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OLIGOHYDRAMNIOS

OLIGOHYDRAMNIOS. Dr. Mona Shroff, M.D. Diploma in Obs. & Gynaec Ultrasound EMOC Clinical Trainer (JHPIEGO). PHYSIOLOGY OF AMNIOTIC FLUID. OUTFLOW (1000 ml/d) 1.FETAL SWALLOWING. INFLOW (1000 ml/d) 1.FETAL URINE 2.LUNG LIQUID INTRAMEMBRANOUS (placenta,cord)

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OLIGOHYDRAMNIOS

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  1. OLIGOHYDRAMNIOS Dr. Mona Shroff, M.D.Diploma in Obs. & Gynaec UltrasoundEMOC Clinical Trainer (JHPIEGO)

  2. PHYSIOLOGY OF AMNIOTIC FLUID

  3. OUTFLOW (1000 ml/d) 1.FETAL SWALLOWING INFLOW (1000 ml/d) 1.FETAL URINE 2.LUNG LIQUID INTRAMEMBRANOUS (placenta,cord) TRANSMEMBRANOUS(amniotic membranes) RECYCLING – 3hrs

  4. FUNCTIONS OF AMNIOTIC FLUID • Shock absorber – protects from external trauma. • Protects cord from compression. • Permits fetal movements – development of musculoskeletal system, prevents adhesions. • Swallowing of AF enhances growth & development of GIT. • AF volume maintains AF pressure – reduces loss of lung liquid – pulmonary development. • Maintenance of fetal body temperature. • Some fetal nutrition, water supply. • Bacteriostatic properties – decreases potential for infection

  5. DEFINITION • AMNIOTIC FLUID VOLUME < 5 th percentile for gestational age • AMNIOTIC FLUID INDEX < 5 • SINGLE VERTICAL POCKET < 2 cms

  6. INCIDENCE 0.5 – 5%

  7. AETIOLOGY FETAL PROM (50%) CHROMOSOMAL ANOMALIES CONGENITAL ANOMALIES IUGR IUFD POSTTERM PREGNANCY MATERNAL PREECLAMPSIA APLA SYNDROME CHRONIC HT PLACENTAL CHRONIC ABRUPTION TTTS CVS DRUGS PG SYNTHETASE INHIBITORS ACE INHIBITORS IDIOPATHIC

  8. SYMPTOMS NO SPECIFIC SYMPTOMS H/O leaking p/v Postterm s/o preeclampsia Drugs Less fetal movements SIGNS Uterus – small for date Feels full of fetus Malpresentations IUGR DIAGNOSIS

  9. USG METHODS MVP <2 cms (<1 severe) AFI <5 cms (5-8 borderline) 2D pocket <15 sq cms

  10. FETAL Abortion Prematurity IUFD Deformities –CTEV,contractures,amputation Potters syndrome- pulmonary hypoplasia Malpresentations Fetal distress MSAF – MAS Low APGAR MATERNAL Increased morbidity Prolonged labour: uterine inertia Increased operative intervention (malformations, distres) COMPLICATIONS

  11. MANAGEMENT DEPENDS UPON • AETIOLOGY • GESTATIONAL AGE • SEVERITY • FETAL STATUS & WELL BEING

  12. DETERMINE AETIOLOGY • R/O PROM • TARGETED USG FOR ANOMALIES • R/O IUGR ,IUFD when suspected • Amniocentesis if chromosomal anomalies suspected – early symmetric IUGR • Tests for APLA Syndrome , if suspected

  13. TREATMENT • BED REST – decreases dehydration • HYDRATION – Oral/IV Hypotonic fluids temperory increase helpful during labour,prior to ECV, USG • SERIAL USG – Monitor growth,AFI,BPP • INDUCTION OF LABOUR/ LSCS Lung maturity attained Lethal malformation Fetal jeopardy Sev IUGR Severe oligo

  14. AMNIOINFUSION INDICATIONS 1.Diagnostic 2.Prophylactic 3.Therapeutic Decreases cord compression Dilutes meconium

  15. TREATMENT ACC. TO CAUSE • Drug induced – OMIT DRUG • PROM – INDUCTION • PPROM – Antibiotics,steroid – Induction • FETAL SURGERY VESICO AMNIOTIC SHUNT-PUV Laser photocoagulation for TTTS

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