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3. Y5 Zero to finals: O&G > Polyhydramnios > Flashcards

Polyhydramnios Flashcards

1
Q

What is Polyhydramnios?

A

Too much amniotic fluid @ pregnancy

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2
Q

What is the numerical definition of Polyhydramnios?

A

Amniotic fluid index above 95% centile for GA

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3
Q

How does the volume of Amniotic fluid change throughout pregnancy? (3 points)

A
  • 0-33 weeks: Increases steadily
  • 33-38 weeks: Plateaus
  • 38+ weeks: Declines
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4
Q

What is the volume of Amniotic fluid at term?

A

500ml

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5
Q

What is Amniotic fluid made up of? (3 things)

A
  1. Foetal urine output (mostly)
  2. Placenta contributions
  3. Foetal secretions
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6
Q

What is the pathophysiology of Polyhydramnios?

A

Problems w any of structures in Amniotic fluid pathway

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7
Q

What is the Amniotic fluid pathway? (5 steps)

A
  1. Foetus breathes + Swallows Amniotic fluid
  2. AF processed
  3. AF fills blader
  4. AF voided
  5. Cycle repeats
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8
Q

What are the causes of Polyhydramnios? (11 things)

A
  1. Idiopathic (60%)
  2. Swallowing abn (oesophageal atresia / CNS abn / muscular dystrophies)
  3. Duodenal atresia
  4. Anaemia
  5. Foetal hydrops
  6. Twin-to-Twin transfusion syndrome
  7. Increased lung secretions
  8. Chromosomal abn
  9. Maternal DM
  10. Maternal ingestion of lithium
  11. Macrosomia (bc big babies make more urine)
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9
Q

What investigation is Polyhydramnios diagnosed with?

A

US

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10
Q

What are the ways to measure AF using US to diagnose Polyhydramnios? (2 things)

A
  1. Amniotic Fluid Index (AFI) (more common)
  2. Maximum Pool Depth (MPD)
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11
Q

Apart from the Dx, why are examinations / investigations done for Polyhydramnios?

A

To find out the cause

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12
Q

What examination can you do for Polyhydramnios?

A

Palpate uterus to see if it feels tense

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13
Q

What can you check for in the US for Polyhydramnios? (3 things)

A
  1. Assess foetal size
  2. Assess foetal anatomy (to check for structural causes)
  3. Doppler (to detect foetal anaemia)
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14
Q

What other investigations can you do for Polyhydramnios?

A
  1. Maternal Glucose Tolerance Test (for maternal DM)
  2. Karyotyping (for chromosomal abn)
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15
Q

Is any Medical intervention routinely required for women with Polyhydramnios?

A

No

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16
Q

If Maternal symptoms of Polyhydramnios are severe (aka SOB), what can be considered?

A

Amnioreduction

17
Q

What are the complications of Amnioreduction? (2 things)

A
  1. Infection
  2. Placental abruption (bc sudden decrease in intrauterine pressure)
18
Q

What medication can be used enhance water retention in foetus in Polyhydramnios?

A

Indomethacin

19
Q

What is a con of Indomethacin?

A

Premature closure of Ductus Arteriosus

20
Q

How do you get around the con of Indomethacin?

A

Don’t use it beyond 32 weeks

21
Q

What is special about Idiopathic Polyhydramnios?

A

Baby has to be examined by Paediatrician before first feed

22
Q

How does the Paediatrician examine a baby with idiopathic polyhydramnios before their first feed?

A

Pass NG tube to ensure no Tracheoesophageal fistula / oesophageal atresia

23
Q

What is Severe + Persistent + Unexplained Polyhydramnios associated with?

A

Perinatal mortality

24
Q

Why does Severe + Persistent + Unexplained Polyhydramnios have a bad prognosis? (2 things)

A
  1. Likely presence of underlying abn / congenital malformation
  2. Increased incidence of preterm labour (bc of uterus over-distension)
25
Q

What needs to be looked out for with Polyhydramnios DURING pregnancy?

A
  1. Malpresentation (transverse lie / breech)
  2. Membrane rupture
  3. Cord prolapse
26
Q

Why are Malpresentations possible with Polyhydramnios?

A

Foetus has more room to move within cavity

27
Q

What needs to be looked out for with Polyhydramnios AFTER pregnancy? Why?

A
  • PPH
  • Bc uterus has to contract further to achieve haemostatis

3. Y5 Zero to finals: O&G (27 decks)

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