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Polyhidramnion: Causes,

Diagnosis & Therapy


Penyaji:
Tiffani Febrina Ramadhani
Desri Luhonna
Pembimbing:
Dr. Yusra Septivera, Sp.OG

Introduksi
Polyhydramnion is defined as a pathological
increase of amniotic fluid volume in pregnancy
Common causes : diabetes gestasional, fetal
anomalies (disturbed swallowing), fetal infection,
etc.
Typical symptoms: dyspneu, preterm labor,
premature rupture of membranes (PPROM),
abnormal fetal presentation, prolapse cord, and
HAP
To prevent the above complications :
amnioreduction dan farmakologis NSAIDs.

Physiology Amnion Fluid


There is a dynamic equilibrium
between the production and
resorption of amniotic fluid.
Production: fetal urination and fetal
lung liquid production.
Resorpsi : Fetal Swallowing &
intramembranous and intravascular
absorption
On 3rd Trisemester, urin production:
500-1200ml, swallow: 210-760

Etiology
1. Esophageal atresia
2. Duodenal Atresia -> Trisomy 21
3. Myotonic dystrophy
4. Increased urine production
5. Gestational diabetes (fetal
hyperglycemia -> increased osmotic
diures -> polyuria)

Ultrasound Assessment of Amniotic


Fluid Volume
The examiner estimates the volume of amniotic
fluid based on personal impressions of the
amniotic fluid depot
Single deepest pocket measurement
Measurement the uterus is divided into four
quadrants. The amniotic fluid volume is measured
vertically in the deepest amniotic fluid pocket.
4 method quadrant (AFI- Amniotic Fluid Index)
With this method, the deepest amniotic pocket in
each of the four quadrants is measured vertically
and the values added together.

AFI :
1. <5 : indicates severe oligohydramnios
2. 5,1-8 : Indikasi oligohidramnion
3. 8,1 18 = normal
4. > 18 = polyhidramnion
Another Literature:
25-30cm : mild polyhydramnios
30,1-35cm : moderate polyhydramnios
>35,1cm : severe polyhydramnios

Treatment options to reduce AF


Volume
Amnioreduction
Indication : AFI 15-20cm, intra-amnion pressure <
20mmHg
Contraindication : maternal discomfort or placental
abruption
Complication : 1-3% from all cases, can include
premature labor, placental abruption, premature
rupture ofmembranes, hyperproteinemia and amniotic
infection syndrome .
After the procedure, regular monitoring of amniotic
fluid volumes is recommended, with monitoring done
every 1 to 3 weeks.

Pharmocological
Prostaglandin synthetase inhibitor
Stimulate fetal secretion of arginine
vasopressin > reduced renal blood flow
-> reduced urin production & inhibit
fetal lung liquid production & increase
reabsorption
Sulindac
Sulindac is an NSAIDs can also lead to
a reduction of amniotic fluid volume.

Prognosis
The risk of the following obstetric complications
is increased when polyhydramnios is present
due to over-expansion of the uterus :
1. Maternal dyspneu
2. Preterm labor
3. Premature Rupture of Membranes
4. Prolapse Cord umbilical
5. Post Partum Hemorrhage
6. Fetal macrosomia due to maternal DM
7. Hypertensive disorders of pregnancy

Delivery
Fetal head presentation should be
checked several times during labor.
Spontaneous rupture ofmembranes
can lead to acute uterine
decompression
polyhydramnios does not constitutes
a contraindication for the application
of oxytocin or prostaglandins

Conclusion
Polyhydramnios diagnosed on
ultrasound requires further maternal
and fetal diagnostic tests.
Maternal gestational diabetes should
be excluded and maternal ToRCH
screening is recommended
Detailed morphological testing
should be planned for the fetus

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