Polyhydramnios Overview

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Questions and Answers

What is the approximate volume of amniotic fluid at 20 weeks of gestation?

400 mL (correct)

50 mL

1 liter

600–800 mL

Which of the following is true regarding the composition of amniotic fluid in late pregnancy?

It contains fetal urinary metabolites that alter its composition. (correct)

It closely resembles plasma in its composition.

It is composed of 98–99% solid constituents.

It has no organic constituents.

What is the osmolality of amniotic fluid that suggests fetal maturity?

350 mOsmol/L

300 mOsmol/L

250 mOsmol/L (correct)

150 mOsmol/L

Which statement describes the physical features of amniotic fluid near term?

It may appear pale straw-colored. Signup and view all the answers

What happens to the amount of amniotic fluid after 38 weeks of gestation?

It diminishes. Signup and view all the answers

Which element's concentration remains unaltered as pregnancy advances?

Potassium Signup and view all the answers

What is the primary origin of amniotic fluid?

It is of mixed maternal and fetal origin. Signup and view all the answers

What is the specific gravity of amniotic fluid typically measured at?

1.010 Signup and view all the answers

What is the main function of amniotic fluid?

Providing nutrition and acting as a shock absorber Signup and view all the answers

How is polyhydramnios clinically defined?

Excess accumulation of liquor amnii causing discomfort Signup and view all the answers

What is the estimated incidence of excessive amniotic fluid in pregnancies?

Approximately 1% of pregnancies Signup and view all the answers

Which of the following fetal anomalies is most commonly associated with polyhydramnios?

Anencephaly Signup and view all the answers

What is a common factor associated with hydramnios in pregnancies?

Congenital fetal malformations Signup and view all the answers

What is the threshold for the deepest vertical pocket (DVP) to diagnosis polyhydramnios?

More than 8 cm Signup and view all the answers

What may lead to excess production of liquor amnii, potentially causing hydramnios?

Deficient absorption and excessive production Signup and view all the answers

Which term describes a condition with liquor amnii exceeding 2,000 mL?

Polyhydramnios Signup and view all the answers

Which of the following assessments indicates a potential issue during pregnancy?

Presence of fluid waves during ballottement Signup and view all the answers

What is a primary goal during the planning phase of the nursing process?

Promote maternal-fetal well-being Signup and view all the answers

During the evaluation phase, which outcome is expected from the mother?

Verbalizes support and self-care measures Signup and view all the answers

Which sign indicates that the height of the uterus is greater than the period of amenorrhea?

Increased girth of the abdomen around the umbilicus Signup and view all the answers

What risk diagnosis may relate to difficulties in weight management and physical mobility during pregnancy?

Impaired physical mobility Signup and view all the answers

What is a common association of hydramnios from maternal diabetes?

Increased fetal diuresis Signup and view all the answers

What is typically observed when performing auscultation in cases of polyhydramnios?

Fetal heart sound is not distinctly heard Signup and view all the answers

Which action is crucial during the implementation phase to prevent complications such as preeclampsia?

Assess fetal heart rate consistently Signup and view all the answers

Which method is NOT typically used to diagnose polyhydramnios?

Magnetic resonance imaging (MRI) scan Signup and view all the answers

Which type of polyhydramnios has an onset that is insidious and gradual?

Chronic polyhydramnios Signup and view all the answers

What abnormality of amniotic fluid is indicated by an amniotic fluid index greater than 25 cm?

Polyhydramnios Signup and view all the answers

What is the most prominent symptom associated with chronic polyhydramnios?

Sitting position due to dyspnea Signup and view all the answers

Which condition can be confused with polyhydramnios due to enlarged abdomen and many fetal parts?

Pregnancy with twins Signup and view all the answers

What clinical sign may indicate the presence of preeclampsia in a patient with chronic polyhydramnios?

Hypertension and proteinuria Signup and view all the answers

In multiple pregnancies, what is often observed regarding hydramnios in monozygotic twins?

Hydramnios usually affects the second sac Signup and view all the answers

In cases of pregnancy with a huge ovarian cyst, how can the gravid uterus typically be distinguished?

Cervix is pushed down into the pelvis Signup and view all the answers

What is a complication associated with hydramnios for the fetus?

Increased risk of congenital malformations Signup and view all the answers

What is a characteristic physical examination finding in a patient with chronic polyhydramnios?

Abdomen is markedly enlarged and globular Signup and view all the answers

What is the estimated incidence of hydramnios in cases of maternal diabetes?

30% Signup and view all the answers

Which symptom is indicative of maternal ascites rather than hydramnios?

Resonance over midline Signup and view all the answers

Which of the following conditions is NOT commonly associated with hydramnios?

Gestational hypertension Signup and view all the answers

Study Notes

Amniotic Fluid

Clear, slightly yellow liquid surrounding the fetus during pregnancy.
Originates from maternal and fetal sources and is completely replaced every 3 hours.
Volume varies with gestational age: 50 mL at 12 weeks, 400 mL at 20 weeks, peaks at 1 liter at 36-38 weeks, decreases to 600-800 mL at term, 200 mL at 43 weeks.
Physical features include slightly alkaline nature, low specific gravity (1.010), and fluctuating osmolarity related to fetal maturity.
Appears colorless in early pregnancy; becomes pale straw-colored near term due to fetal skin cells and vernix caseosa.
Composition: 98-99% water and 1-2% solids, primarily fetal urinary metabolites in late pregnancy.
Solid constituents include proteins, lipids, glucose, hormones, urea, and creatinine, plus suspended particles like lanugo and epithelial cells.
Functions to protect the fetus, provide nourishment, act as a shock absorber, maintain temperature, assist in cervical dilation during labor, and flush the birth canal of infections.

Polyhydramnios

Defined as amniotic fluid volume exceeding 2,000 mL; clinically diagnosed when it causes discomfort or is identified via imaging.
Diagnosed sonographically with an Amniotic Fluid Index (AFI) over 25 cm or a deepest vertical pocket (DVP) greater than 8 cm.
Occurs in approximately 1% of pregnancies, more common in multiparae versus primigravidae; serious cases affect 1 in 1,000 pregnancies.
Etiology remains largely speculative, involving inadequate absorption and/or excessive production of amniotic fluid, often linked to fetal, maternal, or placental factors.

Causes of Polyhydramnios

Fetal Anomalies: Congenital malformations in 20% of cases, including:
- Anencephaly: 50% association with hydramnios.
- Open spina bifida.
- Esophageal or duodenal atresia, leading to swallowing issues.
- Hydrops fetalis (Rhesus isoimmunization, infections like TORCH).
- Genetic syndromes and aneuploidy.
Placental Issues: Chorioangioma causing increased fluid transudation.
Multiple Pregnancies: Increased occurrence, especially in monozygotic twins.
Maternal Factors:
- Diabetes linked to elevated blood sugar and fetal diuresis in 30% of cases.
- Cardiac or renal diseases causing placental edema.
Idiopathic Cases: Around 50-60% of cases lack identifiable causes.

Clinical Types of Polyhydramnios

Chronic Polyhydramnios: Gradual onset; most common form.
Acute Polyhydramnios: Sudden onset within days, can lead to early labor.
Severity categorized by DVP measurements:
- Mild: DVP > 8-11 cm
- Moderate: DVP 12-15 cm
- Severe: DVP ≥ 16 cm

Symptoms and Signs

Symptoms stem from mechanical effects: dyspnea, palpitations, leg edema, varicosities, and hemorrhoids.
Signs include:
- Markedly enlarged, globular abdomen with fullness at flanks.
- Excessive fundal height and abdominal girth.
- Fluid thrill noted in all directions; fetal parts may be difficult to identify.

Investigations

Sonography: Detects large echo-free spaces, assesses lie and presentation of the fetus, evaluates for congenital malformations.
Blood Tests: Include ABO and Rh grouping, glucose tests.
Amniotic Fluid Analysis: Alpha-fetoprotein estimation for neural tube defects.

Differential Diagnosis

Twins: Enlarged abdomen, multiple fetal parts, and fluid thrill differentiate from hydramnios.
Ovarian Cyst: Separate from the gravid uterus; hydramnios shows cervix drawn up.
Maternal Ascites: Identified by shifting dullness; hydramnios shows dullness instead.

Complications

Maternal Complications: Include fluid wave ballotement, excessive fundal height, fetal abnormalities, and fatigue.
Nursing Diagnoses: Risks for fetal injury, anxiety, impaired mobility, and altered family process.

Management Planning

Promote maternal comfort and well-being.
Facilitate tests like amniocentesis and sonograms.
Anticipate potential complications such as premature labor or postpartum hemorrhage.

Evaluation

Ensure the mother verbalizes comfort, progresses to an uneventful birth, and understands self-care measures.

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Description

This quiz covers essential topics related to polyhydramnios, including its definition, causes, incidence, and management strategies. It's designed for those studying obstetrics and maternal-fetal medicine. Test your knowledge on the signs, symptoms, and implications of this condition.