Академический Документы
Профессиональный Документы
Культура Документы
Nancy Chescheir MD
Basics
Description
Oligohydramnios (oligo) refers to pathologically low volumes of AF.
Age-Related Factors
Not uniquely related to maternal age
Rare in 1st trimester
Epidemiology
The incidence of oligohydramnios ranges from 0.55% or more, depending on the
patient population, high risk factors, and GA.
Risk Factors
Vascular compromise
PROM
Medication use:
o
ACE inhibitors
NSAIDs
Pathophysiology
Abnormal production of AF:
o Poor placental perfusion in response to decreased intravascular volume
or BP, fetus preferentially perfuses vital organs, decreases GFR,
reduces urine production (prerenal)
Loss of fluid:
o
PROM
Prolonged early severe oligo can results in pulmonary hypoplasia, facial and
limb abnormalities.
Associated Conditions
HTN
Severe diabetes
Lupus
Smoking
IUGR
Post-dates pregnancy
Placental abnormality:
Chronic abruption
Infarction
Circumvallate
Fetal abnormality:
o
Diagnosis
Signs and Symptoms
History
Typically not helpful
Physical Exam
Size < dates by 3 cm in normal-sized woman
Tests
Imaging
US required to make diagnosis:
Fetal crowding
MVP <1 cm is strictest definition
AFI <5 cm
Doppler may be useful; color confirms renal artery presence; umbilical artery
assessment if IUGR
Treatment
General Measures
Weigh risks of continuing pregnancy vs. neonatal morbidity and mortality
risks and consider delivery.
Efforts to improve perfusion:
Complete bed rest not likely helpful, but avoid aerobic exercise.
Maternal fluid hydration not useful except for severe maternal dehydration
Pregnancy-Specific Issues
Make as complete a diagnosis as possible.
By Trimester
With absent fetal renal function or urine output, oligohydramnios occurs after
~16 weeks.
With known risk factors, actively assess AF volume at intervals after
intervention is considered.
Risks for Mother
Increased risk for cesarean delivery
Risks for Fetus
Related primarily to etiology, duration
Cord compression with IUFD, possible CNS injury possible
P.411
Medication (Drugs)
Steroids if anticipate preterm birth
Followup
Disposition
Issues for Referral
Perinatal consultation if known or suspected fetal anomaly, severe IUGR, severe
maternal vascular disease
Prognosis
Related to underlying cause, duration, and severity of oligohydramnios
Patient Monitoring
Fetus
If potentially viable fetus, consider fetal monitoring:
o Cord compressions: Variable decelerations
o
Miscellaneous
Clinical Pearls
Oligohydramnios is a sign of another problemfind the problem.
Send the placenta to pathology lab if etiology not known.