poly hydro mn ios

8/19/2019 Poly Hydro Mn Ios

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DR.HAJRA HUMA TMO GYNAE-B UNIT

HMC

POLYHYDROMNIOS


2/21

Amniotic Fluid:Surround fetus after rst fe ee!s of"estat#on.

$rote%t#onAnt#&a%ter#a' (ro(ert#esReser)o#r for ater and nutr#ents.Nor*a' de)e'o(*ent of feta' 'un"+*us%u'os!e'eta' s,ste*+GI s,ste*.


3/21

In ear', "estat#on der#)ed d#re%t', fro* *ot er a*n#on+ feta'

surfa%e of ('a%enta and feta' &od, surfa%e.

In *#d "estat#on feta' ur#ne and feta' 'un"Near Ter* feta' ur#ne and feta' 'un" '#/u#d.

Sour%es of A0


4/21

Flow into Amnioticsac

0eta ur#ne

1233-4533*'6da,7

0eta' 'un" '#/u#d 1483*'6da,7

Ora'6nasa' se% 159*'6da,7

0eta' s a''o #n"

1933-4333*'6da,7

Intra*e*&ranous :o

1533-;33*'6da,7

Trans*e*&ranous :o 1433*'6da,7

Flow out of Amnioticsac


5/21

0ro* 43 !s 153*'7 - 52 !s 1883*'7 #n%reasesdra*at#%a'',.After 52 !s unt#' #n < rd tr#*ester #s 833-233*'Nor*a' ran"e at


6/21

$ ,s#%a' e a*#nat#onE a*#nat#on of :u#d %o*(art*ents.D,e d#'ut#on test 1#n)as#)e te% n#/ue7.

U'trasono"ra( , 1SD$ + A0I7

E)a'uat#on of A0>


7/21

Sono"ra( er *easure dee(est A0 (o%!et #n ea% ;

/uadrants of a&do*en.$o%!ets *easured (er(end#%u'ar to :oor #t (at#entsu(#ne #t out %onta#n#n" s*a'' (arts or u*&'#%a' %ord.A0I #s su* of a'' t ese four /uadrants *easure*ents.

SD$ #s s#n"'e 'ar"est *easure*ent o&ta#ned.ABNORMA ITIES A0I of 59%* or *ore OR ? 9%* SD$ of 2%* or *ore OR ?5%*.

T ese )a'ues are %ons#dera&', outs#de of t e 9t

and=9 t (er%ent#'e.E)#den%e su""est SD$ *ore s(e%# % t an A0I.

Measur#n" A0I SD$


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De nition: A0I of 59%* or "reater. OR

SD$ of *ore t an 2%*.

T e =9 t (er%ent#'e for t e *a #*u* A0)o'u*e #n nor*a' (re"nan%, #s a&out 5533*' and t e=9 t (er%ent#'e of A0I at *a #*u* :u#d )o'u*e for

nor*a' "estat#on #s &et een 42%* to 53%*.

Occurance: 4 to < of (re"nan%#es.

$O YHYDROMNIOS


10/21

M#'dA0I -59%* to


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!IOLO"Y O#stetrics$om%lication

Fetal Anemias Fetal Anomalies Rare$om%lication

47TTT s,ndro*e 47Materna'a''o#*un# at#on

47CNSa&nor*a'#t#es1anen%e( a',7

47In er#tedD#sorder of rena'fun%t#on

57Materna'd#a&etes

570eta'#nfe%t#ons 1$ar)o)#rus

B4= Con"s,( #'#s#nfe%t#on7

57M,oton#%d,stro( ,

a7 Barters,ndro*e

&7 $er'*anFs s,nd

%7 Be%! #t s,ndd7 O)er"ro ts,nd


12/21

Materna' Co*('#%at#on1. abdominal discomfort + dyspnea2. Maternal respiratory distress3. Edema4. Increase prevalence of preeclampsia associated with mirror

syndrome.5. Preterm labo r !. Increase li"elihood of #$% d e to fetal malpresentation&. 'br ptio placenta

(. 'mnitic fl id embol s). PP* + terine atony

Co*('#%at#ons


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Fetal com%lications:1. etal macrosomia2. Preterm labo r,1- /2- 03. etal malpresentation4. etal death,3 /5 05. etal anomalies!. %evere 'nemia syndrome.


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DIAGNOSTIC WORKUP:

etailed *istory / dr e6pos re /maternal M /prior prenatal screenin for ane poloidy /family history of myotonic dystrophy or

/past history of dysplasia$ arthro yroposis /history of red cell alloim ni7ation.

INVESTIGATIONS:

1. Maternal blood s ar series2. 83. 9lood type $'9 screenin4. :%8 assesment ,de ree; fetal anomalies;fetal anemia; fetal tachyarrythmia;

evidence of %05.


15/21

Patient $ounsellin& Pro nosis depends on severity etiolo y. 9est pro nosis with mild and idiopathic . pre nancy with severe polyhydromnios increased ris" of pretermdelivery; perinatal mortality.

Treat*entMainly to relieve symptoms and to prolon estation.

Mildly symptomatic E6pectantly mana ed with no evidence for se

of di retics ; salt or fl id restriction.


16/21

'( Standard

Most e e%t#)e for s(e%e % d#a"nos#s #.eD#a&etes %ontro''+0eta' TTTS.

Materna' to feta' ater:o

-*aterna' de ,drat#on

-D#uret#%s

Materna' ad*#n#strat#on of $G s,nt etaseIn #tor.

Indo*et a%#n

Su'#nada%

-NSAIDs

-de%reases A0

-'ess (otent#a' to %onstr#%t du%tusarter#os#s 1?#ndo*et a%#n7

Ot er T era(#es

-Intraa*n#ot#% DDA>$ -*odu'at#on of A*n#ot#%

*e*&rane ater % anne's

1a/ua(or#n7

S$ECI0IC TREATMENT

)( *%erimental


17/21

INDOM !HA$IN: Me% In%reases ater rea&sor&t#on #n rena' tu&u'es &, #n #ton

of $Gs.

Dose 59*" r', 1*a 533*"6da,7 Durat#on

sto((ed #f o'#"o ,dro*n#os or s#"ns of du%ta' %onstr#%t#onot er #se %an &e %ont#nued unt#''


18/21

Standard A*n#oredu%t#on :u#d re*o)ed at rate of ;9-=3*'6*#n

A""ress#)e A*n#oredu%t#on

:u#d re*o)ed *ore ra(#d',Co*('#%at#ons Bot asso%#ated #t s#*#'ar rates1; -49 7

$ROM

Infe%t#ons$'a%enta' a&ru&t#on0eta' deat

A*n#oredu%t#on


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20/21

Fetal Sur&er+:

No #nter)ent#on #s s(e%# %a'', tar"eted to(o', ,dro*n#os #t t e e %e(t#on offeta' 'aser a&'at#on of )as%u'ar anasto*os#s #n(at#ents #t TTTS

Ind#re%t t era(, #.e s unt#n" of #ntrat ora%#%%,st#% 'e#s#ons0eta' sur"er, for t ora%#% 'e#s#ons of terato*as


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THANKS

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