Hydramnios

Question 1

Define Oligohydramnios.

Answer 1

Decreased volume of amniotic fluid.

• <5th centile
• Deepest pool <2cm

Question 2

What are the risk factors for oligohydramnios?

Answer 2

• Reduced input fluid - placental insufficiency, pre-eclampsia
• Reduced output fluid - structural pathology, medications (ACEi, NSAIDs)
• Lost fluid - ROM, IUGR, post-term pregnancy carry, TTTS
• Chromosomal abnormalities

Question 3

What are the signs and symptoms of oligohydramnios?

Answer 3

• History of fluid leak PV/rupture of membranes
• Abdominal exam – decreased fundal height, foetal parts easily palpable
• Speculum – assess for membrane rupture if appropriate - AmniSure

Question 4

What are the appropriate investigations for suspected oligohydramnios?

Answer 4

• USS – liquor volume, foetal anomalies
• CTG– foetal wellbeing

Question 5

What is the management of oligohydramnios?

Answer 5

• Term
  
  • Delivery is appropriate - IOL if no CI
• Pre-term
  
  • Monitor serial USS for growth, liquor volume, dopplers, regular CTGs
  • Delivery if further abnormalities arise

Question 6

What are the complications of oligohydramnios?

Answer 6

• Labour – increased incidence of CTG abnormalities, meconium liquor, emergency CS
• Neonate – pulmonary hyperplasia, limb deformities
• Prognosis = Increased perinatal mortality rates with early onset oligohydramnios

Question 7

Define Polyhydramnios.

Answer 7

• AFI >95th centile
• 2-3L fluid
• Deepest pool >8cm

Question 8

What are the risk factors for polyhydramnios?

Answer 8

• Failure of foetal swallowing
  
  • Neurological → neurology, chromosomal abnormalities
  • GIT → duodenal atresia, oesophageal atresia
• Congenital infections
• Foetal polyuria - maternal diabetes, TTTS

Question 9

What are the signs and symptoms of polyhydramnios?

Answer 9

• Symptoms of underlying cause
• Abdomen – increased fundal height, impalpable foetal parts, tense abdomen

Question 10

What are the appropriate investigations for suspected polyhydramnios?

Answer 10

• Liquor volume
• Foetal growth
• Umbilical artery dopplers
• Exclude foetal anomalies
• Maternal cause - maternal diabetes etc

Question 11

What is the management of polyhydramnios?

Answer 11

• Antenatal monitoring of foetus - ensure diabetes control, paediatrician at delivery
• Amnioreduction - if gross polyhydramnios or discomfort
• COX inhibitors - decrease foetal urine output

Question 12

What are the complications of polyhydramnios?

Answer 12

• Pre-term labour
• Malpresentation
• Placental abruption
• Cord prolapse
• PPH
• Increased risk CS

Prognosis – increased perinatal morbidity and mortality, related to PTL/congenital