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Polyhydramnios And Oligohydramnios
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| Polyhydramnios And Oligohydramnios |
Polyhydramnios simply called hydramnios is excess of liquor amnij above the normal range of 500 ml to 1500ml. It accumulates gradually and it is most noticeable from the 30th week of pregnancy but it may occur earlier than that. Its origin is both maternal and fetal. The details of its origin are beyond the scope of this book. However, there are certain conditions in which hydramnios are most common.
- Multiple Pregnancy. 3. Maternal Diabetes.
- Fetal Abnormality. 4. Molar Pregnancy.
The patient presents in the clinic with:
- Unduly large abdomen
- Difficulty in breathing
- Flatulent dyspepsia
On examination of the abdomen, it is difficult to feel the fetal parts and fetal heart sound is inaudible. Malpresentation of the fetus is usual as the fetus is very mobile in the large liquor. In terms of treatment, it is better to leave it till term when the baby is
delivered. Some opinions recommend an amniocentesis. Complications of hydramnios include:
- Spontaneous preterm labor.
- Premature rupture of membrane
- Unstable lie
Oligohydramnios
This is a condition in which the amniotic fluid is inadequate. The fetus has little room to move about and therefore deformities are likely to occur.
Unstable Lie
By this is meant fetal lie that changes from time to time. The cause may be maternal or fetal.
Maternal Causes:
1. Polyhydramnios.
2. Grandmultip with the lax abdomen.
3. Fetal abnormality.
Most of the patients first present in the clinic with a transverse lie and this may persist till labor sets in. Some turn to oblique before labor while others too turn to longitudinal lie before labor. Investigations done are -ray pelvimetry and ultrasound scan.
ray pelvimetry will confirm contracted pelvis if present. An ultrasound scan will be able to confirm placenta Previa, tumor, multiple pregnancies, fetal abnormality, and prematurity.
Management:
Opinions vary:- Most Doctors prefer to leave it and allow patients to go into labor hoping that it will turn to longitudinal lie. If it does not, a cesarean section is performed on the patient. It was observed in the majority of these cases that there was a loop of cord around the neck of the fetus. However, in secondary and tertiary health institutions such patients are admitted at the 36th week of pregnancy for observation. At the 37th week, an external cephalic version is performed to turn the fetus into a longitudinal lie. Labour is then induced and the membrane ruptured. Version is done only when the membrane has not ruptured, no contraction, no placenta praevia, and the patient is not hypertensive.
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