Severe Oligohydramnios Research Articles

Increased Renal Echogenicity: A Sonographic Sign for Differentiating Between Obstructive and Nonobstructive Etiologies of in Utero Bladder Distension

Purpose The combination of in utero bladder distension and bilateral hydroureteronephrosis in male fetuses may result from a number of pathological processes. The prenatal and postnatal treatment of patients with an enlarged bladder is dictated by the specific etiology leading to these changes. We propose specific ultrasonographic criteria for differentiating between obstructive and nonobstructive etiologies in these fetuses. Materials and Methods We reviewed the medical records and prenatal imaging studies of 18 cases of marked in utero bladder distension in which a diagnosis of posterior urethral valves, the megacystis-megaureter association or the prune-belly syndrome was confirmed postnatally. Amniotic fluid volume and renal echogenicity were assessed before knowledge of the specific diagnosis. Oligohydramnios was graded as mild, moderate or severe. Increased renal echogenicity was defined as greater echogenicity of the renal cortex and/or medulla than of adjacent liver tissue. Postnatal imaging, clinical course and outcome were also reviewed. Results The study included 15 cases with adequate followup, including 8 in which a diagnosis of posterior urethral valves was confirmed postnatally. Nonobstructive etiologies included the megacystis-megaureter association in 6 cases and the prune-belly syndrome in 1. Seven of the 8 patients with posterior urethral valves had moderate to severe oligohydramnios, whereas all but 1 with a nonobstructive etiology had normal amniotic fluid. Seven of the 8 cases with posterior urethral valves had a marked bilateral increase in renal echogenicity, while none of the nonobstructive cases had this finding. Conclusions Increased renal echogenicity and oligohydramnios in the setting of bladder distension are highly predictive (87%) of an obstructive etiology. This finding is important in the prenatal counseling and treatment of boys with bilateral hydronephrosis and marked bladder dilatation.

Confined placental mosaicism for trisomy 2 with intrauterine growth retardation and severe oligohydramnios in the absence of uniparental disomy in the fetus

Confined placental mosaicism for trisomy 2 with intrauterine growth retardation and severe oligohydramnios in the absence of uniparental disomy in the fetus

Confined placental mosaicism for trisomy 2 with intrauterine growth retardation and severe oligohydramnios in the absence of uniparental disomy in the fetus

Confined placental mosaicism for trisomy 2 with intrauterine growth retardation and severe oligohydramnios in the absence of uniparental disomy in the fetus

Diabetes insipidus in pregnancy: A treatable cause of oligohydramnios

Diabetes insipidus, which presents with polyuria, polydipsia, and profound electrolyte abnormalities, occurs rarely in pregnancy. We report a patient with severe oligohydramnios that resolved after treatment of diabetes insipidus. A 14-year-old girl was admitted at 33 weeks' gestation with cramping and vaginal spotting. A sonogram indicated oligohydramnios and an amniotic fluid index (AFI) of 2.6, with normal fetal kidneys and bladder. On hospital day 2, the AFI was 0.0. Recorded fluid was 8 L in and 13.6 L out. Serum sodium was 153 mEq/L. Diabetes insipidus was diagnosed and treated with intranasal desmopressin acetate. The oligohydramnios resolved rapidly, and the patient delivered a healthy 2700-g male infant at 38 weeks. Although rare, diabetes insipidus may present initially in pregnancy and should be considered in patients with oligohydramnios. Simple diagnosis with determination of 24-hour urine volume and serum electrolytes can identify this potentially reversible cause of oligohydramnios and poor obstetric outcome.

Amniotic fluid volume in spurious labour.

A prospective study was undertaken to assess the amniotic fluid index (AFI) in women with spurious labour and its possible role in management. Eight hundred and ninety-three women in early labour, who had uncomplicated pregnancy, were recruited for the study. Of these, 133 were later diagnosed to have had spurious labour, while 760 were in true labour. An admission cardiotocography and determination of AFI was done for all patients at the time of their admission to the labour ward. Labour was induced within 24 hours for those women in spurious labour who had severe oligohydramnios. The incidence of severe oligohydramnios (AFI < 5) was significantly higher in the patients later diagnosed to have had spurious labour (15.7%) compared with those in true labour (2.1%). With this management protocol, the obstetric and the neonatal outcome was similar in the spurious labour and the true labour groups. The assessment of AFI could be a simple and useful screening tool to avoid adverse perinatal outcome in women who experience spurious labour.

Determination of chorionicity in twin gestations by high-frequency abdominal ultrasonography: Counting the layers of the dividing membrane

OBJECTIVE: Our aim was to determine whether chorionicity in twin gestations can be diagnosed by use of high-frequency ultrasonography to count the layers of intraamniotic membrane. STUDY DESIGN: This prospective study of 66 twin pregnancies between 13 and 38 weeks' gestation used transabdominal ultrasonography at 10 MHz. The pregnancy was classified as monochorionic when two layers were counted and as dichorionic when three or four layers were counted. The findings of the examiner, who had no other information about chorionicity, were compared with those of the histopathologic examination of the placenta. RESULTS: Ultrasonography allowed chorionicity to be determined correctly in 60 of 63 cases (95%; 100% in the second trimester and 92% in the third). The predictive value for dichorionicity was 100% (48/48) and the sensitivity 94% (48/51). The 12 monochorionic diamniotic pregnancies in which the membrane was visualized were all correctly diagnosed. In a thirteenth case, with severe oligohydramnios, the membrane could not be seen. Two patients were lost to follow-up. In 95% of the cases (63/66) only one examination was required to diagnose chorionicity. Intraobserver variability was 0% (0/26). Interobserver variability, tested by photographs, was 3% (2/65). CONCLUSIONS: This technique should be the first-line method for determining chorionicity in the second and third trimesters because it is the most effective. Its excellent reproducibility may be attributable to the use of high-frequency ultrasonography. (Am J Obstet Gynecol 1996;175:1529-33.)

Serial transabdominal amnioinfusion in the management of gastroschisis with severe oligohydramnios

Two fetuses with gastroschisis diagnosed in utero (at 19 weeks' gestation) had severe oligohydramnios at 30 to 31 weeks. Serial transabdominal amnioinfusions were performed to fill the amniotic cavity with saline, thereby avoiding the potential consequences of fetal exposure to severe oligohydramnios. In both cases, premature rupture of membranes occurred at 36 weeks, and the fetuses were delivered by cesarean section. There were minimal lesions of the extraabdominal bowel. After primary closure of the abdomen, the postoperative course was uneventful. These observations show that serial amnioinfusion is a feasible therapeutic approach for severe third-trimester oligohydramnios associated with gastroschisis.

Defining limits of survival: Lethal pulmonary hypoplasia after midtrimester premature rupture of membranes

OBJECTIVE: Our purpose was to determine prospectively whether sequential ultrasonographic assessment of amniotic fluid volume (<1 cm vertical pocket constitutes severe oligohydramnios), in conjunction with other readily available clinical data, could predict the occurrence of pulmonary hypoplasia and neonatal mortality in pregnancies complicated by second-trimester premature rupture of membranes. STUDY DESIGN: Singleton pregnancies complicated by premature rupture of membranes at <29 weeks' gestation were prospectively monitored by weekly ultrasonographic assessments. Stepwise multiple logistic regression analysis was used to determine the independent predictive value of ultrasonographically determined factors in the development of lethal pulmonary hypoplasia, neonatal mortality, and skeletal deformations. RESULTS: Neonatal mortality and pulmonary hypoplasia were statistically predicted by gestational age at rupture of membranes and interaction of premature rupture of membranes of >14 days' duration with severe oligohydramnios. The occurrence of skeletal deformations was related to the interaction of duration of premature rupture of membranes and severe oligodramnios (p < 0.0001). Fetal breathing, fetal movements, and thoracic circumference/abdominal circumference ratios were not predictive of outcome. CONCLUSION: Both duration of severe oligohydramnios exposure and gestational age at premature rupture of membranes were independent significant predictors of increased neonatal risk. Severe oligohydramnios >14 days after premature rupture of membranes at <25 weeks' gestation has a predicted neonatal mortality of >90%. (Am J Obstet Gynecol 1996;175:675-81.)

Accuracy of prenatal diagnosis of renal agenesis with color flow imaging in severe second-trimester oligohydramnios: Sepulveda W.; Stagiannis K.D.; Flack N.J.; Fisk N.M. GBR Am. J. Obstet. Gynecol. 1995 173/6 (1788–1792)

International Journal of Gynecology & ObstetricsVolume 54, Issue 1 p. 87-87 Citations from the literature perinatology Accuracy of prenatal diagnosis of renal agenesis with color flow imaging in severe second-trimester oligohydramnios Sepulveda W.; Stagiannis K.D.; Flack N.J.; Fisk N.M. GBR Am. J. Obstet. Gynecol. 1995 173/6 (1788–1792) First published: July 1996 https://doi.org/10.1016/0020-7292(96)89729-3AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume54, Issue1July 1996Pages 87-87 RelatedInformation

Cytogenetic evaluation of cystic hygroma associated with hydrops fetalis, oligohydramnios or intrauterine fetal death: the roles of amniocentesis, postmortem chorionic villus sampling and cystic hygroma paracentesis.

Pregnancies complicated by fetal cystic hygroma in the second and third trimesters are often associated with hydrops fetalis, oligohydramnios or intrauterine fetal death which may make genetic assessment more difficult. We investigated the roles of amniocentesis, postmortem chorionic villus sampling and cystic hygroma paracentesis in cytogenetic evaluation of cystic hygroma under such circumstances. Thirty-five fetuses of cystic hygroma associated with hydrops fetalis, oligohydrammos, or intrauterine fetal death were studied. All fetuses were delivered at Mackay Memorial Hospital, Taipei, Taiwan between January, 1987 and July, 1995. Data collected included maternal age, prenatal sonograms, gestational age at diagnosis, fetal karyotypes and diagnostic procedures. Of 35 fetuses, all had hydrops fetalis, 19 had suffered IUFD at the time of diagnosis, and 10 had severe oligohydramnios. Cytogenetic studies were performed via amniocentesis, postmortem chorionic villus sampling, or cystic hygroma paracentesis. Successful karyotyping was achieved in 32 fetuses and the karyotype of 45,X was found in 24 fetuses. In cases with IUFD, successful karyotyping rates on cells from amniotic fluid, chorionic villi and cystic hygroma fluid were 88.9% (8 of 9), 69.2% (9 of 13) and 20% (1 of 5), respectively, whereas, in cases with living hydropic fetuses, successful karyotyping was achieved in 12 of 12 amniotic fluid and 5 of 5 cystic hygroma fluid samples. Amniocentesis is a better method for cytogenetic evaluation of fetal cystic hygroma associated with intrauterine fetal death than postmortem chorionic villus sampling and cystic hygroma paracentesis. However, in the case with a living hydropic fetus and oligohydramnios, cystic hygroma paracentesis appears to be a practical alternative for cytogenetic assessment.

Outcome of singleton pregnancies with severe oligohydramnios in the second and third trimesters.

We evaluated the significance of severe oligohydramnios, or anhydramnios, in the second and third trimesters, by determining the range of etiologies as well as the differences in fetal and neonatal outcome. All prenatal ultrasound results on pregnancies found to have severe oligohydramnios over a 7.5-year period at 13-42 weeks' gestation were retrospectively collected. Follow-up results were obtained from review of medical records, autopsies and pathology reports. A total of 250 singleton pregnancies met the criteria of having severe oligohydramnios. A bimodal distribution in gestational age at diagnosis was seen, with more cases diagnosed at 13-21 weeks and at 34-42 weeks. Fetal abnormalities were present in 50.7% of those diagnosed with severe oligohydramnios in the second trimester and in 22.1% of those in the third trimester. There were 10.2% and 85.3% survivors when severe oligohydramnios was diagnosed in the second and third trimesters, respectively. The rate of aneuploidy was at least 4.4% for the entire singleton population. A bimodal distribution of pregnancies presenting with severe oligohydramnios represents two different naturally occurring populations in terms of both etiology and prognosis.

Accuracy of prenatal diagnosis of renal agenesis with color flow imaging in severe second-trimester oligohydramnios

OBJECTIVE: Our purpose was to examine the potential of color flow imaging to assess the presence of renal arteries in second-trimester pregnancies complicated by severe oligohydramnios. STUDY DESIGN: Thirty-three consecutive second-trimester pregnancies referred with severe oligohydramnios were prospectively studied with high-resolution color Doppler ultrasonography to establish the presence or absence of renal arteries. Prenatal findings were correlated with the presence or absence of fetal kidneys at postmortem or postnatal examination. RESULTS: Neither renal artery was visualized in eight fetuses; postmortem examination confirmed bilateral renal agenesis in seven and unilateral renal agenesis with a contralateral atrophic multicystic kidney in the other. Only one renal artery was seen in three; postmortem examination demonstrated unilateral renal agenesis in two fetuses and bilateral multicystic dysplastic kidneys in the other. Postmortem or postnatal evaluation confirmed the presence of both kidneys in all 22 fetuses in which both renal arteries were identified prenatally. CONCLUSIONS: Color Doppler ultrasonography is useful in the prenatal evaluation of fetuses with severe second-trimester oligohydramnios to demonstrate the presence or absence of renal arteries. This technique should be added to the armamentarium of prenatal tests to evaluate second-trimester fetuses with severe oligohydramnios.

Fetal urinary insulin‐like growth factor I and binding protein 3 in bilateral obstructive uropathies

Fetal urinary concentrations of insulin-like growth factor I (UIGF-I) and binding protein 3 (UIGFBP-3) were determined in patients with prenatal diagnosis of bilateral obstructive uropathy. Patients were retrospectively assigned to three groups, on the basis of outcome: group 1, termination of pregnancies (n = 11) with sonographic evidence of severe oligohydramnios or renal dysplasia, confirmed at histological examination; group 2, patients (n = 10) with postnatal plasma creatinine > 50 mumol/l at the age of 1 year (1 yr-pCreat); and group 3, patients (n = 16) with 1 yr-pCreat < or = mumol/l. The results show a significant increase in UIGF-I and UIGFBP-3 in groups 1 (18,159 +/- 9083 pg/ml; 2657 +/- 669 ng/ml) and 2 (1574 +/- 847 pg/ml; 176 +/- 50 ng/ml) in comparison with group 3 (35 +/- 6 pg/ml; 21 +/- 2 ng/ml). UIGF-I and UIGFBP-3 were significantly correlated with postnatal plasma creatinine, and were both sensitive (90 per cent; 80 per cent) and specific (88 per cent; 88 per cent) for prediction of elevated 1 yr-pCreat (> 50 mumol/l). Fetal urinary IGF-I and IGFBP-3 are increased in severe fetal bilateral obstructive uropathy, possibly reflecting tubular dysfunction or/and increased synthesis consequent upon fetal kidney injury. Their predictive value for postnatal renal function needs further assessment.

Effects of Viral Virulence on Intrauterine Growth in SIV-Infected Fetal Rhesus Macaques (Macaca mulatta)

Studies with a simian immunodeficiency virus (SIV)-infected fetal monkey model were conducted with a focus on fetal growth and viral pathogenesis. Twenty-six fetuses were inoculated in utero via ultrasound guidance with an uncloned pathogenic strain of SIV or vehicle during the second or third trimesters [gestational day (GD) 65, 110, or 130], sonographically monitored weekly (biometrics, blood flow), then necropsied at incremental time points postinfection. Peripheral blood hematologic (complete blood counts, clinical chemistries), immunologic (immunophenotyping), and endocrine studies [insulin-like growth factor (IGF), IGF-binding proteins (IGFBP)] were conducted. Severe intrauterine growth restriction (IUGR), oligohydramnios, and altered lymphocyte counts were noted for fetuses infected on GD 65. Less severe effects were detected for fetuses inoculated at the later time points, with severity dependent upon the length of SIV infection in utero. IGF studies indicated significant reductions in IGF-I and elevated immunoreactive levels of IGFBP-3 in infected fetuses during the third trimester. Parallel studies conducted with four fetuses infected on GD 65 with a nonpathogenic, molecularly cloned virus (SIVmac1A11) resulted in normal fetal growth, with no effects on hematopoiesis or IGF/IGFBP levels, and no evidence of clinical disease. Taken together, these studies show that (1) infection of fetuses during the early second trimester with an uncloned pathogenic strain of SIV results in severe IUGR and a disruption in the molar ratio of IGF:IGFBP-3, and (2) outcome of fetal SIV infection is determined by the timing of infection and the virulence of the viral inoculum.

Uterine artery blood flow response to correction of amniotic fluid volume

OBJECTIVE: Our purpose was to investigate whether acute alterations of amniotic fluid volume affect uteroplacental perfusion.STUDY DESIGN: Three groups of patients of comparable gestational age were studied in a fetal medicine referral unit: (1) eight pregnancies with severe polyhydramnios because of twin-twin transfusion syndrome undergoing therapeutic amnioreduction, (2) seven with severe oligohydramnios undergoing diagnostic amnioinfusion, and (3) six control women having invasive procedures of similar duration without manipulation of amniotic fluid volume. Color Doppler imaging was used to measure uterine artery impedance index values and quantitative blood flow before and within 15 minutes of the end of the procedure.RESULTS: Quantitative flow measurements increased after amnioreduction (74% median increase of volume flow, range 22% to 329%, p < 0.01) and decreased after amnioinfusion (33% median decrease of volume flow, range 17% to 51%, p < 0.05). Impedance index values increased after amnioinfusion (25% median increase in pulsatility index, range 4% to 71%, p < 0.05) and did not alter with amnioreduction. There were no significant changes in the control group.CONCLUSION: Acute changes in amniotic fluid volume after uteroplacental perfusion. In twin-twin transfusion syndrome amelioration in uterine flow may improve fetal condition and explain in part the success of serial amnioreduction therapy.

Indomethacin for Treatment of Fetofetal Transfusion Syndrome

Indomethacin for Treatment of Fetofetal Transfusion Syndrome

Pregnancy Following Cardiac Prosthetic Valve Replacement

OBJECTIVE To determine the effect of cardiac valve replacement on pregnancy outcome. METHODS We reviewed retrospectively 151 pregnancies in 88 women: 56 pregnancies in 31 women with mechanical valves and anticoagulation therapy, and 95 pregnancies in 57 women with porcine tissue valves. Student t, chi 2, and Fisher exact tests were used for analysis. RESULTS There was a significantly greater rate of fetal loss in patients with mechanical valve replacements than in those with porcine tissue valves (27.7 versus 12.3%, respectively; P < .05). No significant differences were found in prematurity (5.9 versus 7.7%) or small for dates infants (8.8 versus 10.8%). Two congenital anomalies were noted in the mechanical valve group. Maternal complications in patients with mechanical valves included valve dysfunction (three), thromboembolism (three), abruptio placentae (two), postpartum hemorrhage (two), severe oligohydramnios (two), and puerperal fever caused by brain abscess (one). Four cases of valve dysfunction and one of infectious endocarditis complicated the condition of patients with porcine tissue valves. The 10-year graft survival rate in the porcine valve group was lower following two subsequent pregnancies (16.7%) than following one (54.8%). CONCLUSION Fewer fetal and maternal complications occurred in subsequent pregnancies after porcine valve replacement. However, the need for reoperation is more likely, and pregnancy might accelerate the degenerative process.

Unilateral Renal Hypoplasia And Contralateral Renal Agenesis: A New Association With 45,X/46,XY Mosaicism

The association of urinary anomalies with Turner's syndrome is well established. This report describes an unusual antenatal presentation of this cytogenetic disorder and the first reported case of unilateral renal hypoplasia and contralateral renal agenesis in a 45,X/46,XY fetus. The fetus presented with severe third trimester oligohydramnios and symmetrical intrauterine growth retardation at 29 weeks and 2 days' gestation. Chorionic villus cultures revealed a 45,X karyotype. A phenotypically male infant weighing 1833 g was delivered at 35 weeks and 2 days. Chromosomal analysis of the newborn showed a 45,X/46,XY mosaicism, and surgical exploration revealed absence of the left kidney and a hypoplastic right kidney. The infant died at 11 months of age from renal failure and peritonitis. This case demonstrates that monosomy X may be encountered in fetuses with marked growth delay and oligohydramnios. The etiology of the oligohydramnios in this case was a fetal renal malformation not previously described in Turner's syndrome. Antenatal cytogenetic findings should be confirmed postnatally, with a search for mosaicism, when monosomy X is encountered.

Direct volume measurement at midtrimester amnioinfusion in relation to ultrasonographic indexes of amniotic fluid volume

OBJECTIVE: Our purpose was to investigate the relationship between amniotic fluid volume and semiquantitative ultrasonographic assessment of amniotic fluid in the midtrimester. STUDY DESIGN: Sixteen pregnancies between 16 and 28 weeks with minimal amniotic fluid (severe oligohydramnios or anhydramnios) and intact membranes were studied at the time of clinically indicated amnioinfusion. The amniotic fluid index and deepest pool measurement were determined before and immediately after the procedure. Correlations were sought by means of standard regression techniques with amniotic fluid volume (i.e., volume infused) on the basis of the assumption that amniotic fluid volume before amnioinfusion was effectively nil. RESULTS: There was a significant linear relationship between amniotic fluid index and volume infused (y = 7.336 + 0.015x; R2 = 0.30, p < 0.05). However, no correlation with the deepest pool measurement technique was found (R2 = 0.11, p > 0.05). CONCLUSION: Amniotic fluid index is preferable to deepest pool measurement in assessing amniotic fluid volume in the second trimester of pregnancy. The low variance (30%) suggests that better predictors of amniotic fluid volume are still required. (AM J OBSTET GYNECOL 1994;170:1160-3.)

Perinatal lethal conditions: The effect of diagnosis on decision making

To identify factors influencing pregnancy management decisions following identification of a perinatal lethal condition.One hundred thirty pregnancies with perinatal lethal conditions diagnosed before 24 weeks' gestation were examined. Information collected included demographic data, estimated gestational age at presentation, referral indication, nature of the defect, and performance of autopsy.Eighty-seven families elected to abort affected pregnancies and 43 elected to continue. Demographic factors did not influence decision making, nor did gestational age at diagnosis or referral indication. When comparing the diagnosis of one lethal condition with diagnoses of all other lethal conditions, pregnancies with a central nervous system defect or severe urinary tract defect were more often aborted; those with unexplained severe oligohydramnios and twin pregnancies in which at least one twin was affected were more often continued. Autopsy was obtained much more often in pregnancies that were aborted than in those that were continued.The type of defect correlates well with the pregnancy management decision. It is important to consider the type of malformation, certainty of the diagnosis, and level of medical understanding when counseling patients after the diagnosis of a lethal fetal defect. Because many patients will continue pregnancies diagnosed with a perinatal lethal condition, the physician should convey understanding and acceptance of a decision not to abort such a pregnancy. The importance of follow-up testing, including autopsy when appropriate, should be stated clearly.