Bangal V B et. al.

/ JPBMS, 2011, 12 (05)

Available online at www.jpbms.info

Research article

ISSN NO- 2230 7885

CODEN JPBSCT

JPBMS
JOURNAL OF PHARMACEUTICAL AND BIOMEDICAL SCIENCES

Incidence of oligohydramnios during pregnancy and its effects on maternal and

perinatal outcome
*

Vidyadhar B. Bangal1, Purushottam A. Giri2, Bhushan M. Sali3

1Professor

and Head, Dept. of Obstetrics and Gynaecology (OBGY), Rural Medical College & Pravara Rural Hospital of
Pravara Institute of Medical Sciences (Deemed University), Loni, Dist. Ahmednagar, Maharashtra, India.
2Assistant Professor, Dept. of Community Medicine (PSM), Rural Medical College & Pravara Rural Hospital of
Pravara Institute of Medical Sciences (Deemed University), Loni Dist. Ahmednagar, Maharashtra, India.
3Postgraduate student, Dept. of Obstetrics and Gynaecology (OBGY), Rural Medical College & Pravara Rural Hospital of
Pravara Institute of Medical Sciences (Deemed University), Loni Dist. Ahmednagar, Maharashtra, India.

Abstract: Oligohydramnios or reduced amount of amniotic fluid volume is a commonly observed obstetric problem

during third trimester of pregnancy. It accompanies a broad range of reproductive disorders including anomalies of fetus
and functional disorders of mother, fetus and placenta. Reduced amniotic fluid volume is associated with adverse perinatal
outcome. A prospective hospital based study of total 100 cases of oligohydramnios coming for delivery to Pravara Rural
Hospital, Loni was undertaken over a period of two years from October 2007 to September 2009. The information
regarding bio-social characteristics, maternal and perinatal outcome were collected and results were analyzed by using
percentage and proportion. In the present study, the majority of the cases( 78%) were unbooked and belonged to the age
group of 20-30 years and had associated maternal or fetal complications. Postdated pregnancy, pregnancy induced
hypertension and fetal congenital anomalies were the commonest complications associated with oligohydramnios. Forty
four percent cases were delivered by caesarean section. Overall perinatal mortality was 24%. Cases with severe
oligohydramnios and anhydramnios were associated with intrapartum fetal heart rate abnormalities, (16%) low Apgar
score and (8%) meconium aspiration syndrome. Every case of oligohydramnios needs careful evaluation, parental
counseling and individualized decision regarding timing and mode of delivery. Continuous intrapartum fetal monitoring
and good neonatal care support is essential for optimum perinatal outcome.

Keywords: Maternal outcome, perinatal outcome, Oligohydramnios

Introduction:

Oligohydramnios or reduced volume of amniotic fluid

poses challenge to obstetrician, when it is diagnosed
before term. Oligohydramnios can develop in any
trimester, although it is more common in third trimester.
[1] About 12% of women, whose pregnancies continue for
two weeks beyond expected date of delivery; develop
oligohydramnios due to declining placental function.
Oligohydramnios accompanies a broad range of
reproductive disorders including anomalies of fetus and
functional disorders of mother, fetus and placenta.
Decreased amount of amniotic fluid, particularly in third
trimester, has been associated with multiple fetal risks
like, pulmonary hypoplasia and intrauterine growth
restriction. Oligohydramnios may cause compression of
umbilical cord, leading to fetal distress during labour.
Oligohydramnios is found to be associated with an
increased risk of caesarean delivery for fetal distress, low
Apgar score and high perinatal morbidity and mortality [2].
Hence, the present study was carried out to find out the
incidence of oligohydramnios during pregnancy and its
effect on maternal and perinatal outcome.

Medical College and Pravara Rural Hospital- a tertiary

level health care referral centre in Loni, Maharashtra,
India over a period of 2 years from October 2007 to
September 2009. Hundred pregnant women in 3rd
trimester of pregnancy, diagnosed as oligohydramnios
with amniotic fluid index (AFI) less than 5 cm and intact
membranes were included in the study. Findings were
analyzed with the special emphasis on bio-social
characteristics of the patient and maternal and perinatal
outcome. The ethical committee of the institute had
approved the study. Results were analyzed by using
percentage and proportion.

A retrospective hospital based study was carried out in the

department of Obstetrics and Gynaecology of Rural

It was observed that (table 2), pregnancy induced

hypertension (16%), postdated pregnancy (16%) and

Material & Methods:

Results:

It was observed (table 1) that, 78% women with

oligohydramnios were in the age group of 20-29 years.
The mean ( SD) maternal age was 22.8 4.2 years. By
gestational age, 22% of women were in the gestational
age group of 34-36 weeks followed by 20% women in 3840 and >40 weeks. The mean gestational age was 36.7
4.1 weeks. By parity, 54% women were primigravidas
followed by 46% multigravidas.

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Bangal V B et. al. / JPBMS, 2011, 12 (05)

anhydramnios (10%) were commonly seen in women with

oligohydramnios. As regards to mode of delivery, it was
observed that, 56% had spontaneous vaginal delivery and
44% had operative/assisted delivery. Birth asphyxia
(Apgar score of <7 at one minute and five minute) was
more common in the babies delivered in cases of
oligohydramnios. Neonatal morbidity was mainly due to
meconium aspiration and neonatal sepsis. High perinatal
mortality (24%) was observed in the present study.
Bio-social characteristics
1.

Oligohydramnios women
(n=100)

Maternal age
<20 yrs
16
20 - 29 yrs
78
30 yrs
06
Mean SD 22.88 yrs 4.24 yrs
2. Gestational age
30-32 weeks
08
32-34 weeks
14
34-36 weeks
22
36-38 weeks
16
38-40 weeks
20
>40 weeks
20
Mean SD 36.72 weeks 4.11 weeks
3. By Amniotic Fluid Index
0
10
1
06
2
28
3
06
4
30
5
20
Mean SD 3.00 1.04

4. By birth weight
<1000 gms
02
1000-2000 gms
38
2000-3000 gms
58
>3000 gms
02
Mean SD 2140.00 gms 0.51 gms
5. Parity
Primigravidas
54
Multigravidas
46
Mean SD 1.2 1.5
(Data indicates both number and percentage)

Table
2:
Maternal
and
oligohydramnios (n=100)

perinatal

Variables
1. Maternal complications
Pregnancy induced hypertension
Postdate
Intrauterine growth restriction
Preterm delivery
Anhydramnios
Fetal anamolies
2. Mode of delivery
Spontaneous vaginal delivery
Operative/assisted delivery
3 Neonatal morbidity
Meconium aspiration
Neonatal sepsis
4. Apgar score (< 7)
At 1 minute
At 5 minute
5. Perinatal mortality
Still births
Early neonatal death
(Data indicates both number and percentage)

outcome

in

No. of cases
16
16
14
14
10
08
56
44
04
04
10
16
08
16

Discussion:
In the present study, 78% of cases were in the age group
20 to 29 years, as compared to other age groups, reflecting
the child bearing age of most of the women with the mean
(SD) maternal age of 22.8 4.2 years. Similar studies by
Chauhan P et. al. [3], Jun Zhang et. al. [4] and Everett F et. al.
2

found that the mean maternal age were 23.6 6.5 years,
28.4 3.4 years and 23.8 5.7 years respectively.
The mean gestational age in the present study was 36.7
4.1 weeks. Similar studies by Jun Zhang et. al. [4], Casey B et
al .[6] , Everett F et. al. [5] and Iffath A et. al.[ 7] found that, the
mean gestational age were 38.1 3.3 weeks, 37.5 2
weeks, 34.3 2.1 weeks, and (mean SD) was 36.3 2
weeks respectively. These findings indicate that the
problem of oligohydramnios was more common in the
later part of pregnancy. It is mainly due to physiological or
pathological causes of reduced placental perfusion near
term.
In the present study, the incidence of oligohydramnios
was 0.67%. Similar study by Jun Zhang et. al. [4] reported
the incidence as 1.5%. Divon M et. al. [8] found
oligohydramnios in 1.2% in their cases. Casey B et al.6
found that 2.3% cases were complicated by
oligohydramnios. Elliot H et. al. [9] found that, the incidence
of oligohydramnios was 3.9% in their study. Varma T R et.
al. [10] found that, the incidence was 3.1% in their study.
Chauhan P et. al. [19] studied two groups of patients. First
group had AFI less than 5cm and second with AFI less than
5th percentile for that gestational age. The mean amniotic
fluid index was 3.9 2.1 cm (AFI less than 5th percentile)
and 3 1.5 cm in patients with AFI less than 5cm.
The mean amniotic fluid index (AFI) in the present study
was 3.00 1.04cm. Sadovsky Y et. al. [20] in their study,
found that the mean amniotic fluid index was 2.9 cm.
Obstetrical complications frequently associated with
oligohydramnios
were
pregnancy
induced
hypertension(PIH), postdatism, intrauterine growth
restriction, fetal renal anomalies, prematurity and
intrauterine death of the fetus. In the present study 78%
cases had associated obstetrical complications; acting
singly or in combination for causing oligohydramnios. PIH
was present in 16% cases. Golan A et al.12 in his study,
found maternal hypertension in 22.1% cases. Cesarean
section was performed in 35.25% of these cases. Mercer L
J et. al. [13] found that preeclampsia was present in 24.7%
of cases with decreased fluid. Study by Chauhan P et. al. [3]
reported, preeclampsia in 12% cases. They concluded that
the incidence of oligohydramnios ranges from 10 to 30 %
in hypertensive patients requiring hospitalization. Sixteen
percent cases had postdated pregnancies in the present
study. Clement D et. al. [21] studied six cases of postdatism,
in which amniotic fluid volume diminished abruptly over
24 hours. Bowen Chattoor JS et. al. [22], in their study
evaluated the relationship between amniotic fluid index
and perinatal outcomes in fifty five postdate pregnancies.
Oligohydramnios was noted in four (7.2%) cases. In the
present study, intra uterine growth restriction was
present in 20% cases and the rate of caesarean section
was 44% and that of vaginal delivery was 56%. Study by
Casey B et. al. [6] found that, there was increased rate of
induction of labour (42%) and Cesarean section (32%) in
oligohydramnios cases. Jun Zhang et al.4 found that, the
overall cesarean delivery rates were similar between
women with oligohydramnios and the controls (24% Vs
19%). Golan A et. al. [12] et al found that, the cesarean
section was performed in 35.2% of pregnancies. In the
present study, the apgar score was noted at 1 and 5
minutes after birth. Sixteen babies (16%) had low Apgar
score (less than 7 at 5 min). Out of 16 babies with low
Apgar score, eight died during neonatal period. Three
babies with low Apgar score were delivered by caesarian
[5]

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Bangal V B et. al. / JPBMS, 2011, 12 (05)

section. Out of these 3 babies, one died during neonatal

period due to non-immune hydrops fetalis. In a similar
study by Casey B et. al.[6] (6%) babies had Apgar score of
less than 3 at 5 minute. Out of these nine babies, seven
died during neonatal period. Jun Zhang et. al. [4] found that
an Apgar score of <7 at 1 minute was present in fifteen Six
babies had Apgar score of <7 at 5 minute. Desai P et. al. [14]
found that three babies with Apgar score less than 7 at 5
minute as against only one in control group. In a similar
study by Locatelli A et. al. [15] of 341 patients with
oligohydramnios, found no significant difference for Apgar
score of less than 7 at 5 minute in study and control group.
In the present study, four (8%) babies developed
meconium aspiration. All four babies were admitted in
NICU for further management. Three babies were
delivered by caesarean section and one by vaginal route.
Two babies died in neonatal period. Causes of deaths were
meconium aspiration syndrome and development of
septicemia. Babies who died due to meconium aspiration
syndrome were of 37.5 weeks and 39.3 weeks of gestation
with birth weight of 1.3 kg and 2.5kg respectively. Casey B
et. al. [6] studied 6423 patients, who underwent
ultrasonography at more than 34 weeks gestation and
found that 147 (2.3%) cases were complicated by
oligohydramnios. Meconium stained amniotic fluid was
identified, less often in pregnancies complicated by
oligohydramnios (6% vs. 15%, P=0.004). Notably; the
incidence of meconium aspiration syndrome in infants
with oligohydramnios was significantly higher despite the
diminished identification of meconium stained amniotic
fluid.
Bowen Chattoor JS et. al. [22] studied perinatal outcome in
55 postdate pregnancies. Oligohydramnios was noted in
four patients. All 4 babies were admitted with meconium
aspiration. One died due to this complication.
In the present study, there were 92% live births and 8%
still births. Sixteen percent babies died in neonatal period.
The gross perinatal mortality was 24% in present study.
Out of 12 perinatal deaths, 11 deaths were seen in
unregistered cases. Chhabra S et. al. [16] reported very high
(87.7%) perinatal mortality in their study. Wolff F et. al.
[17] found that the perinatal mortality in their study was
7.2%. Apel-Sarid L et. al. [18] found that the perinatal
mortality was 9.9%. Chamberlin PF et. al. [23] calculated the
gross and corrected perinatal mortality rate in patients
with decreased qualitative amniotic fluid volume and
found it to be 188/1000 and 109/1000 respectively.
Overall, the perinatal mortality is markedly increased in
patients with oligohydramnios. The lack of amniotic fluid
allows compression of fetal abdomen, which limits the
movement of the diaphragm.

Conclusion:
Oligohydramnios is being detected more often these days,
due to routinely performed obstetric ultrasonography.
Pregnancy induced hypertension and post dated
pregnancies are the commonest causes of reduced
amniotic fluid during third trimester of pregnancy.
Anomalies of the fetal renal system are responsible for
oligohydramnios in second and third trimester. The time
and mode of delivery of these cases depends on severity of
oligohydramnios and status of fetal wellbeing. Caesarean
section is mostly required for cases with anhydramnios
and intrapartum fetal heart rate abnormalities. Babies are
relatively more prone for certain complications, like
3

intrapartum fetal distress, meconium aspiration syndrome

and birth asphyxia. Adverse perinatal outcome can be
avoided by careful intrapartum fetal heart rate
monitoring. Every case of oligohydramnios needs careful
antenatal evaluation, parental counseling, individualized
decision regarding timing and mode of delivery.
Continuous intrapartum fetal monitoring and good
neonatal care are necessary for better perinatal outcome.

Acknowledgement:

We acknowledge the cooperation extended by

Management of Pravara Medical Trust and The Principal,
Rural Medical College, Loni, Maharashtra, India

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Conflict of Interest: - None

Source of funding: - Not declared
*Corresponding Author:Dr. Vidyadhar B. Bangal.,
Professor and Head,
Dept. of Obstetrics and Gynaecology (OBGY),
Rural Medical College, Loni, Dist. Ahmednagar,
Maharashtra, India Pin- 413736
Contact no- (+91) 02422- 273600, 09822096723.

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