22/10/2017 Polyhydramnios and Oligohydramnios Clinical Presentation: Physical Examination

Polyhydramnios and
Oligohydramnios Clinical Presentation
Updated: Sep 20, 2017
Author: Brian S Carter, MD, FAAP; Chief Editor: Dharmendra J Nimavat, MD, FAAP more...

PRESENTATION

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 total volume is
calculated by multiplying this value by 4.

Polyhydramnios is usually defined as an amniotic fluid index (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

https://reference.medscape.com/article/975821-clinical 1/2
22/10/2017 Polyhydramnios and Oligohydramnios Clinical Presentation: Physical Examination

(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

https://reference.medscape.com/article/975821-clinical 2/2