hydramnios
Defind as a deepest method of>= 8 cm or amniotic fluid index AFI above the 95th centile for getational age ;or AF volume > 2 liter ,complicates 3.5% of pregnancies Mild 8-12cm Moderate 12-15 cm Severe 15cmHow to measure amniotic fluid
Semi-quantitative method :deepest vertical pool or amniotic fluid index New methods:-three-dimentional U/S MRI.
Causes Maternal as in DM Fetal: 1-Obstruction to the fluid transit through GIT intestinal atresia ,eosophageal compression 2-neurological impairment of swallowing CNS lesion e.g. anencephaly Chromosomal abnormality e.g. trisomy 18 Muscular dystrophy
causes
3-fetal polyuria TTTS 4-high output cardiac failure Fetal anemia Sacrococcygeal teratoma Chorioangioma 5- conganital infection e.g. syphilis ,viral hepatitis.
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Diagnosis U/S: a.Confirm diagnosis: b.Detect the degree:
c.Detect the cause:
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Complications During pregnancy: 1.Malpresentation 2.PROM: cord prolapse, placental abruption 3.increase perinatal mortality{ pretem labor, congenital malformation, cord prolapse} During labor: postpartum hemorrhage
Treatment
Mild asymtomatic is managed expectantly Treatment usually needed in moderate to severe cases during the mid or early 3rd trimester or excesive maternal symptoms Also treatment should directed towards the cause e.g. correction of fetal anaemia ,drainage of pleural effusion ,laser coagulation of vascular connections..
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Is an ulternative PG synthase inhibitor ;it is safer,with less effect on fetal urine output &ductus arteriosus A PG Inhibitor selective for cyclooxygenase-2 ( COX-2)
Definition Marked deficiency of the amniotic fluid volume below the normal limits an AFI<5th centile for gestational age or DP<2cm
Diagnostic evaluationa
1. history ; hypertension,rupture membrane &congenital infection 2.U/S to assess degree of oligohyramnios The presence of growth deficiency The structure of the kidney Genitourinary malformations 3.color Doppler for fetal renal arteries 4.other invasive methods done in developed centers if necessary like :amnioinfusion to improve U/S results ,fetal intra peritoneal infusion to out line renal bed fetal specimen for karyotyping &viral infection