![]() The cookie is used to store the user consent for the cookies in the category "Other. This cookie is set by GDPR Cookie Consent plugin. The cookies is used to store the user consent for the cookies in the category "Necessary". The cookie is set by GDPR cookie consent to record the user consent for the cookies in the category "Functional". The cookie is used to store the user consent for the cookies in the category "Analytics". These cookies ensure basic functionalities and security features of the website, anonymously. Necessary cookies are absolutely essential for the website to function properly. Without this, the fetus can develop severe muscle contractures - which may lead to disability despite physiotherapy after birth. These cases will carry a poorer prognosis than that of a normally grown fetus.Īmniotic fluid also allows the fetus move its limbs in utero (exercise). When oligohydramnios is associated with placental insufficiency, there is also a higher rate of preterm deliveries (usually through planned induction of labour). ![]() In the majority of these cases, there is premature rupture of membranes (which may or may not be associated with infection), with subsequent premature delivery and pulmonary hypoplasia - which can cause significant respiratory distress at birth Oligohydramnios in the second trimester carries a poor prognosis. These babies are likely to be delivered before 36-37 weeks. Umbilical artery and middle cerebral artery Doppler scans.In women where oligohydramnios is caused by placental insufficiency, the timing of delivery depends on a number of factors: before 37 weeks' gestation), and where labour doesn't start automatically, induction of labour should be considered around 34-36 weeks (in the absence of infection).Ī course of steroids should be given to aid fetal lung development, and antibiotics to reduce the risk of ascending infection. In cases of preterm rupture of membranes (i.e. If oligohydramnios is due to ruptured membranes, labour is likely to commence within 24-48 hours in most pregnancies. The two most common causes are rupture of the membranes and placental insufficiency. The management of oligohydramnios is largely dependent on the underlying cause. In cases of oligohydramnios, the kidneys should be assessed. Fig 2 - Ultrasound image of normal fetal kidney. Perform a speculum examination (can a 'pool' of liquor be seen in the vagina?).Viral infections (although may also cause polyhydramnios).Renal agenesis (known as Potter's syndrome).Placental insufficiency - resulting in the blood flow being redistributed to the fetal brain rather than the abdomen and kidneys.It gets processed, fills the bladder and is voided, and the cycle repeats. Problems with any of the structures in this pathway can lead to either too much or too little fluid.Īnything that reduces the production of urine, blocks output from the fetus, or a rupture of the membranes (allowing amniotic fluid to leak) can lead to oligohydramnios. The fetus breathes and swallows the amniotic fluid. It is predominantly comprised of the fetal urine output, with small contributions from the placenta and some fetal secretions (e.g. It plateaus from 33-38 weeks, and then declines - with the volume of amniotic fluid at term approximately 500ml. The volume of amniotic fluid increases steadily until 33 weeks of gestation. Polyhydramnios is over the 95th centile, oligohydramnios is below the 5th centile Pathophysiology Fig 1 - Amniotic fluid centiles during pregnancy. These proteins are found in amniotic fluid, and if detected, strongly suggest membrane rupture. ![]() When considering ruptured membranesas a cause for oligohydramnios, a bedside test can be performed to detect the presence of IGFBP-1 (insulin-like growth factor binding protein-1) or PAMG-1 (placental alpha-microglobulin-1) in the vagina. Karyotyping (if appropriate) – particularly in cases of early and unexplained oligohydramnios.Small babies can result from placental insufficiency, which also causes oligohydramnios. There may also be a rise in pulsatility index of the umbilical artery Doppler in placental insufficiency. Assess for liquor volume, structural abnormalities, renal agenesis and obstructive uropathy.Perform a speculum examination (can a ‘pool’ of liquor be seen in the vagina?).Inquire about symptoms of leaking fluid and feeling damp all the time (often described as new urinary incontinence).Therefore, the clinical assessment of the patient is directed at establishing any underlying cause: Oligohydramnios is a diagnosis made via ultrasound examination.
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