DR NABEEL S BONDAGJI MD FRCSC Department of

DR. NABEEL S. BONDAGJI, MD, FRCSC Department of Obstetrics and Gynecology Feto-Maternal Unit

PHYSIOLOGY OF AMNIOTIC FLUID l Early pregnancy: composition of AF similar to ECF. Transfer of water across amnion and through fetal skin. l By second trimester: fetus begins to urinate swallow, and inspire AF During last 2/3 of pregnancy, AF is principally comprised of fetal urine.

NORMAL AMNIOTIC FLUID VOLUME

DEFINITIONS: l Polyhydramnios: 2000 cc amniotic fluid l Amniotic Fluid Index = largest vertical pocket in 4 quadrants polyhydramnios 24 cm.

ETIOLOGY OF POLYHYDRAMNIOS l Idiopathic l Fetal Anomalies l Diabetes l Multifetal gestation l Immune/Non-immune hydrops l Fetal infection l Placental haemangiomas

Etiology of Polyhydramnios: Fetal Anomalies l Problems with swallowing and GI absorption l Increased transudation of fluid: anencephaly, spina bifida l Increased urination: anencephaly (lack of ADH, stimulation of urination centers) l Decreased inspiration

SYMPTOMS l l l Dyspnea Abdominal pain Venous stasis Contractions preterm labor Decreased Perception of Fetal Movements

DIAGNOSIS Fundal height > gestational age l Difficulty palpating fetal parts/hearing heart tones l Tense uterine wall l ***Sonography l

(fetus)? l Fetal prognosis worsens with more severe hydramnios and congenital anomalies l 15 -20% fetal malformations l Preterm delivery l Suspect diabetes l Prolapse of cord l Abruption

(Mother)? l Dyspnea l Venous l l Stasis Placental abruption Uterine dysfunction Post-partum hemorrhage Abnormal presentation -- C/S

TREATMENT l Mild to Moderate hydramnios: rarely requires treatment l Hospitalization, bed rest l Amniocentesis l Non-steroidal anti-inflammatory analgesia l Blood sugar control

OLIGOHYDRAMNIOS

DEFINITION l AFI 5

ETIOLOGY l l l l Postdate Fetal Anomalies: obstruction of fetal urinary tract/renal agenesis IUGR ROM Twin/Twin transfusion Exposure to ACE inhibitors, and Non-steroidal anti-inflammatory

SIGNS/SYMPTOMS l Fundal height < gestational age l Decreased fetal movement l Fetal Heart Rate tracing abnormality l Diagnosis: Ultrasound

Extremely poor fetal prognosis, especially in early pregnancy l Adhesions between amnion and fetal parts -- malformations and amputations l Musculoskeletal deformities l Pulmonary hypoplasia l

l l Cord Compression -- >fetal hypoxia Passage of meconium into low AF volume: thick particulate suspension -->respiratory compromise

TREATMENT Delivery l Amnioinfusion l