Management Of Oligohydramnios Research Articles

Amnioinfusion compared with expectant management in oligohydramnios with intact amnions in the second and early third trimesters.

Treatment of oligohydramnios in the mid-trimester is challenging, because of the high incidence of adverse perinatal outcomes mainly due to bronchopulmonary dysplasia. Antenatal amnioinfusion has been proposed as a possible treatment for oligohydramnios with intact amnions, but there are few relevant studies. This study aimed to evaluate the effectiveness of transabdominal amnioinfusion in the management of oligohydramnios without fetal lethal malformations in the second and early third trimesters. It is a historical cohort study. A total of 79 patients diagnosed with oligohydramnios at 18-32 weeks gestation were enrolled. In the amnioinfusion group (n = 39), patients received transabdominal amnioinfusion with the assistance of real-time ultrasound guidance. In the expectant group (n = 41), patients were treated with 3000 mL of intravenous isotonic fluids daily. The perioperative complications and perinatal outcomes were analyzed. Compared with the expectant group, the delivery latency was significantly prolonged, and the rate of cesarean delivery was significantly reduced in the amnioinfusion group (p < 0.05). Although the rate of intrauterine fetal death was significantly reduced, the incidence of spontaneous miscarriage, premature rupture of membranes (PROMs), and threatened preterm labor were significantly higher in the amnioinfusion group than in the expectant group (p < 0.05). There was no significant difference in terms of perinatal mortality (28.9% vs. 41.4%, p > 0.05). Multivariate logistic regression revealed that amnioinfusion (odds ratio [OR] 0.162, 95% confidence interval [CI] 0.04-0.61, p = 0.008) and gestational age at diagnosis (OR 0.185, 95% CI 0.04-0.73, p = 0.016) were independently associated with neonatal adverse outcomes. Further subgrouping showed that amnioinfusion significantly reduced the frequency of bronchopulmonary hypoplasia for patients ≤26 weeks (26.7% vs. 75.0%, p = 0.021). The rates of other neonatal complications were similar in both groups. Amnioinfusion has no significant effect on improving the perinatal mortality of oligohydramnios in the second and early third trimesters. It may lead to a relatively high rate of PROM and spontaneous abortion. However, amnioinfusion may significantly improve the latency period, the rate of cesarean delivery, and neonatal outcomes of oligohydramnios, especially for women ≤26 weeks with high risk of neonatal bronchopulmonary hypoplasia.

Effect of Maternal Intravenous Hydration in Management of Oligohydramnios and The Changes in the Fetal Doppler

Background and aim: Oligohydramnios is linked to different fetal and maternal conditions. Maternal hydration improves amniotic fluid content, because it promotes uteroplacental perfusion. The current work aimed to determine the results of intravenous hydration on the amniotic fluid index (AFI) and Doppler measurements of uteroplacental blood circulation during pregnancy with the third trimester oligohydramnios.&#x0D; Patients and methods: The current including 50 pregnant women in their third trimester with oligohydramnios. They were selected from the outpatient clinic at Al-Azhar University Hospitals. All were submitted to clinical evaluation by history and examination, followed by abdominal ultrasound and intravenous hydration therapy. Values before and after hydration were compared, delivery mode and fetal outcome were documented.&#x0D; Results: Maternal age was 30 ± 2.28. The majority of them were multigravida (58.0%) and higher percentage were multiparous (70.0%). The GA at delivery ranged between 32 and 37 weeks of gestation. There was a significant reduction of pulse, mean arterial pressure, temperature, hematocrit after hydration than before hydration. The birth weight ranged between 2765 and 3654 g. AF volume, AMF and uterine artery PI were significantly increased while umbilical artery PI was statistically decreased after hydration that corresponding values before hydration. The mode of delivery was normal vaginal delivery among 34% and cesarean section among 66.0% and the mean Apgar score was 7.8±1.9 and 8.9±0.87 at the first and fifth minutes, respectively.&#x0D; Conclusion: Intravenous maternal hydration therapy was safe and effective in terms of improvement of amniotic fluid index in pregnant females with isolated oligohydramnios in the third trimester. It enhanced the amniotic fluid volume and AFI in females with oligohydramnios.

Effect of Maternal Intravenous Hydration in Management of Oligohydramnios and The Changes in the Fetal Doppler

Effect of Maternal Intravenous Hydration in Management of Oligohydramnios and The Changes in the Fetal Doppler

Management of Oligohydramnios with the Help of Ksheerapaka and Yashtimadhu Siddha Matrabasti: A Case Report

Amniotic fluid protects the baby and helps develop its limb, lung, digestive system, and muscle volume. The volume of amniotic fluid should increase as the pregnancy progresses. Roughly 4% of pregnant women are diagnosed with oligohydramnios. It occurs when the volume of fluid in the amniotic sac is lower than average, usually because the placenta is not functioning properly. It is a very serious complication of pregnancy associated with poor perinatal outcome. An effective treatment for oligo is very needful to grow fetus normally and delivered with no complication. In Ayurveda, oligohydramnios can be compared with Upavishtaka, Nagodara, and Garbhashaya condition in which Garbhaspandana and Anunnatkukshita mentioned by Acharaya Sushtra which is due to reduce of liquor. The present case report of primigravida with period of gestation by last menstruation period is 30 weeks 2 days with foetal movement with no history of labour pain, leaking and bleeding per vaginal. On ultrasound significant that single live uterine foetus with cephalic presentation with 30 weeks with resistance in left uterine artery, FHR – 128 bpm, placenta – anterior, grade 2, AFI – 6.7 cm, two loop of cord seen around neck Estimate weight – 1531 ± 327 kg, BPP- 6/8. The patient was treated by Ksheerapaka of Yashtimadhu, Bala, Ashwagandha, and Yashtimadhu Siddha Matrabasti. This case report revealed that oligohydramnios can be managed by Ayurvedic drug intervention

Oligohydramnios: A review of etiology and management options

Oligohydramnios is both a consequence of fetal malformations and of uteroplacental insufficiency. Its existence is associated with a high rate of both antepartum and intrapartum complications. It is vital that its occurrence is detected as early as possible so that we can manage it correctly. The main causes of its occurrence are identified and described in this review. The management of oligohydramnios is most often expectant, the timing of delivery also being determined by Doppler examination and changes in parameters measuring fetal growth and development.

The Oxytocin Challenge Test: Is it Useful in the Management of Oligohydramnios?

An oxytocin challenge test (OCT) is a tool used to evaluate placental insufficiency, but it can also be time- and labor-intensive. Studies suggest that OCT may allow for early intervention before fetal acidemia in cases of fetal growth restriction (FGR), but its use for other indications is not well-defined. The objective of the study was to determine whether the use of an OCT prior to induction for oligohydramnios reduces the risk of cesarean delivery for nonreassuring fetal heart tracing.

Maternal (oral) hydration increases amniotic fluid volume

Objective:To determine the effect of maternal (oral) hydration on amniotic fluid volume in patients with third trimester oligohydramnios. Design: Interventional study. Place and Duration of Study: Department of Obs &amp; Gynae Unit III, Sir Ganga Ram Hospital, Lahore from May 2002 to October 2002. Patients and Methods: Twenty five women with third trimester oligohydramnios (AFI ?5.0cm) and twenty five controls with normal amniotic fluid volume (AFI 8-24 cm) were prospectively recruited for this study. Maternal urine specific gravity and amniotic fluid index were determined before and after maternal hydration by asking them to drink 2 L of water in 2-4 hours before repeat amniotic fluid index and recorded on printed proformas. Results: Hydration increased amniotic fluid volume in women with oligohydramnios (mean change in amniotic fluid index 4.3 cm, 95% confidence interval 4.02 to 5.06; P value &lt;0.001); as well as in women with normal fluid volume (mean change in Amniotic fluid index 2.7 cm, 95% confidence interval 2.23 to 3.21; P value &lt;0.01). However, percentage increase in mean AFI was 58.6% in the oligohydramnios group, which was significantly greater (P value &lt;0.05) than the percentage increase of 28.4% in control group. Hydration was associated with decrease in urine specific gravity in both groups. Conclusion: Maternal (oral) hydration increases AFV in women with oligohydramnios as well as in women with normal AFV and may be beneficial in the management of oligohydramnios.

The effects of intravenous hydration on amniotic fluid volume and pregnancy outcomes in women with term pregnancy and oligohydramnios: a randomized clinical trial.

Amniotic fluid is an important factor in the prediction of fetal survival. The aim of this research was to evaluate the effects of intravenous hydration of mothers on amniotic fluid volume and in turn on pregnancy outcomes. The current single blind controlled clinical trial was conducted on 20 pregnant mothers with amniotic fluid index of lower or equal to 5 cm and gestational age of 37-41 weeks. The subjects were divided into two groups of case and control through simple random sampling. Amniotic fluid index was measured in all participants. The case group received one liter of isotonic saline during 30 minutes by the bolus method. Reevaluations of amniotic fluid index in both groups were made 90 minutes after baseline measurement. Independent t-test and paired t-test were used to compare the two groups and mean amniotic fluid index before and after treatment, respectively. Hydration of mothers significantly increased the amniotic fluid index in the case group (mean change: 1.5 cm; 95%CI: 0.46 - 2.64; P = 0.01). The mean change of amniotic fluid index in the control group did not significantly increase (P = 0.06). The elevation of amniotic fluid index in the hydration group (32%) was significantly higher than the control group (1%) (P = 0.03). In this study intravenous hydration increased amniotic fluid index of mothers with term pregnancy and oligohydramnios. Since it caused no complications for the mother and the fetus, it can be used as an effective method in management of oligohydramnios.

The role of antepartum transabdominal amnioinfusion in the management of oligohydramnios in pregnancy

Objective. The purpose of this study was to evaluate the role of transabdominal amnioinfusion in the management of oligohydramnios with the view to improving pregnancy outcome.Methods. The study consisted of a retrospective analysis of 17 pregnant women presenting with oligohydramnios who were treated with amnioinfusion during pregnancy in a period from 2003 to 2006.Results. The mean gestational age at first treatment was 24 weeks. The mean pre-procedure deepest pool of amniotic fluid was 1.8 cm and post-procedure was 3.8 cm. The mean number of infusions was 1.05. The mean first infusion to delivery interval was 31 days. Perinatal mortality was 88% and neonatal mortality was 35%, with only one baby surviving the neonatal period. There were three cases of chorioamnionitis, with one of these cases presenting with premature rupture of the membranes at the time of amnioinfusion.Conclusions. Transabdominal amnioinfusion is a useful procedure to reduce complications that result from oligohydramnios. Although the results show a high perinatal mortality, it must be borne in mind that most of these pregnancies had multiple fetal abnormalities with an already predicted poor outcome. Importantly, as this procedure increases the latency period, it may be useful in preterm pregnancies where prolonging the duration of the pregnancy may result in better perinatal outcome by improving important factors that influence survival including increased birthweight.

Intravenous Versus Oral Maternal Hydration Therapy for Increasing Amniotic Fluid Volume

Objective: To determine wether one (intravenous) route of maternal hydration is advantageous over the other (oral) to increase amniotic fluid volume in patients with third trimester oligohydramnios? Study Design: Quassi experimental study. Place and Duration of Study: Department of Obs & Gynae Unit III, Sir Ganga Ram Hospital, Lahore, in one year period from May 2002 to Apr 2003. Material and Methods: Fifty women with third trimester oligohydramnios (AFI £ 5.0 cm) were prospectively recruited for this study. Study inclusion criteria was, singleton pregnancy, well established gestational age, intact membranes, no maternal complication (moderate to severe anemia, cardiac disease, renal disease, moderate/severe pre-eclampsia or hypertension and diabetes), no fetal structural malformation and no evidence of fetal distress. These fifty patients were randomized by pro-bability sampling technique into two groups (intravenous hydration group and oral hydration group). Maternal urine specific gravity and amniotic fluid index were determined before and after hydration therapy by infusing 2 L of 5% D/W in 2 hours in intravenous hydration therapy group, and by asking them to drink 2 liters of water in 2 hours in oral hydration therapy group; and recorded on printed proformas. The data analysis was computer based using statistical package SPSS version 10.0 and sample independent t test was used to compare the mean AFI and urine specific gravity, and the post treatment AFI - pretreatment AFI (Delta AFI). Results: Maternal hydration increased amniotic fluid volume in intravenous hydration group (mean change in amniotic fluid index 4.5 cm ± 1.25, C.I 4.00 to 5.00; P value 0.05) than the percentage increase of 58.2% in oral hydration group. Maternal hydration was associated with decrease in urine specific gravity in both groups. Conclusion: Maternal intravenous as well as oral hydration increases AFV in women with oligohydramnios but neither appears to be advantageous over the other to increase amniotic fluid volume and both routes may be beneficial in the mana-gement of oligohydramnios. Key Words: Maternal hydration, oligohydramnios.

Intravenous maternal hydration in third trimester oligohydramnios: effect on amniotic fluid volume.

To determine the affect of acute intravenous maternal hydration on amniotic fluid volume in patients with third trimester oligohydramnios. Quasi experimental study. Department of Obstetrics and Gynaecology Unit III, Sir Ganga Ram Hospital, Lahore, from May 2001 to April 2002. Twenty-five women with third trimester oligohydramnios (AFI < or = 5.0 cm) and 25 controls with normal amniotic fluid volume (AFI 8-24 cm) were prospectively recruited for this study. Study inclusion criteria were, singleton pregnancy, well-established gestational age, intact membranes, absence of maternal complication (anemia, cardiac disease, renal disease, pre-eclampsia, hypertension, or diabetes); absence of fetal structural malformation and/or distress. Maternal urinary specific gravity and amniotic fluid index were determined before and after intravenous hydration by infusing 2 liters of 5% dextrose water in 2 hours and recorded on printed proformas. Sample independent 't' test was used to compare the mean AFI and urine specific gravity before and after treatment, and the posttreatment AFI--pre-treatment AFI ( delta AFI). Maternal hydration increased amniotic fluid volume (AFV) in women with oligohydramnios (mean change in amniotic fluid index 4.5 cm, 95% confidence interval 4.02 to 5.06; p-value<0.01); as well as in women with normal amniotic fluid volume (mean change in amniotic fluid index 2.7 cm, 95% confidence interval 2.23 to 3.21; p-value<0.01). The percentage increase in mean AFI was 58.6% in the oligohydramnios group, which was significantly greater (p<0.05) than the percentage increase of 28.4% in control group. Maternal hydration was associated with decrease in urinary specific gravity in both groups. Under the conditions of this study, maternal (intravenous) hydration increased the AFV in women with oligohydramnios as well as in those with normal AFV and may be beneficial in the management of oligohydramnios.

Oligohydramnios in Uncomplicated Pregnancies beyond 40 Completed Weeks

Objectives: In low-risk pregnancies, the management of oligohydramnios is not clear. The aim of this study was to compare maternal and neonatal outcomes in cases of isolated oligohydramnios randomised to either induction of labour or expectant management. Methods: 87 women pregnant beyond 40 completed weeks were asked to participate in the study. Fifty-four accepted and were randomised at 288 days of pregnancy. Twenty-six were randomised to expectant management and 28 to induction of labour. The primary maternal outcome was the mode of delivery and the primary neonatal outcomes were cord blood pH and Apgar score at delivery. Results: No significant differences were found for any important maternal or neonatal outcome. Conclusion: Based on these results, the decisions about management could be individualised. Even though the number of patients included was small, these results are well in concordance with others.

Antepartum amnioinfusion: a review

Objective: Antepartum amnioinfusion is a relatively recent procedure introduced with fetal medicine techniques. It is usually indicated for severe oligohydramnios in order to avoid the related complications such as pulmonary hypoplasia, the deforming effects of oligohydramnios, variable fetal heart rate decelerations and intraventricular hemorrhage. Antepartum amnioinfusion is also employed to improve ultrasound visualization in cases with oligohydramnios. Our objective was to evaluate the benefits and complications related to this procedure which is still less commonly used compared to intrapartum amnioinfusion, and whose risks are therefore not well established. Study design: Reports of study designs identified from searches of MEDLINE, PUBMED, the Cochrane Collaboration, specialized databases and bibliographies of review articles were identified. Studies in women who underwent amnioinfusion between 1987 and 2002 were included. Results and conclusions: Amnioinfusion seems to offer several benefits, in terms of both prenatal diagnosis and favorable perinatal outcome. Most clinical experiences report that amnioinfusion is safe, both for the mother and for the fetus. However, randomized control-group studies subdivided on the basis of the cause of oligohydramnios (e.g. premature rupture of membranes, fetal growth restriction, obstructive uropathy and renal agenesis) could help to determine the advantages and risks linked to this procedure. Prospective randomized studies should therefore be encouraged, to clarify any possible doubts regarding the procedure, before it can be introduced into routine practice in the management of oligohydramnios.

Antepartum amnioinfusion: a review

Objective: Antepartum amnioinfusion is a relatively recent procedure introduced with fetal medicine techniques. It is usually indicated for severe oligohydramnios in order to avoid the related complicationssuch as pulmonary hypoplasia, the deforming effects of oligohydramnios, variable fetal heart rate decelerations and intraventricular hemorrhage. Antepartum amnioinfusion is also employed to improve ultrasoundvisualization in cases with oligohydramnios. Our objective was to evaluate the benefits and complications related to this procedure which is still less commonly used compared to intrapartum amnioinfusion,and whose risks are therefore not well established.Study design: Reports of study designs identified from searches of MEDLINE, PUBMED, the Cochrane Collaboration, specialized databases and bibliographiesof review articles were identified. Studies in women who underwent amnioinfusion between 1987 and 2002 were included.Results and conclusions: Amnioinfusion seems to offer several benefits, interms of both prenatal diagnosis and favorable perinatal outcome. Most clinical experiences report that amnioinfusion is safe, both for the mother and for the fetus. However, randomized control-group studiessubdivided on the basis of the cause of oligohydramnios (e.g. premature rupture of membranes, fetal growth restriction, obstructive uropathy and renal agenesis) could help to determine the advantages andrisks linked to this procedure. Prospective randomized studies should therefore be encouraged, to clarify any possible doubts regarding the procedure, before it can be introduced into routine practice inthe management of oligohydramnios.

Maternal hydration for increasing amniotic fluid volume in oligohydramnios and normal amniotic fluid volume.

Oligohydramnios (reduced amniotic fluid) may be responsible for malpresentation problems, umbilical cord compression, concentration of meconium in the liquor, and difficult or failed external cephalic version. Simple maternal hydration has been suggested as a way of increasing amniotic fluid volume in order to reduce some of these problems. The objective of this review was to assess the effects of maternal hydration on amniotic fluid volume and measures of pregnancy outcome. The Cochrane Pregnancy and Childbirth Group trials register and the Cochrane Controlled Trials Register were searched. Date of last search: 1 February 1999. Randomised trials comparing maternal hydration with no hydration in pregnant women with reduced or normal amniotic fluid volume. Eligibility and trial quality were assessed by both reviewers. Two studies of 77 women were included. The women were asked to drink two litres of water before having a repeat ultrasound examination. Maternal hydration in women with and without oligohydramnios was associated with an increase in amniotic volume (weighted mean difference for women with oligohydramnios 2.01, 95% confidence interval 1.43 to 2.56; and weighted mean difference for women with normal amniotic fluid volume 4.5, 95% confidence interval 2.92 to 6.08). Intravenous hypotonic hydration in women with oligohydramnios was associated with an increase in amniotic fluid volume (weighted mean difference 2.3, 95% confidence interval 1.36 to 3.24). Isotonic intravenous hydration had no measurable effect. No clinically important outcomes were assessed in any of the trials. Simple maternal hydration appears to increase amniotic fluid volume and may be beneficial in the management of oligohydramnios and prevention of oligohydramnios during labour or prior to external cephalic version. Controlled trials are needed to assess the clinical benefits and possible risks of maternal hydration for specific clinical purposes.

Umbilical Artery Doppler Velocimetry in Pregnancies Complicated by Oligohydramnios

OBJECTIVE: To determine the role of umbilical artery Doppler velocimetry in the management of oligohydramnios. STUDY DESIGN: In a retrospective chart review covering a two-year period, pregnancies with oligohydramnios evaluated by Doppler velocimetry of the umbilical artery were identified. Those patients with ruptured membranes and complex congenital anomalies were excluded from analysis. In the remainder, various measures of perinatal morbidity, including delivery of a small-for-gestational-age infant, preterm delivery, hyperbilirubinemia, requirement for blood transfusion, and other cardiovascular or pulmonary complications, were correlated with recorded values of the systolic/diastolic (S/D) ratio. RESULTS: Seventy-six subjects were identified for study. Forty-six had normal S/D ratios; 17 (37%) were associated with identifiable perinatal morbidity. When prematurity due to delivery for the sole indication of oligohydramnios was excluded, morbidity occurred in five patients (11%). Conversely, of the 30 patients with abnormal Doppler indices, 80% had an adverse outcome. CONCLUSION: Pregnancies with oligohydramnios and normal umbilical artery Doppler velocimetry were significantly (P <.001) less likely to experience an abnormal perinatal outcome as compared to those with abnormal Doppler indices. An elevated S/D ratio identified an increased risk of an adverse perinatal outcome in women with oligohydramnios. Avoiding intervention in pregnancies with oligohydramnios and normal umbilical artery Doppler velocimetru mau decrease iatrogenic morbidity due to prematurity by as much as 26%.