An abnormally low volume of amniotic fluid (AF) surrounding the fetus; measured as amniotic fluid index (AFI) of less

than 5 cm. Ultrasound is used to measure the amniotic fluid in four uadrants of the uterus and normal AFI is considered to be between about ! and "! cm.

Aetiology
#ecreased fetal urine $roduction or excretion %xcessive amniotic fluid loss &remature ru$ture of membranes 'ongenital abnormalities of the urinary tract of the fetus &lacental insufficiency (win)twin transfusion syndrome &ost*maturity +aternal high blood $ressure Idio$athic %arlier it is; $oorer is the fetal $rognosis

Functions
Allows movement for $ro$er musculos,eletal develo$ment +echanical shoc, absorber (hermoregulation -el$s in develo$ment of normal res$iratory system .ligohydramnios in early $regnancy may lead underdevelo$ment of fetal lung tissue ($ulmonary hy$o$lasia) and $ulmonary arterial hy$eretension /imb defects ('lub foot and hands) It also has nutritional value (fetus swallows the amniotic fluid and at term gets about "* ".5 grmas of $roteins $er day by the absor$tion of the fluid) and thus oligohydramnios is associated with $oor fetal growth or growth restriction (here may be an increased ris, of miscarriage0 $remature birth and stillbirth. #uring labour0 oligohydramnios may lead to fetal distress due to com$ression of the umbilical cord against the fetal $arts or uterus.

(reatment
At any $eriod of gestation; a$$roximately one third of amniotic fluid is contributed by the mother and thus there is some evidence that maternal hydration can increase AFI

Non invasive
Maternal hypotonic fluid challenge test +other is acutely hydrated by giving 1 litres of hy$tonic fluid (52 #extrose) intravenously within a short s$an of 1 hours. (his acutely hydrated the mother and decreases the maternal $lasma osmolality and gets reflected into increased AFI to the fetus within !*"3 hours. 4ince this is acute hydration of both mother and the fetus0 the dictum is this that as fast the fluid comes faster it leaves.

Invasive
Amnio INFUSION Under ultrasound guidance0 a needle is inserted through the uterine wall into the amniotic cavity and isotonic fluid (normal saline)0 is infused slowly and target AFI is ,e$t below the 53th centile for the gestational age. As the fluid instilled and correction of AFI index is done ra$idly0 we don5t intend to distend the uterus suddenly so as to avoid uterine contractions. &atients with $ersistent (67 days) oligohydramnios (maximum cord*free $oc,et of AF 81 cm) are advised for serial amnioinfusions. Amnioinfusion may be used during labour to decrease fetal distress due to oligohydramnios and to facilitate ultrasound scanning of the fetus when the visibility is unsatisfactory due to oligohydramnios.

%fficacy
9ey $arameters are $rolongation of gestation0 reduction in $rematurity0 reduced incidence of $ulmonary hy$o$lasia and im$roved neonatal survival. Pulmonary hypoplasia: Amnioinfusion has been re$orted to significantly lower the incidence of $ulmonary hy$o$lasia among the treated fetuses com$ared to controls. Neonatal morbidity and mortality: $er se if the $rocedure is able to $rolong the $eriod of $regnancy0 it hel$s in decreasing the neonatal morbidity and mortality which is mainly due to $rematurity etention of infused fluid: .ur ex$erience of $ost amnioinfusion0 intrauterine retention of fluid is variable between 7! hours to maximum $eriod of 1" days. Although the $rocedure was com$leted successfully in all the cases0 but only ;32 (one third) retained the infused solution and thus benefitted the most.

Safety
It being a $renatal invasive $rocedure has its ris, of leading to $remature contractions and $reterm labour which is e uivalent to that of amniocentesis that is 3.12 (" in 533). &lacental abru$tion (It is more common due to underlying maternal condition0 maternal hy$ertension) 'horioamnionitis (Its incidence is rare with antibiotic coverage) Fetal trauma (<are as it is done under continuous ultrasound guidance) .ligohydramnios is the most im$ortant inde$endent $redictor of occurrence of $ulmonary hy$o$lasia with associated ris, of $erinatal mortality as high as !32 'onversely0 ade uate residual amniotic fluid volume identifies foetuses with better chances of good $erinatal and neurologic outcome. !omment 'ases in which serial amnioinfusions successfully reversed oligohydramnios had a better $erinatal and long*term neurologic outcome than with $ersistent oligohydramnios. Article source: htt$:==fetalandgeneticclinic.com=oligohydramnios*$regnancy=