Sharon Treesa Antony

Second year M.sc nursing

Govt. College of Nursing Kottayam
Normal amniotic fluid
 12weeks:
50ml

 20
weeks:
400ml

 36-38weeks:
1litre
 Fetal urine

 Fetal lung secretion

 Oral nasal secretion

 Fetal swallowing

 Intramembraneous transfer

 Transmembraneous transfer
 8-24cm
 It is defined as reduced amniotic fluid

volume of < 200ml at term or AFI<5cm at 28-

40 weeks.
 Maternal Conditions
 Hypertensive disorders

 Uteroplacental insufficiency

 Dehydration

 Idiopathic

 Post term pregnancy

 Prelabour rupture of membranes

 Fetal conditions
 Renal agenesis
 Urinary tract obstruction
 Spontaneous rupture of membranes
 Intrauterine infection
 IUGR
 Drugs: PG inhibitors, ACE inhibitors
 Fetal chromosomal and structural
abnormalities
 Amnion nodosum
 Smaller uterine size

 Less fetal movements

 The uterus is “ full of fetus”

 Malpresentation

 Evidences of IUGR
 History
 Watery/ blood stained vaginal discharge
 Hypertension
 Preeclampsia
 Pregestational hypertension
 APLA syndrome
 Family history
Congenital anomalies
Chromosomal abnormalities
 Medications
Physical examination

 Small uterine size

 Less fetal movements

 Uterus is full of fetus

 Malpresentations

 IUGR

 USG: AFI< 5cm

 Speculum examination: watery vaginal discharge

 Maternal

 Prolonged labour due to inertia

 Increased operative interference due to

malpresentations

 Chorioamnionitis
 Fetal

Due to etiology

 Congenital anomalies

 Chromosomal abnormalities

 Fetal growth restriction

 IUD

 Intra uterine infection following ROM

 Prematurity
Due to reduced amniotic fluid volume
 Skeletal deformities
 Contractures
 Amniotic bands and autoamputation
 Pulmonary hypoplasia
 Umbilical cord compression
 Meconium aspiration
 FHR abnormalities
 Low APGAR scores
 Intrapartum death
Management
 Counselling

 Serial USG
 Counselling

 Consider Amnioinfusion

 Serial USG

 Exclude PPROM

 Termination of pregnancy SOS

 Deliver post term cases

 Serial USG and Doppler in IUGR

 Conservative management for preterm

prelabor rupture of membranes till 34 weeks

 Idiopathic cases: NST, serial USG & BPP

 Maternal hydration :1500-2000ml/day

( oral/ IV)

 Amnio infusion
Abdominally/ trans cervically
 USG to exclude placenta
 Painting and draping
 20 G needle
 Connected to sterile tubing, 3 way stopcock
and a 50ml syringe
 NS is injected under USG
 Anti D SOS
 Consent
 Baseline FHR, vital signs, uterine activity
 Monitor FHR and uterine activity
 Measure and mark fundal height and reassess
every hour
 Notify if
• non resolving variable deceleration even
with 800ml of solution infused
• Non reassuring maternal/fetal response
• Intrauterine pressure> 25mmHg
According to

 fetal condition and

specific conditions such as

 preeclampsia

 growth restriction

 fetal anomaly
 Close monitoring by EFM

 Rupture the membranes in active phase of

labor

 Amnioinfusion in case of meconium staining

 If FHR abnormality: immediate CS

 DFMC

 Left lateral position

 FHR monitoring

 Administration of fluids

 Anti D after amnioinfusion SOS

 Close monitoring during labour

 Risk for fetal compromise related to reduced
amniotic fluid volume

 Risk for prolonged labor r/t uterine inertia

 Risk for infection related to premature

rupture rupture of membranes

 Anxiety

 Ineffective coping
THANK YOU