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IMPORTANT TOPICS
Amniotic fluid function Clinical importance of AF Volume and composition Amniotic fluid abnormalities
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Clinical assessment is unreliable. Objective assessment depends on U/S to measure: - deepest vertical pool (DVP). - Amniotic fluid index (AFI). It is a total of the DVPs in each four quadrants of the uterus. it is a more sensitive indicator of AFV throughout pregnancy.
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Amniotic fluid abnormalities Oligohydramnios: Defined as reduced amniotic fluid i.e. amniotic fluid
index of 5 cm or less or the deepest vertical pool < 2 cm. Polyhydramnios: Defined as excessive amount of amniotic fluid of 2000 ml or more (AFI of > 25 cm or the deepest vertical pool of > 8 cm) .
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Causes of oligohydramnios:
1. Fetal causes: * Renal cause (57%): - Renal agenesis (Potters syndrome). - polycystic kidney. - Urethral obstruction (atresia/posterior urethral valve). * Fetal growth restriction. * Fetal death. * Postterm pregnancy. * Preterm premature rupture membranes
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Causes of oligohydramnios:
2. Maternal causes: Uteroplacental insufficiency. Preeclampsia. 3. Placental causes: twin-twin transfusion. 4. Drug causes: Prostaglandin synthase inhibitor as NSAID. 5. Idiopathic
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Complications of oligohydramnios:
In early pregnancy: Amniotic adhesions or bands amputation/death. Pressure deformities (club feet). Pulmonary hypoplasia: - Thoracic compression. - No breathing movement. - No amniotic fluid retain. Flattened face. Postural deformities.
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In late pregnancy: Fetal growth restriction. Placental abruption. Preterm labour. Fetal distress. Fetal death. Meconium aspiration. Labour induction/CS.
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Management:
Treat the cause (pprom, preeclampsia). Assess fatal wellbeing (U/S/CTG/Doppler/BPP). Vesicoamniotic shunting (urethral obstruction). Amnioinfusion (no in fetal death). Powerpoint Templates Page 14
Polyhydramnios
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Causes of polyhydramnios
Fetal malformation: Hydrops fetalis: congestive heart failure, - GIT: severe anaemia or esophageal/duodenal hypoproteinemia atresia, placental transudation tracheoesophageal fistula. - CNS: anencephaly diabetes mellitus (osmotic (swallowing, exposed diuresis). meninges, no antidiuretic hormone). Idiopathic. Twin-twin transfusion fetal polyuria. Powerpoint Templates Page 17
diagnosis of polyhydramnios
Symptoms: - dyspnea. Ultrasound: - edema. - excessive amniotic fluid. - abdominal distention - fetal abnormalities. - preterm labour. Abdominal examination: - uterus than expected. - difficult to palpate fetal parts. - difficult to hear fetal heart sound. - ballotable fetus. Powerpoint Templates
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management
Minor degrees: no treatment. Bed rest, diuretics, water and salt restriction: ineffective. Hospitalization: dyspnea, abdominal pain or difficult ambulation. Endomethacin therapy: . - impairs lung liquid production/enhances absorption. - fluid movement across fetal membranes. * complications: premature closure of ductus arteriosus, impairment of renal function, and cerebral vasoconstriction. So not used after 35 weeks Amniocentesis: to relieve maternal distress and to test for fetal lung maturity. Complications: Powerpoint Templates ruptured membrane, chorioamnionitis, placental Page 19
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