Polyhydramnion

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The risk of fetal death innonanomalous pregnancies aectedby polyhydramnios

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PHYSIOLOGY OF AMNIOTIC FLUID Early pregnancy: composition of AF

similar to ECF. Transfr of !atr across

amnion an" t#ro$%# ftal s&in.

By second trimester: ft$s '%ins to

$rinat s!allo!( an" inspir AF D$rin% last )*+of pr%nanc,( AF is principall, compris" of ftal$rin.

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NORMAL AMNIOTIC FLUID VOLUMENORMAL AMNIOTIC FLUID VOLUME

WeeksGestation

Fetus Amniotic Fluid Placenta!" ml" !"

16

28

36

40

100 200 100

1000 1000 200

2500 900 400

3300 800 500

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DEFINITIONS:

Pol,#,"ramnios- >) cc amniotic /$i"

Amniotic Fl$i" In"0 1 lar%st 2rtical

poc&t in 3 4$a"rants

pol,#,"ramnios >)3 cm.

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Etiology of

olyhydramnios:Fetal !nomalies Pro'lms !it# s!allo!in% an" GI a'sorption

Incras" trans$"ation of /$i"-

anncp#al,( spina 'i5"a Incras" $rination- anncp#al, 6lac& of ADH(

stim$lation of $rination cntrs7

Dcras" inspiration

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"auses of polyhydramnios

Ftal malformation- 8 GIT-

sop#a%al*"$o"nalatrsia(

trac#osop#a%al5st$la.

8 CNS- anncp#al,69s!allo!in%(0pos" mnin%s( noanti"i$rtic #ormon7.

T!in8t!in transf$sion

: ftal pol,$ria.

H,"rops ftalis-con%sti2 #artfail$r( s2r anamiaor #,poprotinmia :

placntal trans$"ation

"ia'ts mllit$s

6osmotic "i$rsis7.

I"iopat#ic.

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olyhydramnios

types

#$ %ild hydramnios &'()*:

a pocket of amniotic +uid measuring ' to ##cm$

,$ moderate hydramnios -)*:

a pocket of amniotic +uid measuring #, to #-cm$

.$ Se/ere hydramnios &-)* 0 t1in0t1intransfusion syndrome :

a pocket of amniotic +uid measuring #2 cm ormore.

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diagnosis of polyhydramnios

S,mptoms-

8 ",spna.8 "ma.8 a'"ominal "istntion

8 prtrm la'o$r.

A'"ominal 0amination-8 ;$tr$s t#an 0pct".8 "i

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SYMPTOMS

D,spna

A'"ominal pain

Contractions prtrm la'or Dcras" Prcption of Ftal

Mo2mnts

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DI!3NOSIS

F$n"al #i%#t = %stationala%

Di>>Sono%rap#,

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6Mot#r7?

D,spna

Placntal a'r$ption

Utrin ",sf$nction

Post8part$m #morr#a%

A'normal prsntation

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6ft$s7?

Ftal pro%nosis !orsns !it# mor s2r#,"ramnios an" con%nital anomalis

@8)B ftal malformations

Prtrm "li2r,

S$spct "ia'ts

Prolaps of cor"

A'r$ption

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s$lt

T# ris& of IUFD in pr%nancis act" ',pol,#,"ramnios !as %ratr at 2r, %stationala% compar" !it# $nact" pr%nancis. T#IUFD ris& in pr%nancis act" ',

pol,#,"ramnios !as mor t#an tims #i%#rt#an $nact" pr%nancis at + !&s

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On%oin% ris& of IUFD is %ratr in lo!8ris&pr%nancis act" ', pol,#,"ramnios at all%stational a%s compar" !it# $nact"pr%nancis !it# t# %ratst incras in ris& at

trm.