DR. NABEEL S. BONDAGJI, MD, FRCSC - PowerPoint PPT Presentation

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DR. NABEEL S. BONDAGJI, MD, FRCSC

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DR. NABEEL S. BONDAGJI, MD, FRCSC Department of Obstetrics and Gynecology Feto-Maternal Unit PHYSIOLOGY OF AMNIOTIC FLUID Early pregnancy: composition of AF similar ... – PowerPoint PPT presentation

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Title: DR. NABEEL S. BONDAGJI, MD, FRCSC


1
  • DR. NABEEL S. BONDAGJI, MD, FRCSC
  • Department of Obstetrics and Gynecology
  • Feto-Maternal Unit

2
PHYSIOLOGY OF AMNIOTIC FLUID
  • Early pregnancy composition of AF
  • similar to ECF. Transfer of water across
  • amnion and through fetal skin.
  • By second trimester fetus begins to
  • urinate swallow, and inspire AF ? During last
    2/3 of pregnancy, AF is principally comprised of
    fetal urine.

3
NORMAL AMNIOTIC FLUID VOLUME

4
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5
DEFINITIONS
  • Polyhydramnios ?2000 cc amniotic fluid
  • Amniotic Fluid Index largest vertical
  • pocket in 4 quadrants
  • polyhydramnios ?24 cm.

6
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7
ETIOLOGY OF POLYHYDRAMNIOS
  • Idiopathic
  • Fetal Anomalies
  • Diabetes
  • Multifetal gestation
  • Immune/Non-immune hydrops
  • Fetal infection
  • Placental haemangiomas

8
Etiology of Polyhydramnios Fetal Anomalies
  • Problems with swallowing and GI absorption
  • Increased transudation of fluid
  • anencephaly, spina bifida
  • Increased urination anencephaly (lack of ADH,
    stimulation of urination centers)
  • Decreased inspiration

9
SYMPTOMS
  • Dyspnea
  • Abdominal pain
  • Venous stasis
  • Contractions ? preterm labor
  • Decreased Perception of Fetal
  • Movements

10
DIAGNOSIS
  • Fundal height gt gestational age
  • Difficulty palpating fetal parts/hearing
  • heart tones
  • Tense uterine wall
  • Sonography

11
(fetus)?
  • Fetal prognosis worsens with more severe
    hydramnios and congenital anomalies
  • 15-20 fetal malformations
  • Preterm delivery
  • Suspect diabetes
  • Prolapse of cord
  • Abruption

12
(Mother)?
  • Dyspnea
  • Venous Stasis
  • Placental abruption
  • Uterine dysfunction
  • Post-partum hemorrhage
  • Abnormal presentation -- ?C/S

13
TREATMENT
  • Mild to Moderate hydramnios rarely requires
    treatment
  • Hospitalization, bed rest
  • Amniocentesis
  • Non-steroidal anti-inflammatory analgesia
  • Blood sugar control

14
OLIGOHYDRAMNIOS
15
DEFINITION
  • AFI ?5

16
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17
ETIOLOGY
  • Postdate
  • Fetal Anomalies obstruction of fetal
  • urinary tract/renal agenesis
  • IUGR
  • ROM
  • Twin/Twin transfusion
  • Exposure to ACE inhibitors, and
  • Non-steroidal anti-inflammatory

18
SIGNS/SYMPTOMS
  • Fundal height lt gestational age
  • Decreased fetal movement
  • Fetal Heart Rate tracing abnormality
  • Diagnosis Ultrasound

19
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20
  • Extremely poor fetal prognosis, especially in
    early pregnancy
  • Adhesions between amnion and fetal parts
    ---?malformations and amputations
  • Musculoskeletal deformities
  • Pulmonary hypoplasia

21
  • Cord Compression -- gtfetal hypoxia
  • Passage of meconium into low AF volume thick
    particulate suspension --gtrespiratory compromise

22
TREATMENT
  • Delivery
  • Amnioinfusion

23
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24
THANK YOU
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