Polyhydramnios



Polyhydramnios

Definition : In amount of AF a degree detected clinically
= ( > 2 Liters ; Amniotic Fluid Index > 20 cm )

Etiology : .. idiopathic in 2/3 of cases

1) Fetal ( 20% )
* Twins ( binovular or uniovular ) uni acute hydramnios
 * CFMF Open NTD
- Anencephaly ( no swallowing , no ADH, CSF
- Spina bifida
 Interfere with swallowing :
- esophageal / duodenal atresia
- tracheo-esophageal fistula
 Congenital repbrosis or liver cirrbosis or gastroscbisis
* Hydrops fetalis


2) Placental Chorioangioma of placenta
Obsruction to circulation in cord as in knots

3) Maternal ( 15% ) Generalized anasarca as . Heart / renal failure

 Diabetes milletus due to . 3 causes

Clinical picture According to the Rate of accumulation of AF

Acute x ChronicIncidence
Etiology
Time 1 / 2000
usually uniovular twins
earlt ( 4 6 months ) 1 / 200
any cause
late ( > 28 wks ) Symptoms - Rapidly progressive ( few days )
- N & V , Abdominal pain
- Dyspnea / Palpitation - Gradually progressive
- Abdominal discomfort
- Less pressure symptoms Signs
1. General


2. Abd.
( FL > amen )

3. P/V

LL edema , weight gain , + PET
- Abdomen markedly enlarged
- Fetal parts unfelt
- FHS not heard - Very tense + stretched skin
- Difficult to feel
- Difficult to hear Cervix is partially dilated with bulging membranes



Investigations :

Etiology . E.g. blood glucose level
 U/S twins , CFMF
Diagnostic . AFI > 20 cm
Tests for FWB . Routine .

D. Diagnosis : Fundal level > periof of amenorrhea

Complications :
PregnancyLaborFetal* Abortion (acute & early cases )
* PTL
* Pressure symptoms
* PET ( 25% of cases )
* APhge
- P. previa ( large placenta )
- Abruptio placenta ( if ROM with rapid drainage of liquor )
* Mal presentations & non-engagement of presenting part 1st stage
- Prolonged ( uterine inertia )
- PROM cord prolapse , infection

2nd Stage Obstruction due to

malpresentation

3rd stage .. S3

- PPhge ( atonic + retained placenta )
- P uerperal sepsis
- subinvolution 1. PTL

2. CFMF 

Management
1) Conservation
- Bed rest on side
 - Treat cause / Stymtomatic ttt / improve nutrition
 - Anti-PG .. renal production of urine in fetus
 Oral 25 mg 1x4 / suppository 100 mg 1x2
- Amnirodeuction .. repeated amniocentesis ( but it recollects )
( not > 0.5 L/ hr , not 2 L / session )


2) TOP
Indications
- Failed conservative ttt ( esp in ACUTE cases )
- Marked pressure symptoms ( e.g. dyspnea ,difficult ambulation )
- CFMF

Methods

 - Vaginal AROM should be slow ( to avoid abruption placenta ) :
* Controlled drainage of amniotic fluid
* Hindwater rupture with Drew smythe catheter
 - C.S malpresentations , uterine inertia , guard against PPHge .

Oligelydraimnos

Definition amount of AF detected clinically ( usually < 0.5 L )

Etiology :

 1. PROM the most common cause
 . Placental insufficiency e.g. PET & DM . IUGR .. Postmaturity
 . CFMF Potter's syndrome ( bilateral renal agenesis + Facial
abnormalities )


 2. Idiopathic / latrogenic prolonged use of anti0PG , after amniocentesis

Clinical picture

 Symptoms history of PROM , decreased fetal kicks
 Signs Abdominal * FL < period of amenorrhea
* Fetal parts easily felt / FHS easy heard
 PV small bag of forewaters .

Invest . U/S

diagnosis : no picket of AF 2 x 2 cm or AFI < 5 cm
Etiology : CFMF . Postmaturity
Test for FWB

Complications :

1) Maternal incidence of CS d.t.
 - Prolonged labor ( small bad of forewaters slow cx dilatation )
 - Perinatal asphyxia ( AF cord compression )
- Prolonged oligohydramnios ( pulmonary hypoplasia + mechanical effects )
 - Breech is more common ( AF interferes with spont correction )

2) Fetal

 - Fetal anomalies CFMS
 - Fetal injury due to operative inference


Management
1) In pregnancy
 * Malformed TOP ( AROM + oxytocin )
 * Not malformed observe for fetal distress +

Amnioinfusion :

- Infusion of : warm saline into amniotic sac ( guided by US )
- Also for ttt : choriomnionitis ( antibiotic ) & MAS ( dilution )
- It may lead : infection , AF embolism , PTL ( irritation) , PROM

2) In labor . Incidence of CS d.t









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