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Introduction: Oligohydramnios is associated with fetal complications and a higher incidence of maternal operative morbidity. A study was planned to determine the effect of hydration therapy in the correction of oligohydramnios in pregnancy and to assess if improvement in amniotic fluid index (AFI) is associated with better obstetric outcomes. MaterialsandMethods: Analytical study with a prospective design, conducted over 1 year from July 2020 to December 2021. Pregnant women in their third trimester with singleton pregnancy and intact membranes, diagnosed to have oligohydramnios were the participants. All women undertook oral rehydration therapy. The proportion of women achieving posthydration cutoff values of AFI and single deepest vertical pocket, was recorded by abdominal ultrasound examination at 24, 48, and 72 h. Adequacy of hydration was assessed by urinary specific gravity, before and after hydration therapy. Results: There were 120 participants. The mean age of the participants was 25.6 years (standard deviation = 5.7). Majority were multigravida. About 60%–80% of women improved with hydration therapy and the proportion of women showing improvement increased with time. Women with uncorrected AFI (<5 cm) at 24 and 48 h had significantly higher odds of preterm delivery, cesarean delivery, low‑birth‑weight baby, baby having 5 min Apgar score < 6, higher likelihood of Sick Newborn Care Unit admission and neonatal death. Conclusion: Maternal hydration therapy can be of value to improve the fetomaternal outcome in pregnancies with oligohydramnios by preventing preterm termination and reducing cesarean deliveries with good neonatal outcomes. Such simple intervention can be home based and assures universal health coverage
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Objetivo:Determinar la relación entre APGAR al minuto y la presencia de oligohidramnios en gestantes a término atendidas en el Hospital Niño Jesús de Barranquilla durante el período 2018 a 2019. Materiales y métodos:Estudio descriptivo, trasversal, retrospectivo, tipo serie de casos. Se incluyeron 203 mujeres embarazadas que fueron atendidas en el Hospital Niño Jesús, con embarazo a término y diagnostico ultrasonográfico de oligohidramnios (ILA menor o igual a 5 cm),durante los años 2018 y 2019. Se relacionaron variables sociodemográficas y gineco obstétricas con el resultado del APGAR y del ILA y se compararon los resultados utilizando Chi2 y prueba de Fisher. Resultados:El promedio de edad de las participantes fuede 23,6 años (DE+/-: 5,7); 48,8% provenían de municipios del departamento del Atlántico y 18,2% de Venezuela; 48,3% tenían un ILA de 4 a 4,9 y 8,4% tuvieron APGAR al minuto menor a 7; 4,9% tuvieron productos con bajo peso al nacer; 15,3% de los que tuvieron ILA de 1 a 3 tuvieron APGAR menor de 7, frente a 5,6% de los que tuvieron ILA de 4 a 5 (Chi2: 5,13; p: 0,024). Así mismo, 40% de las que tuvieron bajo peso al nacer presentaron APGAR <7 en contraste con 6,7% de las que tuvieron productos con peso normal(Fisher: 0,005). Conclusión: Se encontró una relación directamente proporcional entre el valor del ILA y los resultados del APGAR al minuto, y esta relación debe analizarse mediante un estudio de casos y controles. De igual forma se dedujo que el nivel inferior más seguro de líquido amniótico con el que se pueden presentar menos resultados perinatales adversos como la asfixia perinatal es con un ILA igual o mayor de 4 cm.
Objective: To determine the relationship between minute APGAR and the presence of oligohydramnios in full-term pregnant women attended at the Niño Jesús Hospital in Barranquilla during the period 2018 to 2019. Materials and methods: Descriptive, cross-sectional, retrospective study, case series type. 203 pregnant women who were treated at the Niño Jesús Hospital, with term pregnancy and ultrasound diagnosis of oligohydramnios (ILA less than or equal to 5 cm), during the years 2018 and 2019 were included. Sociodemographic and gyneco-obstetric variables were related to the APGAR and ILA and results were compared using Chi2 and Fisher's test. Results: The average age of the participants was 23.6 years (SD +/-: 5.7); 48.8% came from municipalities in the Atlántico department and 18.2% from Venezuela; 48.3% had an ILA of 4 to 4.9 and 8.4% had APGAR at one minute less than 7; 4.9% had products with low birth weight; 15.3% of those with ILA from 1 to 3 had APGAR less than 7, compared to 5.6% of those with ILA from 4 to 5 (Chi2: 5.13; p: 0.024). Likewise, 40% of those with low birth weight had APGAR <7 in contrast to 6.7% of those with normal-weight products (Fisher: 0.005). Conclusion: A directly proportional relationship was found between theILA value and the APGAR results per minute, and this relationship should be analyzed through a case-control study.Similarly, it was deduced that the safest lower level of amniotic fluid with which less adverse perinatal results can occur, such as perinatal asphyxia, is with an ILA equal to or greater than 4 cm
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Humans , Female , Infant, Newborn , Gynecology , Embryonic Structures , Statistical Data , Active MobilityABSTRACT
Background:Oligohydramniosmeans a low level of amniotic fluid during pregnancy. It is defined by an amniotic fluid index that is below 5th percentile for the gestational age. It may cause IUGR, fetal anomalies, malpresentations and fetal distress in labour. Oral or intravenous fluid therapy may increase the amount of amniotic fluid and may improve perinatal outcome. Aims And Objectives:To study efficacy and perinatal outcome of hydrotherapy in patients with oligohydamnios. Material & Methods:A prospective observational study wascarried out at tertiary care centre for 6 months. 30 cases of oligohydramnios were enrolled in this study. Results:In present study, maximum (50%) patients admitted for oligohydramnios were between 28 –32 weeks gestational age and 66% were having severeoligohydramnios. After giving hydration therapy, difference in AFI, was 2.57±0.13, which was statistically significant. 83.3% patients were delivered after 36 weeks and 80% were delivered by normal vaginal delivery. 53.3% babies were live healthy, whereasothers needed resuscitation and admitted to NICU. Conclusion:Oligohydramnios has higher impact on perinalal outcome due to antenatal and intrapartum complication. Because of early diagnosis by ultrasonography or clinical analysis, fluid therapy is an option to increase amniotic fluid volume and so perinatal outcome may be improved.
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Objective:To evaluate the changes of fetal renal artery blood flow parameters in fetuses with isolated borderline oligohydramnios (IBO) in the middle and third trimesters by Doppler ultrasound, and to assess its correlations with maternal and infant pregnancy outcomes.Methods:Twenty-seven IBO fetuses (IBO group) and 27 gestational age-matched normal fetuses (control group) from April to October 2019 in the Second Xiangya Hospital of Central South University underwent prenatal ultrasound examination during the middle and third trimesters. Renal artery blood flow parameters, including renal artery pulsatility index (RAPI), volume corrected renal artery pulsatility index (vcRAPI) and pregnancy outcomes were measured and compared between the two groups. Once diagnosed IBO, patients were recommended to the obstetric clinic for consultation and intervention. The correlation between RAPI, vcRAPI measured before intervention and prepartum amniotic fluid volume and pregnancy outcomes was analyzed, the ROC curve was plotted to find the better predictor.Results:The vcRAPI of the IBO group was higher than that of the control group ( P=0.015). In the IBO group, the vcRAPI measured before intervention was higer in those fetuses who were still IBO before delivery( P=0.048). In the IBO group, the correlation of the vcRAPI measured before intervention and IBO before delivery was statistically significant ( OR=2.41, 95% CI=1.06-5.43, P=0.035). The ROC curve showed that the sensitivity of vcRAPI to IBO was 0.67, the specificity was 0.75( P=0.002). Conclusions:Compared with RAPI, The vcRAPI may reflect the increase in fetal renal artery perfusion resistance of IBO group more timely. The higher vcRAPI before intervention in the IBO group have difficulty in recovering amniotic fluid volume before delivery.Increased vcRAPI is a better predictor of IBO before delivery.
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Objective:To explore the relationship between residual amniotic fluid volume and perinatal outcomes in preterm premature rupture of membranes (PPROM).Methods:The clinical data of each 68 PPROM patients with normal amniotic fluid (group A), less amniotic fluid (group B) and oligohydramnios (group C) were retrospectively analyzed. The delivery modes, perinatal complications, survival of perinatal infants and Apgar score at 1 min and 5 min after birth of live-born neonates were compared among the three groups. Pearson correlation analysis was used to evaluate the correlation between Apgar score of surviving neonates and residual amniotic fluid.Results:There was no significant difference in the incidence of vaginal midwifery and placental abruption among the three groups ( P>0.05). There were significant differences in natural delivery rate, cesarean section rate, incidence of some perinatal complications (amniotic cavity infection, chorioamnionitis, amniotic fluid fecal staining) and perinatal survival rate among the three groups ( P<0.05); There was no significant difference in natural delivery rate and cesarean section rate between group B and group C ( P>0.05); The natural delivery rate in group A was significantly higher than that in group B and C ( P<0.05), and the cesarean section rate was lower than that in group B and C ( P<0.05); There was no significant difference in the incidence of perinatal complications and perinatal survival between group A and group B ( P>0.05); The above perinatal complications in group C were significantly higher than those in group A and group B ( P<0.05), and the perinatal survival rate was lower than that in group A and group B. Using amniotic fluid volume as the independent variable (normal=0, less=1, too little=2) and the above perinatal complications as the dependent variable, logistic regression analysis showed that there was no significant correlation between amniotic fluid volume and the above perinatal complications ( OR=1.029, 1.117, 1.004, 1.045, P>0.05). There were significant differences in Apgar scores at 1 min and 5 min after birth among the three groups ( P<0.05), and the change trend was group A>group B>group C ( P<0.05). Pearson correlation analysis showed that there was a significant positive correlation between Apgar score at 1 min and 5 min after birth and the residual amniotic fluid of pregnant mothers ( r=0.402, 0.371, P<0.05). Conclusions:Residual amniotic fluid volume in PPROM patients is closely related to the degree of neonatal hypoxia, and the reduction of residual amniotic fluid can also increase the cesarean section rate, and oligohydramnios can also affect maternal-infant outcomes, thus it is necessary to pay attention to clinical practice.
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Background: To study the effect of oral and intravenous maternal hydration in patients with isolated oligohydramnios in terms of mean change in amniotic fluid.Methods: A total number of 38 patients included in the study which fulfill the selection criteria. Patients were randomly divided in two groups. Amniotic fluid index (AFI) of all patients was measured before the hydration therapy according to the method of Phelan et al. In maternal oral hydration (Group A), every patient was instructed to drink two liters of water over two hours daily for 1 week. In intravenous hydration (Group B), every woman infused two liters of 0.9% normal saline in two hour daily for 1 week. After 48 hours and 1 week of oral and intravenous hydration, the AFI was reassessed by the same observer. Patients were monitored closely for sign and symptoms of fluid overload. Data was stratified for mean difference in improvement in amniotic fluid index.Results: After oral hydration therapy AFI was 5.926±0.4593 after 48 hours and 8.286±0.6000 after 7 days in Group A. In Group B AFI was 5.784±0.4622 after 48 hours and 7.868±0.2810 after 7 days of intravenous hydration. P value after 48 hours is 0.348 and p=0.014 after 7 days means oral hydration therapy significantly increase amniotic fluid index.Conclusions: Oral maternal hydration significantly increase the amniotic fluid index in patients with isolated oligohydramnios. It is simple, safe and non-invasive method.
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Background: Oligohydramnios is a severe and common complication of pregnancy and its incidence is reported to be around 1 to 5% of total pregnancies. The aim of this study was to perinatal outcome of oligohydramnios (AFI <5) at term.Methods: A prospective study was conducted in which 200 patients at term with oligohydramnios AFI <5 cm with intact membranes were analyzed for perinatal outcome.Results: There were increased chances of FHR decelerations, thick meconium, increased LSCS, low Apgar score at 5 minutes, birth weight <2.5 kg, admission to NICU in pregnancy with oligohydramnios.Conclusions: An amniotic fluid index (AFI) of <5 cm detected after 37 completed weeks of gestation is an indicator of poor perinatal outcome. Determination of AFI can be used as an adjunct to other fetal surveillance methods that helps to identify those infants at risk of poor perinatal outcome.
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Background: Oligohydramnios has got a noteworthy influence on perinatal outcome. Hence, early detection and its timely management will aid in curtailing of perinatal morbidity and mortality and leading to decreased operative interventions. Therefore, the present study is conducted to look for the effects of oligohydramnios.Methods: This comparative study was a prospective observational study conducted at study institution. The women were divided into study and control groups based on AFI (amniotic fluid index), 100 cases were selected in each group.Results: Out of the 200 women, included in the present study, 35% of the patients in the study group had non-reactive non-stress test (NST) while in the control group 7% had it. Caesarean section was performed in 58% of cases in the study group as compared to 30% in the control group. Amongst these, Fetal distress was the most common indication for LSCS (lower segment caesarean section). There were no perinatal deaths in this study.Conclusions: Based on this study it has been observed that, amniotic fluid index of ≤5 cm was commonly associated with increased LSCS rates, intrauterine growth restriction, non-reactive NST, and abnormal Doppler velocimetry studies. Therefore, every case of oligohydramnios requires to be assessed meticulously. Prompt detection; timely management and treating the underlying condition improve outcome.
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Background: Amniotic fluid is contributed by both mother and foetus. It plays a vital role in foetal growth. The main purpose of this study was to evaluate the foetomaternal outcome in pregnant females with oligohydramnios beyond 36 weeks of gestation.Methods: This study was conducted on 230 pregnant females beyond 36 weeks of gestation with decreased liquor clinically and confirmed sonographically. It was conducted from May 2018 to May 2019. Females with leaking per vaginum, patients who did not give consent and with intrauterine foetal death were excluded. Complete labour record was made. Assessment of maternal outcome was done in terms of mode of delivery and foetal outcome was done in terms of birth weight, Apgar score at one and five-minute, respiratory distress, meconium aspiration, seizures in first 24 hours of life, congenital malformations, neonatal intensive care unit admission and death of baby.Results: A total of 230 pregnant females met the inclusion criteria who were having AFI <5. 121 (53%) females were primigravida and 119 (52%) underwent for caesarean section. Most common indication of LSCS was foetal distress. Apgar score at 1 minute was <7 in 97 (42%) babies and after 5 minutes, it was <7 in 93 (40%) babies. Other neonatal outcome results were IUGR in 59 (26%) babies, meconium aspiration syndrome in 52 (23%) babies, respiratory distress in 92 (40%) babies, congenital malformation in 6 (3%) babies, NICU admission of 93 (40%) babies and neonatal death of 11 (5%) babies.Conclusions: Oligohydramnios increases the chances of maternal morbidity and perinatal morbidity and mortality.
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Background: Amniotic fluid plays a vital role during foetal life. The main purpose of this study was to evaluate the foetomaternal outcome in relation to amniotic fluid index in pregnant females beyond 36 weeks of gestation.Methods: This prospective type of study was conducted for one-year duration from May 2018 to May 2019 in 350 pregnant females beyond 36 weeks of gestation with clinically significant abnormal liquor volume. Clinical diagnosis was later on confirmed with ultrasonography and patients were categorized in three categories as patients with Amniotic fluid index (AFI) 5 to 24, AFI <5 and AFI > or = 25. Complete labour record was made and fetomaternal outcome was assessed.Results: In this study, incidence of oligohydramnios was found to be more than polyhydramnios at term. No significant differences were found in relation to age, parity, religion, residence and booking status in all the study groups. Mostly patients 119 (52%) delivered by caesarean section in oligohydramnios group whereas vaginal delivery was commonly seen in patients with normal AFI (80%) and polyhydramnios (55%). Growth restriction 59 (26%) and malpresentation 18 (8%) were commonly seen with oligohydramnios. In the polyhydramnios group, 14 (35%) babies had malformations whereas only 6 (3%) babies had malformations in patients with oligohydramnios. Significant differences were found in the foetal outcome between the patients with oligohydramnios and polyhydramnios in comparison to patients with normal AFI.Conclusions: In pregnant females with abnormal liquor volume increases the chances of maternal morbidity and perinatal morbidity and mortality.
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Background: Oligohydramnios is described as a condition with decreased amniotic fluid volume relative to gestational age. It is a severe and common complication of pregnancy which is associated with increased maternal morbidity and adverse perinatal outcomes. This study was conducted to find out the significance of oligohydramnios in determining the maternal and perinatal outcome in pregnant women with oligohydramnios.Methods: The present study is a hospital-based study conducted in the department of obstetrics and gynecology, of SSIMS and RC Davanagere, during the period between August 2018 to April 2019. Detailed clinical history was taken, AFI was measured using Phelan’s four quadrant ultrasound technique. All the information was entered in the proforma and analyzed.Results: The mean age group of the study participants was 26.36±4.46 years. Majority (51.9%) of them were primigravida. Gestational age, birth weight and abnormal Doppler study were found to have an association with the perinatal outcome. Perinatal mortality in the present study was 4%.Conclusions: Oligohydramnios is a frequent occurrence in obstetrics and this condition requires intensive surveillance and proper antenatal care.
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Background: Oligohydramnios causes many intrapartum maternal and fetal complications. Intrapartum amnioinfusion effectively increases amniotic fluid volume and thereby decreases FH decelerations. The objective of this study was to compare the frequency of fetal heart decelerations and its perinatal outcome with and without amnioinfusion in patients with oligohydramnios and the cesarean rates for fetal distress between them.Methods: In study group, 100 patients in labour with AFI < 5 cm, oligohydramnios and IUGR with normal doppler, postdated pregnancies with AFI ≤ 5 cm with normal doppler were selected and prophylactic amnioinfusion with 300 ml lukewarm saline is given aseptically for 15 minutes after amniotomy. Continuous CTG monitoring done till delivery. If FH decelerations occur, the bolus was repeated up to 3 times. 100 age matched controls managed with conventional methods without amnioinfusion were selected retrospectively from labour room case records.Results: Incidence of FH decelerations was lower in study group (59% versus 84%). Cesarean section for fetal distress was reduced (20.9% versus 79.1%) Perinatal outcome was better. Babies with normal 1-minute Apgar was 86% compared to 75% in controls. Frequency of FH decelerations was reduced (20% versus 73%). Occurrence of 2 FH decelerations were 13% versus 33%, 3 FH decelerations were 7% versus 27% and > 3 times was 0% versus 13%.Conclusions: Prophylactic amnioinfusion can easily and effectively reduce the FH decelerations and caesarean section rate for fetal distress in oligohydramnios improving both maternal and fetal outcomes with negligible risks.
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Background: Premature rupture of membranes (PROM) is the rupture of the fetal membranes before the onset of labor. Preterm PROM complicates approximately 3 percent of pregnancies and leads to one third of preterm births. It increases the risk of prematurity and leads to a number of other perinatal and neonatal complications.Methods: This was a prospective study carried out at the department of obstetrics and gynaecology, UPUMS, Saifai from April 2018 to September 2018 (6 months study). Patients with Spontaneous rupture of membranes any time beyond 28th week of pregnancy, but before the onset of labour. Patients with following conditions were excluded from the study- meconium stain liquor, cord prolapse, antepartum haemorrhage, active infection at other sites, active liver disease.Results: A total of 103 cases of premature rupture of membrane (PROM) were recorded from April 2018 to September 2019 among 1523 admitted pregnant patients. Most of the patients 56 (54.36%) were delivered by caesarean section (C/S). Previous C/S, oligohydramnios, fetal distress, chorioamnionitis were the common indications for doing C/S. Forty-seven (45.63%) patients were delivered vaginally.Conclusions: Most of the affected women belongs to 20-24 years of age (53.39%). Term PROM was more in comparison to PPROM and most of them were multigravidae. Cesarean section rate was high. Most common complication was of subclinical urogenital infection (51.02%).
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Background: Quantitative estimate of amniotic fluid capacity is asection of daily obstetric scan. Semi quantitate determination ofthe quantity of amniotic fluid is done using amniotic fluid index,that is calculated by addition of the depth in centimeters of largestvertical pocket in four quadrants each. Oligohydramnios withdisapproving maternal and fetal circumstances lead to a worstperinatal result than normal amniotic fluid volume under the sameconditions. In these situations oligohydramnios may indicate amore severe impaired function of placenta and fetal compromise.The present study was conducted to evaluate the maternal andneonatal outcome in pregnant females with Oligohydramnios.Materials and Methods: The present prospective study wasconducted in the Department of Obstetrics and Gynecology for aperiod of 1 year. Estimates of amount of amniotic fluid volume wasestimated using AFI. Color Doppler tests were performed amongstwomen with isolated oligohydramnios. All the information from thefemales was taken on a patient information sheet. Details of infantat birth were recorded. All the data this obtained was arranged ina tabulated form and analyzed using SPSS software. Probabilityvalue of less than 0.05 was considered as significant.Results: A total of 130 subjects were enrolled in the study. Theincidence of oligohydramnios was 2.8%. 37.69% patients hadsevere oligohydramnios, 43.84% patients had moderateoligohydramnios and 18.46% patients had mild oligohydramnios.55% patients were primigravidas. 42.3% patients were preterm,48.5% patients were term and 9.2% patients were post dated.26.9% patients with oligohydramnios showed intrauterine growthrestriction. 15.3% patients had pregnancy induced hypertensionand 6.9% patients had both PIH and IUGR. IUGR was maximallyseen in the group of severe oligohydramnios and foetal distresswas also observed more in this group. 33.8% patients weredelivered vaginally without any instrumentation, 2.3% patientswere delivered with help of vaccum, 63.9% underwent LSCS.There were 10% subjects less than 20 years, 51% were between21-25 years, 25% were between 26-30 years, 9% were between31-35 years. There were 85% (majority) with cephalicpresentation. 13% (n=17) had breech and 2% had transversepresentation.73.27% of babies were low birth weight. 6% babieshad congenital anomalies. 11% babies accounted for perinatalmortality with extreme prematurity as the cause of death inmajority.Conclusion: In our study the most common age group afflictedwas 21-25 years as the incidence of pregnancy is also maximumin this age group. Perinatal morbidity and mortality was maximallyseen in patients with severe oligohydramnios. Isolatedoligohydramnios at more than 36 weeks of gestation does notaffect perinatal outcome. The presence of moderate to severeoligohydramnios should alert the Obstetrician to a high risk fetalcondition and should prompt the obstetrician to initiate an activeintervention in collaboration with the neonatologist. Finally, regularANC checkup, fetal surveillance, treatment of associated maternalmedical conditions help to achieve better perinatal outcome.
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Resumen ANTECEDENTES: La enfermedad de Chagas es una zoonosis causada por Trypanosoma cruzi, un parásito endémico de América Latina. Los niños se infectan por el contacto con vectores o por trasmisión congénita. CASO CLINICO: Paciente indígena, de 32 años, procedente del área rural del occidente colombiano, analfabeta, con antecedente de 7 embarazos y 6 partos, el embarazo actual con 29.5 semanas determinadas por la ecografía del tercer trimestre, sin controles prenatales, con trabajo de parto pretérmino y oligohidramnios severo. El embarazo finalizó por cesárea, sin complicaciones y el nacimiento de una niña que pesó 1290 gramos. A los 50 días de vida cursó con inestabilidad hemodinámica, dificultad respiratoria, palidez mucocutánea y fiebre con diagnóstico de sepsis de origen indeterminado. Los estudios de extensión reportaron: parasitemia positiva por microhematocrito para Trypanosoma cruzi, con amastigotes en el líquido cefalorraquídeo. Diagnóstico: meningoencefalitis chagásica. CONCLUSIONES: La trasmisión vertical de la enfermedad de Chagas es baja; la trasmisión congénita es la responsable de la progresiva aparición de la enfermedad en zonas endémicas y no endémicas. En las embarazadas es importante la inclusión del tamizaje para infección por Trypanosoma cruzi, como parte del conjunto de pruebas de control prenatal.
Abstract BACKGROUND: Chagas disease is a zoonosis caused by Trypanosoma cruzi, a parasite endemic to Latin America. Children become infected by contact with vectors or by congenital transmission. CLINICAL CASE: Illiterate indigenous patient, 32 years old, from the rural area of western Colombia, with a history of 7 pregnancies and 6 deliveries, the current pregnancy with 29.5 weeks determined by the third trimester ultrasound, without prenatal controls, with preterm labor and severe oligohydramnios. The pregnancy ended by cesarean section, without complications and the birth of a girl who weighed 1290 g. At 50 days of life, he developed hemodynamic instability, respiratory distress, mucocutaneous pallor and fever with a diagnosis of sepsis of undetermined origin. Extension studies reported: positive microhematocrit parasitaemia for Trypanosoma cruzi, with amastigotes in the cerebrospinal fluid. Diagnosis: Chagasic meningoencephalitis. CONCLUSIONS: The vertical transmission of Chagas disease is low; congenital transmission is responsible for the progressive appearance of the disease in endemic and non-endemic areas. In pregnant women, it is important to include screening for Trypanosoma cruzi infection, as part of the prenatal control test suite.
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Resumen: La disgenesia tubular renal es una enfermedad adquirida o hereditaria autosómica recesiva. Se manifiesta durante la etapa fetal como oligoamnios por anuria fetal y en el recién nacido como anuria persistente, hipoplasia pulmonar, hipotensión severa refractaria y alteración de la osificación de los huesos craneales. Histológicamente es una alteración del desarrollo de los túbulos renales. Se expone un caso clínico de un recién nacido que presentó al nacer insuficiencia renal, múltiples dismorfias e hipoplasia pulmonar, falleciendo a los tres días de vida. La necropsia consigna el diagnóstico de disgenesia tubular renal.
Summary: Renal tubular dysgenesis is an acquired or inherited autosomal recessive disease. Before birth, it shows as oligohydramnios resulting from fetal anuria and after birth, it shows as persistent anuria, pulmonary hypoplasia, severe refractory hypotension and alteration of the ossification of the cranial bones. Histologically, it is an alteration of the development of the renal tubules. We hereby introduce a clinical case of a newborn who presented renal failure, multiple dysmorphia and pulmonary hypoplasia at birth, who died at 3 days of age and whose autopsy showed renal tubular dysgenesis.
Resumo: A disgenesia tubular renal é uma doença autossômica recessiva adquirida ou herdada. Manifesta-se durante o estágio fetal como oligoâmnio causado pela anúria fetal e no recém-nascido como anúria persistente, hipoplasia pulmonar, hipotensão grave refratária e alteração da ossificação dos ossos cranianos. Histologicamente, é uma alteração do desenvolvimento dos túbulos renais. Apresentamos um caso clínico de um recém-nascido que apresentou insuficiência renal, dismorfias múltiplas e hipoplasia pulmonar ao nascer, falecido aos 3 dias de vida e cuja autópsia estabelece o diagnóstico de disgenesia tubular renal.
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Background: Amniotic fluid is vital to the well-being of the fetus. Severe oligohydramnios and polyhydramnios are associated with increased maternal morbidity and perinatal morbidity and mortality.Methods: This was prospective observational study conducted at tertiary teaching institute from July 2012 to July 2013. Total 200 patients were included in the study. On the basis of amniotic fluid index (AFI), patients were categorized in 3 groups, Normal AFI (8-24 cm), oligohydramnios (AFI <5cm) and polyhydramnios (AFI > = 25 cm). Results were analysed in the form of incidence, mode of delivery and perinatal outcome which includes preterm, low birth weight, still births, NICU admissions and neonatal deaths in all the 3 groups.Results: Out of 200 patients, there was 150 cases of normal AFI, 39 cases of oligohydramnios and 11 cases of polyhydramnios. Incidence of oligohydramnios was 4.1% and polyhydramnios was 1.1%. PIH was the most common etiological factor found in oligohydramnios (30.7%) and in polyhydramnios congenital anomalies (36.3%) followed by idiopathic cause (27.2%) was most common. Incidence of caesarean section was 58.9% in oligohydarmnios and 17.3% in normal AFI group. Incidence of NICU admission was 25.6% in oligohydramnios and 50% in polyhydramnios group in comparison to 9.3% in normal AFI group.Conclusions: Amniotic fluid index is an important part of antepartum fetal surveillance. Abnormalities of AFI are associated with high perinatal morbidity and mortality and maternal morbidity.
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Introduction: Orofacial clefts are important congenital malformations of the lip, palate, or both caused by complex genetic and environmental factors. Aims and Objectives: The present study aims to highlight the phenotypic heterogeneity of trisomy 13 mosaicism. Material and Methods: We present one clinical case of a 30-year-old, Caucasian woman who is pregnant for the first time. Techniques of work study: anamnesis, clinical examination, serological tests for Toxoplasmosis, Rubeola, CMV and Herpes, ultrasound examination at 20 weeks gestation with General Electric Echographe Voluson E10 BT18, amniocentesis, fetal chromosome analysis and genetic counseling. Results: Ultrasound examination showed a viable singleton fetus with intra-uterine growth restriction, oligohydramnios, bilateral cleft lip and cleft palate, hypoplastic nasal bone and bilateral polycystic kidneys. Amniocentesis was done, and the fetal chromosomal analysis revealed a fetus with 46, XY/47, XY,+13 mosaic karyotype. After a complex genetic counselling the parents opted, to terminate the pregnancy. The autopsy confirm the prenatal ultrasound diagnosis. Conclusion: Routine ultrasound examination during pregnancy and specific genetic testing are essential for the early prenatal detection of major structural fetal anomalies associated with rare genetic chromosome syndromes.
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Background: Intrauterine growth restriction (IUGR) is one of the major reasons for neonatal morbidity and mortality. Oligohydramnios is a common finding in IUGR. In majority of these cases diminished utero-placental blood flow is observed. However, in spite of this understanding and identification of high-risk patients, the management options are limited. Sildenafil citrate, a phosphodiesterase type-5 inhibitor improves utero-placental perfusion.Methods: We present a retrospective interventional study involving 50 adult pregnant women diagnosed with early-onset IUGR (n=38) and oligohydramnios (n=12). Vaginal sildenafil citrate 25 mg t.i.d. was started from the day of diagnosis till delivery. Primary efficacy endpoints included changes in Doppler parameters i.e., amniotic fluid index (AFI), uterine artery (UA)- pulsatility index (PI), resistance index (RI) and systolic diastolic ratio (S/D ratio). Secondary endpoints included live birth, birth weight, Apgar score at birth, neonatal survival to hospital discharge and adverse maternal side effects.Results: There was a statistically significant improvement in UA-PI, RI and S/D ratios (p<0.0001) in all cases. In oligohydramnios cases, treatment showed a statistical significant increase in AFI score (2.86±1.33 cm). The mean birth weight on delivery was 2200 gm with good Apgar scores. No major adverse effects were reported by women using sildenafil citrate vaginally.Conclusions: Sildenafil citrate, by increasing utero-placental perfusion, improves uterine artery Doppler patterns, AFI, fetal weight and overall better neonatal survival rates by reducing neonatal morbidity and mortality. Sildenafil citrate may hold a promising treatment strategy for management of IUGR and oligohydramnios.
ABSTRACT
Introduction: The prevalence of intrauterine growth restriction (IUGR) is about 28% in the general population. IUGR posesincreased risk of fetal mortality and morbidity and also contributes to developmental origin of health and disease. Of the threetypes of IUGR, Type III is more common in developing countries. This study evaluates the clinical profiles of Type II and Type IIIIUGR and also to evaluate any differences between the two types.Materials and Methods: This cross-sectional, observational, and analytical study was conducted on 86 pregnant women withgestational age of more than 24 weeks, clinically diagnosed as IUGR and confirmed by ultrasound. They were followed up tilldischarge in the postnatal period. Any significant antenatal, intranatal, or postnatal events were recorded.Results: There were increased incidences of oligohydramnios, preterm birth, and requirement of cesarean section whichare increased in the cases of IUGR, more in Type II than in Type III IUGR. Furthermore, there were significant differences inmaternal Vitamin D levels between the low and normal birth weight groups in Type II IUGR.Conclusion: IUGR is associated with increased risk of preterm birth and operative delivery. Deficient maternal serum Vitamin Dlevels are a risk factor for low birth weight in asymmetric IUGR only, though further studies need to be conducted in this regard.