Oligohydramnios & Polyhydramnios

Oligohydramnios is too little amniotic fluid, an amniotic fluid index of 5 cm or less, and polyhydramnios is too much, an index of 24 cm or more, against a normal range of 5 to 24 cm. Because fetal urine makes much of the fluid, oligohydramnios comes from fetal kidney or urinary tract problems, ruptured membranes, placental insufficiency, post-term pregnancy, and maternal ACE inhibitors or NSAIDs. The fundus measures small for dates, and in labor the unprotected cord is compressed during contractions, so the nurse monitors the fetal heart rate continuously, reports variable or prolonged decelerations, and may assist with amnioinfusion. Polyhydramnios comes from maternal diabetes, a fetus that cannot swallow fluid, multiple gestation or fetal anemia, and often no cause is found. The fundus measures large for dates and the client may be short of breath, eased by a semi-Fowler's or side-lying position. When the membranes rupture, the nurse checks the fetal heart rate and the perineum for a prolapsed cord. After birth, the overstretched uterus is watched for atony and hemorrhage, and the newborn for esophageal atresia.