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Poly-oligohydramnios

Poly-oligohydramnios. Dr Matthews Anyanwu Specialist obstetrician, lecturer UTG. Amniotic Fluid Index (AFI). The amniotic fluid index is measured by dividing the uterus into four quadrants The linea nigra is used to divide the uterus into right and left halves.

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Poly-oligohydramnios

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  1. Poly-oligohydramnios Dr Matthews Anyanwu Specialist obstetrician, lecturer UTG

  2. Amniotic Fluid Index (AFI) • The amniotic fluid index is measured by dividing the uterus into four quadrants • The linea nigra is used to divide the uterus into right and left halves. • The umbilicus serves as the dividing point for the upper and lower halves. • The transducer is kept parallel to patient’s longitudinal axis and perpendicular to the floor.

  3. Amniotic Fluid Index (AFI) • The deepest, unobstructed, vertical pocket of fluid is measured in each quadrant • “Brief appearances of cord or an extremity are ignored, but aggregation of either one, to the exclusion of fluid, is not considered part of a fluid pocket.” • Add these numbers together and the sum represents the Amniotic fluid Index (AFI).

  4. Interpretation of the AFl 10.1 to 24.0 cm Normal 5.1 to 10.0 cm Borderline Less than or equal 5.0 cm Abnormal Greater than 24.0 cm Abnormal

  5. oligohydramnios • Reduced liquor volume: AFI<5cm or DP<2cm • How to make diagnosis: • Detailed clinical history • Sterile speculum examination • Refer to fetal medicine unit

  6. Causes of oligohydramnios • Fetal : - reduced production of fetal urine (renal disease or agenesis, posterior urethral valve obstruction, adverse drug effect such as ACE inhibitors, NSAIDs, diuretics and placental insufficiency -Maternal: increased loss of amniotic fluid e.g. PROM, PPROM following trauma, infection or idiopathic

  7. Further investigation • Karyotyping • Fetal doppler studies • Intra-amniotic fluid injection • Fetal morphometry

  8. General comments on oligohydramnios • Is a sign of underlying maternal or fetal complication • Such as PPROM or PROM, utero-placental insufficiency, fetal structural or chromosomal abnormalities and postmaturity • Prognosis is poor when it occurs in the 2nd trimester (82%) • When associated with fetal anomalies PNM is 26%

  9. A negative sterile speculum does not exclude preterm ROM • USS can check for fetal bladder filling as this may distinguish different causes

  10. Complications of oligohydramnios • Pulmonary hypoplasia • IUFD • Hypoxic ishaemicencephalopathy • Cerebral palsy • Compression deformities egTalipes • Termination of pregnancy is not recommended only if fetal malformation is present

  11. Polyhydramnios • Increased AF • How to make a diagnosis: by USS -AFI more than 24cm -DP more than 8cm

  12. Causes of polyhydramnios • Fetal: anencephaly, intestinal atresia, neuromuscular abnormalities, fetal DI, sacrococcygealteratoma, macrosomia, fetal anemia, TTTS • Maternal: DM, congenital infections • Others : placenta chorioangioma, idiopathic

  13. Management of Polyhyramnios • Always involve: a detailed USS examination of the fetus and placenta, maternal viral studies, VDRL, OGTT • Amnio-reduction and karyotyping is not always required • Mgt depend on aetiology, gestational age at presentation,and the presence or absence of maternal symptoms relating to overdistention of the uterus

  14. Complications of polyhydramnios • Antepartum : preterm delivery, PPROM, malpresentation, cord prolapse, abruption, PET, maternal discomfort, unexplained IUFD • Intrapartum: dysfunctional labour, increased risk of C/S, cord prolapse • Postpartum: PPH

  15. Intervention • Amnioreduction: complications are PPROM, chorioamnionitis, abruption • Prostaglandin synthetase inhibitors: -When cause is due to increased urine output and not impaired swallowing -1st was Indomethacin 50-200mg; complications include oligohydramnios, premature closure of ductusarteriosus, cerebral vasoconstrition, pulmonary hypertension, renal failure, necrotisingenterocolitis • Sulindac: is a nonsteroidal prostaglandin synthetase inhibitor with fewer side effects.

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