‫بسم هللا الرحمن الرحيم‬

POLYHYDRAMNIOS &
OLIGOHYDRAMNIOS

Prepared by : Hamzah Qarawi

To: Miss Mahdia Kony
Outline

Defenition
Diagnosis
Sign &symptoms
Complication
treatment
Description

Amniotic fluid is the liquid that

surrounds the developing fetus
during pregnancy. It is
contained within the amniotic
membrane that forms the
amniotic sac (bag of waters).
NORMAL AMNIOTIC FLUID VOLUME
INFLOW OUTFLOW
(1000 ml/d) (1000 ml/d)
1.FETAL URINE 1.FETAL SWALLOWING
2.LUNG LIQUID

INTRAMEMBRANOUS
(placenta,cord)
TRANSMEMBRANOUS(amniotic
membranes)
RECYCLING – 3hrs
FUNCTIONS OF AMNIOTIC FLUID
Shock absorber – protects from external*
.trauma
.Protects cord from compression*
Permits fetal movements – development of*
musculoskeletal system, prevents
.adhesions
.Maintenance of fetal body temperature*
.Some fetal nutrition, water supply*
Bacteriostatic properties – decreases*
. potential for infection
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Definition
- Polyhydramnios: A
condition in which there
is too much fluid around
the fetus in the amniotic
sac.
Causes and symptoms

.Fetal causes.1
.Maternal causes.2
.Placental causes.3
Idiopathic ( in two third of.4
the cases the cause is
.unknown
Infections passed from mother to fetus can also
result in damage to the fetus and elevated
amniotic fluid levels. Fetal abnormalities,
including many that are life-threatening or
lead to a significant impairment in the quality
of life, are found in up to a quarter of all
patients. For this reason, the initial finding of
excess amniotic fluid should be followed by
thorough diagnostic studies to determine the
.cause and the prognosis
Because fetal swallowing is a major factor in
amniotic fluid removal, fetal abnormalities
that prevent fluid uptake should be
investigated. These include gastrointestinal
obstructions such as esophageal atresia
and duodenal atresia, as well as neurological
conditions that affect swallowing including
anencephaly. Certain cardiac abnormalities,
kidney disorders, and genetic conditions
such as myotonic dystrophy and alpha-
thalassemia can also cause polyhydramnios
Fetal chromosome abnormalities are frequently
associated with elevated amniotic fluid
levels. The more severe the polyhydramnios
the more likely it is that fetal abnormalities
will be present. In addition, there are other,
infrequent causes, and in a number of cases,
no cause can be found. Polyhydramnios can
lead to maternal abdominal discomfort and
respiratory difficulties as well as preterm
labor. When polyhydramnios is associated
with fetal abnormalities, perinatal mortality is
significantly increased
Complication of polyhydramnios
.Preterm labour.1
.Preterm premature rupture of membranes.2
Placental abruption especially when there is.3
sudden rupture of membranes which cause
.sudden release of pressure
Higher incidence of Malpresentations and.4
.unstable lie
Higher risk of developing postpartum.5
.haemorrhage due to uterine inertia
Higher incidence of C/S due to the above .5
.complications
:Fetal risks
High perinatal mortality rate ranging
from 10%- 30% which is largely due
:to
.Congenital malformations.1
.Prematurity.2
Fetal hypoxia secondary to cord.3
prolapse, placental abruption and
uteroplacental dysfunction
Management
All woman with polyhydramnios should
:have
:Ultrasound examination to assess.1
.the degree of polyhydramnios-
.presence of multiple pregnancy-
.Any fetal abnormalities-
Fetal specimens for karyotyping and.2
.viral infections
Maternal blood sugar assessment.3
:Treatment
There is no known method of
controlling the production or
,absorption of amniotic fluid
except that strict control of diabetes
may reduced the prevalence of
.polyhydramnios in diabetic women
:The therapeutic aims are to
.Relieve symptoms
Prolong pregnancy
Oligohydramnios:

is a condition in
pregnancy characterized
by a deficiency of
amniotic fluid in the
amniotic sac

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 AETIOLOGY
FETAL MATERNAL
PROM (50%) PREECLAMPSIA
CHROMOSOMAL APLA SYNDROME
ANOMALIES CHRONIC HT
CONGENITAL ANOMALIES
IUGR
IUFD DRUGS
PG SYNTHETASE
INHIBITORS
PLACENTAL ACE INHIBITORS
CHRONIC ABRUPTION
TTTS
CVS
IDIOPATHIC
Oligohydramnios is most commonly
associated with abnormalities of
the fetal kidneys. Since fetal urine
is the main source of amniotic fluid
in the latter two-thirds of
pregnancy, any condition that
interferes with fetal urine
production can lead to
oligohydramnios
Renal agenesis, cystic kidneys, and
bladder outlet obstructions are common.
Meckel-Gruber syndrome, a lethal
autosomal recessive genetic disorder
featuring brain and kidney abnormalities
and extra digits is one specific cause.
Placental insufficiency and fetal growh
retardation can also result in
.oligohydramnios
Premature rupture of membranes,
especially between 16 and 24 weeks is
another cause and, because amniotic
fluid is important in lung growth, it can
lead to underdevelopment of the lungs
(pulmonary hypoplasia). In general,
regardless of the cause,
oligohydramnios that arises early in a
,pregnancy
can cause hypoplastic lungs. It can also
result in space limitations within the
amniotic sac that cause fetal compression
and orthopedic abnormalities such as
clubbed feet in the newborn. In general,
oligohydramnios that begins near the time
of delivery is associated with a better
outcome than cases than have an onset
.earlier in pregnancy
Diagnosis
In current obstetrical practice,
polyhydramnios and oligohydramnios
are usually detected during a routine
prenatal ultrasound. If the
ultrasonographer suspects that
excess or reduced fluid is present, it
is customary to take measurements of
pockets of fluid visualized around the
fetus
The mother should be counseled about the
possible complications and offered
.additional testing as necessary
COMPLICATIONS
FETAL MATERNAL
Abortion
Prematurity Increased morbidity
IUFD
Deformities – Prolonged labour: uterine
CTEV,contractures,amputation inertia
Potters syndrome- pulmonary
hypoplasia Increased operative
Malpresentations intervention
Fetal distress (malformations,
MSAF – MAS Distres
Low APGAR
 MANAGEMENT
According

GestationalAge -
Severty -
Fetal status & well being-
 TREATMENT

ADEQUATE REST – decreases dehydration -

HYDRATION – Oral/IV Hypotonic fluids(2 Lit/d) -

temperory increase
helpful during labour

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 AMNIOINFUSION
Amnioinfusion is a procedure in which
normal saline or lactated Ringer's solution
is placed into the uterus after sufficient
cervical opening and rupture of
membranes. Amnioinfusion can treat
problems associated with decreased intra-
amniotic volume, including: prophylactic
treatment of oligohydramnios, treatment of
severe variable decelerations during labor,
and to reduce the risk of meconium
aspiration during labor in patients with
moderate or thick meconium fluid.
Amnioinfusion is, therefore, performed
during intense situations and the benefits
often outweigh the risks
AMNIOINFUSION 

INDICATIONS
Diagnostic.1
Prophylactic.2
Therapeutic.3

Decreases cord
compression
Dilutes meconium

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Prognosis
The prognosis for both polyhydramnios 
and oligohydramnios depends on the
cause. If excess or reduced amniotic
fluid is the result of an underlying fetal
abnormality, the nature of that
abnormality will determine the
.prognosis
This is one reason why it is important to
perform the necessary follow-up
studies. A woman who has been
diagnosed with polyhydramnios or
oligohydramnios needs to be made fully
aware of the types of testing available
and carefully counseled about the
diagnosis and its impact on the chance
for a successful pregnancy outcome
and a healthy infant
Prevention
In order to prevent polyhydramnios or
oligohydramnios, it would be necessary
to prevent the underlying cause. Good
control of maternal diabetes and the
prevention of infections transmittable
from mother to fetus are two approaches
for a subset of cases, but, in general,
.prevention is not possible
THANKS