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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.
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)
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
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
Terima Kasih