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DR. NABEEL S. BONDAGJI, MD, FRCSC Department of Obstetrics and Gynecology Feto-Maternal Unit

DR. NABEEL S. BONDAGJI, MD, FRCSC Department of Obstetrics and Gynecology Feto-Maternal Unit. PHYSIOLOGY OF AMNIOTIC FLUID. Early pregnancy: composition of AF similar to ECF. Transfer of water across amnion and through fetal skin. By second trimester: fetus begins to

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DR. NABEEL S. BONDAGJI, MD, FRCSC Department of Obstetrics and Gynecology Feto-Maternal Unit

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  1. DR. NABEEL S. BONDAGJI, MD, FRCSC Department of Obstetrics and Gynecology Feto-Maternal Unit

  2. PHYSIOLOGY OF AMNIOTIC FLUID • Early pregnancy: composition of AF similar to ECF. Transfer of water across amnion and through fetal skin. • By second trimester: fetus begins to urinate swallow, and inspire AF  During last 2/3 of pregnancy, AF is principally comprised of fetal urine.

  3. NORMAL AMNIOTIC FLUID VOLUME

  4. DEFINITIONS: • Polyhydramnios: 2000 cc amniotic fluid • Amniotic Fluid Index = largest vertical pocket in 4 quadrants polyhydramnios 24 cm.

  5. ETIOLOGY OF POLYHYDRAMNIOS • Idiopathic • Fetal Anomalies • Diabetes • Multifetal gestation • Immune/Non-immune hydrops • Fetal infection • Placental haemangiomas

  6. Etiology of Polyhydramnios: Fetal Anomalies • Problems with swallowing and GI absorption • Increased transudation of fluid: anencephaly, spina bifida • Increased urination: anencephaly (lack of ADH, stimulation of urination centers) • Decreased inspiration

  7. SYMPTOMS • Dyspnea • Abdominal pain • Venous stasis • Contractions  preterm labor • Decreased Perception of Fetal Movements

  8. DIAGNOSIS • Fundal height > gestational age • Difficulty palpating fetal parts/hearing heart tones • Tense uterine wall • ***Sonography

  9. (fetus)? • Fetal prognosis worsens with more severe hydramnios and congenital anomalies • 15-20% fetal malformations • Preterm delivery • Suspect diabetes • Prolapse of cord • Abruption

  10. (Mother)? • Dyspnea • Venous Stasis • Placental abruption • Uterine dysfunction • Post-partum hemorrhage • Abnormal presentation -- C/S

  11. TREATMENT • Mild to Moderate hydramnios: rarely requires treatment • Hospitalization, bed rest • Amniocentesis • Non-steroidal anti-inflammatory analgesia • Blood sugar control

  12. OLIGOHYDRAMNIOS

  13. DEFINITION • AFI 5

  14. ETIOLOGY • Postdate • Fetal Anomalies: obstruction of fetal urinary tract/renal agenesis • IUGR • ROM • Twin/Twin transfusion • Exposure to ACE inhibitors, and • Non-steroidal anti-inflammatory

  15. SIGNS/SYMPTOMS • Fundal height < gestational age • Decreased fetal movement • Fetal Heart Rate tracing abnormality • Diagnosis: Ultrasound

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

  17. Cord Compression -- >fetal hypoxia • Passage of meconium into low AF volume: thick particulate suspension -->respiratory compromise

  18. TREATMENT • Delivery • Amnioinfusion

  19. THANK YOU

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