Oligohydramnion in post

term pregnancy
Kheluwis.s
406148098

Amniotic fluid function:

Allows

room for fetal growth,

movement and development.

Ingestion

into GIT growth and

maturation.
Fetal

pulmonary development

(20 weeks).
Protects

the fetus from trauma.

Amniotic fluid function:

Maintains
Contains
Aids

temperature.

antibacterial activity.

dilatation of the cervix

during labor.
Protects

cord and placenta from

compression in labor

Normal Amniotic Volume

Increases

from approximately 30
mL at 10 weeks to 200 mL by 16
weeks and reaches 800 mL by
the mid-third trimester and start
to gradually decrease after 40
weeks of pregnancy

Physiology
During

the first half of pregnancy,

transfer of water and other small
molecules takes place across the
amnion intramembranous flow, and
across fetal skin
Fetal urine: 8 and 11 weeks (became
major component after 18 weeks)
Transport across the fetal skin
continues until keratinization occurs
at 22 to 25 weeks.

Amniotic Fluid Volume Regulation

in Late Pregnancy
Pathway

Effect on Volume

Approximate Daily
Volume (mL)

Fetal urination

Production

1000

Fetal swallowing

Resorption

750

Fetal lung fluid

secretion

Production

350

Intramembranous
flow across fetal
vessels on the
placental surface

Resorption

400

Transmembranous
flow across amnionic
membrane

Resorption

Minimal

Amniotic fluid volume assessment

Objective assessment depends on U/S to
measure:
Deepest vertical pocket (DVP)
Amniotic fluid index (AFI): It is a total of the
DVPs in each of the four quadrants of the
uterus. it is a more sensitive indicator of AFV
throughout pregnancy

Amniotic fluid abnormalities

Oligohydramnios:

Defined as reduced amniotic fluid

i.e. amniotic fluid index of 5 cm or
less or the deepest vertical pool <
2 cm
Polyhydramnios:

Defined as excessive amount of amniotic

fluid of 2000 ml or more (AFI of > 24 cm
or the deepest vertical pool of > 8 cm).

ETIOLOGY
FETAL

PROM

CHROMOSOMAL ANOMALIES

CONGENITAL ANOMALIES

IUGR

IUFD

POSTTERM PREGNANCY

PLACENTAL

CHRONIC ABRUPTION

TTTS

CVS

MATERNAL
PREECLAMPSIA
CHRONIC HT

DRUGS

NSAIDs

ACE INHIBITORS

IDIOPATHIC
9

DIAGNOSIS
SYMPTOMS
NO SPECIFIC
SYMPTOMS
Postterm
preeclampsia
Less fetal movements

SIGNS
Uterus small
for date
Feels full of
fetus
Malpresentations
IUGR
10

USG
METHODS
DVP

<2 cms
(<1 severe)

AFI

<5 cms
(5-8
borderline)

11

Technique of AFI
Uterus

divided into 4 quadrants

Transducer in vertical plane
Sum of 4 quadrants max pocket
depth excluding cord & limbs.
Prior to 20 wks 2 halves
Twins: composite AFI or individual
vertical pockets

12

COMPLICATIONS

FETAL

Abortion
Prematurity
IUFD
Deformities
CTEV,contractures,amputation
Potters syndrome- pulmonary
MATERNAL
hypoplasia
Malpresentations
Increased morbidity
Fetal distress
Low APGAR

Increased operative
13
intervention

MANAGEMENT
DEPENDS UPON
ETIOLOGY

GESTATIONAL
SEVERITY
FETAL

AGE

STATUS & WELL BEING

14

DETERMINE ETIOLOGY
R/O

PROM, h/o medical illness

TARGETED USG FOR ANOMALIES
R/O IUGR ,IUFD when suspected
Amniocentesis if chromosomal
anomalies suspected early symmetric
IUGR

15

TREATMENT
ADEQUATE REST decreases dehydration
HYDRATION Oral/IV Hypotonic fluids(2 Lit/d)
helpful during labour,prior
to ECV, USG
SERIAL USG Monitor growth,AFI
INDUCTION OF LABOUR

16

AMNIOINFUSION

1.
2.

INDICATIONS
Prophylactic
Therapeutic
Decreases cord
compression

17

TREATMENT ACC. TO CAUSE

Drug

induced
PROM INDUCTION
PPROM Antibiotics,steroid
Induction
Laser photocoagulation for TTTS

18