婦產(chǎn)科學(xué)課件：羊水量異常(英文版)

Abnormalamnioticfluidvolume1Review

11FunctionofamnioticfluidAvaluablesourceforanalysisoffetaltissuesandfluids；Cushion(緩和）thefetusagainstsevereinjury；Provideamediuminwhichthefetuscanmoveeasily；Asourceoffetalnutrition;Inearlypregnancy,essentialforfetallungdevelopmentInhibitsbacterialgrowth

1

Amnioticfluidoriginmaternalserumdialysedsecretedbyamnioticmembrane(羊膜）fetalurine（胎兒尿液）Theaveragevolumeis800mLAmnioticfluidabsorb

fetal

membranefetalskinfetusswallowsabout400mlofamnioticfluidadayinthefinalstageofpregnancyumbilical

cord

1Polyhydramnios1DefinitionThevolumeofamnioticfluidincreasesbeyond2000mlduringpregnancy1Etiology1.Fetalanomalies（18%-40%）

1)neuraltubedefects

-50%：exposedmeninges（腦脊膜）

openspinabifida(開放性脊柱裂）oesophagealatresia

(食道閉鎖）duodenalatresia（十二直腸閉鎖）11Etiology2)chromosomalabnormalities:18-trisome，21-trisome（唐氏綜合征），13-trisome：causeabsenceoffetalswallowingreflex3)hydropsfetalis(胎兒水腫）：

Incompatibilityofmotherandfetusgroup;infectioninuterine121-trisome（唐氏綜合征）Etiology1Maternalfactors:diabetes,cardiacorrenaldisease,acutehepatitisPlacentafactor:largeplacentaMultiplepregnancy:excessivebloodandurinationSpecificpolyhydramnios(30%)ClinicalmanifestationAcutepolyhydramniosSeldomseen,appeargenerallyat20-24weeksSeriesofoppressing（壓迫）symptoms1ChronicpolyhydramniosUterusislargerthanexpectedgestationalageFetalpartsisdifficulttobepalpated(normallypalpablefrom26-28weeks)Auscultation:fetalheartsoundunclearly,faraway1ClinicalmanifestationAncillaryexamination

UltrasonicexaminationAmnioticfluidindex----AFI>18cmAmnioticfluidvolume----AFV>8cm

AFP(alphafetoprotein)

anencephalus（無腦兒）spinabifida1Ancillaryexamination

Bloodsugar:especiallythechronicpolyhydrymniosBloodgroups:hydrops

1DiagnosisSonography-themostimportant

HydatidiformmoleTwinpregnancyFetalmacrosomia（巨大兒）1PrognosisHypertensivedisorderComplicatingpregnancyPrematuredeliveryPlacentalabruptionProlapseofumbilicalcord

Perinatalmortalityis7timesthannormal1Treatment

Normalfetusreducetheamnioticfluidattention:500ml/h,don’texceed1500mlonetimeindometacinadministration:reducesfetalrenalexcreting

11Treatment

Malformedfetus

terminatepregnancy

1Oligohydramnios

1

DefinitionAmnioticfluidvolumeislessthan300mlatthelastpregnancytermIncidence

0.4-4%1Etiology1.Fetusdefectofurinarysystem

kidney:nokidney,agenesisureterurethraobstruction12.Placentaproblem

posttermpregnancyhypertensivedisorderFGR(fetalgrowthrestriction)1Etiology3.Maternalfactor:

dehydration(脫水）blooddeficiency4.Amniondisorder：rupture1EtiologyClinicalpresentationUterussmallerthanexpectedgestationalageAbdominalpainwhenfetusmovingSeverepaininlabor1PrognosisDefectoffetusPulmonaryhypoxiaFetaldistressorneonatalasphyxia（窒息）1DiagnosisClinicalsymptomsSonographyAFIExternalelectronicmonitoring:latedeceleration≤8cmalert≤5cmcertainty1Treatment

Pretermgestationinfusephysiologicalsolutionintouteruscavityenoughliquidsupplytomother,improveplacentalinfusion

1