L6: Abnormalities of Amniotic Fluid Flashcards by Ahmed Farag

Q

Def of Polyhydramnios

A

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Q

Incidence of Polyhydramnios

A

1% in all pregnancies

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Q

Types of Polyhydramnios

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Causes of Polyhydramnios

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Q

Maternal Causes of Polyhydramnios

A

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Q

Maternal prolactin may play a role by increasing the …… of amniotic fluid.

A

osmotic pressure

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Q

Fetal causes of Polyhydramnios

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Q

Causes of Polyhydramnios

Multiple gestation

A

(in monochorionic twins it may be twin-to-twin transfusion syndrome)

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Q

Causes of Polyhydramnios

Anencephaly and spina bifida in most cases & the causes may be ….

A

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Q

Causes of Polyhydramnios

Congenital Heart failure

A

Congenital Heart Disease with congestive ht. failure

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Q

Causes of Polyhydramnios

Increased placental mass

A

That occurs with edema of the placenta: e.g. Hydrops
fetalis: e.g. Rh. iso-immunization, severe anemia, CMV infection

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Q

Causes of Polyhydramnios

Liver Cirrhosis

A

Causing fetal ascites “as in Syphilis”

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Q

Clincal Dx of Polyhydraminos

A

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Q

Clincal Dx of Polyhydraminos

Acute type

A

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Q

Clincal Dx of Polyhydraminos

Symptoms of acute type

A

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Q

Clincal Dx of Polyhydraminos

Signs of acute type

A

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Q

Clincal Dx of Polyhydraminos

General Examination of acute type

A

breathlessness, anxious, and
cyanotic

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Q

Clincal Dx of Polyhydraminos

Inspection of acute type

A

Over distended with glistening skin and visible dilated veins.

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Q

Clincal Dx of Polyhydraminos

Palpation of acute type

A

Size of uterus > duration of amenorrhea & tense, tender
Difficult to palpate fetal part.
Common malpresentation & mal-position

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Q

Clincal Dx of Polyhydraminos

Percussion of acute type

A

Positive fluid thrill

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Q

Clincal Dx of Polyhydraminos

Auscultation of acute type

A

Difficult to auscultate FHS

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Q

Clincal Dx of Polyhydraminos

vaginal Examination of acute type

A

boggy fomices & cervix is pulled high up & may be dilated

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Q

Clincal Dx of Polyhydraminos

Chronic Type

A

Symptoms and Signs are slowly progressive course & after 20 weeks.

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Q

In acute polyhydramnios: Symptoms are …..
In chronic polyhydramnios: Symptoms are ……

A

severe & of sudden onset.
slight & of gradual onset.

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INVx in **Polyhydraminos**

DDx of **Polyhydraminos**

- Causes of oversized uterus more than amenorrhea. - Ascites with pregnancy. - Ovarian cyst with pregnancy.

Managment aspects of **Polyhydraminos**

- Plan of ttt - Expectant treatment - Termination of pregnancy - Neonatal Care

Managment aspects of **Polyhydraminos** - Plan of TTT

Managment aspects of **Polyhydraminos** - Expectant Treatment

Managment aspects of **Polyhydraminos** - TOP

Managment aspects of **Polyhydraminos** - Neonatal Care

- Diagnose & treatment of congenital anomalies, anemia, jaundice & infection. - Care of preterm baby & care of infant of diabetic mother.

Complications of **Polyhydraminos**

Fetal & Maternal

Fetal Complications in **Polyhydraminos**

- Birth injuries - Cord prolapse, Placental separation and fetal asphyxia. - Prematurity complications when delivered early

Maternal Complications of **Polyhydraminos**

Maternal Complications of **Polyhydraminos** - During Pregnancy

Maternal Complications of **Polyhydraminos** - During Labor

Splanchic Shock Due to polyhyrdraminos

- Due to pooling of blood in dilated splanchnic vessels as a result of sudden drop of intra-amniotic pressure after ROM.

Def of **Oligohydraminos**

- Too little amniotic fluid (oligohydramnios) is commonly defined as amniotic fluid index (AFI) less than the 5th centile for gestation. - It is the decreased amount of liquor amnii (< 500 cm3) OR on U/S AFI < 5cm.

Incidence of Oligohydraminos

1/750

Causes of **Oligohydraminos**

maternal Causes of Oligohydraminos

Rare or absent and the commonest is severe PET.

Fetal Causes of **Oligohydraminos**

Fetal Causes of **Oligohydraminos** - Renal Anomalies

e.g. bilateral renal agenesis, complete obstruction of urinary tract, bilateral multicystic kidneys.

Fetal Causes of **Oligohydraminos** - Multifetal Pregnancy with TITS

Donor fetus develops oligohydramnios

Fetal Causes of **Oligohydraminos** - Post tem pregnancy

Due to placental insufficiency

Clinical Dx of **Oligohydraminos**

INVx in **Oligohydraminos**

TTT of **Oligohydraminos**

TTT of **Oligohydraminos** - In PROM

Treatment of PROM

TTT of **Oligohydraminos** - In Post-term Pregnancy

TOP

TTT of **Oligohydraminos** - If there is lethal fetal anomalies or IUFD

TOP

TTT of **Oligohydraminos** - If there is fetal risk (cord compression or IUGR)

Immediate CS

TTT of **Oligohydraminos** - If there is no fetal risk

Vaginal delivery is allowed with careful electronic fetal monitoring to detect any change in FHR which indicates CS

TTT of **Oligohydraminos** - Aminoinfusion

Method in which physiological solution (normal saline) is infused via double lumen catheter through cervix into uterine cavity

Complications of **Oligohydraminos**

Matrenal Complications of **Oligohydraminos**

Malpresentation & prolonged labo

Fetal Complications of **Oligohydraminos**

Fetal Complications of **Oligohydraminos** - Pulmonary hypoplasia

Fetal Complications of **Oligohydraminos** - Asphyxia

Due to cord compression

Fetal Complications of **Oligohydraminos** - Cutaneous & skeletal abnormalities