Pregnancy is a physiological thing, even though during pregnancy many things change in the body. Pregnancy that concerns the lives of mothers and children must be considered, because pregnancy is not just saving children for a period of 9 months and then ready to be born. But pregnancy must pay attention to maternal and child health. During pregnancy many pathological things are also experienced by pregnant women, one of which is oligohydromions.
Oligohydramnios refers to amniotic fluid volume that is less than expected for gestational age. It is typically diagnosed by ultrasound examination and may be described qualitatively (eg, normal, reduced) or quantitatively (eg, amniotic fluid index [AFI] ≤5). An adequate volume of amniotic fluid is critical to allow normal fetal movement and growth, and to cushion the fetus and umbilical cord. Oligohydramnios may inhibit these processes and can lead to fetal deformation, umbilical cord compression, and death. (Beloosesky and Ross)
Amniotic fluid is one part of a baby's life support system that is formed around 12 days after conception. This liquid can protect the baby and help the growth and development of muscles, legs, lungs and digestive system of the baby, to be a cushion to protect the fetus from external trauma, stabilize temperature changes, exchange fluids, a means that allows the fetus to move freely, to regulate internal pressure uterus. Not only that amniotic water also functions to protect the fetus from infection.
At first the amniotic fluid contained water from the mother, but at gestational age 20 weeks the amniotic fluid contained the urine of the fetus. This amniotic fluid can be too low or too high, if it is too low it is called oligohydramnios and if it is too high it is called polyhydramnios. This amniotic fluid should not be small, but some complications can cause the amniotic fluid of pregnant women to run out which can endanger pregnant women and babies.
Amniotic fluid is usually produced by the fetus and mother, and both have their own roles at each gestational age. In early pregnancy, amniotic fluid is mostly produced by the secretion of the amniotic membrane epithelium. With increasing gestational age, the production of amniotic fluid is dominated by the skin of the fetus by membrane diffusion. At 20 weeks' gestation, when the fetus's skin begins to lose its permeability, the fetal kidney takes over this role in producing amniotic fluid. At term pregnancy, about 500 ml per day of amniotic fluid is secreted from fetal urine and 200 ml comes from tracheal fluid. In studies using radioisotopes, an exchange of about 500 ml per hour between maternal plasma and amniotic fluid in the presence of a disturbance in the fetal kidney, such as renal agenesis, will cause oligohydramnios.
The exact cause of Oligohydramnios is unclear, but is thought to be related to fetal renal agenosis. Other primary etiologies may be because amniotic growth is not good and other secondary etiologies, for example in premature rupture of membranes.
Secondary causes are usually associated with:
1. Rupture of the amniotic membrane
2. Decreasing kidney function or the occurrence of congenital kidney abnormalities in the fetus so that the fetal urine production is reduced, even though the urine of the fetus is one of the sources of the formation of amniotic water
3. Post-term pregnancy resulting in decreased placental function.
4. Impaired fetal growth
5. Maternal diseases such as hypertension, diabetes mellitus, blood clotting disorders, and the presence of autoimmune diseases such as Lupus.
Signs and Symptoms of Oligohydramnios
1. The mother feels pain when the fetus moves in the womb
2. When the membranes rupture, the fluid that comes out is very little or none at all and feels very painful during contractions
3. The uterus appears smaller than gestational age and there is no ballotment.
4. The mother feels pain in the abdomen at every movement of the fetus.
5. Often ends with prematurous delivery.
6. The child's heart sounds have been heard from the fifth month and sound more clearly.
7. Labor is longer than usual.
8. When the contraction is very painful.
9. If the membranes rupture, there is very little amniotic fluid and no one even comes out.
10. The fetus is easily moved.
11. Deceleration of fundal height
Nursing Assessment of Oligohydromions
a. Assessment
1. The stomach feels bigger and heavier than normal
2. Shortness of breath, some mothers experience severe shortness of breath, in extreme cases the mother can only breathe when standing upright
3. Heartburn and cyanosis
4. Abdominal pain due to tense uterus
5. Oliguria. Cases are very rare. This occurs because the urethra has obstruction due to the enlarged uterus over normal pregnancy.
b. Inspection
1. The stomach looks very distended and tense, the stomach skin is shiny, the cracks of the skin are clear and sometimes the umbilicus is flat
2. Mother looks short of breath and cyanosis and looks bad because of pregnancy
3. Edema in both legs, vu.va and abdomen. This occurs because of compression of most of the venous system due to the uterus being too large
c. Palpation
1. Stomach tense and tenderness
2. Uterus fundus is higher than the actual gestational age
3. Fetal parts are difficult to recognize
d. Auscultation
1. Fetal heart rate is difficult to hear
Oligohydramnios - Nursing Care Plan
Reference :
1. Ron Beloosesky, MD and Michael G Ross, MD, MPH. https://www.uptodate.com/contents/oligohydramnios
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Nursing Assessment
