Amniotic Fluid Abnormality Overview
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Questions and Answers

What is polyhydramnios and how does it differ from oligohydramnios?

Polyhydramnios is an abnormal increase in amniotic fluid volume, while oligohydramnios is a decrease in amniotic fluid volume.

What are the primary components of amniotic fluid?

Amniotic fluid primarily consists of proteins, lipids, carbohydrates, inorganic salts, and fetal-derived cells.

At what gestational age is the amniotic fluid volume approximately 250ml?

At 17 weeks of gestation, the amniotic fluid volume is approximately 250ml.

What are the risks associated with severe polyhydramnios, and how may it be managed?

<p>Severe polyhydramnios can lead to complications like preterm labor or fetal distress and may require treatments such as amniocentesis.</p> Signup and view all the answers

How does indomethacin help in managing polyhydramnios?

<p>Indomethacin reduces lung liquid production and fetal urine production, thereby decreasing amniotic fluid volume.</p> Signup and view all the answers

What defines the onset of mild, moderate, and severe polyhydramnios in terms of amniotic fluid volume?

<p>Mild polyhydramnios is defined as an AFV of 8-11cm, moderate as 12-15cm, and severe as &gt;= 16cm.</p> Signup and view all the answers

What is the approach to management for mild to moderate oligohydramnios?

<p>Mild to moderate oligohydramnios rarely requires treatment and is mainly monitored for potential complications.</p> Signup and view all the answers

What is a common complication associated with indomethacin therapy during pregnancy?

<p>A common complication is the constriction of the fetal ductus arteriosus.</p> Signup and view all the answers

What is the definition of oligohydramnios in terms of amniotic fluid volume?

<p>Oligohydramnios is defined as an amniotic fluid volume less than the 5th percentile for gestational age.</p> Signup and view all the answers

List two fetal and two maternal etiologies of oligohydramnios.

<p>Fetal etiologies include congenital anomalies and IUGR; maternal etiologies include preeclampsia and chronic hypertension.</p> Signup and view all the answers

What are the common signs indicating oligohydramnios during a physical examination?

<p>Signs include the uterus being small for gestational age and the abdomen feeling full of the fetus.</p> Signup and view all the answers

Describe one potential complication of oligohydramnios for the fetus.

<p>One potential complication is pulmonary hypoplasia, which can occur due to Potter's syndrome.</p> Signup and view all the answers

What management strategies should be considered for a patient with oligohydramnios?

<p>Management depends on the etiology, gestational age, severity, and fetal well-being.</p> Signup and view all the answers

What role does amnioinfusion play in managing oligohydramnios?

<p>Amnioinfusion can decrease cord compression and dilute meconium in the amniotic fluid.</p> Signup and view all the answers

What is one indication for performing an amniocentesis in a case of suspected oligohydramnios?

<p>Amniocentesis is indicated when chromosomal anomalies are suspected, especially in cases of early symmetric IUGR.</p> Signup and view all the answers

How can hydration impact the management of oligohydramnios?

<p>Hydration, either oral or IV, can temporarily increase amniotic fluid volume and is helpful during labor.</p> Signup and view all the answers

Study Notes

Amniotic Fluid Abnormality

  • Amniotic fluid is composed of proteins, lipids, carbohydrates, inorganic salts, and cells derived from fetal epithelium, amniotic membrane and dermal fibroblasts.
  • The fetus is surrounded by amniotic fluid everywhere except at its attachment with the umbilical cord.
  • The volume of amniotic fluid increases from 15 ml at 8 weeks gestation to around 750-1000 ml at 28-35 weeks.
  • Polyhydramnios is an excess of amniotic fluid, indicated by an amniotic fluid index (AFI) of >24 cm or a depth of the largest amniotic fluid pool (AFV) >= 7 cm.
    • Mild polyhydramnios: AFV 8-11 cm
    • Moderate polyhydramnios: AFV 12-15 cm
    • Severe polyhydramnios: AFV >= 16 cm
  • Treatment for polyhydramnios involves hospitalization, bed rest, and treating the underlying cause. Severe cases may require repeated amniocentesis to relieve tension and in acute cases, termination of pregnancy may be necessary.
  • Indomethacin, a non-steroidal anti-inflammatory drug, is used to decrease fetal lung fluid and urine production.
  • Oligohydramnios is a deficiency of amniotic fluid, defined as AFV < 5th percentile for gestational age, AFI < 7, or a single vertical pocket < 3 cm.
  • The etiology of oligohydramnios can be fetal (PROM, chromosomal anomalies, congenital anomalies, IUGR, IUFD, post-term pregnancy), maternal (preeclampsia, APLA syndrome, chronic HTN, drug use: PG synthase inhibitors, ACE inhibitors), or placental (chronic abruption, TTTS, CVS).
  • Oligohydramnios often presents with no specific symptoms, but may include a history of leaking liquor, post-term pregnancy, signs and symptoms of preeclampsia, drug use, and decreased fetal movements.
  • Diagnosis of Oligohydramnios is made by a combination of history, physical exam, and ultrasound.
    • On physical exam, the uterus may be small for dates and feel full of fetus.
    • Malpresentations and IUGR may be present, as well.

Complications of Oligohydramnios

  • Fetal complications:
    • Abortion
    • Prematurity
    • IUFD
    • Deformities (CTEV, contractures, amputation)
    • Potter's syndrome (pulmonary hypoplasia)
    • Malpresentations
    • Fetal distress
    • Low Apgar scores
  • Maternal complications:
    • Increased morbidity
    • Prolonged labor (uterine inertia)
    • Increased operative interventions (malformations, fetal distress)

Management of Oligohydramnios

  • Depends on etiology, gestational age, severity, and fetal status and well-being.
  • Initial management:
    • Determine etiology: PROM, ultrasound for anomalies, IUGR, IUFD, amniocentesis for chromosomal anomalies, tests for APLA syndrome
    • Adequate rest
    • Hydration: Oral/IV hypotonic fluids
    • Serial ultrasounds to monitor growth, AFI, and biophysical profile (BPP)
  • Treatment depends on etiology:
    • Drug-induced - omit drug
    • PROM - Induction
    • Premature PROM (PPROM) - Antibiotics, steroid therapy, induction
    • Fetal surgery: Vesico-amniotic shunt for posterior urethral valves, laser photocoagulation for TTTS
  • Induction of labor/ cesarean section:
    • Lung maturity attained
    • Lethal malformation
    • Severe IUGR
    • Severe oligohydramnios
  • Amnioinfusion:
    • Diagnostic
    • Prophylactic
    • Therapeutic
    • Reduces cord compression
    • Dilutes meconium

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Amniotic Fluid Abnormality PDF

Description

This quiz covers the essential aspects of amniotic fluid abnormalities, including polyhydramnios. It discusses the composition of amniotic fluid, variations in volume during gestation, and the classifications of polyhydramnios. Additionally, treatment options for severe cases are outlined.

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