1

2 Republic of the Philippines

3 UNIVERSITY OF NORTHERN PHILIPIENS
4 Tamag, Vigan City
5 2700, Ilocos Sur
6

9 OLIGOHYDRAMNIOS
10

11 CASE STUDY
12

13

14 By:
15 Cadaoas, Kate Anne
16 Ciubal, Criselle
17 Iloreta, April Joy
18 Llanes, Eloisa Louise
19 Tabuso, Mark James
20 Carta, John Jerick
21 Mindong, Grinjel
22 Montero, Princess Joy
23 Pacpaco, Diana Rose
24 Bachelor of Science in Midwifery
25
26
27 Presented to:
28 MRS. GERILETTE P. ROSARIO
29 Clinical Instructor

1
30

2
31 INTRODUCTION

32 Oligohydramnios is a disorder of amniotic fluid resulting in decreased amniotic fluid

33 volume for gestational age. Low amniotic fluid volumes can be the result of numerous maternal,

34 fetal, or placental complications and can lead to poor fetal outcomes. This activity will highlight

35 the pathophysiology, etiology, evaluation, and treatment of oligohydramnios, and also review the

36 role of healthcare teams in the assessment and management of this condition. Oligohydramnios

37 is defined as decreased amniotic fluid volume (AFV) for gestational age. The volume of

38 amniotic fluid changes over gestation, increasing linearly until 34 to 36 weeks gestation, at

39 which point the AFV levels off (approximately 400mL) and remains constant until term. The

40 AFV then begins to decrease steadily after 40 weeks gestation, leading to reduced volume in

41 post-term gestations. This pattern allows for clinical assessment of AFV throughout pregnancy

42 using fundal height measurements and ultrasound evaluation. Amniotic fluid disorders should be

43 included in the differential diagnosis whenever there is a discrepancy between the fundal height

44 measurement and gestational age. Discrepancies should prompt an amniotic fluid assessment by

45 ultrasound. Transabdominal ultrasound evaluation of AFV includes the use of either the

46 maximum vertical pocket (MVP) or the amniotic fluid index (AFI) depending on the institution.

47 The sonographer systematically scans the abdomen and obtains an image that demonstrates the

48 maximum vertical pocket - the deepest pocket of amniotic fluid that does not include fetal

49 umbilical cord or body parts. The measurement should be made from the 12 o’clock position to

50 the 6 o’clock position. The normal range for MVP is 2-8 cm: a pocket <2cm is considered

51 oligohydramnios in both single and multifetal gestations An MVP > 8 is considered

52 polyhydramnios.

53 The amniotic fluid index (AFI) is an alternative assessment of AFV. The AFI can be

54 determined after 20 weeks of gestation by dividing the uterus into four quadrants through the
1
55 umbilicus and determining the MVP in each quadrant. The sum of the four maximum vertical

56 pockets is equal to the AFI. An AFI <5cm is consistent with oligohydramnios. The use of the

57 maximum vertical pocket tends to overly diagnose cases of polyhydramnios, while the use of the

58 AFI tends to underdiagnose cases of oligohydramnios. With this in mind, some institutions opt to

59 use the MVP in gestations with low AFV and use the AFI in cases of high AFV. The MVP

60 should serve to evaluate oligohydramnios in multifetal pregnancies, as you will not be able to

61 measure all four quadrants for each fetus. (Keilma, Shanks,2022).

62 Oligohydramnios occurs during pregnancy when your amniotic fluid is lower than

63 expected for your baby’s gestational age. Amniotic fluid is a water-like fluid that surrounds your

64 baby in your uterus. It protects your baby from infection and umbilical cord compression and

65 cushions their movements while they’re in your uterus. Amniotic fluid also helps develop your

66 baby’s digestive and respiratory system, as well as regulates their [Link] little amniotic

67 fluid can cause health problems in your baby or be a sign of an underlying condition. These

68 conditions could affect your baby’s development or cause complications during labor and

69 delivery. Low amniotic fluid affects about 4% of people who are pregnant. It’s most common in

70 the last three months of pregnancy. This rate rises to about 12% in people who are past their due

71 date because amniotic fluid levels decrease after 40 weeks of pregnancy. Amniotic fluid does

72 have during pregnancy. It depends on how many weeks pregnant you are. You begin making

73 amniotic fluid about 12 days after conception. The amount of amniotic fluid you produce

74 increases until its peak at 36 weeks of pregnancy. After that, your levels of amniotic fluid start

75 decreasing (Cleveland,2021)

76

77

2
78 OBJECTIVES

79 At the end of the shift, the midwifery student should be able to enhance their

80 knowledge, ability and skills in caring a patient with oligohydramnios.

81 Specific Objectives:

82  To discuss the patient’s data, past medical history, family history, and physical

83 assessment using head to toe assessment: the Inspection, Palpation, Percussion, and

84 Auscultation.

85  To review the anatomy and physiology of the oligohydramnios particularly the

86 development stages, function, complications of oligohydramnios, possible causes,

87 symptoms, and how it is diagnosed.

88  To discuss the drug study: its dosage, adverse effect, mechanisms of action,

89 indication and contraindication, and its route.

90  To develop a clear, rationalized, and effective midwifery care plan for the patient.

91  To give health teachings for the patient to continue receiving care even at home.

92

93 RATIONALE

94 To summarize the etiology of oligohydramnios and describe the appropriate history,

95 physical, and evaluation of the disorder of the amniotic fluid. Also, to study the outline and the

96 treatment management options available and to identify inter-professional team strategies for

97 improving care coordination and communication to advance the care of oligohydramnios and

98 improve outcomes.

3
 99

100 I. CLINICAL SUMMARY

101 A. PATIENT DATA

102 NAME: Hazel Alarca

103 CASE NUMBER:

104 ADDRESS: Pantay Fatima, Vigan City

105 AGE: 23 Years Old

106 STATUS: Married

107 RELIGION: Roman Catholic

108 DATE ADMITTED: December 02, 2022

109 FINAL DIAGNOSIS: G2 P1 L0 at 34 weeks AOG with longitudinal lie with cephalic

110 presentation and non-engaged head with severe IUGR with Oligohydramnios

111

112 B. CHIEF COMPLAINT

113 Routine antenatal check-up at 9 months of pregnancy. No signs of contraction, cervix closed.

114

115 Vital Signs: BP: 110/70 mmHg PR: 90 bpm RR: 18 bpm Temp: 98.4F Weight: 40 kg

116 LMP: 04-05-2022

117 EDD: 01-12-2023

4
118 Age of Menarche: 12 years

119 Duration of Menstruation: 4-5 days

120 Interval in days: 28 plus/ -2 days

121 Regularity of Cycle: Regular

122 Amount of Bleeding: Moderate (suggested by the use of 2-3 packs/day)

123 LMP lasted for 4 days normal flow of blood and no clots were present.

124

125 II. HISTORY OF PAST AND PRESENT ILLNESS

126 A. Present Health History

127 The patient complains of cessation of menstruation for the last nine months. She labeled

128 herself pregnant after a positive urine pregnancy test after she was one and a half month

129 amenorrhoeic.

130 1st Trimester

131  The pregnancy was confirmed by urine pregnancy test after she missed her periods for

132 one and a half months.

133  There are no antenatal checkups in the first trimester.

134  There is no history of vomiting or increased frequency of micturition.

135  There is no history of fever, burning micturition, loin pain or difficulty in micturition.

136  There is no history of any drug intake or exposure to radiation.

5
137  There is no history of vaginal discharge or bleeding per vagina.

138  There is no history of any abdominal pain, breast discomfort.

139  Bowel and bladder habits are normal.

140  Sleep is normal but appetite is reduced.

141  There are no medical or surgical events in the first trimester.

142  There is no history of trauma.

143 2nd Trimester

144  The patient says that there was progressive enlargement of the abdomen.

145  The First fetal movements were perceived at round 5th months of gestation, exact date could

146 not be specified, since then she has been perceiving till date.

147  She went for her first antenatal checkup at 5th months at Azara Community Health Care and

148 then regularly at monthly interval.

149  Total two antenatal checkups were done in 2nd trimester.

150  Iron and folic acid tables have been consumed regularly from the 5th month.

151  Calcium supplements have been taken.

152  No Tetanus Toxoid has been administered.

153  There is no history of fever, burning micturition.

154  Frequency of micturition was normal.

155 2nd Trimester (contd)

156  The patient does not give history of swelling of legs or other parts of the body like face,

157 abdomen, vulva or whole body or tightness of ring of the finger.

6
158  There is no history of headache, dizziness or blurring of vision or abnormal body

159 movements.

160  There is no history of pain abdomen or vomiting.

161  There is no history of vaginal discharge or bleeding per vagina.

162  Bowel and bladder habits are normal.

163  Sleep is normal but Appetite is reduced.

164  There are no medical or surgical events in the second trimester.

165  There is no history of trauma.

166 3rd Trimester

167  Fetal movements can be felt regularly @ 10-12/12-hr period.

168  Total no. of antenatal checkups in 3rd trimester is three.

169  Tetanus toxoid, one dose, was received at 8th month.

170  There is no history of breathing difficulty.

171  Frequency of micturition is normal.

172  There is no history of fever, swelling of legs, pain abdomen or vomiting.

173  There is no history of vaginal discharge or bleeding per vagina.

174  There is no history of exposure to caffeine.

175  The patient does not give history of breaking of water yet.

176  Bowel and bladder habits are normal.

177  Sleep is normal but Appetite is reduce.

178  There are no medical or surgical events in the third trimester.

179  There is no history of trauma.

180

7
181 B. Past Obstetric History
182 Duration of marriage is 5 years.
183 Gravida 2 Parity 1 with no living issue.
SI. Year of Pregnancy Labour events Place and mode Puerperium Baby
No birth events of delivery

1. Decem 1) Duration 1) Onset = 1) Mode of [Link] Live birth,

ber of spontane delivery ed Female, birth
2014 pregnanc ous and =normal. 2No H/O weight is 1.3
y = 28 early. 2) Place of blood kg, Preterm,
weeks. 2) Duration delivery transfusion. admitted to
2) Antenatll of labor = transit. [Link] stay NICU
y cared. = = 9 days immediately
3) Prematur lnormal, after birth.
e rupture not Death 10th of
of prolonge day of birth.
membran d.
e at 7th 3) There is
month no
and early history
onset of of
labor. PROM.

184
185
186 C. Past Medical and Surgical History
187  The patient has no Family Medical History and Surgical History.

188  There is no history of hypertension, diabetes mellitus, tuberculosis, bronchial asthma,

189 heart disease, renal disease or vascular disease in the past.

190  There is no history of blood transfusion in the past.

191  There is no previous history of surgical intervention in the past.

192  There is no history of MTP.

193

194

8
195 D. Menstrual History
196

197  LMP: 04-05-2022

198  EDD: 01-12-23

199  Age of Menarche: 12 years

200  Duration of Menstruation: 4-5 days

201  Interval in days: 28 plus/ -2 days

202  Regularity of Cycle: Regular

203  Amount of Bleeding: Moderate (suggested by the use of 2-3 packs/day)

204  LMP lasted for 4 days normal flow of blood and no clots were present.

205

206 E. Personal History

207
208  The patient is a non-smoker and non-alcoholic.

209  She does not consume betelnut or tobacco.

210  She consumes an average non-vegetarian Assamese diet.

211

212 F. Family History

213  The patient lives with her husband.

214  There is no history of diabetes mellitus, hypertension, bleeding disorders or TB in other

215 members of the family.

216  There is no history of repeated abortions, still births, congenital anomalies, multiple

217 pregnancy in the family

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218

219 G. Socioeconomic History

220  The patient lives in a pucca house with 2 rooms, a separate kitchen and sanitary latrine.

221  Total income of the family is Rs. 6000/- per month, suggesting lower socioeconomic

222 strata.

223  The family consumes filtered water and the source of water is tube well.

224

225 H. Contraceptive History

226  There is no history of usage of any contraceptive.
227
228 I. Immunization History
229  BCG scar is present.

230  In her first pregnancy 2 years back, she received two doses of Tetanus at 5 th and 6th

231 months of pregnancy.

232  In the current pregnancy, she received one dose of Tetanus toxoid at 8 th month of

233 gestation.

234

235 J. Drug History

236  The patient has been prescribed iron and folic acid tablets along with Calcium

237 supplements which she has been taking regularly from 5th month.

238  No history of intake of any other medications.

239
240 K. Allergy History

241

10
242  The patient is not allergic to any known allergen.
243
244

245

246 III. PHYSICAL ASSESSMENT

247

248 General Examination:

249  Consciousness- Patient is alert and conscious.

250  Orientation- Well oriented to time, place and person.

251  Appearance & Facies- Normal.

252  Decubitus- Of choice.

253  Build- Average.

254  Nutrition- Poor.

255  Height- 147 cm.

256  Weight- 40 kg.

257  Gait- Normal.

258  Skin- Normal, stretch marks present on abdomen.

259  Icterus- Absent.

260  Pallor- Absent.

261  Dehydration- absent.

262  Cyanosis- Absent.

263  Edema- Absent.

264  Clubbing- Absent.

11
265  Oral cavity- oral hygiene is maintained, no features of malnutrition, no dental caries, gums,
266 tongue, is moist with normal papillae.

267  Neck veins- Not engorged.

268  Neck glands- Not enlarged.

269  Leg Veins- No varicose vein, tortuosity.

270

271 Vital signs: BP: 110/70, T: 98.4o F, P: 90 bpm, RR: 198bpm

272

REVIEW OF TECHNIQUE RESULT SIGNIFICANCE

THE SYSTEM USED (IPPA)
Central Nervous Inspection Higher Function: the patient Normal
System is alert, conscious,
cooperative, and well oriented
to time, place and person.
Cranial Nerves: functions of
all the cranial nerves are
Palpation intact.
Motor System: ton, power
and bulk of muscles of all four
limbs are normal.
Coordination is normal. No
abnormality detected. All the
superficial and deep reflexes
are intact.
Sensory and Autonomic:
functions are normal

Cardiovascular Inspection Precordium is normal. No Normal

12
System visible pulsations or engorged
veins seen. No scar is seen.

Palpation Apex is palpable just medial

to mid-clavicular line in the
left 5th intercostal space. It is
normal in character.

Heart sounds are normal. No

Auscultation added sounds heard.
Respiratory Inspection Shape and symmetry of chest Normal
System is normal and symmetrical.
Respiratory movements are
bilaterally symmetrical.
Respiratory rate is 18/ minute
and regular rhythm. No
deformity detected.

Palpation Trachea is in midline. Chest

expansion is normal and
bilaterally symmetrical. Vocal
fremitus is bilaterally
symmetrical and normal.

Percussion Resonant in all the areas. No

abnormality detected.

Auscultation Normal breath sounds are

heard in all the areas. Vocal
resonance is normal and
bilaterally symmetrical in all

13
 the areas. No added sounds
heard.
Abdomen Inspection Size: enlarged Normal
Shape: globular
Ovoid: longitudinal
Flanks: not full
Fundus: convex
Suprapubic Region: convex
Condition of Skin: healthy
Skin: presence of stria
gravidarum and linea nigra
Umbilicus: everted, midline
in position
Venous prominence: none
Scar mark of previous
operation: none
Visible pulsation: none

Palpation Local rise of temperature:

none
Tenderness: none
Abdominal girth: 70cm
Symphysio- fundal height:
28cm
Uterus: soft, relaxed and non-
tender
Fetal Movements: felt
Fundal height: corresponds
to 28 weeks of pregnancy

 Obstetric Fundal Grip: soft, broad,

14
 Grips/ irregular and non-ballotable
Leopold’s mass felt, suggestive of
Maneuver buttocks.
Lateral Grip: smooth,
curved, resistant surface felt
on the right side of the
abdomen suggestive of back.
Small knob like structures felt
on the left side, suggestive of
legs.
First Pelvic Grip: hard
globular and smooth mass felt
suggestive of head. Head is
not engaged. It is ballotable.
Second Pelvic Grip:
confirmation of the findings
of first pelvic grip is done.
Head is not engaged. It is
Auscultation ballotable.

Fetal heart sound: present

Site: right spinoumbilical line
Rate: 130/min.
Rhythm: irregular

Perineum Inspection Vulva is healthy. No active Normal

bleeding or discharge seen.

Palpation No tenderness elicited. No

local rise of temperature.
Breast Inspection Both breast are uniformly Normal

15
 enlarged in size.
Skin over the breasts:
healthy
Nipples: everted
Areola: hyperpigmented:
Montgomery tubercles are
seen.
No nipple discharge seen.
Palpation
No lump present.
No tenderness felt.
No local rise of temperature.
273

274

275 IV. LABORATORY

276
277
278

279 HEMATOLOGY
280

281 Date: 12/02/22

282 Name: Hazel Alarca
283 Age: 23 years old
284 Sex: F
285

286 Blood Group: A-

287 Hemoglobin: 10 g/dL of blood
288 Total Leucocyte Count (T.L.C.): 7.58x 103/uL of blood
289 Differential Leucocyte Count (D.L.C):
290 Neutrophils: 74%

16
291 Lymphocytes: 21.9%
292 Monocytes: 3.3%
293 Eosinophils: 0.8%
294 Platelet Count: 1.7 lacs/ uL of blood
295 Random Blood Sugar (R.B.S): 86 mg/dL of blood
296 Serum Creatinine: 0.63 mg/dL of serum
297 Serum (T.S.H): 2.92 mlU/cc of serum
298 Urine R/E: No abnormality detected
299 Urine C/S: No growth
300 H.I.V: Non-reactive
301 V.D.R.L.: Non-reactive
302 HBsAg: Non-reactive
303

304

305 ULTRASONOGRAPHY RESULT

306

307 Date: 12/02/22

308 Name: Hazel Alarca
309 Age: 23 years old
310 Sex: F
311

312 Single live foetus in cephalic presentation

313 Calculated Gestational: 30 weeks
314 Foetal Movements Seen; Daily foetal movement score: 12
315 Foetal Heart Rate: 130 beats/minute
316

317 a. Placenta: Fundo-body Posterior; Grade: II

318
319 b. Amniotic Fluid Index (A.F.I.) 2.1+2.4+1+1.6+=7.1 cm

17
320
321
322 c. Foetal Biometry Not available
323
324 d. Femur Length: Single femur epiphysis seen
325
326
327 e. Estimated Foetal weight (E.F.W.) 1.4 kg
328
329 f. Ponderal Index: Not measured
330
331
332 g. Doppler Ultrasound Velocemetry:
333
334 i. Umbilical Artery Systole/Diastole ratio (U.A.S/D): 3.2
335
336 ii. U.A.R.I (Resistance Index): 0.51
337
338
339 iii. U.A.P.I. (Pulsatility Index): Not measured
340
341
342
343 V. DIAGNOSIS
344

345 G2P1L0 at 34 weeks AOG with longitudinal lie with cephalic presentation and non-

346 engaged head with severe IUGR with oligohydramnios.

347

348

349

350

351

352

353

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354

355

356

357

358

359

360 VI. CLINICAL DISCUSSION OF THE DISEASE

361
362 A. Ecological Model
363
364
Natural Environment
365
Filtered water source is tubewell
366
367
368 Human- moderated Environment
Routine antenatal check-up at 9 months of
369 pregnancy
370 Social Determinants
371 Lives in Pucca house
Lower
372 socioeconomic strata
373 Individual Determinants
374
23 years old Married
375
376 Female Individual
377 Lifestyle
378 Non-vegetarian
379 Roman Catholic

380

381

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382 Oligohydramnios is associated with poor maternal and perinatal outcomes.
383 Oligohydramnios incidence was higher among women who were from low socioeconomic status.
384 It is also due to poor nutrition, lack of rest and the nutrients requirements of the body. We
385 recommend increased surveillance for oligohydramnios in the third trimester, especially among
386 prime gravidas, those with history of malaria in pregnancy, post-term pregnancies, and those
387 with poor nutrition in order to enable prompt detection of this complication and plan timely
388 interventions.

389 B. Conclusions and Recommendations

390

391 Conclusions

392  Oligohydramnios is a condition of abnormally low amniotic fluid volume that has been

393 associated with poor pregnancy outcomes, the outcomes assessed include maternal

394 morbidity and fetal and neonatal mortality, preterm birth and low-birth weight.

395  Oligohydramnios is associated with poor maternal and perinatal outcome, so it frequent

396 occurrence and demands intensive fetal surveillance and proper antepartum and

397 intrapartum care.

398 Recommendations

399  Seek maternal-fetal specialist or regularly do prenatal check-ups to develop an optimal

400 care plan to reduce limit the risk of complications for both mother and child.

401  Rely on inter-professional communication among several providers to ensure adequate

402 screening, diagnosis, and management of the condition in the antepartum, partum, and

403 postpartum periods.

404  It is advisable to have regular ultrasounds to keep track of the amniotic fluid level, to

405 check both maternal and fetal health.

20
406  The midwife should establish a treatment plan, the possible treatment options like bed

407 rest, and give advice on proper nutrition requirements.

408

409

410

411

412 VII. ANATOMY AND PHYSIOLOGY

413

414

415 Amniotic fluid is a clear to slightly yellow liquid that cushions a fetus within the amniotic

416 sac. The unborn baby floats in amniotic fluid for the duration of a pregnancy. The amniotic fluid

417 constantly circulates as the fetus swallows or "inhales" the amniotic fluid before releasing it by

418 urinating. At around 34 weeks of gestation, roughly 800 milliliters (mL) of amniotic fluid

419 surround the baby. At a full-term pregnancy at 40 weeks gestation, roughly 600 mL of amniotic

420 fluid remain Amniotic fluid is a clear to slightly yellow liquid that cushions a fetus within the

21
421 amniotic sac. The unborn baby floats in amniotic fluid for the duration of a pregnancy. The

422 amniotic fluid constantly circulates as the fetus swallows or "inhales" the amniotic fluid before

423 releasing it by urinating. At around 34 weeks of gestation, roughly 800 milliliters (mL) of

424 amniotic fluid surround the baby. At a full-term pregnancy at 40 weeks gestation, roughly 600

425 mL of amniotic fluid remain

426 Development

427 Amniotic fluid is present at the formation of the amniotic sac. This is a thin-walled sac

428 that contains the fetus during pregnancy.

429 The development of amniotic fluid is broken into two stages:

430  Early gestation: In the period from fertilization to eight weeks, the amniotic fluid is

431 composed mainly of water from the mother. At 10 weeks, the fetus produces urine, which

432 enters the amniotic sac.

433  Late gestation: In the second and third trimesters, the amniotic sac expands and amniotic

434 fluid is mainly composed of fetal urine. Alongside this, lung secretions from the fetus, as

435 well as gastrointestinal secretion and excretions from the umbilical cord and placental

436 surface, also contribute to the content of amniotic fluid.

437 Amniotic fluid is made up of 98% water and electrolytes, along with peptides,

438 carbohydrates, and signaling molecules. The remaining 2% is made up of lipids and hormones

22
439 Function

440 Amniotic fluid serves a number of purposes during pregnancy, primarily to protect the fetus

441 from harm. The functions of the amniotic fluid include:

442  Acting as a cushion: This protects the fetus from injury should the mother's abdomen be

443 the subject of trauma or a sudden impact.

444  Protecting the umbilical cord: Amniotic fluid flows between the umbilical cord and fetus.

445  Protecting from infection: Amniotic fluid has antibacterial properties.

446  Containing essential nutrients: These include proteins, electrolytes, immunoglobulins,

447 and vitamins that assist in the development of the fetus.

448  Allowing for the fetus to move: Amniotic fluid also allows the developing fetus to move

449 around in the womb, which in turn allows for proper development and growth of the

450 musculoskeletal system, gastrointestinal system, and pulmonary system.

451  Maintaining temperature: Amniotic fluid assists in keeping a constant steady temperature

452 around the fetus throughout pregnancy, protecting the baby from heat loss.

453 Complications

454 Complications related to amniotic fluid can occur when there is too much or too little fluid.

455

456

457

23
458

459

460 Oligohydramnios

461 Oligohydramnios occurs when there is too little amniotic fluid surrounding the fetus

462 during pregnancy. This occurs in about 4% of pregnancies. On average, pregnant people have

463 roughly 0.5 quart to 1 quart (500 to 1000 mL) of amniotic fluid. Too little amniotic fluid can

464 cause problems with the development of the fetus as well as pregnancy complications.

465 Too little amniotic fluid can lead to abnormal development of the baby's lungs. It may

466 also stop the baby from growing properly. Too little amniotic fluid can put pressure on the

467 umbilical cord, which can prevent the fetus from getting enough oxygen and nutrients.

468 Oligohydramnios can occur for a number of reasons. Either not enough amniotic fluid is being

469 made, or there are issues causing the amount of amniotic fluid to decrease.

470 Possible causes include:

471  Poor fetal growth

472  Water breaking before going into labor

473  A pregnancy that extends past the due date

474  Identical twins who share a placenta

475  Birth defects (most commonly kidney and urinary tract issues)

24
476 Symptoms of oligohydramnios may vary between women and may also present as symptoms

477 of other conditions. A healthcare provider will be able to provide a conclusive diagnosis.

478 Possible symptoms include:

479  Not enough amniotic fluid is seen during an ultrasound exam

480  Smaller uterus than expected for the stage of pregnancy

481  Leaking amniotic fluid

482 Oligohydramnios may be diagnosed following an ultrasound. A Doppler flow study, a special

483 type of ultrasound, may be used to check blood flow through the fetus' kidneys and the placenta.

484 Treatment for oligohydramnios is focused on continuing the pregnancy for as long as is safe

485 while keeping the mother comfortable.

486 This may involve:

487  Regular monitoring to see how much amniotic fluid remains

488  Amnioinfusion, where fluid is infused into the amniotic sac. This may be performed

489 during labor if the water has broken, but not outside of labor.

490  If low amniotic fluid presents a risk for the mother and baby, early delivery may be

491 necessary.

492

493

494

25
495

496

497

498

499

500

501 VIII. PATHOPHYSIOLOGY

502
503 Laboratory was include:
504
505
506
OLIGOHYDRAMNIOS
507

508
Fetal Cardiac Activity

 

Amniotic Fluid Index = 2.1+2.4+1+1.6= 7.1 cm IUD

Estimated Fetal Weight = 1.4 kgkg

Abnormal 26
509

27
 IX. DRUG STUDY

Drug Name Mechanism of Action Indication Contraindication Adverse Effect

Generic Name: Addition of ascorbic acid  For prevention  Hyper sensitivity  Nausea
Iron and Folic converts the ferric form to and treatment of  Haemolytic anaemia unless  Vomiting
Acid ferrous form thus making it iron deficiency iron deficiency anaemia is  Constipation
absorbable from duodenum anemia in present  Diarrhea
Dosage:100mg and upper jejunum, resulting pregnancy and to  Haemochromatosis  Abdominal pain
in considerable supply  Haemosiderosis
Route: oral enhancement of the maintainance  Peptic ulcer
absorption of iron. It has dosage of folic
 Regional enteritis
been demonstrated that acid.
 Ulcerative colitis
Fe(II) ascorbate is less
 Those receiving repeated
easily oxidized than Fe(II)
blood transfution
in ferrous sulphate.
Absorption of ferrous
Precautions: this product may
ascorbate averaged 52%
contain inactive ingredient (peanut)
higher than ferrous sulphate
soy) which can cause allergic
in subjects with ID. (Marx
reaction.
et al., 1982) Thus when
 administered as ferrous
ascorbate, Fe(II) salt is more
resistant to oxidation at
alkaline pH,delivers
maximum amount of ferrous
iron to the duodenal brush
border and at the same time
produces minimum GI
adverse effects.

Uses: it is used to treat or

prevent low iron in the
body, treat low folate levels,
and help growth and good
health.
510
 Drug Name Mechanism of Action Indication Contraindication Adverse Effect

Generic Name: High-dose calcium  By mouth they are  Taking calcium tablets  The side effects
Calcium supplementation (≥ 1 used to treat and during pregnancy. One is of calcium
Supplements g/day) may reduce the risk prevent low blood that they can give you gas supplements can
of pre-eclampsia and calcium, or make you constipated. include:
Route: oral preterm birth, particularly osteoporosis, and constipation and
for women with low rickets upset stomach.
calcium diets (low-quality Additionally,
evidence). The treatment more serious
effect may be calcium side
overestimated due to effects can
small-study effects or include:
publication bias. It reduces nausea/vomiting,
the occurrence of the loss of appetite,
composite outcome unusual weight
'maternal death or serious loss,
morbidity', but not mental/mood
stillbirth or neonatal high changes,
care admission. There was bone/muscle pain,
an increased risk of headaches,
 HELLP syndrome with increased
calcium supplementation, thirst/urination,
which was small in weakness and
absolute numbers. fatigue. Allergic
reactions can also
be included in the
list of calcium
side effects.
 X. MIDWIFERY CARE PLAN

ASSESSMENT DIAGNOSIS INFERENCE PLANNING INTERVENTIO RATIONALE EVALUATION

N
Subjective: • Knowledge Oligohydramnios • After 8 hours Independent: • to determine • After 8 hours
“ there was progressive
enlargement of the deficient occurs during of midwife • to ascertain the what of midwife
abdomen” regarding pregnancy when interventions, understanding on information to interventions,
As verbalized by the
patient. nutritional your amniotic the patient will nutritional needs provide with the patient was

status fluid is lower than identify the for pregnancy. client. able to identify

Objective: expected for your right daily food the right daily
requirements
 appetite is baby’s gestational intake and • to discuss eating • provide a food intake. She
reduced of the body.
age. Amniotic modify the habits and total baseline data. is now aware on
 amenorrhea
 severe IUGR fluid is a water- nutritional daily food intake her nutritional
 oligohydramnios like fluid that needs with and maintain diary • helps in further status
surrounds your increase of calories intake. care of the requirements
baby in your protein, patient. and able modify
VS taken as follows: uterus. It protects carbohydrate, • to provide diet the foods that
Bp: 110/70 mmHg
your baby from and calories. modifications with • help to stimulate
T: 98.4 F
PR: 90 bpm infection and increase protein, maintain the appetite.
RR: 18 bpm
umbilical cord calcium, and adequate
compression and carbohydrates. nourishment
cushions their require.
movements while • to encourage
they’re in your client to choose • to increase the
uterus. Amniotic foods that are intake of diet to
fluid also helps appealing to improve
develop your stimulate appetite. nutritional
baby’s digestive status,
and respiratory Collaborative:
system, as well as Discuss the • to see the
regulates their importance of effectiveness of
temperature. proper nutrition in intervention.
relation to its
Too little amniotic condition.
fluid can cause
health problems in
your baby or be a
sign of an
underlying
condition. These
conditions could
 affect your baby’s
development or
cause
complications
during labor and
delivery.
511

ASSESSMENT DIAGNOSIS INFERENCE PLANNING INTERVENTIO RATIONALE EVALUATION

N
Subjective: •Knowledge Oligohydramnios • After 8 hours Independent: • to determine • After 8 hours
“ there was progressive deficient
enlargement of the
occurs during of midwife • to assess fetal what follow up of midwife
abdomen”
regarding
pregnancy when interventions, well-being. plan to interventions,
As verbalized by the maternal-fetal
patient. care your amniotic the patient will formulate to the patient was
management of fluid is lower than focus on the • to assess the minimize able to focus on

Objective:
oligohydramnios expected for your importance of fetal heart rate. complications. the importance
 appetite is .
baby’s gestational receiving of receiving
reduced
age. Amniotic prenatal care • to advice patient • to ensure the prenatal care
 amenorrhea
 severe IUGR fluid is a water- and will rely on to adequate rest. fetal well- and rely and
 oligohydramnios like fluid that inter- being. trust on inter-
surrounds your professional • to assess the professional
baby in your communication daily fetal • to monitor communication
VS taken as follows: uterus. It protects to minimize the movements. fetal growth. to minimize the
Bp: 110/70 mmHg
your baby from risk of both fetal risk of both fetal
T: 98.4 F
PR: 90 bpm infection and and maternal • to prevent and maternal
RR: 18 bpm
umbilical cord complications. Collaborative: dehydration complications.
compression and Discuss the through bed
cushions their importance of rest.
movements while seeking maternal-
they’re in your fetal specialist.
uterus. Amniotic
fluid also helps
develop your
baby’s digestive
and respiratory
system, as well as
regulates their
temperature.

Too little amniotic

fluid can cause
health problems in
your baby or be a
sign of an
underlying
condition. These
conditions could
affect your baby’s
development or
cause
complications
during labor and
delivery.
512 XI. DISCHARGE PLAN

513
514 XII. REFERENCES

515 [Link]

516 [Link]

517 [Link]

518 Iron-Folic Acid Oral: Uses, Side Effects, Interactions, Pictures, Warnings & Dosing -
519 WebMD

520 Calcium supplementation during pregnancy and lactation: effects on the mother and the
521 fetus - PubMed ([Link])

522 Oligohydramnios: Causes, Symptoms, Diagnosis & Treatment ([Link])

523

524

525

526