Disorders of Amniotic Fluid

Question 1

US evaluation of amniotic fluid

Answer 1

1) single deepest pocket (DVP) maximum vertical pocket normal range from 2-8cm
2) AFI amniotic fluid (phelan) index the deepest unobstructed vertical pocket of fluid (the one used out of all quadrants)

Question 2

Polyhydramnios def , inc , etio

Answer 2

Excessive fluid of amniotic fluid
Inc 1 to 2 percent
Etio: 1) idiopathic 40% ,
2)Fetal causes: a) fetal anomalies one third of cases dec swallowing due to GI obstruction ( duodenal , esophageal , intestinal atresia ) excessive accumulation : open NTD (anencephaly) - omphalocele
b) chromosomal anomalies trisomy 18 and 21 c) genetic errors: barrter syndrome ( renal tubular dysfunction d) high fetal cop so increased urine production ( fetal anemia and hydrops) e) fetal infection : CRTS cytomegalo, rubella , toxoplasm, syphillis
3)Maternal causes:
a)Maternal diabetes ( one quarter of cases ) , b)severe generalized maternal edema CRN
4) placental causes : a)twin to twin transfusion S in monochroionic multiple gestation
b) chorioangioma and large placenta

Question 3

Complications of polyhydraminos

Answer 3

1)During Preg: maternal resp compromise , dyspepsia vomiting abdominal discomfort , renal insult maybe due to pyelonephritis , PIH , IVC ; LL ; varicose veins
2)PROM: preterm labor , chorioamniotis , umbilical cord prolapse , Due to sudden decrease of high intrauterine pressure: placental abruption and splanchnic shock
3) during labor and puerperium: preterm labor( spont or iatrogenic) , prolonged labor due to malpresentation and uterine inertia , PPH uterine atony+- traumatic , puerperal sepsis 4P’s
Perinatal mortality increased 2-5 fold

Question 4

Diagnosis of polyhydraminos

Answer 4

Inc abdominal enlargement
ANC routine
SFH more than normal so US is done
AFI>25cm or DVP > 8 cm
Polyhydraminos : mild to moderate top at 39 wks , follow up
Severe Anti pg <32 wks , Amnioreduction <34 wks , Top 34-37 wks
Mild 8 to 11.9 mod 12to 15.9 , severe >16 DVP
MIld 25to 30 mod 30.1 to 35 , severe >35 AFI

Question 5

Management of SGA (Polyhydraminos)

Answer 5

Full history taking RR : DM , Previous fetal malformations
INV: 1) US fetal anomalies , fetal hydrops , TTT S or chorioangioma
2) screening of DM
3) screening for immune and non immune hydrops
4) screening of chromosomal & genetic disorder : should be offered in all cases of severe polyhydraminos
5) screening for infection
Tests for fetal well being: NST , BPP , Doppler US indicated 1-2 weeks
top at 39 - 40 mild to mod
Severe at 34 to 37 wks : less than 32 wks idiomethacin administration
From 32 to 34 wks avoid idiomethacin to avoid pre mature closure of ductus arteriosus
TOP at 34-37 wks