oligohydramnios and iugr

Uterus smaller than date

Oligohydramnios & Intrauterine Growth Restriction (IUGR)

M. Kamil

Amniotic fluid • Function• Physical space for fetal movement -> important for normal musculoskeletal

development• Permits fetal swallowing

• Important for GI tract development• Permits fetal breathing

• Necessary for lung development• Prevent umbilical cord compression• Protect from trauma

Amniotic fluid evaluation• Component of fetal testing for 2nd and 3rd trimester sonogram.

• Measurements 2 ways:• Single deepest vertical fluid pocket (nl 2 – 8 cm)• AFI - The sum of the deepest vertical pockets from each of four equal uterine

quadrants (nl 5 – 24 cm)

Gestational-age-specific nomogram of AFI

Oligohydramnios• Definition• AFI 5 cm (or < 5th percentile)/• The absence of a fluid pocket 2-3 cm in depth/• Fluid volume of less than 500 mL at 32 – 36 weeks.

• Anhydramnios – No measurable pocket of amniotic fluid is identified

Clinical manifestation and diagnosis

• Uterine size < expected for gestational age

• Performed ultrasound to assess AF volume• AFI 5 cm• Single deepest pocket of amniotic fluid 2 cm• Gestational age specific nomogram: < 2.5th percentile• A fluid volume of less than 500 mL at 32-36 weeks.

Evaluation• Thorough maternal history• Targeted physical examination•Ultrasound evaluation with fetal biometry and fetal

anomalies• Fetal growth restriction• Aneuploidy - nuchal translucency • Placental abnormalities (abruption)

Management• Admission for investigation

• Rule out ROM

• Amniocentesis - > Karyotyping

• Doppler ultrasound for fetal distress

• Evidence of fetal distress- > immediate C-sec

• If no fetal distress, induced and delivered via SVD

• Send placenta for pathological examination

Complications of oligohydramnios• Early onset of oligohydramnios• Potter sequence syndrome• Limb deformities• Abdominal wall defects

• Pulmonary hypoplasia

• Cord compression

Intrauterine Growth Restriction (IUGR)

Intrauterine Growth Restriction (IUGR)• Introduction• Detection usually on routine U/S• Important for prenatal care• Confirming diagnosis• Determining the cause and severity of fetal growth restriction (FGR)• Counseling the parents• Closely monitor fetal growth and well-being• Determining the optimal time for route of delivery

IUGR VS SGA• Definition of IUGR: • A fetus or infant whose weight is less than the 10th percentile at a given GA as

determined by U/S• Or Infants whose growth velocity < expected

• SGA: An infant with a birth weight at the lower extreme of the normal birth weight distribution.• BW <10th % • BW < 2SD below the mean (3rd %)

FGR VS SGA

http://datab.us/i/smallforgestationalage

Beckmann, C., Herbert, W., Laube, D., Ling, F., Smith, R., & American College of Obstetricians Gynecologists. (2014). Obstetrics and gynecology (7th ed.).

Uterine fetal growth pattern

Reethiya, L., & Rokeshwar, H.D., Doctrina Perpetua: Guides on Obstetrics. (2015).

Types of IUGR

Reethiya, L., & Rokeshwar, H.D., Doctrina Perpetua: Guides on Obstetrics. (2015).

Pondoral index: Ratio of BW to Length:

Causes and risk factors of FGR

Beckmann, C., Herbert, W., Laube, D., Ling, F., Smith, R., & American College of Obstetricians Gynecologists. (2014). Obstetrics and gynecology (7th ed.).

Evaluation• Assess gestational age on early routine

visit.• History to assess the risk factors.• Physical examination• Screening test – serial measurements of

fundal height.• Fundal height should increase approx.

1cm/week between 20 and 36 weeks• Significant discrepancy of > 2 cm may indicate

IUGR

Ultrasound

Evaluation (Continued)• Investigation• CBC – Hb, WBC (possible infection)• TORCHES Screening• Look for dysmorphic features • Mother urine for substance/ meconium for substance• Blood sugar• Calcium • Bilirubin

• Ultrasound• To assess fetal size and

growth.• Fetal biometry

measurements and compare with standardized table• Biparietal diameter• Head circumference• Abdominal circumference

(AC) – false negative < 10%• Femur length

Evaluation (Continued)

•Direct studies• Invasive studies of the fetus.• Amniocentesis for fetal lung

maturity• Fetal karyotyping and viral

cultures and PCRs

Evaluation (Continued)

Evaluation (Continued)• Doppler velocimetry• On fetal umbilical artery.• Measured by Systolic/ Diastolic ratio• Normal at term: 1.8 to 2.0

Doppler velocimetry (continued)• IUGR secondary to uteroplacental insufficiency

• Show reversed end- dystolic flow

• May suggest impending fetal demise

Complication• Fetal• Hypothermia• Hypoglycemia• Hypocalcemia

• Perinatal• Perinatal asphyxia• Hypothermia• Hypoglycemia• Polycythemia, hyperviscosity• meconium aspiration syndrome

• Neurodevelopment• Lower intelligent• Learning/behavior disorders• Neurologic handicap

References• Beckmann, C., Herbert, W., Laube, D., Ling, F., Smith, R., & American College

of Obstetricians Gynecologists. (2014). Obstetrics and gynecology (7th ed.).• http://www.stanfordchildrens.org/en/topic/default?id=amniocentesis-90-

P02429• Callahan, T., & Caughey, A. (2007). Blueprints obstetrics & gynecology (4th

ed. / Tamara L. Callahan, Aaron B. Caughey. ed., Blueprints). Philadelphia ; London: Lippincott Williams & Wilkins.• Cunningham, F., & Williams, J. (2014). Williams obstetrics. (24th ed. /

[edited by] F. Gary Cunningham et al. ed.). New York ; London: McGraw-Hill Medical.

References• Beckmann, C., Herbert, W., Laube, D., Ling, F., Smith, R., & American College

of Obstetricians Gynecologists. (2014). Obstetrics and gynecology (7th ed.).• https://ghr.nlm.nih.gov/condition/vacterl-association• https://www.uptodate.com/contents/placental-abruption-clinical-features-an

d-diagnosis?source=machineLearning&search=abruptio+placenta&selectedTitle=1~150&sectionRank=1&anchor=H4#H4

• Cunningham, F., & Williams, J. (2014). Williams obstetrics. (24th ed. / [edited by] F. Gary Cunningham et al. ed.). New York ; London: McGraw-Hill Medical.

• https://www.uptodate.com/contents/oligohydramnios?source=search_result&search=oligohydramnios&selectedTitle=1~150

• Callahan, T., & Caughey, A. (2007). Blueprints obstetrics & gynecology (4th ed. / Tamara L. Callahan, Aaron B. Caughey. ed., Blueprints). Philadelphia ; London: Lippincott Williams & Wilkins.

Thank You