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POLYHYDRAMNIOS

POLYHYDRAMNIOS. Polyhydramnios is defined as a state where liquor amnii exceeds 2000 ml or when A.F.I. is more than 24-25 cm or a single pocket of amniotic fluid is greater than 8 cm by ultrasonography. Incidence: 1% to 2 % of the cases Causes Maternal (15%) Rh iso-immunization

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POLYHYDRAMNIOS

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  1. POLYHYDRAMNIOS

  2. Polyhydramnios is defined as a state where liquor amnii exceeds 2000 ml or when A.F.I. is more than 24-25 cm or a single pocket of amniotic fluid is greater than 8 cm by ultrasonography. • Incidence: 1% to 2 % of the cases • Causes • Maternal (15%) Rh iso-immunization DM • Placental (less than 1%) Placental chorioangioma Circumvallate placental syndrome • Fetal (18%) Multiple pregnancies Fetal anomalies • Idiopathic (65%)

  3. Clinical types: Depending on the rapidity of onset hydramnios can be Acute – rare – appear in a matter of few days Chronic – more common 10 times more commoner to acute appear in a matter of few months

  4. Routine OBH • History suggestive of Rh iso- immunization such as still birth, fetal hydrops, jaundice in new born requiring exchange transfusion etc. • History suggestive of DM – Previous big baby fetal death at 35 weeks, classical symptoms of DM like polyurea, polydypsia, polyphagia • History of Drug intake especially in First trimester • History of Previous fetal anomalies like Anencephaly-risk of recurrence is 2%

  5. Acute Polyhydramnios: Onset is acute usually occurs before 20 weeks of pregnancy and presents usually with symptoms and labour starts before 28 weeks of pregnancy. • It may present as Acute abdomen - abdominal pain, nausea, vomiting Breathlessness which increases on lying down position Palpitation Oedema of legs, varicosities in legs, vulva and hemorroids • Signs: Patient looks ill, with out features of shock Oedema of legs with signs of PIH Abdomen unduly enlarged with shiny skin Fluid thrill may be present • Internal examination shows taking up of cervix or even dilatation with bulging membranes

  6. Chronic Polyhydramnios: More common than acute 10% more common • Since accumulation of liquor is gradual and so patient may be symptomatic or asymptomatic. • Symptoms are mainly due to mechanical causes Dyspnoea is more in supine position Palpitation Oedema Oliguria may result from ureteral obstruction by enlarged uterus • Pre-eclampsia 25 %( oedema, hypertension and proteinuria)

  7. Signs GPE • Patient may be dyspnoic at rest • Pedal Oedema • Evidence of PIH Abdominal examination Inspection • Abdomen is markedly enlarged globular with fullness in flanks • Skin over the abdomen is tense shiny with large striae Palpation • Height of uterus is more than the corresponding periods of Amenorrhoea • Abdominal girth is more • Fetal parts cannot be well defined external ballotment is more easily elicited • Malpresentations are more common and presenting part is usually high up • Fluid thrill is present Auscultation • Fetal heart sounds are not heard distinctly

  8. Internal examination : Cervix is pulled up May be sometimes dilated and admits tip of finger through which bag of membranes which is tense is felt. • At times patient may present with complications like Pre ecclampsia PROM Preterm labour Placental abruption Cord prolapse

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