S SPECIFIC TIME SUBJECT MATTTER A.V.

AIDS TEACHING EVALUATION

NO OBJECTIVE METHOD
.
1. To introduced 2 INTRODUCTION- Ppt Lecture
about mints. Amniotic fluid normally increases in amount throughout pregnancy from a few
oligohydramnios millilitres to a litre at 38th week .the fluid is not static, the water and solutes in it
and are changed every few hours.
polyhydramnios
there are two chief abnormalities of amniotic fluid –
 polyhydramnios and
 Oligohydramnios.

2. To define 1 POLYHYDRAMNIOS[HYDRAMNIOS]- Ppt Lecture Define

polyhydramnios. mints. polyhydramnios?
Polyhydramnios is an excessive amount of amniotic fluid, which exceeds 1,500
ml. it occurs in 0.9 percent of pregnancies. It is typically diagnosed when the
amniotic fluid index (AFI) is greater than 20 cm ( ≥ 20 cm).

3. To describe 3 ETIOLOGY- Ppt, Lecture Describe the

about etiology mints. poster etiology of
of  FETAL ANOMALIES- polyhydramnios?
polyhydramnios 1. Anencephaly.
2. Open spina bifida.
3. Oesophageal Artesia.
4. Facial cleft and neck masses.
5. Hydrops fetalis.
 PLACENTA-
1. Chorioangioma of the placenta.
 MULTIPLE PREGNANCIES.
  MATERNAL
1. Diabetes.

2.cardiac or renal disease,

4. To deal about 3
types mints. TYPES OF POLYHYDRAMNIOS- Ppt Lecture What are the
 Chronic polyhydramnios. type’s
 Acute hydramnios. polyhydramnios?

CHRONIC POLYHYDRAMNIOS-it is gradual in onset, usually from about 30th

week of pregnancy. This most common type.

ACUTE POLYHYDRAMNIOS –it is very rare. It occurs at about 20 weeks and

comes on very suddenly.th uterus reaches the xiphisternum in about 3-4 days .it
is often associated with monozygotic twins and severe foetal abnormalities.
5. To deal about 2
sign and mints. SIGN AND SYMPTOMS- Ppt Lecture What are the sign
symptom The sign and symptom of polyhydramnios include the following – and symptoms of
 Uterine inlargement, abdominal girth and fundal height are far beyond polyhydramnios?
expected for gestational age.
 Tenseness of the uterine wall making it difficult to-auscultate foetal
heart tones; palpate the foetal outline, large and small part.
 Elicitation of uterine fluid thrill.
 Mechanical problem such as-
1. Severe dyspnoea.
2. Lower extremity and vulval edema.
3. Pressure pains in back, abdomen and thighs.
4. Nausea and vomiting.
  Frequent change in fetal lie.
 Auscultation of the fetal heart is difficult.
 Screening for diabetes.
 Screening for ABO/RH disease.
6. To deal about 3
COMPLICATIONS-
complication mints. Ppt Lecture What are the
 Maternal. complications of
 Fetal. polyhydramnios?

MATERNAL-

 DURING PREGNANCY-
1. Pre-eclamcia.
2. Malpresentation
3. PROM
4. Preterm labour
5. Accidental haemorrhage
 DURING LABOUR-
1. Early rupture of membrane
2. Cord prolapsed
3. Retained placenta
4. Postpartum haemorrhage
5. Shock
6. Increased operative delivery due to malpresentation.
 Puerperium-
1. Sub involution
2. Increased puerperal morbidity.
FETAL-
 Increased perinatal mortality.
7. To deal about 3 INVESTIGATION- Ppt Lecture What are the
investigation mints. investigations
 SONOGRAPHY-To detect abnormally large single pool>8 cm.AFI done for
is diagnosis of
More than 25 CM. polyhydramnio?
 RADIOGRAPHY-not commonly performed. it is used to detect
bony congenital malformation of the fetus.
 ABO AND RH GROUPING-rhesus isoimmunisation may cause
hydrops fetalis and fetal ascites.
 AMNIOTIC FLUID-estimation of alfa feto protein which is
markedly elevated in the presence of fetus with open neural tube
defect.

8. To explain about 7 MANAGEMENT – Ppt Lecture What are the

management mints. PRINCIPLES- management of
 To relieve the symptoms. polyhydramnios?
 To find out the cause.
 To avoid and deal with the complication.

MILD ASYMPTOMATIC POLYHDRAMNIOS -is managed expectantly. The woman

is not admitted. She is advised to get adequate rest. She should be advised that
if she suspects that membranes have ruptured, immediate admission would be
necessary.

FOR A WOMAN WITH SYMPTOMATIC PLYHYDRAMNIOS -admission to a

hospital is required. Care will depend on the condition of the woman and fetus,
the cause and degree of hydramnios and the stage of pregnancy. Upright
position will help to relieve heartburn and nausea.

 SUPPORTIVE THERAPY-includes bed rest with back rest,analgesics and

 treatment of theassociated conditions like pre-
eclampsia,diabetes.indomethacin given orally to the mother 25 mg 6
hourly has been found to decrease amniotic fluid.

 INVESTIGATIONS ARE TO BE DONE.

 PREGNANCY LESS THAN 37 WEEKS-If the discomfort from the swollen

abdomen is severe, amniocenteses or amniocentesis or amnioreduction
may beconsidered. Up to 500 ml of amniotic fluid may be removed to
provide temporary relief. Fluid will accumulate again and there is risk of
introducing infection with this procedure.

 PREGNANCY MORE THAN 37 WEEKS-Labor will be induced if the

symptoms become worse or gross abnormality is diagnosed. For
induction, the fetal lie must be corrected if it is not longitudinal.
Membranes will be ruptured cautiously; allowing the amniotic fluid to
drain out very slowly in order to avoid altering the lie and prevent cord
prolapsed of placental abruption. Labour will be usually normal, but
postpartum haemorrhage is a possibility. Te baby will need to be
examined for abnormalities.

 WITH COGENITAL FETAL ABNORMALITY-termination of pregnancy is to

be done irrespective of the duration of pregnancy.

 DURING LABOUR-if intrauterine contraction become sluggish, oxytocin

infusion may be started if not contraindicated. To prevent PPH
intravenous methargin 0.2 mg should be given with the delivery of
anterior shoulder.
 OLIGOYDRAMNIOS
Oligohydramnios is an abnormally small amount of amniotic fluid. At
9. To define 2 term it may be 300-500 ml but the amount vary and it can be even less. Ppt Lecture Define
oligohydramnios mints. oligohydramnios?
COMPLICATIONS
Oligohydramnios may lead to the following further complications:
10. To deal about 3
MATERNAL-
complication of mints. Ppt ,ohp Lecture What are the
oligohydramnios  Prolonged labour. complications of
 Increased operative interference. oligohydramnios?
 Maternal morbidity.
FETAL-
 Abortion
 Congenital abnormalities
 Cord compression
 High fetal mortality
 Fetal pulmonary hypoplasia.
ETIOLOGY-
 fetal chromosomal anomalies
11. To deal about 3  intrauterine infection Ppt, ohp Lecture Describe the
etiology mints.  renal agenesis etiology of
 IUGR associated with placental insufficiency. oligohydramnios?
 Postmaturity
 drugs
CLINICAL SIGNS AND SYMPOMS
 These are because the amniotic fluid volume is below what is normally
12. To deal about 3 found for the particular gestational age. Ppt Lecture What are the sign
sign and mints.  Reduced fetal movements compared to previous normal pregnancies and symptoms of
symptoms  The uterus is small and compact and compact and fetal parts are easily oligohydramnios?
felt
 The fetus is not ballotable
  Auscultation is normal.
 Amniotic fluid volume detection is done by ultrasonography.

MANAGEMENT
The woman will be admitted to the hospital. If ultrasound scan demonstrates
renal agenesis, the baby will not survive. If agenesis is not present, placental
13. To deal about 3 function tests are performed in order to prevent compression deformities and Ppt Lecture What are the
management mints. hypoplastic lung disease. In women with oligohydramnios, labor may intervene management of
or it may be induced because of the possibility of placement insufficiencys. oligohydramnios?
ePidural anesthesia may be indicated because uterine contraction are often
usually painfull.continuous fetal heart monitoring is essential because of the
possibility of cord compression or placental insufficiency and resultant
hypoxia.contriction rings are a possibility owing to the small amount of fluid .in
rare cases the membrane may adhere to the fetus.

NURSING PROCESS-
ASSESSMENT-
 Assess for the following-
14. To deal about 10  Ballottement results in fluid waves. Ppt Lecture How will you
nursing process mints.  Fundal height excessive for gestation. make nursing
 Fetus difficult to outline with palpation. process?
 Supine hypotension.
 Fetal abnormalities of central nervous system or GI tract.
 Easy fatigability.
ANALYSIS AND NURSING DIAGNOSIS-
 RISK for fetal injury.
 Impaired physical mobility.
 Actual risk for fluid volume deficit.
 Anxiety.
 Anticipatory grieving.
  Altered family process.
 Actual risk for altered parenting.
 Health seekingbehaviors.
PLANNING-
 Promot maternal comfort.
 Promote maternal –fetal well being.
 Provide opportunities for counselling and support.
 Provide education for selfcare measures in increasing comfort.

IMPLEMENTATION-
 Facilitate testing –amniocentasis, sonography.
 Assess FHR.
 Anticipate premature labour and postpartum haemorrhages caused by
over distension of the uterine muscle
 Instruct and explain-nature of problem.
-need to obtain immediate medical attention for problems
-need to observe for preeclampsia.
EVALUATION-
 Verbalize increased expectant mother.
 Progresses to uneventful birth, as dos her baby.
 Verbalizes support.
 Verbalizes self-care measures.
 BIBLIOGRAPHY

 D.C. DUTTA, TEXT BOOK OF OBSTETRICS, SIXTH EDITION 2004, 213-218.

 NEELAM KUMARI, MIDWIFERY AND GYNACOLOGICAL NURSING, FIRST EDITION 2010, 234-239.

 ANNNAMA JACOB,TEXT BOOK OF OBTETRICS,SECOND EDITION,151-155

 ASHA OUMACHIGUI S SOUNDARA RAGHAVN S HABEEBULLA, ESSENTIAL OBSTETRICS, FIRST EDITION, 173-178.

 MYLES, TEXT BOOK FOR MIDWIVES, 14th EDITION, 337-344.

 C.S. DAWN, TEXT BOOK OF OBSTETRICS, SIXTEENTH EDITION, 2004, 239-242.

 WWW.WIKIPEDIA.COM