Physical Examination

Amniotic fluid

The volume of the amniotic fluid is evaluated by visually dividing the mother's abdomen into four quadrants. The largest vertical pocket of fluid is measured in centimeters. The sum of these measurements is the amniotic fluid index (AFI).

Polyhydramnios is usually defined as an AFI of more than 24 cm or a single pocket of fluid at least 8 cm in depth that results in an amniotic fluid volume of more than 2000 mL.^[14]

Oligohydramnios is ultrasonographically defined as an AFI less than 7 cm or the absence of a fluid pocket 2-3 cm in depth.

Polyhydramnios

Visual inspection may reveal a rapidly enlarging uterus in the pregnant mother. Multiple gestations are associated with polyhydramnios.

Fetal abnormalities associated with polyhydramnios include neonatal macrosomia, fetal or neonatal hydrops with anasarca, ascites, pleural or pericardial effusions, and gastrointestinal tract obstruction (eg, duodenal atresia, tracheoesophageal fistula).

Skeletal malformations can also occur, including congenital hip dislocation, clubfoot, and limb reduction defect.

Abnormalities in fetal movement are suggestive of primary neurologic abnormalities or may be in association with a genetic syndrome, such as polyploidy.

Oligohydramnios

When the oligohydramnios is associated with renal agenesis or dysgenesis, symptoms/signs include a marked deformation of the fetus due to of intrauterine constraint (Potter syndrome). Obstructive uropathies cause similar deformations, including external compression with a flattened facies and epicanthal folds, hypertelorism, low-set ears, a mongoloid slant of the palpebral fissure, a crease below the lower lip, and micrognathia. Thoracic compression may also occur.

Oligohydramnios adversely affects fetal lung development, resulting in pulmonary hypoplasia that typically leads to death from severe respiratory insufficiency. Other fetal deformations include bowed legs, clubbed feet, a single umbilical artery, gastrointestinal atresias, and a narrow chest secondary to external compression. Infants are typically small for their stated gestational age (SGA).^[15] When an abdominal mass is found on examination of the infant in this clinical setting, it often represents multicystic-dysplastic kidney, enlarged urinary bladder, or prune-belly syndrome.

Workup

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Author

Brian S Carter, MD, FAAP Professor of Pediatrics, University of Missouri-Kansas City School of Medicine; Attending Physician, Division of Neonatology, Children's Mercy Hospital and Clinics; Faculty, Children's Mercy Bioethics Center

Brian S Carter, MD, FAAP is a member of the following medical societies: Alpha Omega Alpha, American Academy of Hospice and Palliative Medicine, American Academy of Pediatrics, American Pediatric Society, American Society for Bioethics and Humanities, American Society of Law, Medicine & Ethics, Society for Pediatric Research, National Hospice and Palliative Care Organization

Disclosure: Nothing to disclose.

Coauthor(s)

Roland L Boyd, DO Neonatologist, Section of Neonatology, Neonatal Services, Ltd

Roland L Boyd, DO is a member of the following medical societies: American Academy of Osteopathy, American Academy of Pediatrics, American College of Osteopathic Pediatricians

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

David A Clark, MD Professor and Martha Lepow Chairman of Pediatrics, Professor of Obstetrics and Gynecology, Albany Medical College; Director, Children's Hospital at Albany Medical Center

David A Clark, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American College of Nutrition, American Forestry Association, American Pediatric Society, Capital District Pediatric Society, Christian Medical and Dental Associations, European Society for Paediatric Research, Eastern Society for Pediatric Research, Floyd W Denny Pediatric Alumni Society, Medical Society of the State of New York, New York Academy of Sciences, Society for Pediatric Research

Disclosure: Nothing to disclose.

Chief Editor

Dharmendra J Nimavat, MD, FAAP Associate Professor of Clinical Pediatrics, Department of Pediatrics, Division of Neonatology, Southern Illinois University School of Medicine; Staff Neonatologist, Clinical Director, NICU Regional Perinatal Center, HSHS St John's Children's Hospital

Dharmendra J Nimavat, MD, FAAP is a member of the following medical societies: American Academy of Pediatrics, American Association of Physicians of Indian Origin

Disclosure: Nothing to disclose.

Additional Contributors

Ted Rosenkrantz, MD Professor, Departments of Pediatrics and Obstetrics/Gynecology, Division of Neonatal-Perinatal Medicine, University of Connecticut School of Medicine

Ted Rosenkrantz, MD is a member of the following medical societies: American Academy of Pediatrics, American Pediatric Society, Eastern Society for Pediatric Research, American Medical Association, Connecticut State Medical Society, Society for Pediatric Research

Disclosure: Nothing to disclose.

Sections Polyhydramnios and Oligohydramnios
Overview
Presentation
Workup
Treatment
Medication
References

Polyhydramnios and Oligohydramnios Clinical Presentation

Physical Examination

Amniotic fluid

Polyhydramnios

Oligohydramnios

References

Tables

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