A Randomized Trial of Inpatient and Home-Based Maternal Oral Hydration Therapy in Isolated Oligohydramnios and Its Effect on Amniotic Fluid Index and Perinatal Outcome.

Background Isolated oligohydramnios, without any known fetal/maternal abnormality, may be associated with insufficient oral intake (such as water, glucose, and rehydration therapy). Therefore, the present study was conducted to assess the improvement following maternal hydration. Method A total of 50 cases of isolated oligohydramnios (other high-risk pregnancy conditions not present) were included in the study (25 in each group). Patients were encouraged for an additional 2 liters of oral rehydration solution intake daily along with regular diet. The fluid intake was unsupervised in the home group and supervised in the hospital group. Serial amniotic fluid index (AFI) measurements and fetal monitoring were performed. Birth weight and APGAR scores were recorded, and data were analyzed. Results The two groups were comparable in terms of demographics and baseline laboratory findings. AFI significantly improved in the hospital group compared to the home group (p-value: <0.001). Birth weight, placental weight, and APGAR scores were also significantly better in the hospital group than in the home group. Conclusion Maternal oral hydration therapy improves the amniotic fluid volume and subsequently improves the perinatal outcome. Due to poor compliance with home-based treatment, institution of supervised hydration therapy is recommended.

Isolated oligohydramnios - should induction be offered after 36 weeks?

OBJECTIVE: Isolated oligohydramnios (IO) - oligohydramnios in the absence of maternal or gestational comorbidity is debated as an indication for induction of labor. Previous meta-analyses regarding perinatal outcomes of IO at term have yielded conflicting results. We aimed to investigate the neonatal outcomes among gestations with IO delivered at 36°/7-396/7. METHODS: The study cohort included all women undergoing a trial of labor between during 2011 and 2019 of a singleton gestation with cephalic presentation between 36°/7 and 40°/7. We allocated the study groups into women with IO and those with normal amniotic fluid volume. Neonatal outcomes were compared between the groups and in relation to gestational age and induction of labor. RESULTS: Overall, there were 529/17,709 (3.0%) IO cases. IO was associated with maternal age <25 years (OR [95% CI] 1.62 (1.20-2.20), p = .001). Induction of labor was more common with IO (OR [95% CI] 1.33 (1.05-1.69) p = .01. IO was associated with preterm delivery (OR [95% CI] 1.81 (1.36-2.40), p < .001). The rate of neonatal adverse outcome did not differ between study groups. Overall composite adverse neonatal outcome occurred among 1,399/17,709 (7.9%) deliveries. Adverse neonatal outcome was associated with induction of labor (OR [95% CI] 1.61 (1.40-1.86), p < .001) and low birth weight (OR [95% CI] 7.41 (6.27-8.75), p < .001). When Stratified by gestational age, neonatal adverse outcome did not differ between IO and no IO groups. When examining cases of induction of labor per gestational age, induction of labor at 36 weeks among IO gestations, was associated with adverse neonatal outcome as compared to no IO group (OR [95% CI] 5.7 (1.23-26.3), p = .04). CONCLUSIONS: Induction of labor in gestations complicated by IO at 36 weeks gestational age is associated with an increased risk for adverse neonatal outcome. Our study results adds to the current literature regarding outcomes of IO and time of delivery. SYNOPSIS: Induction of labor in gestations complicated by IO at 36 weeks gestational age is associated with an increased risk for adverse neonatal outcome.

Diagnostic Accuracy of Cerebroplacental Ratio in Prediction of Postnatal Outcomes in Oligohydramnios.

BACKGROUND AND AIM: The evidence on isolated oligohydramnios (IO) patients and their postnatal outcomes are inconsistent. Recent research has clarified the connection between that IO and negative outcomes in the postnatal period. Our goal was to analyze the correlation between Doppler measurements and postnatal outcomes in oligohydramnios patients, with a focus on the cerebroplacental ratio (CPR). METHODOLOGY: A cohort study was conducted in the Radiology Department of Khan Research Laboratories (KRL) Hospital from October 2021 to July 2022. One hundred women were chosen as the sample size. For this study, we used the Raosoft sample size calculator with a 95% confidence interval and a 5% margin of error. Both the middle cerebral artery and the umbilical artery were imaged using ultrasound, and the systolic-to-diastolic ratio and peak systolic velocity are recorded. Pulsatility index (PI) and resistive index (RI) were also calculated. If the amniotic fluid index (AFI) is less than 5 cm, the condition is known as oligohydramnios. The newborn's APGAR score was taken immediately after birth as well as after 5 minutes. RESULTS: We have determined that, on average, mothers are 35.45 weeks/248.15 days pregnant. When compared to the reference standard, CPR diagnostic features showed a sensitivity of 92% and a specificity of 77.27. Overall diagnostic accuracy is predicted to be 93.0%, with a 93.50% positive prognosis and a 73.91% negative prognosis. The effect size for the change in APGAR scores before and after the test was -2.38 1.03, with a 95% confidence interval of -2.58 to -2.17 and a significance level of 0.00. CONCLUSION: This study concludes that CPR is an effective screening tool and that it can be used to predict postnatal outcomes in patients with oligohydramnios. Clinical prediction rules were found to be a more effective screening tool, with a sensitivity of 92%, a specificity of 77.27%, and a diagnostic accuracy of 92.3%.

Fetal left ventricular modified myocardial performance index and renal artery pulsatility index in pregnancies with isolated oligohydramnios before 37 weeks of gestation

Objective: The aim was to evaluate fetal left modified myocardial performance index (Mod-MPI) and renal artery Doppler parameters in fetuses with isolated oligohydramnios and a normal amount of amniotic fluid. Material and Methods: This was a prospective cohort study; 25 pregnancies with isolated oligohydramnios and 25 healthy, gestational age-matched controls, between 24+0 to 36+6 weeks of gestation, were recruited. Primary outcome was to compare left modified MPI and mean fetal renal artery pulsatility index (PI). The secondary outcome was to compare adverse perinatal outcomes between the groups. Results: Mean Mod-MPI was significantly higher (p=0.001) and isovolumetric relaxation time was longer (p=0.009) in the isolated oligohydramnios group. Mean renal artery PI values were not different between the groups. Birthweight (p=0.041) and gestational age at birth (p=0.001) were significantly lower, and incidences of delivery before 37 weeks (p=0.034) and Cesarean section due to non-reassuring fetal heart rate testing (p=0.021) were significantly higher in women with isolated oligohydramnios than the control group. We found no significant relationship between Mod-MPI and adverse perinatal outcomes. Conclusion: Fetuses with isolated oligohydramnios have increased left Mod-MPI, which may be due to mild cardiac diastolic dysfunction. Increased Mod-MPI is not associated with adverse perinatal outcomes and does not seem to help in the management of pregnancies before 37 weeks of gestation with isolated oligohydramnios.

Maternal and perinatal outcomes of induction of labor in oligohydramnios at term-a retrospective cohort study.

Objective: To evaluate the maternal and perinatal outcomes of labor induction in women at term with oligohydramnios.Methods: A retrospective cohort of women with a singleton pregnancy, who had oligohydramnios at or beyond term (37-42 weeks) and underwent induction of labor for oligohydramnios were studied. Antenatally diagnosed fetal anomalies and intrauterine fetal demise were excluded. The women were categorized into two groups: 1) women with isolated oligohydramnios (n = 166) and 2) women with oligohydramnios associated with other maternal or fetal complications (n = 43). Maternal and perinatal outcomes were collected from the records of all deliveries, data compiled, and appropriate statistical tests were applied.Results: The study included 209 women with mean gestational age of 38.76 ± 1.00 weeks and mean induction-delivery interval of 17.45 ± 8.70 hours (16.98 hours in group 1 versus 19.23 hours in group 2). Most (75%) women delivered vaginally. Only one of the neonates had an Apgar score of less than 7 at 5 min. Average neonatal ICU length of stay was 5.52 days (5.27 days in group 1 versus 6.17 days in group 2). Among all the maternal and neonatal outcomes studied, only the mean birth weights among the two groups was found to be statistically significant (p = 0.0017).Conclusions: Women with isolated oligohydramnios and their neonates were not found to suffer any additional harm due to labor induction at term than women who had oligohydramnios associated with other complications.

Induction of labor in cases of late preterm isolated oligohydramnios: is it justified?

OBJECTIVES: To analyze in a retrospective cohort study the outcomes of pregnancies with isolated oligohydramnios at the late preterm period (34-36.6 weeks of gestation). STUDY DESIGN: This retrospective cohort study included three groups of women: (1) Women with isolated oligohydramnios whose pregnancy was managed conservatively (n = 33 births); (2) women with isolated oligohydramnios who were managed actively (i.e. induction of labor) (n = 111 births); and (3) a control group including women with normal amount of amniotic fluid who had a spontaneous late preterm delivery (n = 10,445 births). Maternal and fetal characteristics and obstetrics outcomes were collected from a computerized database of all deliveries at Soroka University Medical Center during the study period. RESULTS: Our cohort included 10,589 births. The rate of inducing labor was higher in the oligohydramnios groups compared to the controls (p < .001). There was an increase in the rate of cesarean section (CS) in the conservative treatment group (p < .001), compared with the other groups. Conservative management was associated with higher rates of maternal infection (p = .026), chorioamnionitis (p = .01), and transitory tachypnea of the newborn (p = .02). After controlling for confounding factors, mal presentation (OR = 19.9), and a prior CS (OR = 2.4) were independently associated with an increased risk for CS, while induction of labor was associated with a reduced risk for CS (OR = 0.28). CONCLUSIONS: Women with late preterm isolated oligohydramnios had a higher rate of induction of labor than women with a normal amount of amniotic fluid. Induction of labor seems to be beneficial to both the neonate and the mother as seen by a lower rate of CS conducted in this group, as well as lower maternal and neonatal morbidity in comparison to the conservative group. Therefore, women with oligohydramnios at late preterm may benefit from induction of labor.

Is pregnancy associated plasma protein-A (PAPP-A) a marker for adverse perinatal outcomes in preterm isolated oligohydramnios cases?

OBJECTIVE: Isolated oligohydramnios is defined as an amniotic fluid index below five centimeter with no other coexisting condition. There are still controversies about the management and pregnancy outcomes. A marker predicting these is crucial. Low pregnancy associated plasma protein-A levels were reported to be related with adverse pregnancy outcomes. We aimed to determine the role of first trimester pregnancy associated plasma protein-A for poor outcomes in preterm isolated oligohydramnios cases. MATERIAL AND METHODS: Fifty-one patients with singleton pregnancies diagnosed as isolated oligohydramnios at 28/0-36/6 weeks of gestation and 110 gestational age matched healthy controls between January and December 2015 were included. Maternal age, gestational age at delivery, mode of delivery, indication for cesarean section, Apgar scores at first and fifth minutes, birth weight, neonatal intensive care unit admission and mortality were recorded. Pregnancy associated plasma protein-A levels were compared between groups and its role in adverse perinatal outcomes was evaluated. RESULTS: Pregnancy associated plasma protein-A levels and pregnancy outcomes were similar in two groups (p > 0.050) except birth weight, gestational age at delivery and presence of fetal distress. Pregnancy associated plasma protein-A levels did not differ in terms of delivery mode, presence of fetal distress, first and fifth minutes Apgar scores and neonatal intensive care unit admission (p = 0.323,0.650,0.990,0.112,0.853). Also, it was not determined as a risk factor for cesarean section, presence of fetal distress, low Apgar scores and neonatal intensive care unit admission. CONCLUSION: Pregnancy associated plasma protein-A, a well-known prognostic factor for some of high risk pregnancy conditions, may not be used as a marker in preterm isolated oligohydramnios cases.

Perinatal outcome of monochorionic diamniotic twin pregnancies complicated with isolated amniotic fluid volume abnormality of one twin less than 26 weeks of gestation.

AIM: To evaluate the incidence of twin-twin transfusion syndrome (TTTS) and the perinatal outcome at 28 days of age in monochorionic diamniotic (MCDA) pregnancies complicated with isolated polyhydramnios (I-Poly) and isolated oligohydramnios (I-Oligo) diagnosed < 26 weeks of gestation. METHODS: This was a retrospective study of women with MCDA pregnancies diagnosed with I-Poly or I-Oligo before 26 weeks of gestation over a period of six years. The incidence of subsequent TTTS and neonatal outcome in terms of intact survival (IS) at 28 days of age were evaluated. Intact survival was defined as being alive without any neurological complications at 28 days of age. RESULTS: There were 30 cases of I-Poly and 53 of I-Oligo that were eligible as per the inclusion criteria. Subsequent TTTS were complicated in six (20.0%) of the I-Poly and 26 (49.0%) of the I-Oligo cases. Among subjects with I-Poly, 17 had spontaneously normalized amniotic fluid volume. Prolonged oligohydramnios until intrauterine death, delivery or the onset of emerging TTTS was noted in 16 cases of I-Oligo. Both the twins exhibited IS in 26 (86.7%) cases of I-Poly and 31 (58.4%) cases of I-Oligo. CONCLUSION: One-fifth of I-Poly and half of I-Oligo MCDA twins at < 26 weeks of gestation potentially develop TTTS. I-Oligo in particular should be regarded as a high-risk condition as neonatal IS is less than 60%.

Comparison of oxidative stress in pregnancies with and without first trimester iron supplement: a randomized double-blind controlled trial.

OBJECTIVE: Iron supplementation was found to be a cause of oxidative stress. The aim of this study was to compare oxidative stress in pregnancies with and without iron supplementation in the first trimester pregnancies. METHODS: One hundred and eight women in the first trimester of normal pregnancies were randomly assigned to three groups. Patients were grouped as following: Group 1 received placebo (n = 36), group 2 received folate supplementation (n = 36) and group 3 was directed to the iron supplementation (n = 36). Oxidative stress was assessed at 14th week of gestation by the utilization of serum γ-glutamyl transferase level. Pregnancies were followed until delivery. Relationship between the oxidative stress and pregnancy outcome was assessed among groups. RESULTS: Mean age was similar among groups, mean gravidity and parity were significantly lower in group with Fe supplementation (p < 0.05). Maternal weight and weight gain during pregnancy were also significantly lower in group 3 (p < 0.05). Mean serum albumin levels were similar among groups while serum γ-glutamyl transferase (GGT) levels were significantly higher in group 3. There were 10 cases of oligohydramnios in group 3, two cases in group 2 and no cases in group 1 (p < 0.001). CONCLUSION: Iron supplementation during first trimester pregnancy was found to be associated with an increased oxidative stress.

Perinatal outcomes of isolated oligohydramnios at term and post-term pregnancy: a systematic review of literature with meta-analysis.

OBJECTIVE: The management of isolated oligohydramnios (IO) in post/term pregnancies is controversial. The aim of this paper was to review outcomes of term and post-term pregnancies with IO versus normal amniotic fluid (AF) at labor assessment. STUDY DESIGN: A search in PubMed, Medline, EMBASE, and reference lists was performed. Inclusion criteria for articles selection: singleton pregnancy, definition of olgohydramnios as AFI <5cm, AF assessment at 37-42 gestational weeks. EXCLUSION CRITERIA: fetal malformations, preterm delivery, premature rupture of membranes, intrauterine growth restriction. Perinatal outcomes were: obstetric intervention for non-reassuring fetal heart rate (cesarean section, operative delivery), meconium-stained AF, Apgar score <7 at 5min, umbilical artery pH <7.0, small for gestational age infants (SGA), admission to neonatal intensive care unit (NICU) and perinatal death. Meta-analysis compared outcomes of pregnancies with IO vs normal AF. Inter-studies heterogeneity was tested. Pooled odds ratio (OR) and 95% confidence interval (95% CI) were calculated. Differences between the two groups were considered significant if 95% CI did not encompass 1. MOOSE guidelines were followed. RESULTS: Four articles provided 679 (17.2%) cases with IO and 3264 (82.8%) with normal AF. Obstetric interventions occurred more frequently in the IO than normal AF group (IO: 89/679, 13% vs normal; AF: 166/3354, 5%; OR: 2.30; 95% CI: 1.00-5.29). Meta-analysis did not show differences with regard to meconium, Apgar, pH, SGA, NICU and perinatal death. CONCLUSION: In term or post-term pregnancies, IO is associated with increased risk of obstetric interventions but outcomes are similar to those of pregnancies with normal AF.

Management of Isolated Oligohydramnios between 34(+0) and 36(+6) Weeks of Gestation / 대한주산의학회잡지

The optimal management in pregnancies complicated isolated oligohydramnios between 34(+0) and 36(+6) weeks of gestation is not established yet. Although previous studies reported that increased risks of adverse perinatal outcomes were observed in pregnancies with oligohydramnios, it is notable that these studies include cases with maternal or fetal complications such as hypertensive disorders or fetal growth restriction. Therefore, it remains unclear that the increased adverse perinatal outcomes from oligohydramnios are caused from oligohydramnios itself or from maternal or fetal complications. Meanwhile, recent evidences demonstrated that neonates born at late preterm are also at increased risks for prematurity related complications such as respiratory distress syndrome, intraventricular hemorrhage, neonatal hypoglycemia, necrotizing enterocolitis and cerebral palsy as well compared with term neonates. With this background, this article was aimed to review recent literatures on the optimal management in pregnancies with isolated oligohydramnios between 34(+0) and 36+6 weeks of gestation and to present the results from survey of obstetricians in our country on this topic.

Efectividad de la hidroterapia materna parenteral en el oligohidramnios aislado: its effectiveness in isolated oligohydramnios / Parenteral maternal hydrotherapy:

El oligohidramnios u oligoamnios es la disminución del líquido amniótico a cifras patológicas con un índice de líquido amniótico (ILA) menor o igual a 5 cm, y constituye un alto riego fetal y secundariamente materno. OBJETIVO: demostrar a través de un ensayo clínico controlado la efectividad de la hidroterapia materna parenteral en oligoamnios aislados, en el aumento del ILA y consecutivamente su repercusión en esos resultados perinatológicos. MÉTODOS: se realizó un ensayo clínico controlado para valorar la efectividad de la hidroterapia materna parenteral (HMP) en gestantes con oligoamnios aislado, de 28 sem o más de embarazo, en el Hospital Ginecoobstétrico Docente de Guanabacoa, entre el 1ro de enero del 2000 y el 31 de diciembre de 2004. La muestra fue de 141 oligoamnios aislados y se dividió en 2 grupos: grupo estudio: 56 y el grupo control: 85. Al grupo estudio se le aplicó HMP con 2000 mL de solución salina isotónica al 0,9 por ciento, y con el grupo control se mantuvo conducta expectante. RESULTADOS: el oligoamnios aislado es más frecuente en el embarazo a término. Al administrar HMP aumenta el ILA en un 43 por ciento (grupo estudio) y solo en un 22 por ciento de los casos del grupo control. Igualmente, se logra aumentar la edad gestacional en 2 sem desde el diagnóstico. Fue mayor el parto transpelviano en el grupo estudio; la principal causa de cesárea fue el sufrimiento fetal agudo en ambos, principalmente en el grupo control. En el grupo estudio no hubo recién nacidos con Síndrome de distress respiratorio ni bronconeumonía congénita. CONCLUSIONES: la HMP parece ser efectiva en el manejo del oligoamnios aislado, lo cual disminuye la morbilidad y mortalidad perinatal y secundariamente el bienestar materno.

Oligohydramnios or oligoamnios is the amniotic fluid decrease to pathological figures with a high amniotic fluid rate (AFR) less or similar to 5 cm, and it is a fetal high risk, and secondarily maternal. OBJECTIVE: To demonstrate through a controlled clinical assay the effectiveness of parenteral maternal hydrotherapy (PMH) in isolated oligoamnios, in increase of AFR, and consecutively its repercussion on those perinatal results. METHODS: We made a controlled clinical assay to assess effectiveness of PHM in pregnants with isolated oligoamnios of 28 weeks or more of pregnancy in Gynecology and Obstetrics Teaching Hospital of Guanabacoa municipality from January 1, 2000 to December 31, 2004. Sample included 141 isolated oligoamnios and it was divided in two groups: study group with 56 patients and control-group with 85 patients. In study group, we administered PHM with 2000 mL of 0,9 percent isotopic saline solution, and in control-group there was an expectant behavior RESULTS: Isolated aligoamnios is more frequent in term pregnancy. Administration of PHM increases AFR in 43 percent (study group), and only in 22 percent of cases from control- group. Likewise, it was possible to increase gestational age in two weeks from diagnosis. In study group, transpelvic pregnancy; main cause of cesarean section was the acute fetal suffering in both groups, mainly in the control one. In study group there were not newborns presenting with neither respiratory syndrome nor congenital bronchopneumonia. CONCLUSIONS: PMH looks to be effective in management o isolated oligoamnios, decreasing perinatal morbidity and mortality, and secondarily, maternal wellbeing.