OLIGOHYDRAMNIOS

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OLIGOHYDRAMNIOS
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PHYSIOLOGY OF AMNIOTIC FLUID
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• INFLOW
• (1000 ml/d)
• 1.FETAL URINE
• 2.LUNG LIQUID
• INTRAMEMBRANOUS (placenta,cord)
• TRANSMEMBRANOUS(amniotic membranes)
• RECYCLING 3hrs

• OUTFLOW
• (1000 ml/d)
• 1.FETAL SWALLOWING

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FUNCTIONS OF AMNIOTIC FLUID

• Shock absorber protects from external trauma.
• Protects cord from compression.
• Permits fetal movements development of
  musculoskeletal system, prevents adhesions.
• Swallowing of AF enhances growth development of
  GIT.
• AF volume maintains AF pressure reduces loss of
  lung liquid pulmonary development.
• Maintenance of fetal body temperature.
• Some fetal nutrition, water supply.
• Bacteriostatic properties decreases potential
  for infection

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DEFINITION

• AMNIOTIC FLUID VOLUME lt 5 th percentile for
  gestational age
• AMNIOTIC FLUID INDEX lt 5
• SINGLE VERTICAL POCKET lt 2 cms

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INCIDENCE

• 0.5 5

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AETIOLOGY

• FETAL
• PROM (50)
• CHROMOSOMAL ANOMALIES
• CONGENITAL ANOMALIES
• IUGR
• IUFD
• POSTTERM PREGNANCY

• MATERNAL
• PREECLAMPSIA
• APLA SYNDROME
• CHRONIC HT

• DRUGS
• PG SYNTHETASE INHIBITORS
• ACE INHIBITORS
• IDIOPATHIC

• PLACENTAL
• CHRONIC ABRUPTION
• TTTS
• CVS

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DIAGNOSIS

• SYMPTOMS
• NO SPECIFIC SYMPTOMS
• H/O leaking p/v
• Postterm
• s/o preeclampsia
• Drugs
• Less fetal movements

• SIGNS
• Uterus small for date
• Feels full of fetus
• Malpresentations
• IUGR

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USG

• METHODS
• MVP lt2 cms
• (lt1 severe)
• AFI lt5 cms
• (5-8 borderline)
• 2D pocket lt15 sq cms

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COMPLICATIONS

• FETAL
• Abortion
• Prematurity
• IUFD
• Deformities CTEV,contractures,amputation
• Potters syndrome- pulmonary hypoplasia
• Malpresentations
• Fetal distress
• MSAF MAS
• Low APGAR

• MATERNAL
• Increased morbidity
• Prolonged labour uterine inertia
• Increased operative intervention
• (malformations,
• distres)

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MANAGEMENT

• DEPENDS UPON
• AETIOLOGY
• GESTATIONAL AGE
• SEVERITY
• FETAL STATUS WELL BEING

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DETERMINE AETIOLOGY

• R/O PROM
• TARGETED USG FOR ANOMALIES
• R/O IUGR ,IUFD when suspected
• Amniocentesis if chromosomal anomalies suspected
  early symmetric IUGR
• Tests for APLA Syndrome , if suspected
  
  
  

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TREATMENT

• 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
• Fetal
  jeopardy
• Sev IUGR
• Severe
  oligo
• 
  
  

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• AMNIOINFUSION
• INDICATIONS
• 1.Diagnostic
• 2.Prophylactic
• 3.Therapeutic
• Decreases cord compression
• Dilutes meconium

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TREATMENT ACC. TO CAUSE

• Drug induced OMIT DRUG
• PROM INDUCTION
• PPROM Antibiotics,steroid Induction
• FETAL SURGERY
• VESICO AMNIOTIC SHUNT-PUV
• Laser photocoagulation for TTTS

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