Amniotic Fluid Abnormality PDF

Amniotic fluid abnormality 1  2  3 Objective  Tounderstand causes, management and complication of polyhydramnios and oligohydramnio.  4 Abnormal Liquor Volume  Polyhydramnios  Oligohydramnios  5  The com...

Amniotic fluid abnormality 1  2  3 Objective  Tounderstand causes, management and complication of polyhydramnios and oligohydramnio.  4 Abnormal Liquor Volume  Polyhydramnios  Oligohydramnios  5  The composition of amniotic fluid is heterogenous consisting of proteins (albumins & globulins), lipids (phospholipids, cholesterol & lecithin) carbohydrates (predominantly glucose), inorganic salts, and cells derived from fetal epithelium, amniotic membrane, & dermal fibroblasts. This latter cell type grows well in culture and is frequently used for karyotyping. The fetus is surrounded by AF everywhere except at its attachment with the umbilical cord. AF is largely derived from fetal urine & fetal lung secretion although an additional contribution to AF comes from amniotic membrane secretions. 8wks: 15ml, volume increases 10ml/wk 17wks: 250ml, increases at 50ml/wk 28-35wks: ~750-1000ml 42wks: 18cm or AFI >24cm  Depth of largest amniotic fluid pool (amniotic fluid volume, AFV) >= 7cm  AFV 8-11cm, as mild polyhydramnios  AFV 12-15cm, as moderate polyhydramnios  AFV >= 16cm, as severe polyhydramnios  20 Other tests  AFP evaluation  Anti-Rh antibodies  Parvovirus , CMV assay  Toxoplasma detection  glucosemia  21 Treatment  hospitalization, bed rest  Treatment of underling cause  non-steroidal anti-inflammatory drugs (indomethacin)  severe cases → repeated amniocentesis to relieve the tension  mild to moderate hydramnios: rarely requires treatment  NO diuretics, water and salt restriction. Acute cases → TERMINATION OF PREGNANCY  22  Indomethacin therapy:  Mechanism: decrease lung liquid production or  fetal urine production,  absorption fluid movement across fetal membranes  Dose: 1.5-3 mg/kg per day.  Complications: constriction of fetal ductus arteriosus. Oligohydramnios  24 Definition  AMNIOTIC FLUID VOLUME < 5 th percentile for gestational age  AMNIOTIC FLUID INDEX < 7  SINGLE VERTICAL POCKET < 3 cms Incidence : (0.5 – 5%)  25 AETIOLOGY FETAL PROM (50%) MATERNAL CHROMOSOMAL ANOMALIES PREECLAMPSIA CONGENITAL ANOMALIES APLA SYNDROME IUGR IUFD CHRONIC HT POSTTERM PREGNANCY DRUGS  PG SYNTHETASE INHIBITORS PLACENTAL  ACE INHIBITORS  CHRONIC ABRUPTION  TTTS  CVS IDIOPATHIC  26 DIAGNOSIS Symptoms NO SPECIFIC SYMPTOMS History of leaking liquor p/v Postterm Sign and symptom of preeclampsia Drugs Less fetal movements  27 SIGNS Uterus – small for date Feels full of fetus Malpresentations IUGR  28 COMPLICATIONS FETAL Abortion Prematurity IUFD Deformities – CTEV,contractures,amputation Potters syndrome- pulmonary hypoplasia Malpresentations Fetal distress Low APGAR  29 MATERNAL Increased morbidity Prolonged labour: uterine inertia Increased operative intervention (malformations, fetal distres) 30  31 MANAGEMENT DEPENDS UPON  AETIOLOGY  GESTATIONAL AGE  SEVERITY  FETAL STATUS & WELL BEING  32 DETERMINE AETIOLOGY  PROM  USG FOR ANOMALIES , IIUGR ,IUFD when suspected  Amniocentesis if chromosomal anomalies suspected – early symmetric IUGR  Tests for APLA Syndrome , if suspected  TREATMENT 33  ADEQUATE REST – decreases dehydration  HYDRATION – Oral/IV Hypotonic fluids(2 Lit/d) temperory increase helpful during labour,prior to ECV, USG SERIAL USG – Monitor growth,AFI,BPP INDUCTION OF LABOUR/ LSCS Lung maturity attained Lethal malformation Sev IUGR Severe oligo  34 AMNIOINFUSION INDICATIONS 1.Diagnostic 2.Prophylactic 3.Therapeutic Decreases cord compression Dilutes meconium  35 TREATMENT OF CAUSE  Drug induced – OMIT DRUG  PROM – INDUCTION  PPROM – Antibiotics, steroid – Induction  FETAL SURGERY VESICO AMNIOTIC SHUNT-PUV Laser photocoagulation for TTTS Thanks