Polyhydramnios and Oligohydramnios - Nursing Case Study

by - June 24, 2020

DESCRIPTION:
The amniotic fluid volume is usually at 500 to 1,000 mL at term. When there is an excess fluid of more than 2,000 mL or an amniotic fluid index is above 24 cm then the mother is polyhydramnios. This condition can cause fetal malpresentation because of the additional uterine space that allows the fetus to turn to transverse lie. It can also lead to premature rupture of membranes due to the increased pressure that usually leads to additional risks of infection, prolapsed cord, and preterm birth. On the other hand, a woman can also experience less than the average amount of amniotic fluid which is called the Oligohydramnios. It is usually caused by a bladder or renal disorder in the fetus that is interfering with voiding and severe growth restriction because of the small size fetus is not voiding as much as usual.
FOCUS ASSESSMENT (SIGNS AND SYMPTOMS):
The signs that can be observed for polyhydramnios are unusually rapid enlargement and unusually tense of the uterus that makes it hard to palpate the small parts of the fetus.  There will be an extreme shortness of breath because of the overly distended uterus that pushes up against the diaphragm. The woman may also develop lower extremity varicosities and hemorrhoids because the good venous return from the lower extremities is blocked by extensive uterine pressure. And also, since there is an increased amount of fluid, there will be an increased weight gain too. In oligohydramnios, it will be observed that the baby is in malpresentation, smaller symphysiofundal height, and undue prominence of fetal parts.
DIAGNOSTIC AND LABORATORY TEST:
Ultrasound can be perform in order to document and to discover the reason behind the presence of polyhydramnios and oligohydramnios.

RISK FACTORS:
The risk factors that is associated with polyhydramnios are maternal diabetes mellitus, multiple gestation, fetal anomalies, fetal anemia, and twin to twin transfusion. While oligohydramnios risk factors are fetal UT problems, uteroplacental insufficiency like hypovolemia, hypertension, preeclampsia, and abruptio placentae, drugs like ACE inhibitors and NSAIDs, rupture of membranes, and fetal chromosomal abnormalities.

PATHOPHYSIOLOGY:

NURSING DIAGNOSES BY PRIORITY:
Ineffective breathing pattern related to pressure on diaphragm due to increased amniotic fluid
Acute pain related to fetal movements
Activity intolerance related to enlargement of uterus
Anxiety related to fetal outcome
Risk for fetal injury related to uteroplacental insufficiency manifested by decreased amniotic fluid.

NURSE CARE PLAN:
Ineffective breathing pattern related to pressure on diaphragm due to increased amniotic fluid
Acute pain related to fetal movements
Activity intolerance related to enlargement of uterus
NURSING MANAGEMENT / INTERVENTION:
The patient should maintain bed rest in order to increase the uteroplacental circulation and reduces pressure on the cervix that might help prevent preterm labor. The client should be taught that it is vitally important to report any sign of ruptured membranes or uterine contractions. Straining defecation might increase the uterine pressure and cause a rupture of membranes so it better to advise her that she needs to eat high – fiber diet to avoid constipation or suggest a stool softener if diet is not effective. Her vital signs should be always asses frequently as well as her lower extremity edema.

MEDICAL / SURGICAL MANAGEMENT:
In polyhydramnios, amniocentesis can be performed to remove some of the extra fluid, however, this may be done almost everyday to be effective since the amniotic fluid is being replaced rapidly. To prevent sudden loss of fluid and the accompanying danger of a prolapsed cord during labor, membranes can be needled, where a thin needle is inserted vaginally to pierce them, to allow a slow controlled release of fluid. After birth, the infant must be assess carefully for factors that may have interfered with the ability to swallow in utero such as gastrointestinal blockage. In oligohydramnios, vesico – amniotic shunts will be done since this procedure involves diverting the fetal urine into the uterus in women with fetal obstructive uropathy. Infants need to be careful inspected at birth to rule out kidney disease and compromised lung development.

REFERENCES:

  • Doenges, M.E., Moorhouse, M.F., & Murr, A.C. (2016). Nurse’s Pocket Guide: Diagnoses, Prioritized Interventions, and Rationales. Philadelphia, Pennsylvania: F.A. DAVIS COMPANY
  • Potter et. Al (2017). Fundamentals of Nursing (9th ed.). Singapore: Elsevier Inc.

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