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Oligohydramnios
- Oligohydramnios is defined as decreased amniotic fluid volume (AFV) for gestational age.
- Isolated oligohydrominos is the presence of decreased liquor of an appropriate for gestational age , non compromised fetus with no maternal disease
- Causes :
In general Oligohydramnios is caused by a reduction in production of fetal urine due to placental insufficiency, fetal renal anomalies or obstruction of urine flow; or because the urine that is produced, drains away due to ruptured amniotic membranes
- Maternal
- Medical conditions that cause utero-placental insufficiency (e.g., preeclampsia, chronic hypertension, collagen vascular disease, nephropathy, thrombophilia)
- Medication: as ACE inhibitors
àFetal
o Chromosomal abnormalities
o Congenital abnormalities (renal agenesis )
o Growth restriction
o Fetal demise
o Post term pregnancy
o Ruptured fetal membranes
o Placental thrombosis
o Twin to twin transfusion
- Early oligohydrominous complications :
pulmonary hypoplasia , limb contrtactures , abnormal chest wall and lethal infection .
- Late oligohydrominous (in 3rd trimester )complications
Fetal risks : stillbirth , neonatal death , fetal distress , low apgar score and neonatal complications
Maternal risks: failure of VBAC or ECV and increase risk of urgent cesarean section, and post partum sepsis
-Investigations :
Ultrasound to check on the fetal kidneys and urinary bladder and fetal measurments, with umbilical artery Doppler to check for IUGR and placental flow
- Time of delivery :
-At gestational age >= 37 weeks Induction of labour should be considered. If not acceptable by the patient, after counselling, organise scans every week for liquor volume and Umbilical artery Dopplers, and twice weekly CTG.
- Steroid should be considered if cesarean delivery is planned at less than 39 weeks.
- patient should report any change in fetal movements.
Dr Najeeb Layyous F.R.C.O.G
Consultant Obstetrician, Gynecologist and Infertility Specialist
