Case Study for Oligohydramnios

Wesleyan University Philippines Mabini Extension Cabanatuan City, N.E College of Nursing

 A CASE STUDY ON

OLIGOHYDRAMNIOS

Submitted By: BJ ADETTE J. HILARIO BSN III- Blk.3

Submitted To: Clinical Instructor Fe Adriano RN, MAN.

I. Introduction

Oligohydramnios is a condition in pregnancy characterized by a deficiency of   amniotic fluid.  The common clinical features are smaller symphysio fundal height, fetal malpresentation, undue prominence of fetal parts and reduced amount of amniotic fluid. It is typically caused by fetal urinary tract abnormalities such as unilateral renal agenesis ( Potter's syndrome ), fetal polycystic kidneys, or genitourinary obstruction. Uteroplacental insufficiency is another common cause. Most of these abnormalities can also be detected by obstetric ultrasound. It may also occur simply due to dehydration of the mother, maternal use of angiotensin converting enzyme inhibitors, or without a determinable cause (idiopathic).

II. History Taking

a. Information i. ii. iii. iv. v. vi. vii. viii. ix. x. xi. xii. xiii.

Name: Jocelyn Tapang Japones  Age: 32 years old Gender: Female Birthday: August 17, 1980 Birth place: General Natividad Marital Status: Married  Address: 149, Balangkare Norte, General Natividad, Nueva Ecija Occupation: N/A Religion: Iglesia Ni Cristo Nationality: Filipino Spouse Name: Herb Japones

Father’s Name: Alfredo Tapang Mother’s Name: Adelina Tapang

b.  Admission Record  Admitting Date: 22-Nov-2012  Admitting Time: 2:35am  Attending Physician: Amorin, Edeliza MD c. Initial diagnosis: G4P1, (1021), PU 36 5/7 weeks AOG, Oligohydramnios d. Final diagnosis: G4P2 (1102) delivered operatively to a live, preterm baby girl/ BW= 1.9kg, APAS, uterine varicosities; Oligohydramnios e. Operation Performed: Lower Transverse Cesarean Section (LTCS) (midline) f. History of Present Illness G4P1 (1021). Known case of APAS during this pregnancy. On regular PNCU today, (+) Oligohydramnios noted on ultrasound. Advised primary LTCS. g. Past Medical/ Health History Unremarkable (+) Hypertension (+) Diabetes Mellitus h. OB-Gyne History G4P1 (1021)  AOG 36 5/7 weeks LMP 3/10/2012 i.  Allergies: SMC, Celecoxib

III. Collecting Objective Data a. Course of Confinement i.

Medications administered since date of admission

Physician’s Order:

ii.

METRONIDAZOLE 500mg every 8 hours intravenously KETOROLAC 30mg every 8 hours as necessary for pain intravenously METRONIDAZOLE 500mg/tablet 1 tablet 3x a day per orem CEFUROXIME 5oomg/capsule 1 capsule 2x a day per orem TRAMADOL 37.5, PARACETAMOL 325mg (Algesia)/tablet 1 tablet 3x a day round the clock per orem

IVF, BT and other parenteral medication infused/administered since date of admission

IVF: D5LRS 1L for 8 hours 41-42 gtts/min

iii.

 All diagnostic tests made to patient since date of admission

 Variables Hemoglobin Hematocrit Red Cell Count White Cell Count Platelet Count

Normal Value Male: 130-170 g/L Female: 120-150 g/L Male: 0.40-0.50 Female: 0.37-0.45 Male: 4.5-5.5 x10 12/L Female: 4.6-5.2 x10 12/L 5-10 x10g/L Manual: 150-400 x10/L Machine: 130-500 x10/L

Nucleated RBC/100WBC Reticulocyte CT

Adult: 0.5%-1.5% Newborn: 2.0%-6.0%

Result 135 0.43 6.02 x10 1/L 18.52 x10g/L  __ x10/L

MCV

80-100fl

72.8fl

MCH

27-31

MCHC

32-36 g/dL

30.8 g/dL

RDW CV

11.6-14.6%

17.1%

22.4

Differential Count Neutrophils

0.55-0.65

0.89

Lymphocytes

0.25-0.35

0.09

Monocytes

0.02-0.06

0.02

Eosinophils

0.02-0.04

Basophils

0-0.005

Stabs

0-0.05

Others

iv.

Other relevant events during hospitalization 

None.

b. Physical Assessment i.

General Appearance:  Ambulatory Coherent  

ii.

Weight and Vital Signs Weight-58 kg.  Vital Signs Blood Pressure- 110/80 mmHg  Temperature- 36.8 ˚C  Pulse Rate- 72 bpm  Respiratory Rate- 18 bpm  

iii.

HEENT: Pink, PC, AS 

iv.

Neurologic Exam: E/N 

v.

Chest and Lungs: SCE, CBS 

vi.

Heart:  AP NRRR  

vii.

 Abdomen: Soft, round, FHT 

viii.

Extremities: Pulses, full and equal 

IV.  Anatomy and Physiology

 Amniotic fluid is a clear, slightly yellowish liquid that surrounds the unborn baby (fetus) during pregnancy. It is contained in the amniotic sac. While in the womb, the baby floats in the amniotic fluid. The amount of amniotic fluid is greatest at about 34 weeks (gestation) into the pregnancy, when it averages 800 mL. Approximately 600 mL of amniotic fluid surrounds the baby at full term (40 weeks gestation). The amniotic fluid constantly moves (circulates) as the baby swallows and "inhales" the fluid, and then releases it. The amniotic fluid helps: 

The developing baby to move in the womb, which allows for proper bone growth

  

The lungs to develop properly Keep a relatively constant temperature around the baby, protecting from heat loss Protect the baby from outside injury by cushioning sudden blows or movements

 An excessive amount of amniotic fluid is called polyhydramnios. This condition can occur with multiple pregnancy (twins or triplets), congenital anomalies (problems that exist when the baby is born), or gestational diabetes.  An abnormally small amount of amniotic fluid is known as oligohydramnios. This condition may occur with late pregnancies, ruptured membranes, placental dysfunction, or fetal abnormalities.  Abnormal amounts of amniotic fluid may cause the health care provider to watch the pregnancy more carefully. Removal of a sample of the fluid, through  amniocentesis, can provide information about the sex, health, and development of the fetus.

 V. Treatment   

Close medical supervision of the mother and fetus. Fetal monitoring

 Amnioinfusion (infusion of warmed sterile normal saline or lactated Ringer’s solution) to treat or prevent variable decelerations during labor.

 VI. Nursing Intervention

1. Monitor maternal and fetal status closely, including vital signs and fetal heart rate patterns. 2. Monitor maternal weight gain pattern, notifying the health care provider if weight loss occurs. 3. Provide emotional support before, during, and after ultrasonography. 4. Inform the patient about coping measures if fetal anomalies are suspected. 5. Instruct her about signs and symptoms of labor, including those she’ll need to report immediately. 6. Reinforce the need for close supervision and follow up. 7.  Assist with amnioinfusion as indicated. 8. Encourage the patient to lie on her left side. 9. Ensure that amnioinfusion solution is warmed to body temperature. 10.Continuously monitor maternal vital signs and fetal heart rate during the amnioinfusion procedure. 11.Note the development of any uterine contractions, notify the health care provider, and continue to monitor closely. 12.Maintain strict sterile technique during amnioinfusion.