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Sharon Treesa Antony
Second year M.sc nursing
Govt. College of Nursing Kottayam
Normal amniotic fluid
 12 weeks:
50ml
 20 weeks:
400ml
 36-38weeks:
1litre
 Fetal urine
 Fetal lung secretion
 Oral nasal secretion
 Fetal swallowing
 Intramembraneous transfer
 Transmembraneous transfer
 8-24cm
 It is defined as reduced amniotic fluid
volume of < 200ml at term or AFI<5cm at 28-
40 weeks.
 Maternal Conditions
 Hypertensive disorders
 Uteroplacental insufficiency
 Dehydration
 Idiopathic
 Post term pregnancy
 Prelabour rupture of membranes
 Fetal conditions
 Renal agenesis
 Urinary tract obstruction
 Spontaneous rupture of membranes
 Intrauterine infection
 IUGR
 Drugs: PG inhibitors, ACE inhibitors
 Fetal chromosomal and structural
abnormalities
 Amnion nodosum
 Smaller uterine size
 Less fetal movements
 The uterus is “ full of fetus”
 Malpresentation
 Evidences of IUGR
 History
 Watery/ blood stained vaginal discharge
 Hypertension
 Preeclampsia
 Pregestational hypertension
 APLA syndrome
 Family history
Congenital anomalies
Chromosomal abnormalities
 Medications
Physical examination
 Small uterine size
 Less fetal movements
 Uterus is full of fetus
 Malpresentations
 IUGR
 USG: AFI< 5cm
 Speculum examination: watery vaginal discharge
 Maternal
 Prolonged labour due to inertia
 Increased operative interference due to
malpresentations
 Chorioamnionitis
 Fetal
Due to etiology
 Congenital anomalies
 Chromosomal abnormalities
 Fetal growth restriction
 IUD
 Intra uterine infection following ROM
 Prematurity
Due to reduced amniotic fluid volume
 Skeletal deformities
 Contractures
 Amniotic bands and autoamputation
 Pulmonary hypoplasia
 Umbilical cord compression
 Meconium aspiration
 FHR abnormalities
 Low APGAR scores
 Intrapartum death
Management
 Counselling
 Serial USG
 Counselling
 Consider Amnioinfusion
 Serial USG
 Exclude PPROM
 Termination of pregnancy SOS
 Deliver post term cases
 Serial USG and Doppler in IUGR
 Conservative management for preterm
prelabor rupture of membranes till 34 weeks
 Idiopathic cases: NST, serial USG & BPP
 Maternal hydration :1500-2000ml/day
( oral/ IV)
 Amnio infusion
Abdominally/ trans cervically
 USG to exclude placenta
 Painting and draping
 20 G needle
 Connected to sterile tubing, 3 way stopcock
and a 50ml syringe
 NS is injected under USG
 Anti D SOS
 Consent
 Baseline FHR, vital signs, uterine activity
 Monitor FHR and uterine activity
 Measure and mark fundal height and reassess
every hour
 Notify if
• non resolving variable deceleration even
with 800ml of solution infused
• Non reassuring maternal/fetal response
• Intrauterine pressure> 25mmHg
According to
 fetal condition and
specific conditions such as
 preeclampsia
 growth restriction
 fetal anomaly
 Close monitoring by EFM
 Rupture the membranes in active phase of
labor
 Amnioinfusion in case of meconium staining
 If FHR abnormality: immediate CS
 DFMC
 Left lateral position
 FHR monitoring
 Administration of fluids
 Anti D after amnioinfusion SOS
 Close monitoring during labour
 Risk for fetal compromise related to reduced
amniotic fluid volume
 Risk for prolonged labor r/t uterine inertia
 Risk for infection related to premature
rupture rupture of membranes
 Anxiety
 Ineffective coping
THANK YOU

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Oligohydramnios

  • 1. Sharon Treesa Antony Second year M.sc nursing Govt. College of Nursing Kottayam
  • 3.  12 weeks: 50ml  20 weeks: 400ml  36-38weeks: 1litre
  • 4.  Fetal urine  Fetal lung secretion  Oral nasal secretion
  • 5.  Fetal swallowing  Intramembraneous transfer  Transmembraneous transfer
  • 7.  It is defined as reduced amniotic fluid volume of < 200ml at term or AFI<5cm at 28- 40 weeks.
  • 8.  Maternal Conditions  Hypertensive disorders  Uteroplacental insufficiency  Dehydration  Idiopathic  Post term pregnancy  Prelabour rupture of membranes
  • 9.  Fetal conditions  Renal agenesis  Urinary tract obstruction  Spontaneous rupture of membranes  Intrauterine infection  IUGR  Drugs: PG inhibitors, ACE inhibitors  Fetal chromosomal and structural abnormalities  Amnion nodosum
  • 10.  Smaller uterine size  Less fetal movements  The uterus is “ full of fetus”  Malpresentation  Evidences of IUGR
  • 11.  History  Watery/ blood stained vaginal discharge  Hypertension  Preeclampsia  Pregestational hypertension  APLA syndrome  Family history Congenital anomalies Chromosomal abnormalities  Medications
  • 12. Physical examination  Small uterine size  Less fetal movements  Uterus is full of fetus  Malpresentations  IUGR  USG: AFI< 5cm  Speculum examination: watery vaginal discharge
  • 13.  Maternal  Prolonged labour due to inertia  Increased operative interference due to malpresentations  Chorioamnionitis
  • 14.  Fetal Due to etiology  Congenital anomalies  Chromosomal abnormalities  Fetal growth restriction  IUD  Intra uterine infection following ROM  Prematurity
  • 15. Due to reduced amniotic fluid volume  Skeletal deformities  Contractures  Amniotic bands and autoamputation  Pulmonary hypoplasia  Umbilical cord compression  Meconium aspiration  FHR abnormalities  Low APGAR scores  Intrapartum death
  • 18.  Counselling  Consider Amnioinfusion  Serial USG  Exclude PPROM  Termination of pregnancy SOS
  • 19.  Deliver post term cases  Serial USG and Doppler in IUGR  Conservative management for preterm prelabor rupture of membranes till 34 weeks  Idiopathic cases: NST, serial USG & BPP
  • 20.  Maternal hydration :1500-2000ml/day ( oral/ IV)  Amnio infusion Abdominally/ trans cervically
  • 21.  USG to exclude placenta  Painting and draping  20 G needle  Connected to sterile tubing, 3 way stopcock and a 50ml syringe  NS is injected under USG  Anti D SOS
  • 22.  Consent  Baseline FHR, vital signs, uterine activity  Monitor FHR and uterine activity  Measure and mark fundal height and reassess every hour  Notify if • non resolving variable deceleration even with 800ml of solution infused • Non reassuring maternal/fetal response • Intrauterine pressure> 25mmHg
  • 23. According to  fetal condition and specific conditions such as  preeclampsia  growth restriction  fetal anomaly
  • 24.  Close monitoring by EFM  Rupture the membranes in active phase of labor  Amnioinfusion in case of meconium staining  If FHR abnormality: immediate CS
  • 25.  DFMC  Left lateral position  FHR monitoring  Administration of fluids  Anti D after amnioinfusion SOS  Close monitoring during labour
  • 26.  Risk for fetal compromise related to reduced amniotic fluid volume  Risk for prolonged labor r/t uterine inertia  Risk for infection related to premature rupture rupture of membranes  Anxiety  Ineffective coping