GOVT.

COLLEGE OF
NURSING,JODHPUR

Case study
On
Oligohydramnios

SUBMITTED TO: SUBMITTED BY:

Mrs. JYOTI BALA JANGID PRIYANKA GEHLOT
NURSING LECTURER M.Sc. (N) FINALYEAR
GOVT. COLLEGE OF NURSING BATCH-2019

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 CASE STUDY:-
 BIODATA OF THE CLIENT:
 Name :Mrs. Bimla
 Age : 22 years
 Sex : Female
 Register no: 13608
 Ward : Antenatal ward
 Cot no :6
 Doctor’s unit: Dr. ranjana (GUC unit )
 Admission date: 20-8-21
 Education: 10th passed
 Occupation: house wife
 Income :- 9000/ month
 Address :- c.h.b. jodhpur
 Nationality: Indian
 Marital status: married
 LMP :- 10-12-2020
 EDD :- 17-9-2021
 Obstetrics score: G1P0A0L0
 Diagnosis: Oligohydramnios
 Surgery : no any surgery

PRESENT OBSTETRICAL HISTORY:

 My client bimla is primipara women and 22 years old , on date of admission morning she is came for
routine antenatal examination that time doctors found that oligohydramnions .
 She was admitted on Date : 20-8-2021in umaid hospital.
 At present she having Mild abdominal pain, back pain and no other complain.
 After examination (USG) find that there is vertex presentation and less amniotic fluid index that is 9.5
cm.

CHIEF COMPLAIN WITH DURATION:-

Mrs. bimla having complain of less fetal movement since 1 weeks

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 PAST HISTORY:

Medical and surgical history

 She had no history of TB, hypertension, diabetes mellitus, other medical complains or surgical history in
past.

Past obstetrical history:-

S.NO Year full pre Abortion type of Baby remarks
. term term delivery still
Sex alive born Weight
ND with
1 2010 yes - - episiotomy F Yes - 2.8 kg Good

FAMILY HISTORY:-

Name Age Sex Relationa Education Occupation Income Remark

l ship
with
patient

Mr. Mohanlal ji 58 M Father in 7th passed Shopkeeper 5000/ -

yrs law
month

Mrs. Reema 54 F Mother in 5th passed House wife - -

yrs low

Mr. Ashish ji 26 M Husband B.A passed Factory 10000/ -

yrs worker month

Mrs. bimla 22 F Self 10thpassed House wife - -

yrs

-
Farhana M. Mirza 2yrs F Daughter - - -

Except patient, no any family members having disease like T.B , diabetes, hypertension, heart disease, asthma.

There is no history of any blood or psychiatric disorder.

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SOCIO ECONOMIC HISTORY:

 Client lives in joint family . She is a house wife & her husband and father in low are an earning person
in her family. Monthly income are 9000/ month so Their economic condition is not very good.
 Her family members are very supportive to her. In the hospital, one member always remains with client.
Her social relations with family members, friends and neighbours are good and heathy.
 Her social status in her community is good. She participates in allsocial & family functions.

MENSTRUAL HISTORY :
 The age of menarche started is 14 years.
 Interval is 35 days. Duration is 3 days.
 Before pregnancy she is having regular menstrual cycle and normal flow.

Marital history :-

Age of marriage: - she married when she was 18 years old.

Present pregnancy:-
 Admission notes
Admitted on :- 20-8-2021
 Height of fund :- 32 cm
 Presentation: - Vertex presentation .
 Position: - LOA.
 Engaged/not engaged/free :- not engaged
 FHR :- 148 beats / min

PRENATAL VISITS:-
Date of Weight Height Urine B.P FHR Weeks of Height Treatment
booking Gestation of
fundus
Protein Glucose
11.1.2021 60 kg 154 cm Nill Nill 120/80 -- 6 weeks - -
11.3.2021 61 kg 154 cm Nill Nill 120/80 - 13weeks - Inj.TT+
mm of tab. Iron
Hg
11.5.2021 63 kg 154 cm Nill Nill 124/86 - 18 weeks 18 cm Tab. Iron
15.8.2021 65 kg 154 cm Nill Nill 118/80 - 24 weeks 24 cm Tab. Iron

 GENERAL CONDITION
B.P. : - 120/80

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T P R: - Temperature: - 97.4 ‘F., Pulse: - 88 beats / min, Respiration:- 22b/min
Urine: Specific. Gravity: - 1.014
Reaction: - acidic
Protein: - absent
Glucose: - absent

HEAD TO TOE EXAMINATION

 Head: No dandruff was present but hairs become rough. Noskull injury or scalp.

 FACE: Face looking anxious by facial expression.

 EYES: Eyes were clean, conjunctiva appeared light pink colour and sclera appeared whitish
in colour, eye sight of patient was normal. No discharge was present in the patient’s eye.
 EAR: Ears were normal in size in shape, hearing was normal, no any discharge
was Present in the ear, both ears were clean.
 NOSE: No septal deviation was there. Curvature of nose appeared normal.
No complication was seen in the patient.

 MOUTH: No cracked lips were present, tongue was appeared pale in colour ,
Ulcer was not present in the patient’s mouth. Slight yellow discoloration was seen in the teeth.

 NECK :- No enlargement of the lymph node.

 CHEST:-Shape and size of the chest was normal. There was symmetrical movement
of both chest.

 BREAST: Primary and secondary areolas are Present. Montego marries tubercles are
prominent. No palpable mass in both breast. Nipple is retracted.

 ABDOMEN:
- Inspection: linea nigra and strea gravidarum are present on abdomen , abdomen look ovoid shape, and
there is no any previous scar marks.
- Abdominal Palpation:
Fundal grip :- feel smooth , soft and globular mass suggest of breech of fetus.
Lateral grip:- left lateral side smooth curved mass feel means back is there, right lateral side irregular mass
feel means extremities are present.
Pelvic grip :- hard globular mass feel means head is present.
Pawlik grip :- present part is floating not engage now
- Fundal Height: 32 cm. from symphysis pubis
- Abdominal girth :- 84 cm

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- Mother having mild abdominal pain due to labour process.

 BACK: back pain due to labour process, Normal Curvature.

 EXTRIMITIES: not any abnormality in Extremities. Normal range of motion.
 GENITAL ORGAN :- No any abnormal discharge and any genital infection.

Vital signs of patient :-

Vital signs Patient value Normal value

Temperature 96.4F 96.8- 97.2 F

Pulse 88 beats / min 80-86 beats/ min

Respiration 20breath/ min 20 breaths/ min

Blood pressure 120/80 mm of Hg 120/ 80 mm of Hg

Investigation :-

Name of investigation Patient value Normal value

Complete blood count

- Hb 9.1 gm % 13 – 15 gm %

- RBC 4.8million/cumm 4.5 -5.0 million/cumm

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 - Platelet count 2.9 lakh/ cumm 1.5-4.5 lakh/cumm

Differential count:-

Neutrophils 52% 50- 70%

Lymphocytes 24 % 22-40%

Monocytes 3% 2-6%

Eosinophils 1% 1-6%

Basophils 0 0-2.5%

Blood group A Negative -

HbS Ag Negative Negative

VDRL test Non reactive Non reactive

Abdominal USG - gravid uterus seen single live Normal

intrauterine fetus with breech
presentation with 33 weeks gestation.+
oligohydramnions

And amniotic fluid index 9.5 cm (3.2+

2.7+ 2.8+ 1.5)

Placenta located anteriorly

HIV test Non reactive Non reactive

Urine report

Colour Dark yellow Pale yellow

Odour Aromatic Aromatic

Reaction Acidic (5.5) Slight acidic

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 Specific gravity 1.025 1.o16-1.026

Urine Albumine Negative Negative

Urine sugar Negative Negative

Treatment:-

Drug name Dose Route Time

Inj. D10 % 1 pint Iv slow o.d

Tab. Rekfa 150 mg Orally b.d

Tab. Iron 200 mg Orally b.d

Tab. Calcium 500 mg Orally o.d

Tab. Vitamin C 500 mg Orally b.d

Disease condition of Oligohydramnios

Definition:-
It is an extremely rare condition where the liquior amnii is deficient in amount to the extent of less than 200 ml
at term. Sonographically it is defined when the maximum vertical pole of liquor is less than 2 cm and amniotic
fluid index less than 5 cm .

Scanty liquor so often present in clinical practice should not be designated as oligohydramnions in the true
sense.

Etiology:-
In the book In my patient
Unknown Unknown
Fetal chromosomal anomalies Absent
Intrauterine infection Absent
Drug used like PG inhibitors, ACE inhibitors Absent
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 Renal agenesis or obstruction of urinary tract to Absent
preventing micturition
IUGR associated with placental insufficiency Absent
Amnion nodosum Absent
Post maturity Absent

Sign and symptoms:-

In book In my patient
Uterine size is much smaller than the period of Uterus size smaller than gestation weeks
amenorrhoea
Less than fetal movements Less fetal movements
The uterus is full of fetus because of scanty liquior Less liquiors so uterus like full of bladder
Malpresentation – breech Vertex– normalpresentation present
Evidences of intrauterine growth retardation of the -
fetus
Sonographic diagnosis is made when largest liquor -
pool is s
Chromosomal anomalies -

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Investigation:-

Name of investigation Result Normal value Done in Not done Remark

patient in patient

Routine blood
investigation :-

Hemoglobin 8.1 mg% 13-15 mg% Done - Moderate anaemic

RBC 4.8 million 4.5million to Done - Normal

/cumm 5.1million

WBC 10500/cumm 4000 to 11000 Done - Normal

cumm

Blood group A Negative A,B,AB,O Done - Risk of

isoimmunization

HbsAg test Negative Non reactive Done - Normal

HIV test Non reactive Nonreactive Done - Normal

Platelets count 1.9lakh/ cumm 1.5-4.5 lakh/ Done - Normal

cumm

Abdominal - 34 weeks Normal all Done - Mild polyhydra

sonography gravid uterus abdominal amnion and vertex
seen single organ and presentation
intrauterine live fetus, placenta
fetus with are normal
olighydraamnio ,AFI normal
ns

AFI is 4.5 cm

X- ray study - - - Not done

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 Urine test - -

Colour Dark yellow Pale yellow Done Abnormal

Reaction Acidic (5.5) Slight acidic Done Normal

Odour Aromatic Aromatic

Specific gravity 1.016 1.016-1.026 Done Normal

Urine Albumine Negative Negative Done Protein in urine

Urine sugar Negative Negative Done Normal

Urea 20 mg/dl 15-45 Done Normal

Bio-chemistry

SGPT 24U/L 0-55 Done Normal

S. Creatinine o.60 0.7-1.5 mg/dl Done Normal

Bilirubine (D) o.4 mg/dl 0-0.5 Done Normal

Bilirubine total 0.8 mg/dl 0.2-1.2 Done Normal

Prothrombine time 15.8 sec 9.5- 18 Done Normal

Complication:-

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 In book In my patient
Fetal complication :- Absent
Abortion Absent
Deformity in shape of the skull Absent
Wry neck Absent
Club foot Absent
Fetal pulmonary hypoplasia Absent
Cord compression Absent
High fetal mortality Absent
Maternal :-
Prolonged labour due to inertia Absent
Increased operative interference Absent
Malformation ( breech presentation) Breech presentation
Increased maternal morbidity Absent

Managements: - in book
Treatment options include:

 More fluid intake. Some studies have found that having women drink two liters of water can increase
the amount of amniotic fluid.
 . Drink plenty of fluids, rest more often,
 Stop smoking, and eat a healthful diet.
 If any signs of early labor (such as contractions or vaginal bleeding) contact your doctor right away.
1) the women had an AFI ≤5 cm (n = 66) :- at term to expectant management or induction Maternal
Hydration
2) the women in the other group had an AFI of >5 cm. increased rate of cesarean section secondary to fetal
distress
- If expectant management is desired, maternal hydration can increase the AFI. Oral or IV maternal
hydration has been studied as a treatment for oligohydramnios in women with otherwise healthy term
pregnancies
3) Maternal Hydration
4) One approach to treating oligohydramnios during labor is to perform an amniotomy followed by
amnioinfusion to increase the fluid inside the uterus. the majority of the amniotic fluid is produced
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 through fetal urine production and is reabsorbed through fetal swallowing. Amniotic fluid is also
reabsorbed via the fetal lungs and by the placenta. Maternal hydration and maternal osmolarity affect the
amount of amniotic fluid available to the fetus for urine production and reabsorption near term.
5) Hydration is a simple, inexpensive, and noninvasive method that may apply to clinical situations.

Prevention-
The only way to prevent oligohydramnios is to treat its causes if possible. Getting regular check-ups

Management in my client :-(Medical management )

Treatment:-

Dose Route Time

Inj. D10 % 1 pint Iv slow o.d

Tab. Rekfa 150 mg Orally b.d

Tab. Iron 200 mg Orally b.d

Tab. Calcium 500 mg Orally o.d

Tab. Vitamin C 500 mg Orally b.d

In my client done expectant management so administered daily inj. D 10% to maintain hydration status and
increased amniotic fluid volume .
- Regular check up of maternal and fetal monitoring.
- Advised women to drink coconut water and take more oral fluids.
No any surgical management , after 6 days given discharge to my client and told her to come after 1 week for
check up.

NURSING PROCESS :- ( Oligohydramnions)

Application of Virginia Henderson’s theory :

 Virginia Henderson defined nursing as "assisting individuals to gain independence in relation to the
performance of activities contributing to health or its recovery" (Henderson, 1966).
 She categorized nursing activities into 14 components, based on human needs. 

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  She described the nurse's role as substitutive (doing for the person), supplementary (helping the person),
complementary (working with the person), with the goal of helping the person become as independent as
possible.

Henderson’s 14 activities for client assistance (Basic Needs)

 Breathe normally. Eat and drink adequately.

 Eliminate body wastes.
 Move and maintain desirable postures.
 Sleep and rest.
 Select suitable clothes-dress and undress.
 Maintain body temperature within normal range by adjusting clothing and modifying environment
 Keep the body clean and well groomed and protect the integument
 Avoid dangers in the environment and avoid injuring others.
 Communicate with others in expressing emotions, needs, fears, or opinions.
 Worship according to one’s faith.
 Work in such a way that there is a sense of accomplishment.
 Play or participate in various forms of recreation.
 Learn, discover, or satisfy the curiosity that leads to normal development and health and use the
available health facilities.

Dietary management :-

Early morning:

The early morning should start with tea and biscuits

Breakfast:

The breakfast should consist of easily digestible food and fruits like bread , papaya orange

Lunch:

The patient have lunch with whole grain like well cooked rice, green leafy vegetables containing more iron
and well cooked rice ,dal

Evening tea:

It can be with fruit juice or with tea or coffee

Dinner:

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It should start with soup (vegetable soup or chicken soup). Dinner should be with blend soft rice mixed with
vegetables, etc.

Advised to eat food containing more iron like drum stick, juggery and green leafy vegetable.

Diet plan :

Sr.no Name Time menu Amoun Calorie CHO Protein Fat Iron Calcium
age,sex t
1. Mrs. Ashika 6am Tea 100ml 36 6.5g 0.7g 0.8g ----- 0.03g
22 years 7am Idili 2-nos 130 27.6 4.6g 0.2g 0.6g 0.02g
(136)
10am Milk 1cup 216 9.2g 8.4g 16g 0.8g 0.24g
(200ml)
1pm roti 2nos 168 52.5g 7.5g 1.3g 4.5g 0.02g
brinjal (150g)
vegetabl ½ plate 56 6.1g 1.5g 5.6g 0.9g 0.04g
4 pm e (56g)
Milk or
tea
6 pm 100ml 36 6.5g 0.7g 0.8g ----- 0.03g
Roti, 200ml 216 9.2g 8.4g 16g 0.8g 0.24g
sbaji, and2nos 168 52.5g 7.5g 1.3g 4.5g 0.02g
khichdi (150g)
curry ½ plate 56 6.1g 1.5g 5.6g 0.9g 0.04g
(56g)
Bengal 1serving 118 26.8g 2.4g 0.2g 0.004 1.0g
gram dal. (100g) g
½ cup 25.2g 9.0g 16.4g 0.14g 5.5g
(150g)
0.8g

10pm 200ml 216 9.2g 8.4g 16g 0.24g

Milk

PROGRESS CHART:-

 Day:-1
My client Mrs. Ashika was admitted in V.S hospital with complain of abdominal pain, back pain and
oligohydramnions.

- treatment received from antenatal ward , here after admission done routine blood examination .
- Done USG for identification oligohydramnions.

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 Vital signs Patient value Normal value

Temperature 96.4 F 96.8- 97.2 F

Drug name Dose Route Time

Pulse 88 beats / min 80-86 beats/ min

Inj. D10 % 1 pint Iv slow o.d

Respiration 20 breath/ min 20 breaths/ min

Tab. Rekfa 150 mg Orally b.d

Blood pressure 120/80 mm of Hg 120/ 80 mm of Hg

Tab. Iron 200 mg Orally b.d

Tab. Calcium 500 mg Orally o.d

 Tab.
Day 2Vitamin
: C 500 mg Orally b.d

Mrs. Ashika was feeling much better on the second day. Her health status was much better.

Advise to eat more vitamine and iron containing diet.

Advised her to drink coconut water it helpful for rising amniotic fluid volume.

Vital signs were recorded ie.

Vital signs Patient value Normal value

Temperature 97.2 F 96.8- 97.2 F

Pulse 80 beats / min 80-86 beats/ min

Respiration 20 breath/ min 20 breaths/ min

Blood pressure 110/ 70 mm of Hg 120/ 80 mm of Hg

.Same medicine were continued on the second day

 Day 3 :
On 3rd day her health improved much better. She was fully co operative in all the procedures.

Advise her for ambulation

The same medications were continued on the third day.

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 Following vital sign recorded on 3rd day.

Vital signs Patient value Normal value

Temperature 97.2 F 96.8- 97.2 F

Pulse 82 beats / min 80-86 beats/ min

Respiration 18breath/ min 20 breaths/ min

Blood pressure 110/ 70 mm of Hg 120/ 80 mm of Hg

Given health education about personal hygiene and antenatal care.

Day 4 :

On the fourth day she was feeling much better.

Her appetite was gradually improved. Advised to eat good nutritious food food.
- She was assisted in meeting the hygienic needs. she was able to get out of bed without any support.

Vital signs were checked and recorded.

Vital signs Patient value Normal value

Temperature 97.6F 96.8- 97.2 F

Pulse 78 beats / min 80-86 beats/ min

Respiration 20 breath/ min 20 breaths/ min

Blood pressure 118/ 70 mm of Hg 120/ 80 mm of Hg

Same medications were continued .

Appetite was much better. General condition was also improved.
Health education was given on nutritious diet, breast care

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Assement Nursing Goal Planning Implementation Evaluation
diagnosis
Subjective data: 1.  To relieve Asses characteristics of Assed characteristics of pain Mother
Altered comfort due the pain pain: location, severity on followed all the
Verbal to back pain a
 To make the instruction,
complain of secondary to scale of 1-10, type,
comfort to mother felt
pain. physiological frequency, precipitating
the client factors, better than
changes during
pregnancy relief factors. earlier.
Eliminate factors that
Objective data: precipitate pain:
Teach patient to
Facial changes, request analgesics before
frequent pain becomes severe.
position
changes during Explor non- Advise about non
pharmacological methods pharmacological method
rest.
for reducing
pain/promoting
comfort:
 back rubs
 slow rhythmic
breathing
 repositioning
 diversional
activities such as
music, TV, etc.
 Give inj. voveran Given inj.voveran prescribed
by order of doctor.
by the doctor.

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HEALTH TEACHING:
Given health education regarding :-

- Dietary Instruction
- Antenatal car
- Maintaining personal hygiene ,
- Antenatal exercise
- Regular check up and follow up
- Family planning methods

1. Antenatal advise :-
Advise her to do not left heavy things and take adequate rest.
Advise her to drink more water and nutritious diet.
Advised her to daily pull breast nipple so it helpful for easily breast milk suscking.
Advised her to take 8 hrs rest in night and 2 hrs in afternoon.
Advised her to daily count fetal movement if find less than 10 movement inform doctors.
2. Dietary Instruction:-
- Advised to eat food containing more iron like drum stick, juggery and green leafy vegetable.
- Explained for antenatal diet like high calorie and high protein and vitamin reach diet,
- Eat food at regular interval.
3. Maintain hydration status it helpful for increase amniotic fluid volume.
- Advise mother drink coconut water, orange juice and drink more water daily .
4. Maintaining personal hygiene:-
- Advise for daliy bath, mouth care hair care.
- Advice her to clean perineal area with soap and water after each urination and defecation.
5. Regular check up and follow up:- according to doctors orders.

6. Antenatal Exercise: Explained and taught about deep breathing and , pelvic floor exercise, tailor sitting
7. Advised her to take all medicine regularely and come for routine check up according doctor’s order.
8. Family planning methods :- advised her to use temporary family palnning methods like copper T use after
delivery

- Advise her conceive pregnancy after 2-3 year it help full for improvement of their health status.

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SUMMARY:
 My Patient came with complain of abdominal pain , back pain andless fetal movement . Patient is primipara
women . On admission she is having mild abdominal pain
 In USG find out oligohydramnions ( less amniotic fluid index that is 6.5 cm)
 So she is admitted in antenatal ward.
 Daily administered D 10% IV fluids for improvement of amniotic fluid volume
 Administered medicine as per doctors order and advise her to drink more oral fluids so in second USG find
that her amniotic fluid volume increased
 After providing 5 days care, Patient’s amniotic fluid volume increased. Patient is maintaing stable vital
parameters, so doctors gave discharge to my client.

CONCLUSION:
During my clinical posting in V.S hospital in antenatal ward, I got chance to provide care to, Mrs. Ashika with
diagnosis of oligohydramnions by this study I learn in detail about oligohydramnions definition, causes and its
management. I thank my client for her cooperation and my clinical coordinator for her valuable guidance .

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BIBLIOGRAPHY:-

1 . Basvanthappa B.T : “TEXT BOOK OF MIDWIFERY AND REPRODUCTIVE

HEALTH NURSING”; first edition 2006, Jaypee brother publication, New
Delhi. Page no ; 210-218.

2. Dutta D.C : “TEXT BOOK OF OBTETRICS” ; 6 TH Edition , 2004; New central book
agency publication, calcutta. Page no: 179-190.

3. Jacob Anamma : “A COMPREHENSIVE TEXT BOOK OF MIDWIFEREEY”;1stedition

2005; jaypee brother medical publication; new delhi, page no:164-172.

9. Kumari neelam; (2010); 1st edition; “MIDWIFERY AND GYNAECOLOGICAL

NURSING”; s.vikas and company; jalandhar city; Page no :156-164.

6. myles : “ TEXT BOOK OF MIDWIVES” ; Fourteenth edition,2003 ; Elsevier publisher,

Philadelphia. Page no ; 285-287.

7. Rao Kamini :- “TEXT BOOK OF MIDWIFERY AND OBSTETRICS FOR NURSES”;

first edition,2011, Elsevier publisher, Philadelphia. Page no: 277-281.

Internet resources :-
http://en.wikipedia.org/wiki/Oligohydramnios
www.medscape.com/viewarticle/551032_4
www.healthline.com/.../amniotic-fluid-5-evaluation-and-management...
http://www.uptodate.com/contents/oligohydramnios
www.uptodate.com/contents/oligohydramnios
www.ncbi.nlm.nih.gov/pubmed/19089770
http://www.lexic.us/definition-of/oligohydramnios

http://www.empowher.com/media/reference/oligohydramnios

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