OLIGOHYDRAMNIOS

VOLUME AND COMPOSITION

From 20 weeks up to term (mainly - fetal
urine): At 18th week, the fetus voids 714ml/day; at term fetal kidneys secretes 600700ml of urine/day into AF.
- Fetal respiratory tract secretes 250ml/day
into AF.
- Fluid transfers across the placenta.
- Fetal oro-nasal secretions.
Secretion is controlled by:
- Fetal swallowing at term removes 500ml/day.
- Reabsorption into maternal plasma (osmotic
gradient).
AF constituents:
- urea, creatinine & uric acid + desquamated

AMNIOTIC FLUID VOLUME :

About 500 mls enter and leave the amniotic

sac each hour.
gradual up to 36 weeks to around 600 to
1000 ml then after that.
The normal range is wide but the
approximate volumes are:
- 500 ml at 18 weeks
- 800 ml at 34 weeks.
- 600 ml at term.

PHYSIOLOGY OF AMNIOTIC FLUID

AMNIOTIC FLUID VOLUME

ASSESSMENT
Clinical assessment is unreliable.
Objective assessment depends on U/S to
measure:
- deepest vertical pool (DVP).
- Amniotic fluid index (AFI). It is a total of the
DVPs in each four quadrants of the uterus. it is
a more sensitive indicator of AFV throughout
pregnancy.

INFLOW

(1000 ml/d)

1.FETAL URINE
2.LUNG LIQUID

OUTFLOW
(1000 ml/d)

1.FETAL
SWALLOWING

INTRAMEMBRANOUS (placenta,cord)
TRANSMEMBRANOUS(amniotic membranes)
RECYCLING 3hrs
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FUNCTIONS OF AMNIOTIC FLUID

Shock absorber protects from external trauma.

Protects cord from compression.
Permits fetal movements development of
musculoskeletal system, prevents adhesions.
Swallowing of AF enhances growth & development
of GIT.
AF volume maintains AF pressure reduces loss
of lung liquid pulmonary development.
Maintenance of fetal body temperature.
Some fetal nutrition, water supply.
Bacteriostatic properties decreases potential
for infection
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OLIGOHYRAMINOS
DEFINITION

AMNIOTIC FLUID VOLUME < 5 th

percentile for gestational age

AMNIOTIC FLUID INDEX < 5

SINGLE VERTICAL POCKET < 2 cms

INCIDENCE
0.5 5%

CAUSES OF OLIGOHYDRAMNIOS:
1. Fetal causes:
* Renal cause
(57%):
- Renal agenesis
(Potters
syndrome).
- Polycystic kidney.
Urethral obstruction
(atresia/posterior
urethral valve).

Fetal growth
restriction.
Fetal death.
Postterm
pregnancy.
Preterm premature
PROM (50%)
rupture membranes
Chromosomal

anomalies
Congenital anomalies
IUGR
IUFD
Postterm pregnancy

CAUSES OF
OLIGOHYDRAMNIOS:
2. Maternal causes:
Uteroplacental insufficiency.
Preeclampsia.
APLA syndrome
Chronic HTN
3. Placental causes:
twin-twin transfusion.
Chronic abruption
TTTS
4. Drug causes:
Prostaglandin synthase inhibitor as NSAID.
Ace Inhibitors
5. Idiopathic

DIAGNOSIS

SYMPTOMS
NO SPECIFIC
SYMPTOMS
H/O leaking p/v
Postterm
s/o preeclampsia
Drugs
Less fetal movements

SIGNS
Uterus small for
date
Feels full of fetus
Malpresentations
IUGR

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USG
METHODS
MVP

AFI

<2 cms
(<1 severe)
<5 cms
(5-8 borderline)

2D pocket

<15 sq cms
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COMPLICATIONS OF
OLIGOHYDRAMNIOS:

In early pregnancy:
Amniotic adhesions or bands
amputation/death.
Pressure deformities (club feet).
Pulmonary hypoplasia:
- Thoracic compression.
- No breathing movement.
- No amniotic fluid retain.
Flattened face.
Postural deformities.

In late pregnancy:
Fetal growth restriction.
Placental abruption.
Preterm labour.
Fetal distress.
Fetal death.
Meconium aspiration.
Labour induction/CS.

MANAGEMENT
DEPENDS UPON

AETIOLOGY
GESTATIONAL AGE
SEVERITY
FETAL STATUS & WELL BEING

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DETERMINE AETIOLOGY

R/O PROM
TARGETED USG FOR ANOMALIES
R/O IUGR ,IUFD when suspected
Amniocentesis if chromosomal anomalies
suspected early symmetric IUGR
Tests for APLA Syndrome , if suspected

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TREATMENT

ADEQUATE REST decreases dehydration

HYDRATION Oral/IV Hypotonic fluids(2 Lit/d)
temperory increase
helpful during labour,prior
to ECV, USG
SERIAL USG Monitor growth,AFI,BPP
INDUCTION OF LABOUR/ LSCS
Lung maturity attained
Lethal malformation
Fetal jeopardy
Sev IUGR
Severe oligo
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AMNIOINFUSION
INDICATIONS
1.Diagnostic
2.Prophylactic
3.Therapeutic
Decreases cord
compression
Dilutes meconium

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TREATMENT ACC. TO CAUSE

Drug induced OMIT DRUG

PROM INDUCTION
PPROM Antibiotics,steroid Induction
FETAL SURGERY
VESICO AMNIOTIC SHUNT-PUV
Laser photocoagulation for TTTS

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