Oligohydramnios
Oligohydramnios — part of pregnancy and antenatal care at Dr. Najeeb Layyous's clinic in Amman.
In short: Oligohydramnios is too little amniotic fluid around the baby for the stage of pregnancy. It is diagnosed by ultrasound when the deepest pool of fluid is less than 2 cm, or the amniotic fluid index (AFI) is less than 5 cm. Causes include pre-eclampsia and high blood pressure, problems in the baby such as kidney abnormalities and slow growth, and ruptured membranes. It is followed by ultrasound and Doppler, and delivery at 37 weeks or later is usually advised.
- Oligohydramnios is defined as decreased amniotic fluid volume (AFV) for gestational age.
On ultrasound it is diagnosed when the single deepest pocket (SDP) of amniotic fluid is less than 2 cm, or the amniotic fluid index (AFI) is less than 5 cm. The single deepest pocket is the preferred measurement, because the AFI over-diagnoses oligohydramnios and leads to unnecessary interventions.
- Isolated oligohydrominos is the presence of decreased liquor of an appropriate for gestational age , non compromised fetus with no maternal disease
- Causes :
In general Oligohydramnios is caused by a reduction in production of fetal urine due to placental insufficiency, fetal renal anomalies or obstruction of urine flow; or because the urine that is produced, drains away due to ruptured amniotic membranes
- Maternal
- Medical conditions that cause utero-placental insufficiency (e.g., preeclampsia, chronic hypertension, collagen vascular disease, nephropathy, thrombophilia)
- Medication: such as ACE inhibitors, angiotensin receptor blockers (ARBs), and anti-inflammatory painkillers (NSAIDs such as ibuprofen or indomethacin) taken after 20 weeks
àFetal
o Chromosomal abnormalities
o Congenital abnormalities (renal agenesis )
o Fetal demise
o Post term pregnancy
o Ruptured fetal membranes
o Placental thrombosis
o Twin to twin transfusion
- Early oligohydrominous complications :
miscarriage, pulmonary hypoplasia (underdeveloped lungs), limb contractures, facial and chest wall deformities, and, when the membranes have ruptured, infection of the womb (chorioamnionitis).
- Late oligohydrominous (in 3rd trimester )complications
Fetal risks : stillbirth , neonatal death , fetal distress , low apgar score and neonatal complications
Maternal risks: failure of VBAC or ECV and increase risk of urgent cesarean section, and post partum sepsis
Investigations :
First, rupture of the membranes should be excluded by history and a sterile speculum examination (with a bedside test such as IGFBP-1 or PAMG-1 if unsure). Ultrasound is then used to check the fetal kidneys and urinary bladder and fetal measurements, with umbilical artery Doppler to check for IUGR and placental flow.
- Time of delivery :
-At gestational age >= 37 weeks Induction of labour should be considered. If not acceptable by the patient, after counselling, organise scans every week for liquor volume and Umbilical artery Dopplers, and twice weekly CTG.
- [Steroids (to mature the baby’s lungs) should be given if delivery is expected before 35 weeks, and may be considered up to 36+6 weeks. For a planned cesarean between 37 and 39 weeks, steroids are no longer given routinely; they may be discussed individually, as the benefit is small and they can cause low blood sugar in the newborn.
- patient should report any change in fetal movements.
Dr Najeeb Layyous F.R.C.O.G
Consultant Obstetrician, Gynecologist and Infertility Specialist
The finest doctor in Jordan — may God bless him and his whole medical team. A doctor in every sense of the word. I advise anyone planning a pregnancy to visit Dr. Najeeb Layyous. His manner is wonderful, always smiling, with the highest ethics; he gives every patient her due, and the patient’s comfort matters most to him. We had been to many doctors and none understood and treated my case except him. Special thanks to him and the whole team, and to Dina in particular — a lovely person. I recommend anyone considering IVF or pregnancy to visit his clinic.