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INFLOW INFLOW (1000 ml/d) (1000 ml/d) 1.FETAL URINE 2.LUNG LIQUID INTRAMEMBRANOUS (placenta,cord) INTRAMEMBRANOUS (placenta,cord) TRANSMEMBRANOUS(amniotic membranes) TRANSMEMBRANOUS(amniotic membranes) RECYCLING – 3hrs RECYCLING – 3hrs OUTFLOW OUTFLOW (1000 ml/d) (1000 ml/d) 1.FETAL SWALLOWING 3 Dr Mona Shroff
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OLIGOHYDRAMNIOSOLIGOHYDRAMNIOS
11Dr Mona Shroff Dr Mona Shroff
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PHYSIOLOGY OF AMNIOTIC FLUIDPHYSIOLOGY OF AMNIOTIC FLUID
22
INFLOWINFLOW (1000 ml/d)(1000 ml/d)
1.FETAL URINE1.FETAL URINE2.LUNG LIQUID2.LUNG LIQUID
INTRAMEMBRANOUS (placenta,cord)INTRAMEMBRANOUS (placenta,cord) TRANSMEMBRANOUS(amniotic membranes)TRANSMEMBRANOUS(amniotic membranes) RECYCLING – 3hrsRECYCLING – 3hrs
OUTFLOWOUTFLOW (1000 ml/d)(1000 ml/d)
1.FETAL 1.FETAL SWALLOWINGSWALLOWING
33Dr Mona Shroff Dr Mona Shroff
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FUNCTIONS OF AMNIOTIC FLUIDFUNCTIONS OF AMNIOTIC FLUID Shock absorber – protects from external Shock absorber – protects from external
trauma.trauma. Protects cord from compression.Protects cord from compression. Permits fetal movements – development of Permits fetal movements – development of
musculoskeletal system, prevents adhesions.musculoskeletal system, prevents adhesions. Swallowing of AF enhances growth & Swallowing of AF enhances growth &
development of GIT.development of GIT. AF volume maintains AF pressure – reduces loss AF volume maintains AF pressure – reduces loss
of lung liquid – pulmonary development.of lung liquid – pulmonary development. Maintenance of fetal body temperature.Maintenance of fetal body temperature. Some fetal nutrition, water supply.Some fetal nutrition, water supply. Bacteriostatic properties – decreases potential Bacteriostatic properties – decreases potential
for infection for infection 44Dr Mona Shroff Dr Mona Shroff
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55Dr Mona Shroff Dr Mona Shroff www.obgyntoday.infowww.obgyntoday.info
DEFINITIONDEFINITION
AMNIOTIC FLUID VOLUME < 5 th AMNIOTIC FLUID VOLUME < 5 th percentile for gestational agepercentile for gestational age
AMNIOTIC FLUID INDEX < 5AMNIOTIC FLUID INDEX < 5
SINGLE VERTICAL POCKET < 2 cmsSINGLE VERTICAL POCKET < 2 cms
66Dr Mona Shroff Dr Mona Shroff
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INCIDENCEINCIDENCE
0.5 – 5%0.5 – 5%
77Dr Mona Shroff Dr Mona Shroff
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AETIOLOGYAETIOLOGYFETALFETAL PROM (50%)PROM (50%) CHROMOSOMAL ANOMALIESCHROMOSOMAL ANOMALIES CONGENITAL ANOMALIESCONGENITAL ANOMALIES IUGRIUGR IUFDIUFD POSTTERM PREGNANCYPOSTTERM PREGNANCY
MATERNALMATERNAL PREECLAMPSIAPREECLAMPSIA APLA SYNDROMEAPLA SYNDROME CHRONIC HTCHRONIC HT
PLACENTALPLACENTAL CHRONIC ABRUPTIONCHRONIC ABRUPTION TTTSTTTS CVSCVS
DRUGSDRUGS PG SYNTHETASE INHIBITORSPG SYNTHETASE INHIBITORS ACE INHIBITORSACE INHIBITORS
IDIOPATHIIDIOPATHICC88Dr Mona Shroff Dr Mona Shroff
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DIAGNOSISDIAGNOSIS SYMPTOMSSYMPTOMS
NO SPECIFIC NO SPECIFIC SYMPTOMSSYMPTOMS
H/O leaking p/vH/O leaking p/vPosttermPostterms/o preeclampsias/o preeclampsiaDrugsDrugsLess fetal movementsLess fetal movements
SIGNSSIGNS
Uterus – small for Uterus – small for datedate
Feels full of fetusFeels full of fetusMalpresentationsMalpresentationsIUGRIUGR
99Dr Mona Shroff Dr Mona Shroff
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USGUSGMETHODSMETHODS MVP <2 cmsMVP <2 cms (<1 severe)(<1 severe)
AFI <5 cmsAFI <5 cms (5-8 borderline)(5-8 borderline)
2D pocket <15 sq 2D pocket <15 sq cmscms
1010Dr Mona Shroff Dr Mona Shroff
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COMPLICATIONSCOMPLICATIONS FETALFETALAbortionAbortionPrematurityPrematurityIUFDIUFDDeformities –Deformities –
CTEV,contractures,amputationCTEV,contractures,amputationPotters syndrome- pulmonary Potters syndrome- pulmonary
hypoplasiahypoplasiaMalpresentationsMalpresentationsFetal distressFetal distressMSAF – MASMSAF – MASLow APGARLow APGAR
MATERNALMATERNAL
Increased morbidityIncreased morbidity
Prolonged labour: Prolonged labour: uterine inertiauterine inertia
Increased operative Increased operative interventionintervention
(malformations,(malformations,distres)distres)
1111Dr Mona Shroff Dr Mona Shroff
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MANAGEMENTMANAGEMENTDEPENDS UPONDEPENDS UPON
AETIOLOGYAETIOLOGYGESTATIONAL AGEGESTATIONAL AGESEVERITYSEVERITYFETAL STATUS & WELL BEINGFETAL STATUS & WELL BEING
1212Dr Mona Shroff Dr Mona Shroff
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DETERMINE AETIOLOGYDETERMINE AETIOLOGY
R/O PROMR/O PROMTARGETED USG FOR ANOMALIESTARGETED USG FOR ANOMALIESR/O IUGR ,IUFD when suspectedR/O IUGR ,IUFD when suspectedAmniocentesis if chromosomal Amniocentesis if chromosomal
anomalies suspected – early anomalies suspected – early symmetric IUGRsymmetric IUGR
Tests for APLA Syndrome , if suspected Tests for APLA Syndrome , if suspected 1313Dr Mona Shroff Dr Mona Shroff
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TREATMENTTREATMENT ADEQUATE REST – decreases dehydrationADEQUATE REST – decreases dehydration HYDRATION – Oral/IV Hypotonic fluids(2 Lit/d)HYDRATION – Oral/IV Hypotonic fluids(2 Lit/d) temperory increasetemperory increase helpful during labour,prior helpful during labour,prior to ECV, USGto ECV, USG• SERIAL USG – Monitor growth,AFI,BPPSERIAL USG – Monitor growth,AFI,BPP• INDUCTION OF LABOUR/ LSCSINDUCTION OF LABOUR/ LSCS Lung maturity attainedLung maturity attained Lethal malformationLethal malformation Fetal jeopardyFetal jeopardy Sev IUGRSev IUGR Severe oligoSevere oligo
1414Dr Mona Shroff Dr Mona Shroff
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AMNIOINFUSIONAMNIOINFUSION
INDICATIONSINDICATIONS 1.Diagnostic1.Diagnostic 2.Prophylactic2.Prophylactic 3.Therapeutic3.Therapeutic Decreases cord Decreases cord
compressioncompression Dilutes meconiumDilutes meconium
1515Dr Mona Shroff Dr Mona Shroff
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TREATMENT ACC. TO CAUSETREATMENT ACC. TO CAUSEDrug induced – OMIT DRUGDrug induced – OMIT DRUGPROM – INDUCTIONPROM – INDUCTIONPPROM – Antibiotics,steroid – PPROM – Antibiotics,steroid –
InductionInductionFETAL SURGERYFETAL SURGERY VESICO AMNIOTIC SHUNT-PUVVESICO AMNIOTIC SHUNT-PUV Laser photocoagulation for TTTS Laser photocoagulation for TTTS
1616Dr Mona Shroff Dr Mona Shroff
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1717Dr Mona Shroff Dr Mona Shroff www.obgyntoday.infowww.obgyntoday.info