Oligohydramnios

Oligohydramnios may be a condition in pregnancy characterized by a deficiency of amnionic fluid. It’s the other of polyhydramnios.

Signs and symptoms

The common clinical features are smaller symphysio-fundal height, fetal malpresentation, undue prominence of fetal parts and reduced amount of amnionic fluid.

Complications

Complications may include cord compression, musculoskeletal abnormalities like facial distortion and clubfoot, pulmonary hypoplasia and intrauterine growth restriction. Amnion nodosum is usually also present (nodules on the fetal surface of the amnion).

The use of oligohydramnios as a predictor of gestational complications is controversial.

Potter syndrome may be a condition caused by oligohydramnios. Affected fetuses develop pulmonary hypoplasia, limb deformities, and characteristic facies. Bilateral agenesis of the fetal kidneys is that the commonest cause thanks to the shortage of fetal urine.

Causes

The cause isn't known but is usually related to some:

Ø  fetal chromosomal anomalies like triploidy

Ø  intra uterine infections

Ø  premature rupture of membrane

Ø  drugs; COX inhibitors like indomethacin, ACE inhibitors

Ø  intrauterine growth restriction (IUGR) related to placental insufficiency

Ø  amnion nodosum; failure of secretion by the cells of the amnion covering the placenta

Ø  postmaturity (dysmaturity)

Diagnosis

Ø  uterine size is far smaller than the amount of amenorrhoea

Ø  fewer fetal movements,

Ø  the uterus "full of fetus" due to scanty liquid,

Ø  malpresentation (breech)

Ø  evidences of IUGR of the fetus,

Ø  sonographic diagnosis is formed when largest liquid pool is a smaller amount than 2 cm,

Ø  visualization of normal filling and emptying of fetal bladder essentially rule out tract abnormality,

Treatment

A Cochrane review concluded that "simple maternal hydration appears to extend amnionic fluid volume and should be beneficial within the management of oligohydramnios and prevention of oligohydramnios during labour or before external cephalic version."

In severe cases oligohydramnios could also be treated with amnioinfusion during labor to stop duct compression. there's uncertainty about the procedure's safety and efficacy, and it's recommended that it should only be performed in centres specialising in invasive fetal medicine and within the context of a multidisciplinary team.

In case of congenital lower tract obstruction, fetal surgery seems to enhance survival, consistent with a randomized yet small study.

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