1. Oligohydramnios, polyhydramnios and intrauterine growth retardation
elaboration: Piotr Uzar
Department for Pathology of Pregnancy and Labour PAM

2. Amniotic fluid volume during pregnancy
Amniotic fluid volume is in a dynamic balance state and it is determinated by: placental, fetal and maternal factors.

3. Oligohydramnios
Definition: Considerable deficiency of amniotic fluid volume< 200ml, 0,5%- 5,5% of all pregnancies
Reasons: fetal diseasies (malformations, hypotrophia, TTTS, acardiacus); maternal diseasies (diabetes with microangiopathy, gestosis, ); PROM; bad hydration; post-term pregnancy
Symptoms:  SF,  fetal movements,  circumference of the abdomen, too little weight, easy to feel fetus parts, hard to move presenting part

4. Oligohydramnios
USG estimation: - difficult anatomy estimation - AFI < 5cm (amniotic fluid index by Phelan)  biophysical profil and  fetal movements -  biometrics values (compression of fetus) disturbances of blood flow in AU and AA

5. Oligohydramnios
Complications: IUGR, hypoplasia of fetuses lungs, deformations fetus syndrome, amniotic bands syndrome, intrauterine infections, poor general condition of fetus, fetal necrosis or perinatal death, umbilical cord compression, meconium aspiration syndrome (MAS), brady- and tachycardia of fetus, inconstant decelerations, intrauterine fetal anoxia

6. Oligohydramnios
Prophylaxis and treatment: preconception care: hypertension, nephropathy, systemic disease, diabetes with microangiopathy prenatal care: - treatment above mentioned diseases, detection of malformations, treatment of infections and ionic disorders; - conservative therapy (diet, rest); - operative therapy (amnioinfusion) - during labour: CTG, intranatal amnioinfusion- in case of green amniotic fluid

7. Polyhydramnios
Definition: Pathologic increase of amniotic fluid volume, volume > 2 l ; 0,1%- 3,5% of all pregnancies
Reasons:

8. Polyhydramnios
Symptoms: weak sensation of fetal movements, fetal pulse ausculation with difficulty, excessive diaphragm elevation, pain, pregnant circulatory-respiratory system disorders
USG estimation: AFI > 20cm
Complications: PROM, prolapse of the umbilical cord, premature placental ablation, intrauterine fetal anoxia, premature labour, incorrect lie, weak labour activity, postpartum uterine atonia and hemorrhage in the immediate postpartum period

9. Polyhydramnios
Prophylaxis and treatment: - preconception care: malformations prophylaxis and diabetes control - prenatal care: - primary disease treatment (diabetes, infections, Rh isoimmunization) - symptomatic treatment- amnioreductions; take care!- premature labour, premature placental ablation, PROM and intrauterine infection; Indomethacin- fetal membranes permeability, fetus miction, resorption of amniotic fluid by lungs; take care!-narrowing of Botall’s duct

10. Intrauterine growth retardation
Definition: Type I - IUGR of weight and height of the fetus or newborn <10 centile for gestational age Type II - IUGR of weight of the fetus or newborn <10 centile for gestational age; SGA (small for gestational age)
Clinical classification of hypotrophia: - Type I - symmetrical: 20%, low weight and height - reasons: smaller genetic potential, race, chromosome aberrations, hypovitaminosis, intrauterine infections, drugs

11. IUGR
- Type II - asymmetrical: 80%, low weight with normal height and head circumference, „brain sparing efect”- brain and heart without lesions - reasons: uteroplacental insufficiency, smoking, drinking, multiple pregnancy, diabetes, chronic hypertension with proteinuria, bleeding in the III period of pregnancy, malnutrition  hypovolemia placental blood flow  size of placenta

12. IUGR
USG estimation
Complications:  of: IQ, activity, attention, tension, behaviour; short stature; slim body build
Treatment: primary disease, uteroplacental insufficiency, rest

13. Rh Isoimmunization elaboration: Piotr Uzar
Department for Pathology of Pregnancy and Labour PAM

14. Rh Isoimmunization
Pathomechanism: a women immunization by erythrocytic Ag transmision of antierythrocytic Ig by placenta Ig bindings with fetus blood cells Ig damages blood cells haemolysis (hyperbilirubinemia) anaemiatissue hypoxia damage of: heart (circulatory insufficiency), epithelium, liver oedema and transudate in the body cavities, hypoalbuminemia fetal death
0,2ml shunt is enough to immunize (labour, abortion)
Reasons: pregnancy, transfusion of incompatible blood group, drug addicts

15. Rh Isoimmunization
Diagnostics: - blood group and Coombs test- a) if negative then tests in I, II, III trimester; b) if positive then once a month+ USG - USG estimation: hyperplacentosis (>4,5cm, in I trim. only), hepatosplenomegaly,  umbilical v., cardiomegaly (surface of the heart> 1/3 of breast), transudate in the peritoneum, oedema ( >0,5cm), transudate in the pleura and pericardium - Invasive diagnostics- cordocentesis - indications: Rh isoimmunization in anamnesis, Ig anti D1:16 or Ig anti D<1:16 with USG symptoms

16. Rh Isoimmunization
Determination of: blood group and Rh, direct Coombs test, blood cell count (estimation of anaemia), serum protein, bilirubin, gasometry
CTG monitoring 1h after procedure (FHR- small shunt, FHR- reaction after puncture of artery, if long-lasting then big blood loss)
Start of diagnostics: after 28Hbd if Ig anti D1:16 or Ig anti D<1:16 with USG symptoms of oedema of fetus or 4 weeks before the term fetal oedema appeard during the last pregnancy

17. Rh Isoimmunization
Treatment: - earlier pregnancy termination (36-38Hbd) - Sandoglobulin (0,4mg/kg i.v.) - intrauterine transfusions (triple the survival rate)
transfusion indications: - grave anaemia of fetus - fetal hydrops- the only treatment - anamnesis- several fetal necrosis and father DD
transfusion complications: bleeding, fetus infection, premature labour, umbilical cord tamponade, umbilical venous thrombosis

18. Rh Isoimmunization
Prophylaxis: intramuscular administration of Ig anty-D results in 96-98% effectivness if indirect antiglobulin reaction is negative
150g: after -abortion, -missed labour, -ectopic pregnancy, -intrauterine procedure, -labour, -bleeding (imminent abortion, placenta praevia)
300g: after -multiple pregnancy, cesarean section, -instrumental delivery, - manual removal of placenta
Gestational administration of 150g Ig anty-D about 28Hbd effectivness to 99%