Wesleyan University Philippines

Mabini Extension Cabanatuan City, N.E

College of Nursing

A CASE STUDY ON
OLIGOHYDRAMNIOS

Submitted By:
BJ ADETTE J. HILARIO
BSN III- Blk.3

Submitted To:
Clinical Instructor Fe Adriano RN, MAN.
 I. Introduction

Oligohydramnios is a condition in pregnancy characterized by a deficiency

of amniotic fluid. The common clinical features are smaller symphysio fundal height,
fetal malpresentation, undue prominence of fetal parts and reduced amount of
amniotic fluid. It is typically caused by fetal urinary tract abnormalities such as
unilateral renal agenesis ( Potter's syndrome ), fetal polycystic kidneys, or
genitourinary obstruction. Uteroplacental insufficiency is another common cause. Most
of these abnormalities can also be detected by obstetric ultrasound. It may also occur
simply due to dehydration of the mother, maternal use of angiotensin converting
enzyme inhibitors, or without a determinable cause (idiopathic).

II. History Taking

a. Information

i. Name: Jocelyn Tapang Japones

ii. Age: 32 years old
iii. Gender: Female
iv. Birthday: August 17, 1980
v. Birth place: General Natividad
vi. Marital Status: Married
vii. Address: 149, Balangkare Norte, General Natividad, Nueva Ecija
viii. Occupation: N/A
ix. Religion: Iglesia Ni Cristo
x. Nationality: Filipino
xi. Spouse Name: Herb Japones
xii. Father’s Name: Alfredo Tapang
xiii. Mother’s Name: Adelina Tapang
b. Admission Record

Admitting Date: 22-Nov-2012

Admitting Time: 2:35am

Attending Physician: Amorin, Edeliza MD

c. Initial diagnosis:

G4P1, (1021), PU 36 5/7 weeks AOG, Oligohydramnios

d. Final diagnosis:

G4P2 (1102) delivered operatively to a live, preterm baby girl/ BW= 1.9kg, APAS, uterine
varicosities; Oligohydramnios

e. Operation Performed:

Lower Transverse Cesarean Section (LTCS) (midline)

f. History of Present Illness

G4P1 (1021). Known case of APAS during this pregnancy. On regular PNCU today, (+)
Oligohydramnios noted on ultrasound. Advised primary LTCS.

g. Past Medical/ Health History

Unremarkable
(+) Hypertension
(+) Diabetes Mellitus

h. OB-Gyne History

G4P1 (1021)
AOG 36 5/7 weeks
LMP 3/10/2012

i. Allergies:

SMC, Celecoxib
 III. Collecting Objective
Data
a. Course of Confinement

i. Medications administered since date of admission

Physician’s Order: METRONIDAZOLE 500mg every 8 hours

intravenously
KETOROLAC 30mg every 8 hours as
necessary for pain intravenously
METRONIDAZOLE 500mg/tablet 1 tablet 3x a
day per orem
CEFUROXIME 5oomg/capsule 1 capsule 2x a
day per orem
TRAMADOL 37.5, PARACETAMOL 325mg
(Algesia)/tablet 1 tablet 3x a day round the
clock per orem

ii. IVF, BT and other parenteral medication infused/administered since

date of admission

IVF: D5LRS 1L for 8 hours 41-42 gtts/min

iii. All diagnostic tests made to patient since date of admission

Variables Normal Value Result

Hemoglobin Male: 130-170 g/L 135
Female: 120-150 g/L
Hematocrit Male: 0.40-0.50 0.43
Female: 0.37-0.45
Red Cell Count Male: 4.5-5.5 x10 12/L 6.02 x10 1/L
Female: 4.6-5.2 x10 12/L
White Cell Count 5-10 x10g/L 18.52 x10g/L
Platelet Count Manual: 150-400 x10/L __ x10/L
Machine: 130-500 x10/L
Nucleated RBC/100WBC

Reticulocyte CT Adult: 0.5%-1.5%

Newborn: 2.0%-6.0%
MCV 80-100fl 72.8fl

MCH 27-31 22.4

MCHC 32-36 g/dL 30.8 g/dL

RDW CV 11.6-14.6% 17.1%

Differential Count

Neutrophils 0.55-0.65 0.89

Lymphocytes 0.25-0.35 0.09

Monocytes 0.02-0.06 0.02

Eosinophils 0.02-0.04

Basophils 0-0.005

Stabs 0-0.05

Others

iv. Other relevant events during hospitalization

 None.

b. Physical Assessment

i. General Appearance:
 Ambulatory
 Coherent

ii. Weight and Vital Signs

 Weight-58 kg.
 Vital Signs-
 Blood Pressure- 110/80 mmHg
 Temperature- 36.8 ˚C
 Pulse Rate- 72 bpm
 Respiratory Rate- 18 bpm

iii. HEENT:
 Pink, PC, AS
 iv. Neurologic Exam:
 E/N

v. Chest and Lungs:

 SCE, CBS

vi. Heart:
 AP NRRR

vii. Abdomen:
 Soft, round, FHT

viii. Extremities:
 Pulses, full and equal

IV. Anatomy and

Physiology

Amniotic fluid is a clear, slightly yellowish liquid that surrounds the unborn baby (fetus) during
pregnancy. It is contained in the amniotic sac. While in the womb, the baby floats in the amniotic
fluid. The amount of amniotic fluid is greatest at about 34 weeks (gestation) into the pregnancy,
when it averages 800 mL. Approximately 600 mL of amniotic fluid surrounds the baby at full term (40
weeks gestation).

The amniotic fluid constantly moves (circulates) as the baby swallows and "inhales" the fluid, and
then releases it.

The amniotic fluid helps:

 The developing baby to move in the womb, which allows for proper bone growth
  The lungs to develop properly
 Keep a relatively constant temperature around the baby, protecting from heat loss
 Protect the baby from outside injury by cushioning sudden blows or movements

An excessive amount of amniotic fluid is called polyhydramnios. This condition can occur with
multiple pregnancy (twins or triplets), congenital anomalies (problems that exist when the baby is
born), or gestational diabetes.

An abnormally small amount of amniotic fluid is known as oligohydramnios. This condition may occur
with late pregnancies, ruptured membranes, placental dysfunction, or fetal abnormalities.

Abnormal amounts of amniotic fluid may cause the health care provider to watch the pregnancy more
carefully. Removal of a sample of the fluid, through amniocentesis, can provide information about the
sex, health, and development of the fetus.

V. Treatment

 Close medical supervision of the mother and fetus.

 Fetal monitoring
 Amnioinfusion (infusion of warmed sterile normal saline or lactated Ringer’s solution) to treat or
prevent variable decelerations during labor.

VI. Nursing
Intervention
1. Monitor maternal and fetal status closely, including vital signs and fetal heart rate patterns.
2. Monitor maternal weight gain pattern, notifying the health care provider if weight loss occurs.
3. Provide emotional support before, during, and after ultrasonography.
4. Inform the patient about coping measures if fetal anomalies are suspected.
5. Instruct her about signs and symptoms of labor, including those she’ll need to report
immediately.
6. Reinforce the need for close supervision and follow up.
7. Assist with amnioinfusion as indicated.
8. Encourage the patient to lie on her left side.
9. Ensure that amnioinfusion solution is warmed to body temperature.
10. Continuously monitor maternal vital signs and fetal heart rate during the amnioinfusion
procedure.
11. Note the development of any uterine contractions, notify the health care provider, and
continue to monitor closely.
12. Maintain strict sterile technique during amnioinfusion.