OLIGOHYDRAMNIOS

Dr abdullahwww.obgyntoday.info 1
PHYSIOLOGY OF AMNIOTIC FLUID

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 INFLOW OUTFLOW
(1000 ml/d) (1000 ml/d)

1.FETAL SWALLOWING
1.FETAL URINE
2.LUNG LIQUID

INTRAMEMBRANOUS (placenta,cord)
TRANSMEMBRANOUS(amniotic membranes)
RECYCLING 3hrs
Dr abdullahwww.obgyntoday.info 3
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Dr Mona Shroff
www.obgyntoday.info
 Amniotic uid volume

8 weeks : 15 ml,increases 10 ml/wk

17 wks :250 ml ,increases 50 ml/wk
28-38 wks :750-1000ml (decreases
after 34 wks)
42 wks<500ml

Dr abdullahwww.obgyntoday.info 6
 FUNCTIONS OF AMNIOTIC FLUID
Shock absorber protects from external trauma.
Protects cord from compression.
Permits fetal movements development of
musculoskeletal system, prevents adhesions.
Swallowing of AF enhances growth & development of
GIT.
AF volume maintains AF pressure reduces loss of
lung liquid pulmonary development.
Maintenance of fetal body temperature.
Some fetal nutrition, water supply.
Bacteriostatic properties decreases potential for
infection

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 DEFINITION
AMNIOTIC FLUID VOLUME < 5 th percentile for
gestational age

AMNIOTIC FLUID INDEX < 5

SINGLE VERTICAL POCKET < 2 cms

Amniotic uid volume of less than 500 mL at

32-36 weeks' gestation

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INCIDENCE

0.5 5%

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 AETIOLOGY
FETAL
PROM (50%)
MATERNAL
PREECLAMPSIA
CHROMOSOMAL ANOMALIES
APLA SYNDROME
CONGENITAL ANOMALIES
CHRONIC HT
IUGR
IUFD
POSTTERM PREGNANCY DRUGS
PG SYNTHETASE INHIBITORS
PLACENTAL ACE INHIBITORS
CHRONIC ABRUPTION
TTTS IDIOPATHIC
CVS
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 DIAGNOSIS
SYMPTOMS SIGNS

NO SPECIFIC Uterus small for

SYMPTOMS date
Feels full of fetus
H/O leaking p/v
Postterm
Malpresentations
s/o preeclampsia IUGR
Drugs
Less fetal movements
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 USG
METHODS

MVP <2 cms

(<1 severe)

AFI <5 cms

(5-8 borderline)

2D pocket <15 sq cms

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 Technique of AFI
Uterus divided into 4 quadrants
Transducer in vertical plane
Sum of 4 quadrants max pocket depth
excluding cord & limbs.
Prior to 20 wks 2 halves
Twins: composite AFI or individual vertical
pockets

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Authors' conclusions

The single deepest vertical pocket measurement in the

assessment of amniotic uid volume during fetal
surveillance seems a better choice since the use of the
amniotic uid index increases the rate of diagnosis of
oligohydramnios and the rate of induction of labor
without improvement in peripartum outcomes. A
systematic review of the diagnostic accuracy of both
methods in detecting decreased amniotic uid volume
is required.

Nabhan AF, Abdelmoula YA. Amniotic uid index versus single deepest
vertical pocket as a screening test for preventing adverse pregnancy
outcome. Cochrane Database of Systematic Reviews 2008, Issue 3

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 COMPLICATIONS
FETAL MATERNAL
Abortion
Prematurity Increased morbidity
IUFD
Prolonged labour:
Deformities CTEV,contractures,
uterine inertia
amputation
Potters syndrome- pulmonary Increased operative
hypoplasia intervention
Malpresentations (malformations,
Fetal distress distres)
MSAF MAS
Low APGAR 16
 MANAGEMENT
DEPENDS UPON

AETIOLOGY
GESTATIONAL AGE
SEVERITY
FETAL STATUS & WELL BEING

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 DETERMINE AETIOLOGY

R/O PROM, h/o medical illness

TARGETED USG FOR ANOMALIES
R/O IUGR ,IUFD when suspected
Amniocentesis if chromosomal anomalies
suspected early symmetric IUGR
Tests for APLA Syndrome , if suspected

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Dr Mona Shroff www. 19
obgyntoday.info
 Techniques for Monitoring
Single pocket without cord
AFI = sum of deepest pocket in each of 4 quadrants without cord
BPP =
1. NST
2. breathing 30sec in 30min
3. move 3 limb/body in 30min
4. extension of extremity with exion or open/close hand
5. single vertical non-cord pocket of 2 cm
Scoring: 0 or 2 for each, 10 is normal, 6 equivocal, 4 abnormal

Modied BPP = NST, +/- acoustic stimulation, AFI

AFI > 5 ok
AFI < 5 or non-reactive NST not ok
modied BPP equally useful as BPP for monitoring, per ACOG
 TREATMENT
ADEQUATE REST decreases dehydration
HYDRATION Oral/IV Hypotonic uids(2 Lit/d)
temperory increase
helpful during labour,prior
to ECV, USG
SERIAL USG Monitor growth,AFI,BPP
INDUCTION OF LABOUR/ LSCS
Lung maturity attained
Lethal malformation
Fetal jeopardy
Sev IUGR
Severe oligo
DDAVP: ? Research settings
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Hofmeyr GJ, Glmezoglu AM. Maternal hydration for increasing amniotic uid volume in
oligohydramnios and normal amniotic uid volume. Cochrane Database of Systematic
Reviews 2002, Issue 1.

Authors' conclusions
Simple maternal hydration /IV Hypotonic uid (2 lit)
appears to increase amniotic uid volume and may be
benecial in the management of oligohydramnios and
prevention of oligohydramnios during labour or prior to
external cephalic version. Controlled trials are needed to
assess the clinical benets and possible risks of
maternal hydration for specic clinical purposes.

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 AMNIOINFUSION

INDICATIONS
1.Diagnostic
2.Prophylactic
3.Therapeutic

Decreases cord
compression
Dilutes meconium

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Hofmeyr GJ. Prophylactic versus therapeutic amnioinfusion for oligohydramnios in

labour. Cochrane Database of Systematic Reviews 1996,Issue 1 .

Authors' conclusions
There appears to be no advantage of
prophylactic amnioinfusion over
therapeutic amnioinfusion carried out only
when fetal heart rate decelerations or
thick meconium-staining of the liquor
occur.

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 DDAVP

Oral hydration + DDAVP :Prevents diuresis

Results in maternal plasma hypotonicity -

fetal plasma hypotonicityincreased fetal
urine productionreduced fetal
swallowingincreased AFI

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 DDAVP : concerns

Effecton maternal & fetal bld volume

Long term effects on AFI
Prophylactic or chronic use
Mask oligohydramnios ??

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Therapeutic Interventions:
Oligohydramnios
 TREATMENT ACC. TO CAUSE
Drug induced OMIT DRUG
PROM INDUCTION
PPROM Antibiotics,steroid Induction
FETAL SURGERY
VESICO AMNIOTIC SHUNT-PUV
Laser photocoagulation for TTTS

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 Posterior urethral valves
Sonographic ndings:
Keyhole sign
 Posterior urethral valves
Management:
Karyotyping
Perform serial bladder drainage every 3-4
days
Use sample of 3rd drainage
Isotonic urine indicate poor function
 Posterior urethral valves
Good prognostic biochemical markers:
Na < 100meq/L
Cl < 90meq/L
Osmolarity <210mOsm/L
B2 microglobulin < 4mg/L
Ca < 8mg/dl

Indication for vesico amniotic shunts

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