. Amniotic fluid index (AFI)
MVP : After a general survey
Less than 2 cm
Greater than 8cm

10. Amniotic fluid index
Uterus is divided in four quadrants
A vertical measurement is taken of the
deepest pool of fluid that is free of
umbilical cord in all the four quadrants of
the uterus and is summated
Third trimester: 10-25 cm
Below 5 cm. (less)
Above 25 cm (more)

11. The function of the amniotic
fluid
Protect the fetus from mechanical injury
Permit movement of the fetus while
preventing limb contracture
Prevent adhesions between fetus & amnion
Permit fetal lung development in which
there is two-way movement of fluid into
fetal bronchioles
Absence of AF: pulmonary hypoplasia

12. Polyhydramnios
Amniotic Fluid Index : > 25 cm
pockets in 4 quadrants
Deepest vertical pool: >8cm

14. Incidence:
1-1.5% of pregnancies
Association with underlying pathology
Mild polyhydramnios:
Single deepest pool : 8-11cm: 17 %
Severe: > 15cm : 91%

15. Causes
Placental hemagiomas

16. Etiology of polyhydramnios
due to anomalies

17. Symptoms
 Dyspnea/discomfort
 Abdominal pain
 Preterm labor
 Pressure symptoms of venous stasis
 Decreased perception of movements

18. Diagnosis

19. Complications
Fetal:
Prognosis : directly proportional with
severity of polyhydramnios
• Congenital anomaly
• Preterm delivery
• Cord prolapse and fetal demise

20. Complications
Maternal:
 Dyspnea
 Venous Stasis
 Placental abruption
 Uterine dysfunction
 Post-partum hemorrhage
 Abnormal presentation --  Em C/S

21. Treatment
Mild to Moderate :Rarely requires treatment
 Blood sugar control
 Feto-maternal surveillance
Severe : Needs hospitalization
 Amniocentesis
 NSADIS: Non-steroidal anti-inflammatory
 Analgesia
 Feto-maternal surveillance

22. Amniocentesis

23. Oligohydramnios

24. Definition
 AFI 5
 DVP<2cm

25. Etiology

26. Signs/symptoms
 Fundal height < gestational age
 Decreased fetal movement
 Fetal Heart Rate tracing abnormality
 Diagnosis: Ultrasound

27. Normal VS oligo

28. Complications
• Extremely poor fetal prognosis, especially
in early pregnancy
• Adhesions between amnion and fetal parts
---malformations and amputations
• Musculoskeletal deformities
• Pulmonary hypoplasia

29.  Cord Compression -- >fetal hypoxia
 Passage of meconium into low AF volume:
thick particulate suspension -->respiratory
compromise
Fetal demise
Iatrogenic preterm delivery/cesarean

31. Treatment
Underlying maternal disease (preeclampsia)
Corticosteriod : lung maturity
In utero transfer
Timely delivery
Amnio-infusion?
Clexane/heparin??

32. Time and mode of delivery :
 important to have safe outcome

33. Amnioinfusion

34. Vertical
integration
Beneficence
• TAKE
HOME
MESSAGE
The principle of beneficence is the obligation of physician to act for
the benefit of the patient and supports a number of moral rules to
protect and defend the right of others, prevent harm, remove
conditions that will cause harm, help persons with disabilities, and
rescue persons in danger.
It is worth emphasizing that, the language here is one of positive
requirements. The principle calls for not just avoiding harm, but
also to benefit patients and to promote their welfare.

35. Ethical Consideration
Councelling ( anomaly,fetal prematurity,
still birth ,pregnancy outcome)
 Termination of pregnancy ( fetamaternal
indication)
Mode and time of delivery
Implications on future pregnancy

36. References
1. Obsterics by ten teachers. Louise C. Kenny, Jenny E. Myers. 20th
ed
ISBN 9781498744393. Published June 1, 2017 by CRC Press
2. Polyhydramnios: Causes, Diagnosis and Therapy
A. Hamza,1
D. Herr,1
E. F. Solomayer,2
and G. Meyberg-Solomayer1
Geburtshilfe Frauenheilkd. 2013 Dec; 73(12): 1241–1246.
doi: 10.1055/s-0033-1360163
3. Amnioreduction procedure for singleton pregnancies complicated by
polyhydramnios causing maternal discomfort
B.S. Albaqawi, A.S. Alghamdi, M.M. Abuzaid, W.Y. Alaali, B.I. Sallout
First published: 08 September 2016
https://doi.org/10.1002/uog.17097

38. mcqs
 1. a 24year old primigravida obeses BMI 35Kg/m2presents for first
antenatal booking .she is 26 weeks, her SFH is 36cm and tense
abdomen.what is ur next best step in management?
 a. admit for blood sugar monitoring
 b. Inquire about LMP
 c. ultrasound anomaly +liq,and blood sugar monitoring
 d. expectant management
 e. induce labor

39.  1. a 24year old primigravida obeses BMI 35Kg/m2presents for first
antenatal booking .she is 26 weeks, her SFH is 36cm and tense
abdomen.what is ur next best step in management?
 a. admit for blood sugar monitoring
 b. Inquire about LMP
 c. ultrasound for anomaly+liq and blood sugar monitoring
 d. expectant management
 e. induce labor

40.  2. a G2P1 at 37 weeks presents for checkup.She is known
hypertensive since 4 years.Her SFH IS 32cm,long cephalic with good
fetal heart beats,EFW is 3.1kg.Ultrasound shows almost nil
liquor.bishop score is 9.How will you manage her?
a. b.p monitoring,dopplersultrasound.
 b. Amnioinfusion
 c. steriod cover and induce labor
 d. emergency cesarean section
 e. Expectant managment

41.  2. a G2P1 at 37 weeks presents for checkup.She is known
hypertensive since 4 years.Her SFH IS 32cm,long cephalic with good
fetal heart beats,EFW is 3.1kg.Ultrasound shows almost nil
liquor.bishop score is 9.How will you manage her?
a. b.p monitoring,dopplersultrasound.
 b. Amnioinfusion
 c. steriod cover and induce labor
 d. emergency cesarean section
 e. Expectant managment