P.O.P

• Polyhydramnios


  Excess fluid of more than 2,000 ml or 2 Liters or Amniotic Fluid index above 24cm
• Polyhydramnios


  • Increase in amniotic fluid in pregnancy and is associated with increased maternal and neonatal morbidity and mortality
• Classification of Polyhydramnios


  • MVP (Maximal Vertical Pocket)
  • AFI (Amniotic Fluid Index)
• Severity of Polyhydramnios


  • Mild: MVP 8-12 cm, AFI >24 cm and <30cm
  • Moderate: MVP 12-15 cm, AFI 30 cm and 35 cm
  • Severe: >15 cm and AFI >35 cm
• Polyhydramnios occurs in 1-2% of pregnancies
• Polyhydramnios is more common in Multipara rather than Primipara
• Causes of Polyhydramnios


  • Idiopathic (65%)
  • Diabetes Mellitus (15%): Type 1 Diabetes
  • Rhesus Iso-Immunization: Blood Incompatibility
  • Multiple Pregnancy (18%)
  • Fetal Anomaly
• Assessment Findings of Polyhydramnios


  • Unusually rapid enlargement of the uterus
  • The small parts are difficult to palpate
  • Auscultating the FHR can be difficult due to the increased depth of the increased amount of the AF (Amniotic Fluid) surrounding the fetus
  • Extreme shortness of Breath
  • Lower Extremities varicosities
  • Hemorrhoids
  • Increase Weight Gain
• Amniotic Fluid Index (AFI)


  Calculated by measuring the maximum cord-free vertical pocket of fluid in four quadrants of the uterus and adding them together
• Maximum pool depth (MPD)

  The vertical measurement in any area
• AFI and MPD have similar diagnostic accuracy, however AFI is more commonly used
• Therapeutic Management of Polyhydramnios

  • No medical intervention is required in the majority of women
  • Bedrest is not indicated
  • Assessment and monitoring of vital signs
  • Instruct clients to avoid straining during defecation
  • Increase fiber in the diet
• Complications of Polyhydramnios


  • Preterm Prelabor Rupture of Membranes (PPROM)
  • Preterm Birth
  • Malpresentation
  • Risk for Infection
  • Prolapse of Umbilical Cord
• Oligohydramnios


  Pregnancy with less than the average amount of amniotic fluid
• Amniotic fluid index below the 5th centile for the gestational age


  Indicates Oligohydramnios
• Oligohydramnios affects approximately 4.5% of term pregnancies
• Causes of Oligohydramnios


  • Preterm prelabour rupture of membranes
  • Placental insufficiency
  • Renal agenesis (known as Potter's syndrome)
  • Non-functioning fetal kidneys, e.g. bilateral multicystic dysplastic kidneys
  • Obstructive uropathy
  • Genetic/chromosomal anomalies
  • Viral infections (although may also cause polyhydramnios)
• Assessment Findings of Oligohydramnios


  • The uterus fails to meet the expected growth rate
  • Decreased or less frequent baby movements
  • Slow heartbeat of the baby
  • Fluid leaking from the vagina, which may indicate a rupture of the sac
  • Facial abnormalities or low urine output in the baby, which may be caused by kidney problems
• Diagnosis of Oligohydramnios is the same as Polyhydramnios
• Nursing Management of Oligohydramnios


  • Monitor maternal and fetal status closely, including vital signs and fetal heart rate patterns
  • Monitor maternal weight gain pattern, notifying the health care provider if weight loss occurs
  • Induction of labor should be considered. If not acceptable by the patient, after counseling, organize scans every week for LV and Umbilical artery Dopplers, and twice weekly Cardiotocography (CTG)
  • Steroid should be considered if cesarean delivery is planned at less than 39 weeks
  • Ask patients to report any change in fetal movements
• Complications of Oligohydramnios


  • Intrauterine growth restriction
  • Inability of the fetus to tolerate labor, leading to the need for cesarean delivery
  • Limb contractures (if oligohydramnios begins early in the pregnancy)
  • Delayed or incomplete lung maturation
  • Preterm birth
  • Kidney and compromised lung development in neonate
  • Fetal death
• Post term pregnancy

  Pregnancy which has extended beyond 42 weeks of gestation period (>294 days)
• Post term pregnancy occurs in approximately 4% of all pregnancies
• Causes of Post term pregnancy


  • Error in calculation of gestational age
  • Inaccurate or unknown dates
  • Irregular ovulation (results in over estimation of gestational age)
  • Previous post-term pregnancies
  • Fetal Adrenal Hypoplasia (decrease production of precursor of estriol)
  • Elderly multipara
  • Obesity
  • Irregular menstrual cycle
  • Sulphate deficiency in the placenta
• Prevention of Post term pregnancy

  • Recording LMP and calculating EDD at the time of 1st antenatal visit
  • Routine early ultrasound for dating gestation or pregnancy
  • Review of ANC and ultrasonography reports in terms of fetal growth
  • As soon as prematurity is ruled out in high risk cases, induction of labor will prevent postmaturity
• Physiological Changes associated with post term pregnancy

  • Placental Changes: Aging of Placenta, Calcification, and Infractions
  • Amniotic Fluid Changes: Oligohydramnios, Cloudy, Presence of meconium
  • Fetal Changes: Macrosomia, Intrauterine Malnutrition
• Complications of Post term pregnancy


  • Calcified Placenta
  • Increased morbidity due to increased instrumental & operative delivery in Maternal
  • Intrapartum Fetal Distress
  • Fetal Hypoxia and Acidosis
  • Meconium Aspiration Syndrome
  • Neonatal Complications (hypoglycemia)
  • Increased Perinatal morbidity and mortality
  • Shoulder Dystocia
• Fetal Risks of Post term pregnancy

  • Fetoplacental Insufficiency
  • Meconium Aspiration
  • Oligohydramnios
• Maternal Risks of Post term pregnancy


  • Large for Gestational Age
  • Increased incidence of vacuum assisted forceps assisted or cesarean delivery
  • Psychological stress
  • Probable labor induction
• Maternal Risks of Post term pregnancy


  • Acute cesarean delivery
  • Cephalopelvic disproportion
  • Cervical rupture
  • Dystocia
  • Fetal death during delivery
  • Large fetus
  • Postpartum hemorrhage
  • Puerperal infection
• Neonatal Risks of Post term pregnancy


  • Asphyxia
  • Aspiration
  • Bone fracture
  • Perinatal death
  • Peripheral nerve paralysis
  • Pneumonia
  • Septicemia