Anemia of Prematurity - Portal Neonatal

• Studies show an increased risk of associated fetal anomalies in more severe forms of
polyhydramnios. In series in 1990, 20% of cases of polyhydramnios involved associated fetal
anomalies, including problems of the gastrointestinal system (40%), central nervous system
(26%), cardiovascular system (22%), or genitourinary system (13%). Among these cases of
polyhydramnios, multiple gestations occurred in 7.5%, 5% were due to maternal diabetes,
and the remaining 8.5% were due to other causes. However, at least 50% of the patients
had no associated risk factors.
• The mortality rate in oligohydramnios is high. The lack of amniotic fluid allows compression
of the fetal abdomen, which limits movement of its diaphragm. In addition to chest wall
fixation, this limitation leads to pulmonary hypoplasia. Oligohydramnios is also associated
with meconium staining of the amniotic fluid, fetal heart conduction abnormalities, poor
tolerance of labor, lower Apgar scores, and fetal acidosis. In cases of intrauterine growth
restriction (IUGR), the degree of oligohydramnios is often proportional to growth restriction,
and it is associated with a corresponding increase in the PMR.
• In twin gestation with twin-to-twin transfusion, polyhydramnios may exist in the recipient twin,
and oligohydramnios may exist in the donor. This complication is associated with high
morbidity and mortality rates.
Age: No age variables exist.
Physical:
CLINICAL Section 3 of 9
• Amniotic fluid
o The volume of the amniotic fluid is evaluated by visually dividing the mother's abdomen
into 4 quadrants. The largest vertical pocket of fluid is measured in centimeters. The total
volume is calculated by multiplying this value by 4.
o Polyhydramnios is usually defined as an amniotic fluid index (AFI) more than 24 cm or a
single pocket of fluid at least 8 cm in deep that results in more than 2000 mL of fluid.
o Oligohydramnios is sonographically defined as an AFI less than 7 cm or the absence of
a fluid pocket 2-3 cm in depth.
• Polyhydramnios
o Visual inspection may reveal a rapidly enlarging uterus in the pregnant mother
o Multiple gestations are associated with polyhydramnios.
o Fetal abnormalities associated with polyhydramnios include neonatal macrosomia, fetal
or neonatal hydrops with anasarca, ascites, and pleural or pericardial effusions.
o Skeletal malformations also can occur; these include congenital hip dislocation, clubfoot,
and limb reduction defect.
o Attempt to identify abnormalities in fetal movement suggestive of neurologic
abnormalities and obstruction of the gastrointestinal tract.
• Oligohydramnios
o When the oligohydramnios is associated with renal agenesis, symptoms include a
marked deformation of the fetus due to of intrauterine constraint (Potter syndrome).
o Other 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 also may occur.
o Oligohydramnios adversely affects fetal lung development, resulting in pulmonary
hypoplasia that typically leads to death from severe respiratory insufficiency. Findings
associated with pulmonary hypoplasia include bowed legs, clubbed feet, a single