Oligohydramnios and polyhydramnios Flashcards
What is oligohydramnios?
Decreased amniotic fluid volume below fifth centile, or deepest pool les than 2cm.
What is the aetiology of oligohydramnios?
Rupture of membranes, fetal urinary pathology/malformations, placental insufficiency,
What are the risk factors of oligohydramnios?
Chromosomal abnormalities, post-term, IUGR, PREEC, medication (ACEi, indomethacin), multiple pregnancy (TTS)
What is the epidemiology of oligohydramnios?
4% of pregnancies.
What would you find in the history and examination of Oligohydramnios?
Hx of fluid leak with PV rupture of membranes. Commonly asymptomatic.
Abdomen: low fundal height, fetal parts palpable easily.
Speculum: assess for ruptured membranes if clinically appropriate.
What is the pathology of oligohydramnios?
Reduced amniotic fluid volume by loss of fluid or reduced fetal urine output (placental insuff/RT abnormalities)
What investigations would you do for oligohydramnios?
USS: to assess extent, diagnosis, liquor volume. Fetal growth, umbilical artery doppler, fetal renal trace.
CTG: fetal wellbeing.
What is the management of oligohydramnios?
Term: delivery appropriate (IOL if no contrandications)
Pre-term: monitor with serial USS for growth, liquor volma and Dopplers. Regular CTG. Deliver if further abnormaltiies arise.
Amniofusion has very lmiited use in modern obstetrics.
What are the complications and management of oligohydramnios?
Labour: high incidence of CTG abnormalities, meconium liquor, emergency C sections.
Neonate: pulmonary hypoplasia, limb deformities.
PGX dependent on gestation time when problem arises. Increases perinatal mortality if very early onset.
What is polyhydramnios?
Increased volume of amniotic fluid to more than 95th centile or deepest pool >8cm.
What is the aetiology of polyhydramnios?
Idiopathic, failure of swallowing in child (neuro, chromosomal), getal GI abnormalities (TOF, OA) congenital infecitons, fetal polyutia (DM, TTTS)
What is the epidemiology of polyhydramnios?
1-4% pregnancies.
What would you find in the history and examination of polyhydramnios?
Symptoms of underlying aetiology, maternal discomfort.
Abdomen: high fundal height, impalpable fetal parts, tense abdomen.
What is the pathology of polyhydramnios?
Raised amniotic fluid volume caused by fetal urine production increase or decrease in fetal swallowing/absorption.
What investigations would you do for polyhydramnios?
USS: diagnosis and assessment of liquor volume, fetal growth, umbilical artery dopplers, exclude anomalies.
Other: exclude maternal diabetes!
