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OLIGOHIDRAMNIOS

Introduccin
El liquido amnitico juega un rol importante en la salud y desarrollo fetal,
muy lejos de ser una piscina estancada, el liquid amnitico esta en un
proceso dinamico todo el tiempo.

Management of Oligohydramnios in Pregnancy Mary B. Munn, MD
Obstet Gynecol Clin N Am 38 (2011) 387395
UpToDate Literature review current through: Jan 2014. | This
topic last updated: ago 13, 2013.
FUENTES DE LIQUIDO AMNIOTICO
GESTACION TEMPRANA
Liquido celomico
Se desarrolla entre las membranas amniotica y corionica



The composition of coelomic fluid is similar to maternal plasma and different from AF, suggesting that maternal plasma may be
its source.
The cause of the disappearance of coelomic fluid is unknown. It is likely that solutes and fluid from the exocoelomic cavity
cross the amniotic membrane into the AF and that coelomic fluid is an early source of AF.
Protein and enzyme patterns in the fluid cavities of the first trimester gestational sac: relevance to the absorptive role of
secondary yolk sac. Gulbis B, Jauniaux E, Cotton F, Stordeur P. Mol Hum Reprod. 1998;4(9):857.

Liquido amniotico Early pregnancy AF is likely derived from three sources:
The fetal surface of the placenta
Transport from the maternal compartment across the amnion (transmembranous)
Secretions from the surface of the body of the embryo.
Late gestational sources of AF (fetal urine and lung liquid) do not contribute to the AFV in early gestation. Both coelomic and
amniotic fluids are present in anembryonic pregnancies, indicating that the fetus may not be the primary fluid source in early
pregnancy.

Sem7 => sem 10 => sem12-14
FUENTES DE LIQUIDO AMNIOTICO
GESTACION TARDIA

Brace RA. Physiology of amniotic fluid volume regulation. Clin Obstet Gynecol 1997; 40:280.
Fuentes
mayores
Fuentes
menores
Production fetal urine and
fetal lung liquid
Clearance fetal swallowing
and intramembranous
pathway.
Production secretions from
the fetal oral-nasal cavities
Clearance
transmembranous pathway.

Fisiologa
Isotope and dye dilution techniques have been widely used to determine AFV
variations correlated to gestational age. In the first half of the second
trimester, AFV progressively increases by 10 ml/day until it reaches on
average 500 ml at week 20, and 700 ml and 1000 ml in the early and mid-
third trimester, respectively, before decreasing to 800-900 ml at term.c
Management of Oligohydramnios in Pregnancy Mary B. Munn, MD
Obstet Gynecol Clin N Am 38 (2011) 387395
Fuente de Liquido Amniotico
Fetal urine production 800 to 1200 mL/day
Fetal lung liquid secretion 170 mL/day
Fetal swallowing 500 to 1000 mL/day
Intramembranous flow 200 to 400 mL/day
Oral-nasal secretions 25 mL/day
Transmembranous flow 10 mL/day
Brace, RA, Ross, MG. Amniotic fluid volume regulation. In: Fetus and Neonate Volume 4: Body fluids and kidney
function, Brace, RA, Hanson, MA, Rodeck CH (Eds), Cambridge University Press 1998. p.88.

Funciones
Ayuda a proteger al feto de un traumatismo abdominal de la madre
Se amortigua el cordn umbilical de la compresin entre el feto y el tero
Tiene propiedades antibacterianas que proporcionan cierta proteccin contra la
infeccin
Sirve como un depsito de fluido y nutrientes para el feto
Proporciona los fluidos, espacio, y factores de crecimiento necesarios para permitir
el desarrollo normal de los pulmones del feto y los sistemas musculoesquelticos y
gastrointestinales.
UpToDate Literature review current through: Jan 2014. | This topic last updated: ago 13,
2013.
DEFINICION
Oligohydramnios refers to amniotic fluid volume that is less than expected for
gestational age. It is typically diagnosed by ultrasound examination and may
be described qualitatively (eg, normal, reduced) or quantitatively (eg,
amniotic fluid index [AFI] <5).

LA menor de 500ml
Magann EF, Nolan TE, Hess LW, Martin RW, Whitworth NS, Morrison JC. Measurement of amniotic
fluid volume: accuracy of ultrasonography techniques. Am J Obstet Gynecol 1992;167:1533-7.
La menor de 200ml
Croom CS, Banias BB, Ramos-Santos E, Devoe LD, Bezhadin A, Hiett K. Do semiquantitative
amniotic fluid indexes reflect actual volume? AmJ Obstet Gynecol 1992;167:995-9.
UpToDate Literature review current through: Jan 2014. | This
topic last updated: ago 13, 2013.
Oligohydramnios is thought to complicate 0.5% to 5.5% of
all pregnancies, depending on the definition that is used
and the population under study.
The AFI provides a means of quantifying normal and abnormal fluid volumes
and comparing assessments of amniotic fluid volumes across gestation. As the
5th percentile for AFI averages approximately 7 cm throughout gestation, an
AFI less than 5 cm is greater than two standard deviations below the mean
value
DEFINICION
Brace and Wolf (1989) reviewed the literature and compiled 705
measurements of amniotic fluid between 8 and 43 weeks' gestation. All of the
measurements were either by a dye-dilution technique or by direct
measurement at hysterotomy. They reported that amniotic fluid volume
increased progressively until 33 weeks' gestation and then plateaued. The
mean amniotic fluid volume between 22 and 39 weeks' gestation was 777 ml
with the 95% confidence interval ranged from 302 ml to 1997 ml. This
mathematical modeling of amniotic fluid volume provides a statistical
definition of oligohydramnios. Whether this definition is clinically relevant
with respect to fetal/neonatal outcome has not been determined.
Brace RA,Wolf EJ. Normal amniotic fluid volume changes throughout pregnancy. Am J Obstet Gynecol 1989; 161: 382-
8.
Etiologa

UpToDate Literature review current through: Jan 2014. | This topic last updated: ago 13,
2013.
Primer Trimestre
Etiologa no es clara
Tamao del saco gestacional LCN <5mm
Segundo Trimestre
The following etiologies were observed: fetal anomaly (51 percent), preterm premature
rupture of membranes (PPROM) (34 percent), placental abruption (7 percent), fetal
growth restriction (FGR) (5 percent), and unknown (4 percent)
AFP
Amniocentesis
Tercer Trimestre
Oligohydramnios first diagnosed in the third trimester is often associated with PPROM or
with uteroplacental insufficiency due to conditions such as preeclampsia or other
maternal vascular diseases.
Amniotic fluid volume normally decreases postterm and oligohydramnios can develop in
these pregnancies. In addition, many cases of third trimester oligohydramnios are
idiopathic.
Etiologa

DIAGNOSTICO
In 1981, Manning et al. introduced the concept of AFV determination using the depth of the maximum
vertical pocket (MVP) visible on ultrasound. They defined oligohydramnios as an MVP <1 cm and
reduced AFV as a pocket 1 to 2 cm in depth.
Manning FA, Platt LD. Antepartum fetal evaluation: development of a fetal biophysical profile score. Am J Obstet
Gynecol 1980;136:787-795.
Chamberlain et al. later defined as normal an MVP of 2 to 8 cm.
Chamberlain PF, Manning FA, Morrison I, Harmon CR, Lange IR. Ultrasound evaluation of amniotic fluid volume. I.
The relationship of marginal and decreased amniotic fluid volume to perinatal outcome. Am J Obstet Gynecol
1984;150:245-249.
Phelan et al. in 1987, this method is based on the sum total of the deepest vertical pockets in each of
the four quadrants.
Phelan JP, Ahn MU, Smith CV, Rutherford SE, Anderson E. Amniotic fluid index measurements during pregnancy. J
Reprod Med 1987b;32:601-604.
Moore and Cayle investigated the distribution of AFI measurements in a population of patients with
normal pregnancies. Unlike the definition of oligohydramnios by Phelan et al. (AFI <5 cm), these
authors claimed that a 5 cm AFI was present only in 1% of the normal population
Moore TR, Cayle JE. The amniotic fluid index in normal human pregnancy. Am J Obstet Gynecol 1990;162:1168-
1173.
Manning redefined normal amniotic fluid volume as one pocket of amniotic fluid that measures at least
2.0 cm in two perpendicular planes (Manning 1995)
Manning FA. Dynamic ultrasound-based fetal assessment: the fetal biophysical profile score. Clin Obstet Gynecol
1995;38:26-44
UpToDate Literature review current through: Jan 2014. | This topic last updated: ago 13,
2013.

ILA vs. EVM
It is not surprising that with different sonographic definitions, the prevalence of
oligohydramnios varies from study to study. Magann, found that 8% of their study
population had an amniotic fluid index <5cm. Only 1% of the same population had
a single pocket of amniotic fluid <2cm. While an AFI <5cm may be more sensitive
in the detection of oligohydramnios, it also has a higher false positive rate.
Magann EF, Sanderson M, Martin JN, Chauhan S. The amniotic fluid index, single deepest
pocket, and two-diameter pocket in normal human pregnancy. Am J Obstet Gynecol
2000;182:1581-1588.
A meta-analysis of these studies concluded that the SDVP was the method of
choice for evaluating the amniotic fluid volume. There was no difference in the
outcomes measured (admission to neonatal intensive care unit, acidosis,
meconium, low Apgar scores). When AFI was used, this resulted in more labor
inductions and more cesarean sections for fetal distress
Nabhan AF, Abdelmoula YA. Amniotic fluid index versus single deepest vertical pocket: a
meta-analysis of randomized controlled trials. Int J Gynaecol Obstet 2009;104(3):1848.
Mtodos para Mejorar el Liquido
Amnitico
Amnioinfusion
Para mejorar la deteccin de anormalidades fetales
Para rotar hacia ceflico
Para prevenir secuelas fetales

Maternal hydration
Oral hydration is a means of transiently increasing amniotic fluid volume, and is less invasive than
amnioinfusion. Hydration with oral water reduces maternal plasma osmolality and sodium
concentration, resulting in an osmotically driven maternal to fetal water flux. Increased placental
blood flow volume, fetal urine output, and possibly decreased reabsorption of amniotic fluid via
swallowing or intramembranous flow increases the amniotic fluid volume.
This process was illustrated in a prospective study in which 10 women with third-trimester
oligohydramnios (AFI less than 5 cm) and 10 controls with normal amniotic fluid volume consumed 2
L of water over two hours. Hydration increased the amniotic fluid volume in women with
oligohydramnios (mean change in AFI 3.2 cm, 95% CI 1.1-5.3), but not in those with normal amniotic
fluid volume.
Three randomized trials of hydration in patients with oligohydramnios have been performed:
In cases of oligohydramnios in which delivery is not indicated, we feel that oral hydration may have
some benefit, particularly in patients with evidence of maternal dehydration.
The combined use of oral water ingestion and desmopressin (DDAVP) markedly and transiently
increases amniotic fluid volume. This effect is attributed to both of maternal hydration and
antidiuresis, and thus maternal plasma hypoosmolality. Use of DDAVP for this indication should be
considered experimental, and used only under approved research protocols