Oligohydramnios
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Oligohydramnios refers to a situation where the amniotic fluid volume is less than expected for gestational age. Often these fetuses have < 500 ml of amniotic fluid.
Epidemiology
The estimated prevalence can be up to ~6% of pregnancies 4.
Pathology
Causes
The causes of oligohydramnios are protean and one way to simplify it is by using the following mnemonic: DRIPPC
-
D:
- demise
- drugs: e.g
protaglandinprostaglandin inhibitors(Indomethacin(indomethacin)
-
R:
-renalrenal abnormalities (from decreased urine output) -
I:
- IUGRIUGR (intra-uterine growth restriction):- 80%: maymay occur from decreased renal perfusion due to sparing effect - P: premature rupture of membranes
- P: post dates
- C: chromosomal anomalies (especially if other anomalies are found)
Associations
- Potter sequence
- underlying fetal hypoxia and fetal cardiovascular compromise: from preferential flow to the fetal brain at the expense of renal shut down
- twin pregnancy related complications:
- twin to twin transfusion syndrome: in pump twin
- maternal dehydration
Radiographic assessment
Antenatal ultrasound
Several sonographic criteria can be used which include:
- four quadrant amniotic fluid index (AFI): < 5
- two diameter pocket method: < 1 x 1 cm or < 15 cm2
- maximum vertical pocket depth: < 2 cm
Complications
- first trimester oligohydramnios can result in failure of pregnancy in up to 95% from complications such as:
- pulmonary hypoplasia: implies a very poor prognosis
- fetal limb contractures
Treatment and prognosis
Development of oligohydramnios early is pregnancy is generally a poor prognostic marker. An amnio-infusion can be carried in severe cases in the appropriate situation.
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