Oligohydramnios is amniotic fluid volume that is less than expected for gestational age; it is associated with maternal and fetal complications. Diagnosis is by ultrasonographic measurement of amniotic fluid volume. Management involves close fetal monitoring and serial ultrasonographic assessments.
Causes of oligohydramnios include the following:
Uteroplacental insufficiency (eg, due to preeclampsia, chronic hypertension, placental abruption, a thrombotic disorder, or another maternal disorder)
Rupture of membranes (premature or at term)
Some medications (eg, angiotensin-converting enzyme [ACE] inhibitors, nonsteroidal anti-inflammatory drugs [NSAIDs])
Fetal chromosomal abnormalities (eg, aneuploidy)
Fetal malformations, particularly those that decrease urine production
Fetal death
Idiopathic
Ускладнення
Complications of oligohydramnios include the following:
Fetal death
Intrauterine growth restriction
Limb contractures (if oligohydramnios begins early in the pregnancy)
Delayed or incomplete lung maturation (if oligohydramnios begins early in the pregnancy)
Inability of the fetus to tolerate labor, leading to the need for cesarean delivery
Risk of complications depends on how much amniotic fluid is present and what the cause is.
Symptoms and Signs of Oligohydramnios
Oligohydramnios itself tends not to cause maternal symptoms other than a sense of decreased fetal movement. Uterine size may be less than expected based on gestational age.
Disorders causing or contributing to oligohydramnios may cause symptoms.
Diagnosis of Oligohydramnios
Ultrasonographic measurement of amniotic fluid volume
Comprehensive ultrasonographic examination, including evaluation for fetal malformations
Testing for clinically suspected maternal causes
Oligohydramnios may be suspected if uterine size is less than expected for dates or if fetal movements are decreased; it may also be suspected based on incidental ultrasonographic findings. However, qualitative estimates of amniotic fluid volume tend to be subjective. If oligohydramnios is suspected, amniotic fluid should be assessed quantitatively using the amniotic fluid index (AFI) or single deepest pocket (SDP).
The volume of amniotic fluid cannot be measured directly. Thus, excessive fluid is defined indirectly using one of the following ultrasonographic criteria:
AFI ≤ 5 cm: AFI is the sum of the vertical depth of fluid measured in each quadrant of the uterus; normal AFI ranges from > 5 to < 24 cm.
SDP < 2 cm: SDP is a measurement of the deepest pocket of amniotic fluid; normal SDP is ≥ 2 to < 8 cm.
It appears that neither AFI nor SDP is superior to the other in terms of preventing adverse perinatal outcomes. Each has limitations: AFI often results in overdiagnosis of oligohydramnios; SDP results in overdiagnosis of polyhydramnios (1, 2).
Визначення причини
If oligohydramnios is diagnosed, clinicians should check for possible causes, including premature rupture of membranes. Comprehensive ultrasonographic examination is done to check for fetal malformations and any evident placental causes (eg, placental abruption).
Clinicians can offer amniocentesis and fetal karyotyping if ultrasonography suggests fetal malformations or aneuploidy.
If uteroplacental insufficiency is suspected and intrauterine growth restriction is detected, the umbilical artery is assessed using Doppler ultrasonography.
Довідкові матеріали щодо діагностики
1. Kehl S, Schelkle A, Thomas A, et al: Single deepest vertical pocket or amniotic fluid index as evaluation test for predicting adverse pregnancy outcome (SAFE trial): A multicenter, open-label, randomized controlled trial. Ultrasound Obstet Gynecol 47 (6):674–679, 2016. doi: 10.1002/uog.14924
2. Nabhan AF, Abdelmoula YA: Amniotic fluid index versus single deepest vertical pocket as a screening test for preventing adverse pregnancy outcome. Cochrane Database Syst Rev 2008 (3):CD006593, 2008.
Treatment of Oligohydramnios
Serial ultrasonography to determine AFI and monitor fetal growth
Nonstress testing or biophysical profile
Ultrasonography should be done at least once every 2 to 4 weeks (every 2 weeks if growth is restricted) to monitor fetal growth. The AFI should be measured at least once a week. Most experts recommend fetal monitoring with nonstress testing or biophysical profile at least once a week and delivery at 36 to 37 weeks/6 days for isolated and uncomplicated oligohydramnios or at diagnosis if diagnosed at ≥ 37 weeks (1). However, this approach has not been proved to prevent fetal death.
Also, optimal time for delivery is controversial and can vary based on patient characteristics and fetal complications.
Довідковий матеріал щодо лікування
1. American College of Obstetricians and Gynecologists’ Committee on Obstetric Practice, Society for Maternal-Fetal Medicine: Medically indicated late-preterm and early-term deliveries: ACOG Committee Opinion, Number 831. Obstet Gynecol 138 (1):e35–e39, 2021. doi: 10.1097/AOG.0000000000004447
Ключові моменти
Oligohydramnios is amniotic fluid volume that is less than expected for gestational age.
Oligohydramnios can be caused by uteroplacental insufficiency, drugs, fetal abnormalities, or rupture of membranes.
It can cause problems in the fetus (eg, growth restriction, limb contractures, death, delayed lung maturation, inability to tolerate labor).
If oligohydramnios is suspected, determine the amniotic fluid index or single deepest pocket and test for possible causes (including doing a comprehensive ultrasonographic evaluation).
Do ultrasonography a least once every 4 weeks, and consider fetal monitoring at least once a week and delivery at 36 to 37 weeks/6 days or at diagnosis if diagnosed at ≥ 37 weeks (although optimal time for delivery varies based on clinical context).