Oligohydramnios

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Oligohydramnios
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Oligohydramnios is a medical condition in pregnancy characterized by a deficiency of amniotic fluid, the fluid that surrounds the fetus in the abdomen, in the amniotic sac. The limiting case is anhydramnios, where there is a complete absence of amniotic fluid. It is typically diagnosed by ultrasound when the amniotic fluid index (AFI) measures less than 5 cm or when the single deepest pocket (SDP) of amniotic fluid measures less than 2 cm. [1] Amniotic fluid is necessary to allow for normal fetal movement, lung development, and cushioning from uterine compression. [2] Low amniotic fluid can be attributed to a maternal, fetal, placental or idiopathic cause and can result in poor fetal outcomes including death. The prognosis of the fetus is dependent on the etiology, gestational age at diagnosis, and the severity of the oligohydramnios.

Contents

The opposite of oligohydramnios is polyhydramnios, or an excess of amniotic fluid.

Background

Amniotic fluid is a clear, watery substance that surrounds the fetus. It helps to maintain a constant temperature around the fetus, cushion it from injury, and allows for proper fetal movement and organ development. [3] The cause of anhydramnios is not always clear, but several factors can contribute to its development such as fetal renal abnormalities or placental insufficiency. Untreated anhydramnios can lead to serious complications for the baby, including pulmonary hypoplasia or skeletal deformities.[ citation needed ]

Etiology

The amount of amniotic fluid available is based on how much fluid is produced and how much is removed from the amniotic sac. In the first trimester, the main sources of amniotic fluid are fetal lung secretions, transportation of maternal plasma across the fetal membranes, and the surface of the placenta. By the second trimester, the fetal kidneys start to produce urine which becomes the main source of the amniotic fluid for the remainder of the pregnancy. [4]

The development of oligohydramnios may be idiopathic or have a maternal, fetal, or placental cause. [5]

Maternal

Fetal

Placental

Diagnosis

Clinical manifestation

The volume of amniotic fluid typically increases until 36 weeks and starts decreasing after 40 weeks in post-term gestations. [4] For this reason, discrepancies between fundal height measurements and gestational age can be a clinical indication of amniotic fluid abnormality and should be evaluated by ultrasound. The symptoms of anhydramnios may not always be apparent, but some potential signs include:

Diagnosis

Diagnosis of oligohydramnios or anhydramnios is made by conducting a transabdominal ultrasound of the abdomen. [15]

There are two methods that can be used to make the diagnosis: the amniotic fluid index (AFI) and the single deepest pocket (SDP) measuremen. An AFI of less than 5 cm or an SDP of less than 2 cm indicates oligohydramnios, and an AFI of 0 cm or an absent SDP indicates anhydramnios. [16] In measuring the AFI, the sonographer measures the amniotic fluid in each of the four quadrants of the abdomen (right upper quadrant, left upper quadrant, right lower quadrant, left lower quadrant) and adds the values together. For reference, a normal AFI is 5–25 cm. An AFI <5 cm is considered oligohydramnios and an AFI >25 cm is considered polyhydramnios. Randomized control trials have shown that use of AFI can cause an increased number of false positive diagnosis of oligohydramnios and recommend using the measurement of a single deepest pocket (SDP) of amniotic fluid to diagnose oligohydramnios instead. [1]

To calculate a single deepest pocket, the sonographer scans each of the four quadrants of the abdomen looking for the deepest pocket of amniotic fluid that does not include any fetal body parts or an umbilical cord. It is measured from the 12 o'clock position to the 6 o'clock position. For reference, a normal SDP is 2–8 cm. A SDP <2 cm is considered oligohydramnios and a SDP >8 cm is considered polyhydramnios. The use of a SDP for diagnosis of oligohydramnios is associated with less false positives and thus less unnecessary interventions without an increase in adverse perinatal outcomes. [1]

In a multiple gestation pregnancy, measuring a single deepest pocket is the most accurate determination of adequate amniotic fluid levels. [2]

Management

After initial diagnosis of oligohydramnios has been made, the next step is to perform a thorough history and physical exam, followed by diagnostic testing if indicated. [2] Timely diagnosis and proper intervention for anhydramnios can significantly enhance the outlook for infants affected by this condition. The treatment depends on the underlying cause and may include: [17] [18]

Other point to note are:[ citation needed ]

Increasing amniotic fluid

There is no way to permanently increase the volume of amniotic fluid, but it can be temporarily increased to allow for a complete anatomy scan of the fetus on ultrasound.[ citation needed ]

One way to achieve this is through an amnioinfusion, which is the insertion of 200 mL of saline into the amniotic sac. One study showed an improvement in fetal structure visibility by 26% (51% to 77% before and after the infusion respectively). There is also some low quality data that may indicate a potential benefit of amnioinfusion is to facilitate external cephalic version. [2] Amnioinfusion can be used during labor to prevent umbilical cord compression. There is uncertainty about the procedure's safety and efficacy, and it is recommended that it should only be performed in centers specializing in invasive fetal medicine and in the context of a multidisciplinary team. [19]

One to two liters of oral hydration can temporarily increase amniotic fluid in dehydrated patients with isolated oligohydramnios. [20]

Other investigational therapies may also be useful such as desmopressin, tissue sealants, or sildenafil citrate. These methods are less commonly used and are experimental. [5]

In case of congenital lower urinary tract obstruction, fetal surgery seems to improve survival, according to a randomized yet small study. [21]

Prenatal care

Patients who are preterm are managed in the outpatient setting with weekly or biweekly testing to monitor for accurate fetal growth and decrease chances of unexpected fetal death. This includes a weekly non-stress test (NST) and single deepest pocket (SDP) assessment which is also referred to as the modified BPP. [1] Sonographic fetal growth exams may also be indicated.[ citation needed ]

Timing of delivery

Idiopathic, uncomplicated, and persistent oligohydramnios can be delivered at 36 0/7 weeks – 37 6/7 weeks of gestation or at diagnosis if diagnosis is later. [1]

Complications

Complications may include cord compression, musculoskeletal abnormalities such as facial distortion and clubfoot, pulmonary hypoplasia and intrauterine growth restriction. Amnion nodosum is frequently also present (nodules on the fetal surface of the amnion). [22]

The use of oligohydramnios as a predictor of gestational complications is controversial. [23] [24]

Potter syndrome is a condition caused by oligohydramnios. Affected fetuses develop pulmonary hypoplasia, limb deformities, and characteristic facies. Bilateral agenesis of the fetal kidneys is the most common cause due to the lack of fetal urine.[ citation needed ]

Prognosis

The prognosis of anhydramnios depends on the underlying cause and the severity of the condition. In general, the prognosis is poor for babies with anhydramnios caused by fetal renal abnormalities, with a high mortality rate. However, the prognosis is better for babies with anhydramnios caused by other factors, such as premature rupture of membranes (PPROM).[ citation needed ]

Factors that affect the prognosis of anhydramnios include:[ citation needed ]

With early diagnosis and appropriate treatment, many babies with anhydramnios can be born healthy. However, the prognosis for babies with anhydramnios caused by fetal renal abnormalities remains poor. These babies may require long-term medical care and may have developmental disabilities.[ citation needed ]

See also

Related Research Articles

<span class="mw-page-title-main">Amniocentesis</span> Sampling of amniotic fluid done mainly to detect fetal chromosomal abnormalities

Amniocentesis is a medical procedure used primarily in the prenatal diagnosis of genetic conditions. It has other uses such as in the assessment of infection and fetal lung maturity. Prenatal diagnostic testing, which includes amniocentesis, is necessary to conclusively diagnose the majority of genetic disorders, with amniocentesis being the gold-standard procedure after 15 weeks' gestation.

Fetal distress, also known as non-reassuring fetal status, is a condition during pregnancy or labor in which the fetus shows signs of inadequate oxygenation. Due to its imprecision, the term "fetal distress" has fallen out of use in American obstetrics. The term "non-reassuring fetal status" has largely replaced it. It is characterized by changes in fetal movement, growth, heart rate, and presence of meconium stained fluid.

<span class="mw-page-title-main">Chorionic villus sampling</span> Type of prenatal diagnosis done to determine chromosomal or genetic disorders in the fetus

Chorionic villus sampling (CVS), sometimes called "chorionic villous sampling", is a form of prenatal diagnosis done to determine chromosomal or genetic disorders in the fetus. It entails sampling of the chorionic villus and testing it for chromosomal abnormalities, usually with FISH or PCR. CVS usually takes place at 10–12 weeks' gestation, earlier than amniocentesis or percutaneous umbilical cord blood sampling. It is the preferred technique before 15 weeks.

<span class="mw-page-title-main">Polyhydramnios</span> Excess of amniotic fluid in the amniotic sac

Polyhydramnios is a medical condition describing an excess of amniotic fluid in the amniotic sac. It is seen in about 1% of pregnancies. It is typically diagnosed when the amniotic fluid index (AFI) is greater than 24 cm. There are two clinical varieties of polyhydramnios: chronic polyhydramnios where excess amniotic fluid accumulates gradually, and acute polyhydramnios where excess amniotic fluid collects rapidly.

<span class="mw-page-title-main">Amniotic fluid</span> Fluid surrounding a fetus within the amnion

The amniotic fluid is the protective liquid contained by the amniotic sac of a gravid amniote. This fluid serves as a cushion for the growing fetus, but also serves to facilitate the exchange of nutrients, water, and biochemical products between mother and fetus.

<span class="mw-page-title-main">Twin-to-twin transfusion syndrome</span> Medical condition

Twin-to-twin transfusion syndrome (TTTS), also known as feto-fetal transfusion syndrome (FFTS), twin oligohydramnios-polyhydramnios sequence (TOPS) and stuck twin syndrome, is a complication of monochorionic multiple pregnancies in which there is disproportionate blood supply between the fetuses. This leads to unequal levels of amniotic fluid between each fetus and usually leads to death of the undersupplied twin and, without treatment, usually death or a range of birth defects or disabilities for a surviving twin, such as underdeveloped, damaged or missing limbs, digits or organs, especially cerebral palsy.

Rupture of membranes (ROM) or amniorrhexis is a term used during pregnancy to describe a rupture of the amniotic sac. Normally, it occurs spontaneously at full term either during or at the beginning of labor. Rupture of the membranes is known colloquially as "breaking (one's) water," especially when induced rather than spontaneous, or as one's "water breaking". A premature rupture of membranes (PROM) is a rupture of the amnion that occurs at full term and prior to the onset of labor. In cases of PROM, options include expectant management without intervention, or interventions such as oxytocin or other methods of labor induction, and both are usually accompanied by close monitoring of maternal and fetal health. Preterm premature rupture of membranes (PPROM) is when water breaks both before the onset of labor and before the pregnancy's 37 week gestation. In the United States, more than 120,000 pregnancies per year are affected by a premature rupture of membranes, which is the cause of about one third of preterm deliveries.

Potter sequence is the atypical physical appearance of a baby due to oligohydramnios experienced when in the uterus. It includes clubbed feet, pulmonary hypoplasia and cranial anomalies related to the oligohydramnios. Oligohydramnios is the decrease in amniotic fluid volume sufficient to cause deformations in morphogenesis of the baby.

<span class="mw-page-title-main">Placental abruption</span> Medical condition

Placental abruption is when the placenta separates early from the uterus, in other words separates before childbirth. It occurs most commonly around 25 weeks of pregnancy. Symptoms may include vaginal bleeding, lower abdominal pain, and dangerously low blood pressure. Complications for the mother can include disseminated intravascular coagulopathy and kidney failure. Complications for the baby can include fetal distress, low birthweight, preterm delivery, and stillbirth.

<span class="mw-page-title-main">Prelabor rupture of membranes</span> Breakage of the amniotic sac before the onset of labour

Prelabor rupture of membranes (PROM), previously known as premature rupture of membranes, is breakage of the amniotic sac before the onset of labour. Women usually experience a painless gush or a steady leakage of fluid from the vagina. Complications in the baby may include premature birth, cord compression, and infection. Complications in the mother may include placental abruption and postpartum endometritis.

<span class="mw-page-title-main">Complications of pregnancy</span> Medical condition

Complications of pregnancy are health problems that are related to, or arise during pregnancy. Complications that occur primarily during childbirth are termed obstetric labor complications, and problems that occur primarily after childbirth are termed puerperal disorders. While some complications improve or are fully resolved after pregnancy, some may lead to lasting effects, morbidity, or in the most severe cases, maternal or fetal mortality.

Postterm pregnancy is when a woman has not yet delivered her baby after 42 weeks of gestation, two weeks beyond the typical 40-week duration of pregnancy. Postmature births carry risks for both the mother and the baby, including fetal malnutrition, meconium aspiration syndrome, and stillbirths. After the 42nd week of gestation, the placenta, which supplies the baby with nutrients and oxygen from the mother, starts aging and will eventually fail. Postterm pregnancy is a reason to induce labor.

Placental insufficiency or utero-placental insufficiency is the failure of the placenta to deliver sufficient nutrients to the fetus during pregnancy, and is often a result of insufficient blood flow to the placenta. The term is also sometimes used to designate late decelerations of fetal heart rate as measured by cardiotocography or an NST, even if there is no other evidence of reduced blood flow to the placenta, normal uterine blood flow rate being 600mL/min.

<span class="mw-page-title-main">Triploid syndrome</span> Chromosomal disorder in which there are three copies of every chromosome

Triploid syndrome, also called triploidy, is a chromosomal disorder in which a fetus has three copies of every chromosome instead of the normal two. If this occurs in only some cells, it is called mosaic triploidy and is less severe.

<span class="mw-page-title-main">Amniotic fluid embolism</span> Potentially fatal complication of pregnancy

An amniotic fluid embolism (AFE) is a life-threatening childbirth (obstetric) emergency in which amniotic fluid enters the blood stream of the mother, triggering a serious reaction which results in cardiorespiratory collapse and massive bleeding (coagulopathy). The rate at which it occurs is 1 instance per 20,000 births and it comprises 10% of all maternal deaths.

Amniotic fluid index (AFI) is a quantitative estimate of amniotic fluid and an indicator of fetal well-being. It is a separate measurement from the biophysical profile.

<span class="mw-page-title-main">Velamentous cord insertion</span> Velamentous placenta

Velamentous cord insertion is a complication of pregnancy where the umbilical cord is inserted in the fetal membranes. It is a major cause of antepartum hemorrhage that leads to loss of fetal blood and associated with high perinatal mortality. In normal pregnancies, the umbilical cord inserts into the middle of the placental mass and is completely encased by the amniotic sac. The vessels are hence normally protected by Wharton's jelly, which prevents rupture during pregnancy and labor. In velamentous cord insertion, the vessels of the umbilical cord are improperly inserted in the chorioamniotic membrane, and hence the vessels traverse between the amnion and the chorion towards the placenta. Without Wharton's jelly protecting the vessels, the exposed vessels are susceptible to compression and rupture.

An obstetric labor complication is a difficulty or abnormality that arises during the process of labor or delivery.

<span class="mw-page-title-main">Circumvallate placenta</span> Medical condition

Circumvallate placenta is a rare condition affecting about 1-2% of pregnancies, in which the amnion and chorion fetal membranes essentially "double back" on the fetal side around the edges of the placenta. After delivery, a circumvallate placenta has a thick ring of membranes on its fetal surface. Circumvallate placenta is a placental morphological abnormality associated with increased fetal morbidity and mortality due to the restricted availability of nutrients and oxygen to the developing fetus.

Amnioinfusion is a method in which isotonic fluid is instilled into the uterine cavity.

References

  1. 1 2 3 4 5 "Antepartum Fetal Surveillance". www.acog.org. Retrieved 2021-11-07.
  2. 1 2 3 4 "UpToDate". www.uptodate.com. Retrieved 2021-11-07.
  3. ↑ Grijseels, E. W. M.; van-Hornstra, PTM Echteld; Govaerts, L. C. P.; Cohen-Overbeek, T. E.; de Krijger, R. R.; Smit, B. J.; Cransberg, K. (2011-07-14). "Outcome of pregnancies complicated by oligohydramnios or anhydramnios of renal origin". Prenatal Diagnosis. 31 (11): 1039–1045. doi:10.1002/pd.2827. ISSN   0197-3851. PMID   21755519. S2CID   35572158.
  4. 1 2 Keilman, Courtney; Shanks, Anthony L. (2021), "Oligohydramnios", StatPearls, Treasure Island (FL): StatPearls Publishing, PMID   32965997 , retrieved 2021-11-07
  5. 1 2 "UpToDate". www.uptodate.com. Retrieved 2021-11-07.
  6. ↑ Paternoster, Delia M.; Snijders, Deborah; Manganelli, Francesca; Torrisi, Angela; Bracciante, Roberto (2003). "Anhydramnios and maternal thrombocytopenia after prolonged use of nimesulide". European Journal of Obstetrics & Gynecology and Reproductive Biology. 108 (1): 97–98. doi:10.1016/s0301-2115(02)00343-3. ISSN   0301-2115. PMID   12694979.
  7. ↑ Palermo, Mario S. F.; Espinosa, Ana; Trasmonte, Mónica (2021-11-19), "Disorders of Amniotic Fluid Volume: Oligoamnios and Polyhydramnios", Perinatology, Cham: Springer International Publishing, pp. 687–705, doi: 10.1007/978-3-030-83434-0_39 , ISBN   978-3-030-83433-3 , retrieved 2023-11-21
  8. ↑ Jelin, Angie C.; Sagaser, Katelynn G.; Forster, Katherine R.; Ibekwe, Tochi; Norton, Mary E.; Jelin, Eric B. (2020-02-19). "Etiology and management of early pregnancy renal anhydramnios: Is there a place for serial amnioinfusions?". Prenatal Diagnosis. 40 (5): 528–537. doi: 10.1002/pd.5658 . ISSN   0197-3851. PMC   7780162 . PMID   32003482.
  9. ↑ Atkinson, Meredith A.; Jelin, Eric B.; Baschat, Ahmet; Blumenfeld, Yair J.; Chmait, Ramen H.; O'Hare, Elizabeth; Moldenhauer, Julie S.; Zaretsky, Michael V.; Miller, Russell S.; Ruano, Rodrigo; Gonzalez, Juan M.; Johnson, Anthony; Mould, W. Andrew; Davis, Jonathan M.; Hanley, Daniel F. (2022). "Design and Protocol of the Renal Anhydramnios Fetal Therapy (RAFT) Trial". Clinical Therapeutics. 44 (8): 1161–1171. doi: 10.1016/j.clinthera.2022.07.001 . ISSN   0149-2918. PMC   9847373 . PMID   35918190.
  10. ↑ Riska, Anggun Hatika; Yusrawati, Yusrawati; Efrida, Efrida (2022-09-02). "Korelasi Asupan Vitamin C dan vitamin D dengan Kadar Timbal Ibu Hamil Preeklamsia". Indonesian Journal of Obstetrics & Gynecology Science. 5 (2): 284–292. doi: 10.24198/obgynia/v5n2.430 . ISSN   2615-496X.
  11. ↑ Hromadnikova, Ilona; Kotlabova, Katerina; Hympanova, Lucie; Krofta, Ladislav (2016). "Gestational hypertension, preeclampsia and intrauterine growth restriction induce dysregulation of cardiovascular and cerebrovascular disease associated microRNAs in maternal whole peripheral blood". Thrombosis Research. 137: 126–140. doi:10.1016/j.thromres.2015.11.032. ISSN   0049-3848. PMID   26632513.
  12. ↑ Vikraman, Seneesh Kumar; Chandra, Vipin; Balakrishnan, Bijoy; Batra, Meenu; Sethumadhavan, Sreeja; Patil, Swapneel Neelkanth; Nair, Sabila; Kannoly, Gopinathan (2017). "Impact of antepartum diagnostic amnioinfusion on targeted ultrasound imaging of pregnancies presenting with severe oligo- and anhydramnios: An analysis of 61 cases". European Journal of Obstetrics & Gynecology and Reproductive Biology. 212: 96–100. doi:10.1016/j.ejogrb.2017.03.026. ISSN   0301-2115. PMID   28349892.
  13. ↑ Bader, Arnim A; Schlembach, Dietmar; Tamussino, Karl F; Pristauz, Gunda; Petru, Edgar (2007). "Anhydramnios associated with administration of trastuzumab and paclitaxel for metastatic breast cancer during pregnancy". The Lancet Oncology. 8 (1): 79–81. doi:10.1016/s1470-2045(06)71014-2. ISSN   1470-2045.
  14. ↑ Io, Shingo; Kondoh, Eiji; Chigusa, Yoshitsugu; Tani, Hirohiko; Hamanishi, Junzo; Konishi, Ikuo (2017-11-20). "An experience of second-trimester anhydramnios salvaged by single amnioinfusion". Journal of Medical Ultrasonics. 45 (3): 525–527. doi:10.1007/s10396-017-0842-1. ISSN   1346-4523. S2CID   22787864.
  15. ↑ Visvalingam, G.; Purandare, N.; Cooley, S.; Roopnarinesingh, R.; Geary, M. (2011-12-20). "Perinatal outcome after ultrasound diagnosis of anhydramnios at term". Journal of Obstetrics and Gynaecology. 32 (1): 50–53. doi:10.3109/01443615.2011.618891. ISSN   0144-3615. PMID   22185537. S2CID   23539855.
  16. ↑ Spiro, Judith Eva; Konrad, Martin; Rieger-Fackeldey, Esther; Masjosthusmann, Katja; Amler, Susanne; Klockenbusch, Walter; Schmitz, Ralf (2015-02-13). "Renal oligo- and anhydramnios: cause, course and outcome—a single-center study". Archives of Gynecology and Obstetrics. 292 (2): 327–336. doi:10.1007/s00404-015-3648-7. ISSN   0932-0067. PMID   25676656. S2CID   21433366.
  17. ↑ Hansen, Wendy F.; Cooper, Christopher S.; Yankowitz, Jerome (2002). "Ureterocele Causing Anhydramnios Successfully Treated With Percutaneous Decompression". Obstetrics & Gynecology. 99 (5, Part 2): 953–956. doi:10.1097/00006250-200205001-00033. ISSN   0029-7844.
  18. ↑ Gramellini, D.; Fieni, S.; Kaihura, C.; Piantelli, G.; Verrotti, C. (2003). "Antepartum amnioinfusion: a review". The Journal of Maternal-Fetal & Neonatal Medicine. 14 (5): 291–296. doi:10.1080/jmf.14.5.291.296. ISSN   1476-7058. PMID   14986801. S2CID   19890702.
  19. ↑ Oligohydramnios Archived 2016-09-20 at the Wayback Machine at the National Institute for Health and Clinical Excellence. Based on the overview Therapeutic amnioinfusion for oligohydramnios during pregnancy (excluding labour) Archived 2013-02-18 at the Wayback Machine in 2006
  20. ↑ Hofmeyr, G. J.; Gülmezoglu, A. M. (2002). "Maternal hydration for increasing amniotic fluid volume in oligohydramnios and normal amniotic fluid volume". The Cochrane Database of Systematic Reviews (1): CD000134. doi:10.1002/14651858.CD000134. ISSN   1469-493X. PMC   7045461 . PMID   11869566.
  21. ↑ Morris, R. K.; Malin, G. L.; Quinlan-Jones, E.; Middleton, L. J.; Hemming, K.; Burke, D.; Daniels, J. P.; Khan, K. S.; Deeks, J.; Kilby, M. D. (2013). "Percutaneous vesicoamniotic shunting versus conservative management for fetal lower urinary tract obstruction (PLUTO): A randomised trial". The Lancet. 382 (9903): 1496–1506. doi:10.1016/S0140-6736(13)60992-7. PMC   3898962 . PMID   23953766.
  22. ↑ Adeniran AJ, Stanek J (2007). "Amnion nodosum revisited: clinicopathologic and placental correlations". Arch Pathol Lab Med. 131 (12): 1829–33. doi:10.5858/2007-131-1829-ANRCAP. PMID   18081444.
  23. ↑ Johnson JM, Chauhan SP, Ennen CS, Niederhauser A, Magann EF (2007). "A comparison of 3 criteria of oligohydramnios in identifying peripartum complications: a secondary analysis". Am. J. Obstet. Gynecol. 197 (2): 207.e1–7, discussion 207.e7–8. doi:10.1016/j.ajog.2007.04.048. PMID   17689653.
  24. ↑ Elsandabesee D, Majumdar S, Sinha S (2007). "Obstetricians' attitudes towards 'isolated' oligohydramnios at term". Journal of Obstetrics and Gynaecology. 27 (6): 574–6. doi:10.1080/01443610701469669. PMID   17896253. S2CID   39603642.
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