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POLYHYDRAMNIOS

POLYHYDRAMNIOS. It is a pathological accumulation of excessive AF due to imbalance between its production and removal. Incidence is 1% and increase to 8% with USG Evident when quantity is >2000ml, single vertical pocket of 8cms or AFI 25cms. Acute Chronic – more common. Classification.

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POLYHYDRAMNIOS

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  1. POLYHYDRAMNIOS

  2. It is a pathological accumulation of excessive AF due to imbalance between its production and removal. Incidence is 1% and increase to 8% with USG Evident when quantity is >2000ml, single vertical pocket of 8cms or AFI 25cms.

  3. Acute Chronic – more common Classification

  4. Acute hydramnios forms 2-5% of all cases of hydramnios. seen in MZ twin pregnancies. Maternal symptoms like pain, discomfort and dyspnea are more severe. Generally seen prior to 26 weeks gestation. Prognosis is poor. Acute hydramnios

  5. Chronic hydramnios - 95% of the usually seen in third trimester. Women tolerate this well as there is gradual accumulation of AF. Prognosis is better. Chronic

  6. It is more common in multi than primi 40-50% is idiopathic Fetal anomalies are seen in 20% Esophageal atresia Duodenal atresia Diaphragmatic hernia Sacrococcygeal teratoma Aetiology

  7. Anencephaly • Neck tumors • Musculoskeletal dysfunction • Exposure of meninges – meningocele, anencephaly • Fetal anemia – hydrops fetalis Immune Non immune • Twin to twin transfusion syndrome • Fetal pseudohyperaldosteronism Aetiology

  8. Maternal 20% Diabetes Rh isoimmunisation Syphilis Lithium therapy

  9. Placental : Chorioangioma of the placenta Large placenta

  10. Asymptomatic in cases of mild - moderate hydramnios Abdominal discomfort Pain Dyspnea May report with PTL or PROM Clinical features

  11. Signs : Pedal edema due to compression of major veins. Abdominal skin shiny and stretched. Uterus over distended Difficult to palpate fetal parts Fluid thrill is present FHS may not be audible.

  12. Mild >8cm SDP Moderate >11cm Severe >15cm Severity of polyhydramnios

  13. Multiple pregnancy Maternal/fetal ascitis Ovarian cyst with pregnancy Concealed abruption d/D

  14. Confirms diagnosis – AFI >25cms. Indicates severity Detects fetal anomalies, pl. chorioangioma and twins. Blood group and Rh type. GTT USG

  15. Maternal - antenatal Discomfort Dyspnea PTL PROM Malpresentation Complications

  16. Labour : • Unengaged head • Cord prolapse • Abruption • Dysfunctional labour. • PPH • Increased operative delivery • shock • Subinvolution

  17. Fetal Prematurity Increase PNMR

  18. Determine the cause Prevent PTL and intrapartum complication Relieve mother of discomfort. Management

  19. INDOMETHACIN & SULINDAC – NSAID They act by decreasing fetal UOP, enhance AF absorption across the fetal lungs. 25mg 6th hrly. cannot be used beyond 32-34 wks. Induces closure of the DA cerebral vasoconstriction and impaired renal function increases risk of necrotizing enterocolitis.

  20. Surgical – amnioreduction – risk of PTL, PROM Bed rest Steroid prophylaxis Term pregnancy; stabilizing induction is done.

  21. When the AF is deficient in amount to the extent of less than 200ml at term. • Oligohydramnios is diagnosed when AFI is <5cms, SDP is <2cms. • It is common in third trimester. • Oligohydramnios occurring in 2nd trimester has poor prognosis. Oligohydramnios

  22. Fetal : FGR Post maturity PROM Fetal anomalies – renal agenesis/dysplasia lower UT obstruction. VACTERL TRAP Causes of oligohydramnios

  23. Maternal causes : Preeclampsia Dehydration Drugs – ACE, NSAID Placenta – circumvallate

  24. In presence of oligohydramnios – 4 fold increase risk of FGR. Incidence of fetal anomaly's is 51% in second trimester and 22% in 3rd trimester. Fetal deformities occur as a result of oligohydramnios.

  25. Effects and complications : • Earlier the manifestations – worse prognosis. • Amniotic bands - • constriction – amputation. • Craniospinal, abd. Wall, limb reduction. • Pulmonary hypoplasia. • Increase PNM • Increase risk of fetal distress • Pl. insuffiency • Cord compression • MAS

  26. May c/o decreased fetal movements. Inadequate weight gain Fundal height < the period of gestation Fetus is gripped by uterus. Diagnosis

  27. Mild 5 -8cms AFI Moderate 2 -5 cms AFI Severe < 2cms Classification

  28. : objective are Find the cause Perform a fetal surveillance Ensure timely delivery USG : AFI <5cms, rule out anomalies Fetal growth parameters and BPP. Management

  29. Amioinfusion may be done : Bed rest Aggressive fetal monitoring Elective LSCS If anomalies are present. Pregnancy is terminated

  30. Uterine hypertonus Abnormal FHR Amnionitis PROM Umbilical cord prolapse Placental abruption Complications ai

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