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Chapter-07 Polyhydramnios Oligohydramnios

BOOK TITLE: Management of High-Risk Pregnancy—A Practical Approach

Author
1. Lal Prabha
ISBN
9789380704739
DOI
10.5005/jp/books/11228_7
Edition
1/e
Publishing Year
2010
Pages
12
Author Affiliations
1. Lady Hardinge Medical College and SSK Hospital, New Delhi, India, Lady Hardinge Medical College, New Delhi, India, Lady Hardinge Medical College and Smt Sucheta Kriplani Hospital, New Delhi, India
Chapter keywords

Abstract

Earliest detection of amniotic fluid occurs by 8 weeks which gradually increases to peak volume of 800-1000 ml at 32–35 weeks. Thereafter, it declines to 550 ml by 42 weeks. Polyhydramnios is sonographically defined as AFI of >25 cm or DVP of > 8 cm. It occurs in 1–3.5% of pregnancies and is severe in 5% of cases. Majority of cases are idiopathic. In severe cases 80% have a known underlying etiology like congenital anomalies, diabetes, lithium therapy and substance abuse. Fetal abnormalities are associated in 1%, 2% and 11% of cases of mild, moderate and severe polyhydramnios respectively. Maternal complications are due to uterine over distention and major venous system compression. Fetal complications include spontaneous preterm labor in 22% of cases. Direct method of assessment like dye dilution method are cumbersome and not routinely done. Ultrasonography is the main modality of investigation. In moderate to severe cases, amnioreduction by either drugs or invasive intervention is required. Oligohydramnios is sonographically defined as AFI of < 5 cm or DVP of < 1 cm. Early onset oligohydramnios is usually due to PPROM and congenital anomalies. Late onset is due to term PROM, late onset IUGR and postmaturity. Investigations include ultrasonography and serological studies. Ultrasonography helps to assess degree of oligohydramnios, presence of IUGR, fetal and uterine blood flow studies and presence of fetal anomalies. Pulmonary hypoplasia and skeletal deformities are two important complications. Recent advances in management include cervical occlusion with fibrin plug, intraamniotic sealing techniques with gelfoam, amniopatch application, vesicoamniotic shunting, maternal hydration and oxygen therapy.

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