PREPARED BY:

YVETTE M. BATAR, RN, MAN, DM

 Polyhydramnios
Characterized by excessive Too much amniotic fluid can cause
amount of amniotic fluid fetal malpresentation because the
Estimated to be < 2,000ml or additional uterine space can allow
Amniotic Fluid Index of < 24 the fetus to turn to a transverse lie.
cm Can also lead to premature rupture
TYPES: of the membranes from the
A. CHRONIC HYDRAMIOS increased pressure with possible
prostaglandin release.
– Increase occurred gradually
PROM adds the additional risks of
B. ACUTE HYDRAMIOS
infection, prolapsed cord, and
– Increased occurred quickly preterm birth.
 Polyhydramnios
KINDS/DEGREES/ COMMON CAUSES ADDITIONAL GUIDANCE
CATEGORIES
Mild Hydramnios – AF No cause, Hydrocephaly, FETAL CAUSES:
pockets is 8-11cm in Gestational Diabetes A. ANENCEPHALY
vertical dimensions UTZ B. ESOPHAGEAL ATRESIA
(DVP); AFI - 24 to 29.9 cm. C. SPINA BIFIDA
No cause, Multiple Gestation,
Moderate Hydramnios – AF Hydrops Fetalis (Rh MATERNAL CAUSES
pockets is 12-15 cm in Incompatibility & Fetal Ascities), A. MULTIPLE PREGNANCIES
vertical dimensions UTZ Gestational Diabetes, B. DIABETES MELLITUS
(DVP); AFI - 30.0 to 34.9 cm Congenital Anomaly
(Anencephaly & Hydrocephaly)
Severe Hydramnios – AF Anencephaly, Spina Bifida,
pockets > 16cm in vertical Enphalocele, Multiple
dimensions in UTZ (DVP); Congenital Abnormalities
AFI - > 35 cm
 Polyhydramnios
Signs & Symptoms:
Complications:
1. Excessive uterine size out of
1. Premature labor
proportion to AOG
& delivery
2. Difficulty palpating fetal parts &
finding FHT 2. Abruptio
placenta
3. Shortness of breath
3. Post partum
4. Backpain, varicosities, constipation,
hemorrhage
frequent urination & hemorrhoids
5. Weight increase/gain
4. Cord prolapse
6. UTZ shows amniotic fluid pocket & 5. Malpresentation
index measurements are > normal
 Polyhydramnios
Management:
1. Mild to moderate – no tx
Place in semi-fowler’s position to assist breathing
Empty bladder frequently
Increased fluid & high fiber diet to px constipation
Frequent rest on left lateral position to prevent
fatigue & backache
 Polyhydramnios
Management:
2. Hospitalization if severe: dyspnea, abdominal pain,
difficult ambulation.
Place on bedrest w/ sedation to make situation
endurable
3. Indomethacin therapy (prostaglandin synthase inhibitor)
To decrease fetal urine formation
S/E:
✓ premature closure of ductus arteriosus
✓ Congenital heart disease in infants
 Polyhydramnios
Management:
4. Amnioreduction by amniocentesis
5. Amniotomy
6. Monitor for premature labor due
to overdistention
7. Tocolytics to prevent or halt
preterm labor.
8. Watch closely hemorrhage after
delivery
Oligohydramnios
 Oligohydramnios
Amniotic fluid < 300ml or amniotic fluid index less than 5cm
Abdomen too small for AOG
Newborns has skin that is dry, leathery & wrinkled
Because the fetus is so cramped for space, muscles are left
weak at birth
Lungs fail to develop (hypoplastic lungs), leading to severe
difficulty breathing after birth, and
Features of the face become distorted (termed Potter’s
syndrome).
 Oligohydramnios
Causes: Signs & Symptoms:
1. Fetal renal anomalies (renal 1. Leaking of amniotic
obstruction & renal agenesis) fluid (when sac is
2. PROM ruptured)
3. Exposure to angiotensin
converting enzyme inhibitors 2. Decreased amount of
4. Intrauterine growth
amniotic fluid on UTZ
restriction 3. Uterus small for AOG
5. Post term pregnancy
6. Twin-to-twin transfusion
syndrome
 Oligohydramnios
Management:
1. Frequent monitoring of fetal & maternal well being
2. Observe newborn complications (throughout remainder of
pregnancy)
✓ Clubfoot
✓ Amputation due to adhesion of fetal parts to amnion
✓ Abortion
✓ Stillbirth
✓ Fetal growth retardation
✓ AP
✓ Pulmonary hypoplasia
 Oligohydramnios
3. Watch out for: (during labor & delivery)
✓ Cord compression
✓ Fetal hypoxia (result of cord compression)
✓ Prolonged labor
Pseudocyesis
 Pseudocyesis
Also known as Spurious Pregnancy
Usually occurs in women nearing menopause & in
women who have intense desire to become pregnant.
Women experience all the subjective symptoms of
pregnancy: fatigue, amenorrhea, tingling sensation &
fullness of breast, nausea & vomiting.
Some report feeling fetal movement w/c is actually
movement of air in the intestines or muscular contractions
of abdominal wall.
 Pseudocyesis
Theories regarding the phenomenon:
Wish-fulfillment theory suggests a woman’s desire to be
pregnant actually causes physiologic changes to occur;
Conflict theory suggests a desire for and fear of
pregnancy create an internal conflict leading to
physiologic changes; and
Depression theory attributes the cause to major
depression.
 Pseudocyesis
Management:
1. Explain pregnancy test result, clarify
misconceptions & false beliefs.
2. Provide referrals when necessary such as
psychologic counselling.
3. Provide emotional support & understanding.
PICA OR CRAVINGS
 PICA OR CRAVINGS
Is the craving for, ingestion of nonnutritive
substances, or ingesting only the same kind of food
substance over a period of time.
From latin word for “magpie” a bird that is an
indiscriminate eater.
Often accompanies IDA.
 PICA OR CRAVINGS
Commonly Ingested Pica Substance
1. Soil/Clay - “Geophagia”
2. Starch – “Amylophagia”
3. Ice – “Pagophagia”
4. Baking powder
5. soap, ashes, chalk, burnt match heads, toilet paper, pebbles, dust
from venetian blinds & tire inner tubes
6. Polypica
7. In Phil: Sour tasting food substances, fruits that is out of season &
unnaturally foods such as mangoes w/ 2 seeds
 PICA OR CRAVINGS
Causes: (Possible Explanations) Effects of Pica: (harmful
1. An adaptive behavior to the because)
stress of pregnancy
1. Poisoning
2. May either provide needed
trace elements of maternal & 2. Anemia
fetal development, or may 3. Eating of non food
bind w/ trace elements, substances may affect the
making the elements mother’s intake of other
unavailable for fetal
development
nutritious substances
 PICA OR CRAVINGS
P I C A
Management: Patient Ice Communication Anemia
1. Investigation of pica Centered
-Wait for the - Most -Monitor verbal & - Explore the
in prenatal patient to reply common nonverbal possibility of
assessment using & listen to the ingested item pica in women
PICA strategies content of the w/ low
-Express
(others are message, even if
- Ask if she nonjudgmental
hematocrit &
the patient is anemia
embarrassed to have attitude for though
documented as
admit) non-pica.
excessive how strange may
cravings of the food cravings,
ice & other pica practices may
-Ask prenatal items be practiced by
patients if they many
practice pica at
each visit.
 PICA OR CRAVINGS
Management:
2. For those practicing pica, help patient to substitute
foods w/ artificial value.
3. Help patient understand why these substances may be
harmful to ingest during pregnancy.
4. Encourage patient w/ pica to take their prescribed
multivitamins regularly to prevent nutritional
deficiencies.
 Hyperemesis Gravidarum
!A nausea & vomiting that leads to
complications like dehydration, wt loss,
nutritional deficiencies & acidosis from
starvation
!A nausea & vomiting that persist beyond
the expected duration, even becoming
worse
•
 Hyperemesis Gravidarum
CAUSES (Proposed possible Causes) SIGNS & SYMPTOMS
1.Elevated HCG (most widely Excessive nausea & vomiting
accepted) persisting beyond 12 weeks
HCG disrupts normal activity !Not relieve by ordinary
of the GIT by causing reverse remedies
peristalsis resulting to nausea Sign of dehydration:
& vomiting !Thirst
2. Thyroid Dysfunction !Dry skin
3. Psychological Stress !Increased pulse rate
!Weight loss
!Concentrated & scanty urine
 Hyperemesis Gravidarum: Management
1. Differential diagnosis To rule out other causes

2. Conservative Management A. Have dry, low fat, high carbohydrate & bland diet
(w/ excessive vomiting but no !Take crackers
dehydration) !Small frequent feeding & sips of H2O to avoid
gastric distention w/c could trigger vomiting reflex
!Avoid very hot or very cold food & beverages
B. avoid noxious stimuli that may precipitate nausea
!Motion & pressure around the stomach (tight
waistband)
!Temporary cessation of iron supplement
(contributes to gastric upset)
!Avoid highly seasoned & spicy food
!Avoid strong odors (perfumes)
!Avoid loud noises, bright & blinking lights
 Hyperemesis Gravidarum: Management
2. Conservative Management - C. Take vitamin supplement to correct nutritional
continued deficiencies from decreased food intake
D. Have enough relaxation & rest
E. Take prescribed medications to relieve symptoms:
!Promethazine (Phenergan)
!Prochlorperazine (Compazine)
!Ondansetron (Zofran)
!Droperidol (Inapsine)
!Metoclopramide (Reglan)
!Diphenhydramine (Benadryl)
!Meclizine (Antivert)
3. Hospitalization: if w/ a. IVF (D5LR)
dehydration b. Vitamin supplementation
!to correct dehydration & fluid c. NPO for 24-48h until nausea subsides to rest GIT
& electrolyte imbalances d. Oral intake (after proper hydration & nausea
subsided)
 Hyperemesis Gravidarum: Management
3. Hospitalization - continued When patient begins oral intake of food:
!Administer antiemetics before meals
! Ensure patient is relax & comfortable at meal time
!Introduce food gradually starting w/ liquids
!Do not serve foods w/ strong odor, spicy & greasy
!Do not force patient to eat, remove food if nausea &
vomiting recurs after introducing food.
4. Parenteral or Enteral -If does not improve w/ IV & condition worsens
therapies
5. Complementary therapies: a. Acupressure – on Nelgian point (pericardium 6 or
P6) relieves nausea
b. Herbal medicine – ginger (most popular) for nausea.
Its carminative effect expels flatus/gas from GIT
c. Vitamin Supplement – pyridoxine has been related
to the development of hyperemesis
 Hyperemesis Gravidarum: Management

6. Provide emotional a. Show sincere concern for the

support woman’s welfare
b. Empower woman with knowledge &
encouragement
c. Provide necessary referrals (such as
counselling)