HYDRAMNIOS OR POLYHYDRAMNIOS
• Is an excessive amount of amniotic fluid in the
amniotic sac.
• At 36 weeks of pregnancy there is usually about
a liter of fluid present.
• The amount of amnioc fluid normally decreases
after this time.
• The amount of amniotic fluid present is
controlled in part by fetal urination and
swallowing.
PATHOPHYSIOLOGY:
1. The etiology is often unknown
2. Normal amniotic fluid volume at terms is
500 to 1,000 ml. , the volume in
polyhydramnios exceed 2,000 ml.
3. Anomalies causing impaired fetal
swallowing or excessive micturition may
contribute to the condition.
4. It is associated with maternal diabetes,
multiple gestation, Rh isoimmunization,
anomalies of the CNS including spina
bifida and anencephaly or anomalies in
the gastrointestinal tract including
tracheoesophageal fistula.
Kind / Degree of Hydramnios:
1. Mild Hydramnios = when amniotic fluid
pockets is between 8 to 11 cm in vertical
dimension. (85%)
2. Moderate Hydramnios – when amniotic
fluid pockets is between 12 to 15 cm
vertical dimension. ( 17%)
3. Severe Hydramnios = when amniotic fluid
pockets is more than 16 cm in vertical
dimension. (5%)
Effects on Pregnancy:
• Can cause fetal malpresentation due to
the additional uterine space and can
allow the fetus to turn on a transverse lie
• Can lead to premature rupture of the
membranes from the increased pressure
that can lead to risks for infection,
prolapsed cord and preterm birth
Normal Process during Pregnancy:
• Amniotic fluid is formed by a combination
of the cells of the amniotic membrane
and from fetal urine
• It is evacuated by being swallowed by the
fetus, absorbed across the intestinal
membrane into the fetal bloodstream and
transferred across the placenta
• With polyhydramnios, accumulation of
amniotic fluid suggests difficulty with the
fetus’s ability to swallow or absorb fluid
Causes of inability to swallow fluids:
• Anencephalic
• Fetus with tracheoesophageal fistula with
stenosis
• Fetus with intestinal obstruction
• Occurs among infant with diabetic mother
Causes:
1. Fetal abnormalities
2. Multiple pregnancy
3. Diabetes Mellitus
MANAGEMENT:
1. Hospitalization if there is severe dyspnea
and abdominal pain during ambulation.
2. Amniocentesis – removal of amniotic fluid
to relieved maternal distress.
3. Indomethacin therapy – drug to decrease
fetal urine formation.
4. Amniotomy – fluid is removed by a needle
inserted through the cervix.
CLINICAL MANIFESTATION:
1.Excessive weight gain, dyspnea
2.Abdomen may be tense and shiny.
3.Edema of the vulva, legs and lower
extremities.
4. Increased uterine size for gestational age
= usually accompanied by difficulty in
palpating fetal parts and in auscultation of
fetal heart.
DIAGNOSTIC EVALUATION:
1..Present of amniotic fluid index of above
25 cm.
2. Ultrasound evaluation will show large
pocket of fluid between the fetus and
uterine wall or placenta.
3. Difficult to palpate fetal heart tone
4. Fundal height is above the age of
gestation.
COMPLICATION:
1.Premature labor and delivery
2.Postpartum hemorrhage due to uterine
atony from gross distention of the uterus.
3. Abruptio placenta
4. Cord prolapse
5. malpresentation
NURSING ASSESSMENT:
1. Evaluate maternal respiratory status
2. Inspect abdomen and evaluate uterine
height and compare with previous
findings .
3. Evaluate for abdominal pain, edema,
varicosities of lower extremities and vulva.
NURSING INTERVENTION:
1. Promoting effective Breathing
a. Position to promote chest expansion
with head elevated.
b. Provide oxygen by face mask if
indicated
c. Limit activities and plan for frequent
rest period
d. Maintain adequate intake and
output.
2. Promoting placental tissue perfusion and Oxygen to
fetus
a. Position pt. into side lying position, with
head elevated
b. Encourage passive or active assisted
range of motion to the lower extremities.
c. Monitor FHR as directed and assess
abnormal FHR pattern: decreased or
 absent variability, tachycardia, prolonged, 2. Ultrasound – pockets of amniotic fluid are less
variable or late decelerations. than average
d. Provide good fluid intake and a diet
adequately in protein, iron and fluids. Effects on the fetus after birth:
e. Administer oxygen at 8 to 10 L/min. per
facemask • Muscles are weak due to cramped space
3. Promoting mobility during pregnancy
• Lungs fail to develop that can lead to
a. Assist woman with position changes and hypoplastic lungs- difficulty of breathing
ambulation • Potter syndrome- distorted features of the
b. Advise on alternating activity with rest face
periods for legs Causes:
c. Instruct woman to wear loose-fitting
clothing and low-heeled shoes with good 1.
Fetal Renal anomalies that results in
support. anuria.
4. Deceasing Anxiety 2. Premature rupture o membrane
3. Exposure to angiotensin converting
a.
Explain the cause of hydramnios if known. enzyme inhibitors.
b.
Encourage patient and family to ask MANAGEMENT:
question regarding any treatment or
procedure. 1. Observed newborn for complication
c. Encourage expression of feeling throughout the remainder of pregnancy.
d. Prepare patient for type of delivery 2. Clubfoot
e. Encourage presence of support person. 3. Amputation- due to adhesion of fetal parts
OLIGOHYDRAMNIOS to the amnion.
4. Abortion
• Is marked a decrease of amniotic fluid in 5. Fetal growth retardation
the amniotic sac.cord compression and 6. Abruptio placenta
fetal compromise may occur and lead to a 2. During labor and delivery
poor outcome.
• The infant will suffer from pulmonary a.
Cord compression
hypoplasia and skeletal abnormalities due b.
Fetal hypoxia as a result of cord
to a lack of fluid in the terminal air sac. compression
• Amniotic fluid less than 300 ml amniotic c. Prolonged labor.
fluid index of less than 5 cm. COMPLICATION:
• The abdomen appears too small for
gestational age. a. Umbilical Cord Compression
• New born of women with b. Passage of meconium
oligohydramnios have characteristic c. Fetal/ neonatal death
appearance of dry skin, leathery and NURSING INTERVENTION:
wrinkled.
Refers to a pregnancy with less than the average amount a. Evaluate fetal status by way of fetal
monitoring
of amniotic fluid.
b. Evaluate maternal vital sign for sign of
Part of the volume of amniotic fluid is formed by the infection, especially if oligohydramnios is
secondary to PROM.
addition of fetal urine, this reduced amount of fluid is
c. Assist with an amnioinfusion as indicated
usually caused by a bladder or renal disorder in the fetus
d. Inform health care provider of fetal
that is interfering with voiding compromise, assist woman to a side lying
position.
Another cause: due to growth restriction of the fetus,
Potter syndrome
he/she is not voiding as much as usual.
Nursing Consideration:
Diagnosis:
> Careful inspection among infants at birth to
rule out kidney disease and compromised
lung development

> Therapeutic Management:

1.Hospitalization or home care Goal:

a. .For adequate rest

b. For further evaluation
c. .To maintain adequate uteroplacental
circulation
d. To reduce pressure on the cervix and
prevent preterm labor
2. Advice woman to report any sign of ruptured
membranes or uterine contractions
1. Physical Assessment: Inspection: suspected
during pregnancy if the uterus fails to meet its 3. Advice woman to have high fiber diet and
expected growth rate consult her doctor for stool softener if diet is
 ineffective-to prevent constipation and
straining during defecation to prevent uterine
pressure
4. Monitor vital signs if in the hospital
5. Monitor presence of edema in the lower
extremities
6. Amniocentesis – to remove excess some
of the extra fluid
7. Tocolytics- to prevent or halt preterm
labor
If preterm rupture of the membranes occurs:
• Membranes can be “Needled” (insertion
of a thin needle vaginally to pierce them)
to slow, control the release of fluid and to
prevent prolapsed cord during labor
• Assess infant after birth for gastrointestinal
blockage.
Postterm Pregnancy
• A term pregnancy is 38 to 42 weeks
• Any pregnancy that extends this period is
postterm
Causes:
1. Women who have long menstrual cycle
• 40 to 45 days: they do not ovulate on day
14 which is the normal period
• They ovulate 14 days from the end of their
cycle, or on day 26 or 31, children will be
considered “late” by 12 to 17 days
• Women who are receiving high dose of
salicylates for their severe sinus
headaches or rheumatoid arthritis- this
interferes with the synthesis of
prostaglandin
• Myometrial quiescence-uterus that does
not respond to normal labor stimulation
Danger to the fetus:
1. Meconium aspiration
2. Macrosomia
3. Lack of growth-placenta is functioning for
only 40-42 weeks-exposes the fetus to
decreased blood perfusion, oxygen, fluid
and nutrients
Management:
1. Biophysical profile- to evaluate the placental
perfusion and amount of amniotic fluid present;
• if normal, it is assumed miscalculation
occurs
• If abnormal result or physical examination
or biparietal diameter on ultrasound
result the fetus is in term size, labor will be
induced
How to induce labor:
1. Prostaglandin gel or misoprostol–applied to
the vagina to initiate uterine contraction
followed by an oxytocin infusion
2. if oxytocin is ineffective, C/S is performed
Nursing Consideration during the labor process:
1.Monitor FHR, V/S
After Birth:
1.Assess newborn for meconium aspiration
> Establish and maintain patent airway
2. Assess for polycythemia – due to decreased
oxygenation in the final weeks
> hematocrit may be elevated due to polycythemia and
dehydration that leads to lowered circulating plasma
level.
3. Asess for hypoglycemia-because fetus had to
use stores of glycogen for nourishment in the
final weeks of intrauterine life
4. Maintain an adequate temperature
➢ Newborn has low subcutaneous fats levels
5. Follow up care until at least school age to track
their developmental abilities
Care of the Woman:
➢ Allow woman to stay a longer period of time
with her newborn and let her or assist her in
providing appropriate interventions to her
newborn
Rh Incompatibility
Occurs when the mother is Rh negative and the
fetus is Rh positive
Fetal blood and maternal blood are separate.
Sometimes accidental breaks in the placental villi
results in fetal blood entering the maternal
bloodstream.
If the fetal blood is Rh negative and the maternal
blood is Rh positive, the mother will recognize the
fetal blood as foreign bodies and will produce
antibodies against it. Only a few antibodies are
formed this way so that it usually does not affect the
first infant.
• During placental separation a great amount of
maternal and fetal blood are mixed, causing
the mother to produced large amounts of
antibodies during the first 72 hrs after placental
delivery. Since the infants is already delivered
at this time, the infant will not be affected.
• If the fetus is subsequent pregnancies is Rh
positive, the antibodies already present in the
maternal blood stream will attack and destroy
the fetal red blood cells resulting in fetal
anemia.
DIAGNOSIS IS MADE BY: 3. Provide good skin care because stool is
irritating to the skin.
a. Indirect Coomb’s test- presence of antibodies 4. Expect the urine to be dark colored
in maternal serum because of urobilinogen formation.
b. Direct Coomb’s test- presence of antibodies in
the fetal cord blood 5. Assess for dehydration by skin turgor
PREVENTION: identifying. Fluid loss may occur due
to heat from the fluorescent light
ADMINISTRATION OF Rh ( ANTI-D) GLOBULIN WITHIN above the infant.
THE FIRST 72 HRS AFTER DELIVERY TO WOMAN WHO: 6. Offer glucose water every 2 hrs to prevent
dehydration
1.Have delivered Rh positive fetus 7. 7. Maintain body temperature between 36
2.Have had untypeable pregnancies such as degree to 37 degree
ectopic pregnancies, stillbirth and 8. Infant should removed from the isolette
abortion. during feeding and eye patches
3. Have received ABO compatible Rh removed to allow interaction and
positive blood visual stimulation.
4. Have had invasive diagnostic procedure FETAL DEATH
such as amniocentesis.
ABO Incompatibility ONE OF THE MOST SEVERE COMPLICATION OF
PREGNANCY.
• Occurs when maternal blood type is O and
fetus is CAUSES FOR FETAL DEATH

TYPE A – MOST COMMON • CHROMOSOMAL ABNORMALITIES

• CONGENITAL MALFORMATION
TYPE B – MOST SERIOUS • INFECTIONS SUCH AS:
1. HEPATITIS B
TYPE AB - RARE 2. IMMUNOLOGIC CAUSES
3. COMPLICATION OF MATERNAL DISEASE
•
A and B antibodies are present in
Signs and Symptoms:
maternal bloodstream at birth so
hemolysis of fetal blood occur during the • Painless spotting
first pregnancy. • Uterine contractions with cervical
• The antibodies are the large Ig M type so effacement and dilatation
it does not cross the placenta during
• Fetus is born lifeless and emaciated
pregnancy.
Dx:
• During separation of the placenta
maternal blood mixes with fetal blood ➢ (-) fetal movement
resulting in antibodies of the mother ➢ (-) FHB
entering the bloodstream of the infant. ➢ Uterine growth ceases
These antibodies begin to hemolyze the ➢ Uterine size decrease
fetal RBC after birth. ➢ Fetal heart movement cannot be visualized by
MANAGEMENT FOR HD UTZ
➢ X-ray detected by the appearance of
• Suspension of breastfeeding during first 24 hrs intravascular or intra abdominal fetal gas
(Robert’s sign)
• – to prevent prenanediol

(breakdown product of progesterone excreted in

Management:
breastmilk) from interfering with the conjugation of
indirect bilirubin to direct bilirubin. 1. Induced labor- combination of
misoprostol (Cytotec) applied to the
PHOTOTHERAPY: vagina to effect cervical ripening and
oxytocin administration to begin uterine
1.
Destruction of RBC result in the formation contraction
of indirect bilirubin.
2. Blood studies: test for DIC
2. Phototherapy speeds up the maturation of
red blood cells - to prevent accumulation
of indirect bilirubin.
3. Uses of single quarts halogen lamp or a
bank of 4 to 8 cool white, day bright, or
special blue fluorescent lights positioned
12 to 30 inches above the infant.
NURSING CARE DURING PHOTOTHERAPY

1. Close eyes and cover with dressing

2. Expect the stool to loose and bright green
from excessive bilirubin excretion and skin
to be dark brown ( bronze baby
syndrome)