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Polyhydraminios which is often simply called Hydraminios has been defined as being a quantity of amniotic fluid which exceeds 1,500mls. The average volume of liquor in the latter half of pregnancy is between 500 – 1,500ml. The lower li mit of normal is 500mls of liquor amni while the upper limit of normal is 1,500mls. In most cases, the excess fluid accumulates gradually (chronic hydramnios) and is only noticed after 30th week. In a few exceptional cases, hydramnios occurs earlier and more quickly (acute hydramnios) and many of these cases are associated with uniovular twins.
Hydramnios occur more often in multiparae than in primigravidae. The mechanism of production of liquor amni is not quite understood; consequently the pathophysiology of hydramnios is obscure. Certain maternal and fetal conditions are however known to be associated with hydramnios.
Most times unknown
· Twin pregnancy particular uniovular twins.
· Congenital fetal abnormalities, Open neural tube defect – anencephaly , spinal bifida
· Oesophageal atresia,
· Rarely -rhesus isoimmunization, chorioanagioma of the placenta(rare)
· Hydrops fetalis.
· Maternal diabetes mellitus
· Occurs at about the 20th week & comes on suddenly.
· The fundus reaches the xiphisternum in about 3-4 days.
· Frequently associated with monozygotic twins.
· Abdominal pain and vomiting in rare cases.
· Dyspnoea & indigestion if the uterus is very much enlarged.
· Abdomen is large than expected for the duration of pregnancy.
· Abdominal muscle may be stretched and oedematous
· Difficulty in feeling the fetal part and fetal heart sound may be muffled or inaudible.
· Fetus is unusually mobile and presentation is unstable.
· Oedema of the vulva
· It is gradual in onset, usually from about the 30th week of pregnancy.
· It is the most common type.
· There is gradual increase in abdominal girth.
· There are signs of pain, dyspnoea and digestive discomfort in severe case.
· Difficult in palpating the fetal part and fetal heart sound is inaudible.
· Fluid thrill can be elicited.
· Abdominal girth increases to about 100cm.
· Ultrasound scanning
· Preterm labor
· Cord presentation and prolapse.
· Increased incidence of Caesarean section, mal-presentation may occur.
· Antepartum hemorrhage – placenta abruption.
· After delivery, there is risk of post partum hemorrhage.
· Raised perinatal mortality
There is no known method of controlling the production or absorption of amniotic fluid except that improved control in cases of diabetes may reduce the prevalence of hydramnios.
1. The woman may be admitted to a consultant obstetric unit. Subsequent care depends on condition of the woman, the fetus, the cause and degree of hydramnios and the stage of pregnancy. Hydramnios without symptoms and without any evidence of fetal abnormality requires no treatment.
2. An upright position will help to relieve any dyspnoea and antacid may be given to relieve heartburn and nausea.
3. In the presence of gross abnormalities labor should be induced. Some Obstetrician would draw off part of the liquor by abdominal amniocentesis before the induction.
4. Abdominal amniocentesis is particularly suitable in cases in which the pregnancy is not sufficiently advanced for safe induction but the patient is in discomfort.
5. Labour is usually normal but the midwife should be prepared for the possibility of post partum hemorrhages.
6. The baby should be carefully examined for abnormalities and the potency of the oesophagus ascertained by passing nasogastric tube.
This means small volume of amniotic fluid. The quantity of amniotic fluid is markedly diminished, of less than 500ml and sometimes as less as 60ml.
Oligohydramnios is most often associated with poor placental function and fetal growth retardation. Severe Oligohydramnios is seen with obstructive lessons of the fetal urinary tract and with renal agenesis, if diagnosed in early pregnancy.
In some cases the cause is unknown. The fetus has little room to move and at times will cause compression deformities e.g. talipes and ankytosis of joints
· The uterus appears smaller than expected for the period of gestation.
· Reduction in fetal movement
· Intra uterine growth retardation.
· On palpation, the uterus is small and compact and fetal parts are easily felt.
· Ultrasound scanning will confirm diagnosis
The woman may be admitted to hospital. Check the woman for the possibility of preterm rupture of the membranes by careful questioning.
When fetal abnormality is considered not to be lethal, or the cause of the Oligohydramnios is not known, prophylactic amnioinfusion with normal saline, Ringer’s lactate or 5% glucose may be performed in order to prevent compression deformities.
Labour may be induced because of the possibility of placental insufficiency. Epidural analgesia may be indicated because uterine contractions are unusually painful with this condition.
Continuous fetal heart rate monitoring is desirable as fetus is prone to hypoxia.
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