User:Aziz.hadia/Oligohydramnios
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[edit]Lead
[edit]Oligohydramnios is a medical condition in pregnancy characterized by a deficiency of amniotic fluid in the amniotic sac. It is typically diagnosed by ultrasound when the amniotic fluid index (AFI) measures less than 5 cm or when the single deepest pocket (SDP) of amniotic fluid measures less than 2 cm.
The opposite of oligohydramnios is polyhydramnios, or an excess of amniotic fluid.
Article body
[edit]Management
[edit]After initial diagnosis of oligohydramnios has been made, the next step is to perform a thorough history and physical exam, followed by diagnostic testing when indicated to look for a cause contributing to the diagnosis.
- Retaking a maternal and family history and performing a physical exam can point to maternal conditions or medications that might be causing the oligohydramnios.
- Premature prelabor rupture of membranes or prelabor rupture of membranes is ruled out with a nitrizine test, evidence of ferning, or evidence pooling of liquid in the cervix.
Increasing Amniotic Fluid
[edit]Amnioinfusion
Maternal hydration
Investigational therapies
A Cochrane review concluded that "simple maternal hydration appears to increase amniotic fluid volume and may be beneficial in the management of oligohydramnios and prevention of oligohydramnios during labour or prior to external cephalic version."[1]
In severe cases oligohydramnios may be treated with amnioinfusion during labor to prevent umbilical cord compression. There is uncertainty about the procedure's safety and efficacy, and it is recommended that it should only be performed in centres specialising in invasive fetal medicine and in the context of a multidisciplinary team.[2]
In case of congenital lower urinary tract obstruction, fetal surgery seems to improve survival, according to a randomized yet small study.[3]
Prenatal care
[edit]Patients who are preterm are managed in the outpatient setting with weekly or biweekly testing to monitor for accurate fetal growth and decrease chances of unexpected fetal death. This includes a twice weekly non-stress test (NST) and single deepest pocket (SDP) assessment which is also referred to as the modified BPP. Sonographic fetal growth exams may also be indicated.
Timing of Delivery
[edit]Idiopathic, uncomplicated, and persistent oligohydramnios can be delivered at 36 0/7 weeks - 37 6/7 weeks of gestation or at diagnosis if diagnosis is later.
References
[edit]- ^ Hofmeyr, G. J.; Gülmezoglu, A. M. (2002). "Maternal hydration for increasing amniotic fluid volume in oligohydramnios and normal amniotic fluid volume". The Cochrane Database of Systematic Reviews (1): CD000134. doi:10.1002/14651858.CD000134. ISSN 1469-493X. PMC 7045461. PMID 11869566.
- ^ Oligohydramnios Archived 2016-09-20 at the Wayback Machine at the National Institute for Health and Clinical Excellence. Based on the overview Therapeutic amnioinfusion for oligohydramnios during pregnancy (excluding labour) Archived 2013-02-18 at the Wayback Machine in 2006
- ^ Morris, R. K.; Malin, G. L.; Quinlan-Jones, E.; Middleton, L. J.; Hemming, K.; Burke, D.; Daniels, J. P.; Khan, K. S.; Deeks, J.; Kilby, M. D. (2013). "Percutaneous vesicoamniotic shunting versus conservative management for fetal lower urinary tract obstruction (PLUTO): A randomised trial". The Lancet. 382 (9903): 1496–1506. doi:10.1016/S0140-6736(13)60992-7. PMC 3898962. PMID 23953766.