Treatment 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.

The Effect of L-Arginine on Amniotic Fluid Index in Pregnant Women with Oligohydramnios

Aim of the study: To evaluate the effect of L-arginine in the treatment of oligohydramnios. This prospective cohort study included 90 pregnant ladies who were diagnosed according to clinical and ultrasound findings as having oligohydramnios. The study was carried out in Al-Diwaniyah maternity and child hospital during the period from June 2017 through December 2018. Maternal and gestational age were obtained for all participants and the amniotic fluid index (AFI) was assessed by ultrasound. Women were all informed about the aim and the procedure of the study and verbal consent was obtained from all of them, in addition, the study was approved by the institutional approval committee. Women were given L-arginine treatment for a duration ranging from 8 to 28 days. The change in AFI following treatment was highly significant (P <0.01) and the mean change was 2.19 ±0.36 cm. Mean duration of treatment with L-arginine was 20.70 ±5.47 days and it ranged from 8 to 28 days. The change in AFI was higher with increasing duration of treatment in women within approximately the same weeks of gestation; the change in AFI among all women with respect to duration of treatment was highly significant (P < 0.001).

Danshen extract regulates the expression of aquaporin 3 in human amniotic epithelial cells.

Danshen extract has been used in the treatment of oligohydramnios, however, the mechanism of its action has not been elucidated. Previously, we demonstrated that down-regulation of AQP3 in fetal membranes may contribute to the development of oligohydramnios. In this study, we investigated the effects of Danshen extract on AQP3 expression in human amniotic epithelial cells from term pregnancies with oligohydramnios or those with those with (those with) normovolemic amniotic fluid. Human amniotic epithelial cells from the oligohydramnios group expressed a lower level of AQP3 mRNA and protein than those with normovolemia. Tweleve hour (Twelvehours) of treatment with Danshen extract, in a dose dependent manner, significantly increased the expression of AQP3 in the two groups. However, human amniotic epithelial cells from the oligohydramnios patients showed a greater sensitivity to the treatment of Danshen extract. These data provide a molecular basis for the treatment of patients with oligohydraminos.

Treatment of oligohydramnios with maternal 1-deamino-[8-D-arginine] vasopressin–induced plasma hypoosmolality

OBJECTIVE: Maternal 1-deamino-[8-D-arginine] vasopressin (a selective antidiuretic agonist) and oral water loading decrease maternal and fetal plasma osmolality and markedly increase fetal urine flow in sheep. We hypothesized that a titrated reduction in maternal plasma osmolality would increase human amniotic fluid volume. STUDY DESIGN: Pregnant women ( n = 5) with oligohydramnios at term were administered oral water loading (20 ml/kg) and intravenous 1-deamino-[8-D-arginine] vasopressin (2 μg) to induce antidiuresis. Maternal plasma and urine osmolality and urine production were measured hourly, and water replacement was titrated for 8 hours to reduce plasma osmolality by 15 to 20 mOsm/kg. The amniotic fluid index determined by ultrasonography was measured at baseline, 8 hours, and 24 hours. A control group of pregnant women ( n = 5) with oligohydramnios at term was observed for 8 hours with maintenance intravenous hydration. RESULTS: In 1-deamino-[8-D-arginine] vasopressin - treated women, maternal urine flow increased with oral water loading, decreased with 1-deamino-[8-D-arginine] vasopressin administration, and remained reduced for 8 hours. Maternal plasma osmolality significantly decreased (285 ± 4 to 265 ± 4 mOsm/kg) and the amniotic fluid index significantly increased (4.1 ± 0.6 to 8.2 ± 1.5 cm) at 8 hours. Although maternal urine osmolality returned to basal values at 24 hours, plasma osmolality was reduced and the amniotic fluid index remained significantly increased (8.2 ± 1.3 cm). There was no change in the amniotic fluid index (4.3 ± 0.4 to 4.7 ± 0.7 cm) in control patients observed with maintenance intravenous hydration. CONCLUSIONS: Maternal 1-deamino-[8-D-arginine] vasopressin and oral water administration can reduce and stabilize plasma osmolality and increase amniotic fluid volume. 1-Deamino-[8-D-arginine] vasopressin therapy has potential for the prevention and treatment of oligohydramnios. (AM J OBSTET GYNECOL 1996;174:1608-13.)

1-Deamino-[8-d-arginine] vasopressin - induced maternal plasma hypoosmolality increases ovine amniotic fluid volume

OBJECTIVE: Maternal 1-deamino-[8-d-arginine] vasopressin (a selective antidiuretic agonist) and oral water loading decrease maternal and fetal plasma osmolality and markedly increase fetal urine flow in sheep over 24 hours. We hypothesized that a sustained reduction in plasma osmolality would increase the amniotic fluid volume. STUDY DESIGN: Pregnant sheep (130 ± 1 days, n = 6) were given oral water loading (2000 ml) and intravenous 1-deamino-[8-d-arginine] vasopressin (20 μg injection followed by 4 μg/hr) to induce maternal urinary antidiuresis and to maintain a maternal plasma osmolality decrease of approximately 20 mOsm/kg for 48 hours. Fetal plasma osmolality, electrolytes, atrial natriuretic factor, and arginine vasopressin levels, fetal swallowing activity, and fetal urine flow and composition were measured each study day, and amniotic fluid volume was measured by tracer dilution before and at 48 hours of plasma hypoosmolality. RESULTS: In response to 1-deamino-[8-d-arginine] vasopressin and water loading, maternal plasma osmolality decreased (298 ± 1 to 275 ± 3 mOsm/kg), mirrored by fetal plasma hypoosmolality (293 ± 1 to 271 ± 3 mOsm/kg). Fetal urine osmolality (155 ± 16 to 117 ± 10 mOsm/kg) and amniotic fluid osmolality significantly decreased (281 ± 3 to 269 ± 5 mOsm/kg). Fetal urine flow rate significantly increased (0.33 ± 0.06 to 0.51 ± 0.04 ml/min), whereas fetal swallowing activity decreased (56 ± 7 to 33 ± 5 swallows per hour). In response to alterations in fetal fluid dynamics, amniotic fluid volume significantly increased from 493 ± 80 to 839 ± 160 ml. CONCLUSION: Chronic maternal 1-deamino-[8-d-arginine] vasopressin - induced plasma hypoosmolality induces a sustained reduction in fetal swallowing activity and an increase in fetal urine production, which results in a marked increase in amniotic fluid volume. Use of maternal 1-deamino-[8-d-arginine] vasopressin and oral fluid loading has the potential for manipulation of amniotic fluid volume homeostasis and may prove useful in the treatment of oligohydramnios. (A M J O BSTET G YNECOL 1996;174:1118-27.)

Prophylactic amnioinfusion as a treatment for oligohydramnios in laboring patients: A prospective, randomized trial

Prophylactic amnioinfusion was studied in a randomized sample of 305 patients with oligohydramnios in labor. One hundred seventy-five patients underwent amnioinfusion with the remainder serving as controls. Amniotic fluid was titrated to an amniotic fluid index τ10.0 em in the treatment group. Patients receiving amnioinfusion had significantly less operative intervention for fetal distress (p = 0.0001) and fewer cesarean sections (p = 0.0001). Umbilical artery pH at the time of delivery also was increased (p = 0.0001). Rates of amnionitis and endometritis were not significantly different between infused patients and controls, although the length of hospital stay was significantly decreased (p = 0.002) in the treatment group. Our data support earlier reports in the literature that amnioinfusion is a useful technique for decreasing intrapartum morbidity for both mother and fetus.

216 Prophylactic amnioinfusion as a treatment for oligohydramnios in laboring patients: A prospective, randomized trial

216 Prophylactic amnioinfusion as a treatment for oligohydramnios in laboring patients: A prospective, randomized trial