Hydramniosis Flashcards
Where does amniotic fluid come from
Foetal urine from 2nd trimester onwards
What is oligohydramnios?
Decreased volume of amniotic fluid
(<5th centile for gestational age)
This affects 4% of pregnancies
How many pregnancies are affected by oligohydramnios?
4%
Oligohydramnios can have 4 mechanisms of action which are?
Reduced urine production :
Reduced urine output from kidneys :
Loss of fluid:
Chromosomal abnormalities
Oligohydramnios can have 4 mechanisms, one of which is reduced urine production:
Causes of reduced urine production?
Reduced urine production :
- Placental insufficiency
- Pre-eclampsia
- IUGR
Oligohydramnios can have 4 mechanisms, one of which is reduced urine output from kidney?
Causes of reduced urine output from kidneys?
Reduced urine output from kidneys :
- Maternal medications :NSAIDS, ACEi
- Renal agenesis (potter’s sequence: death in utero)
Oligohydramnios can have 4 mechanisms, one of which is loss of fluid.
Causes of fluid loss?
Loss of fluid:
- PROM
- Post term pregnancy
Oligohydramnios can be caused by potter’s sequence. What is that?
Reduced urine output from kidneys :
- Maternal medications :NSAIDS, ACEi
-
- Renal agenesis (potter’s sequence: = Can cause resultant pulmonary hypoplasia as fetal lungs require amniotic fluid to develop -> death in utero
What is polyhydramnios?
Increased volume of amniotic fluid
(>95th centile for gestational age)
Affects 1-4% of pregnancies
How many people are affected by polyhydramnios?
Affects 1-4% of pregnancies
What are the two mechanisms that can cause polyhydramnios?
Increased fetal urine production:
Reduced fetal swallowing:
Causes of increased fetal urine production that can cause polyhydramnios?
Increased fetal urine production:
- GDM = foetal polyuria
- TTTs
- Foetal anaemia (increase CO = increase urine production)
Causes of reduced fetal urine production that can cause polyhydramnios?
Reduced fetal swallowing:
- Dudodenal atresia
- Bowel malformation
- Chromosomal abnormality
- Neurological issue
- Cleft palate
Clinical features of oligohydramnios?
History of fluid leak = ROM
Abdominal exam = decreased fundal height, foetal parts easily palpable
Abdominal exam findings for oligohydramnios?
History of fluid leak = ROM
Abdominal exam = decreased fundal height, foetal parts easily palpable
Abdominal exam findings for polyhydramnios?
Increased fundal height, inpalpable foetal parts
Investigations to assess oligo/poly hydramnios?
USS = Liquour volume, foetal anomalies
CTG = Foetal wellbeing
Amniotic fluid index (5cm-25cm):
<5cm: oligohydramnios
>25cm: polyhydramnios
Imaging Investigations to assess oligo/poly hydramnios?
USS = Liquour volume, foetal anomalies
CTG = Foetal wellbeing
Amniotic fluid index to assess oligohydramnios?
Amniotic fluid index (5cm-25cm):
**<5cm: oligohydramnios **
>25cm: polyhydramnios
Amniotic fluid index to assess polyhydramnios?
Amniotic fluid index (5cm-25cm):
<5cm: oligohydramnios
**>25cm: polyhydramnios **
Polyhydramnios volume in litres?
== 2-3L amniotic fluid
How to manage oligohydramnios?
If at term deliver the baby
If pre-term, monitor for further abnormalities
How to manage polyhydramnios?
Amnioreduction
or
COX inhibitors (decreasing foetal urine output)
