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Ultrasound in Obstetrics & Gynecology :... Apr 2017To evaluate adverse pregnancy outcomes in singleton pregnancies diagnosed with oligohydramnios through a systematic review and meta-analysis of controlled trials. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To evaluate adverse pregnancy outcomes in singleton pregnancies diagnosed with oligohydramnios through a systematic review and meta-analysis of controlled trials.
METHODS
We searched electronic databases via OVID, EBSCO, Web of Science, Google Scholar and others from 1980 to 2015. Prospective and retrospective studies with a control group were included. Two authors independently reviewed the abstracts from the literature search. Inclusion criteria were: studies in English, singleton pregnancy, normal fetal anatomy, intact membranes and oligohydramnios determined by the amniotic fluid index (AFI) technique. We stratified the meta-analysis into two groups according to risk: high risk including studies of oligohydramnios with comorbid conditions (e.g. hypertension) and low risk including studies of isolated oligohydramnios.
RESULTS
Fifteen trials met the inclusion criteria. Nine were high-risk and six were low-risk studies, including 8067 and 27 526 women, respectively. Compared with women with normal AFI, those with isolated oligohydramnios had significantly higher rates of an infant with meconium aspiration syndrome (relative risk (RR), 2.83; 95% CI, 1.38-5.77), Cesarean delivery for fetal distress (RR, 2.16; 95% CI, 1.64-2.85) and admission to the neonatal intensive care unit (NICU) (RR, 1.71; 95% CI, 1.20-2.42). Patients with oligohydramnios and comorbidities were more likely to have an infant with low birth weight (RR, 2.35; 95% CI, 1.27-4.34). However, rates of 5-min Apgar score < 7 (RR, 1.85; 95% CI, 0.69-4.96), NICU admission (RR, 2.09; 95% CI, 0.80-5.45), meconium-stained amniotic fluid (RR, 1.32; 95% CI, 0.62-2.81) and Cesarean delivery for fetal distress (RR, 1.65; 95% CI, 0.81-3.36) were similar to those for women with normal AFI. Stillbirth rates were too low to analyze in the meta-analysis.
CONCLUSIONS
This review helps to delineate which adverse outcomes are increased with oligohydramnios in low-risk pregnancy (NICU admission, Cesarean delivery for fetal distress and meconium aspiration syndrome), but does not provide enough data to determine the optimal timing of delivery in such cases. Oligohydramnios in complicated pregnancy is associated with an increased risk of delivery of an infant with low birth weight, but this may be confounded by the comorbid condition. Therefore, in high-risk pregnancy, management should be dictated by the comorbid condition and not the presence of oligohydramnios. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
Topics: Birth Weight; Clinical Trials as Topic; Female; Humans; Infant, Newborn; Oligohydramnios; Pregnancy; Pregnancy Complications; Pregnancy Outcome
PubMed: 27062200
DOI: 10.1002/uog.15929 -
The Journal of Maternal-fetal &... Dec 2022To investigate whether the severity of isolated oligohydramnios at term is associated with increased rates of adverse perinatal outcome.
OBJECTIVE
To investigate whether the severity of isolated oligohydramnios at term is associated with increased rates of adverse perinatal outcome.
STUDY DESIGN
A retrospective study conducted in a single medical center from 2017 to 2019. All low-risk pregnancies with incidental isolated oligohydramnios at term were included. The degree of oligohydramnios was arbitrarily classified into mild (AFI = 41-50 mm), moderate (AFI = 21-40 mm) and severe (AFI = 0-20 mm).
RESULT
A total of 610 women were included: 202 with a mild (33.1%), 287 moderate (47.0%), and 121 severe oligohydramnios (19.8%). Non-reassuring monitor requiring immediate delivery and worse composite neonatal outcome were more common among severe than mild or moderate oligohydramnios (14.0% and 6.4%, 7.3% respectively; = .039 and 19.8%, 10.9% and 11.8%, respectively; = .048).
CONCLUSION
Low-risk pregnancies with isolated severe oligohydramnios at term have a higher tendency toward non-reassuring fetal monitoring requiring prompt delivery and adverse neonatal outcomes, this calls for close intrapartum surveillance.
Topics: Pregnancy; Infant, Newborn; Female; Humans; Oligohydramnios; Retrospective Studies; Amniotic Fluid; Pregnancy Outcome; Fetal Monitoring
PubMed: 33645394
DOI: 10.1080/14767058.2021.1892068 -
Midwifery Today With International... 2014
Topics: Female; Humans; Midwifery; Nurse's Role; Oligohydramnios; Pregnancy; Pregnancy Trimesters; Prenatal Care; Risk Factors
PubMed: 25980099
DOI: No ID Found -
Obstetrical & Gynecological Survey Jun 1991Oligohydramnios is a relatively common complication of pregnancy. Etiologies include congenital anomalies, intrauterine growth retardation, premature rupture of the... (Review)
Review
Oligohydramnios is a relatively common complication of pregnancy. Etiologies include congenital anomalies, intrauterine growth retardation, premature rupture of the membranes, drugs, postterm gestation and postmaturity. Sequelae from prolonged oligohydramnios including pulmonary hypoplasia and fetal compression syndrome can be devastating. Perinatal morbidity and mortality are both significantly increased in pregnancies complicated by oligohydramnios. Successful management requires a thorough search for the cause of the decreased amniotic fluid volume, and close antenatal surveillance.
Topics: Female; Humans; Infant Mortality; Infant, Newborn; Oligohydramnios; Pregnancy; Pregnancy Outcome; Ultrasonography, Prenatal
PubMed: 2067755
DOI: 10.1097/00006254-199106000-00002 -
Harefuah Nov 2019There are two methods to diagnose oligohydramnios: maximal vertical pocket (MVP) and amniotic fluid index (AFI). Following a recent large Cochrane review and other... (Review)
Review
There are two methods to diagnose oligohydramnios: maximal vertical pocket (MVP) and amniotic fluid index (AFI). Following a recent large Cochrane review and other studies, MVP is being recommended as the method of choice by professional societies, after it was shown to result in fewer inductions of labor and C-sections (CS), without compromising neonatal outcome. There is controversy regarding the management of isolated oligohydramnios (IO). It is unclear whether this finding reflects an underlying pathological process, and therefore management protocols differ between different institutions. Studies have shown a higher rate of CS (RR of >2) in IO. Whether this is a true complication of IO or is a result of different confounders like labor inductions and primigravidity is unclear. The effects on neonatal outcomes are also unclear; whereas some authors did not show any adverse effects, others have shown higher rates of neonatal intensive care unit (NICU) admissions, lower Apgar scores and higher rate of Meconium aspiration syndrome. Some studies have shown a higher rate of undiagnosed small for gestational age (SGA) in IO pregnancies. There is no consensus regarding the optimal management and time of delivery. Until now, common practice was to induce labor at term, and some advocate induction in late preterm. Recently, the growing awareness to early term morbidity has led practitioners to question the benefit of early induction. There are several studies that have shown maternal hydration to improve AFI, but there is insufficient data to show the effect on outcomes. In conclusion, many questions regarding IO are still unanswered, and further research, specifically RCT studies, is needed.
Topics: Amniotic Fluid; Female; Humans; Infant, Newborn; Labor, Induced; Meconium Aspiration Syndrome; Oligohydramnios; Pregnancy; Pregnancy Outcome
PubMed: 31721516
DOI: No ID Found -
Pediatrics and Neonatology Feb 2017Pulmonary hypoplasia is a substantial cause of death in newborn infants, and oligohydramnios is one of the most commonly associated abnormalities. Lung growth is... (Review)
Review
Pulmonary hypoplasia is a substantial cause of death in newborn infants, and oligohydramnios is one of the most commonly associated abnormalities. Lung growth is influenced by physical factors such as the intrauterine space, lung liquid volume and pressure, and fetal breathing movements. During lung development, the main physical force experienced by the lungs is stretching induced by breathing movements and the lung fluid in the airspaces. Oligohydramnios reduces the intrathoracic cavity size, thus disrupting fetal lung growth and leading to pulmonary hypoplasia. The exact mechanism by which oligohydramnios alters the respiratory system structure and the effect of oligohydramnios on long-term respiratory outcomes remain unknown. In this review, we summarize the effects of oligohydramnios on lung development, discuss the mechanisms of oligohydramnios-induced pulmonary hypoplasia identified in various animal studies, and describe the long-term respiratory outcomes in childhood of oligohydramnios-exposed fetuses reported by a population-based study.
Topics: Animals; Disease Models, Animal; Female; Humans; Lung; Oligohydramnios; Pregnancy; Respiration
PubMed: 27324123
DOI: 10.1016/j.pedneo.2016.04.001 -
Current Opinion in Obstetrics &... Apr 2014Nearly 1% of pregnancies are affected by some type of midtrimester oligohydramnios. Evidence is currently accumulating that suggests the better efficacy of the new... (Review)
Review
PURPOSE OF REVIEW
Nearly 1% of pregnancies are affected by some type of midtrimester oligohydramnios. Evidence is currently accumulating that suggests the better efficacy of the new therapeutic procedures relative to conventional management. This review summarizes the available evidence.
RECENT FINDINGS
The prolongation of the period between the diagnosis of oligohydramnios and delivery following amnioinfusion and amniopatch techniques appears to be strongly associated with the gestational age and whether the situation was based on rupture of the membranes or not. Case series reveal that amnioinfusion significantly improves the perinatal outcome and prolongs the pregnancy in severe second-trimester oligohydramnios in both idiopathic cases and those involving rupture of the amniotic membranes [preterm prelabor rupture of the membranes (PPROM)]. There is clear evidence of a lower frequency of perinatal complications and successfully prolonged gestation in iatrogenic PPROM after the amniopatch technique relative to population controls.
SUMMARY
Identification of potentially modifiable risk factors for the successful prolongation of pregnancy complicated with midtrimester oligohydramnios, and previable PPROM is needed for the improvement of treatment strategies and prognosis. Randomized trials are needed to determine whether amniotic fluid-replenishing strategies can improve pregnancy outcomes.
Topics: Amnion; Amniotic Fluid; Blood Platelets; Directive Counseling; Factor VIII; Female; Fetal Membranes, Premature Rupture; Fibrinogen; Gestational Age; Humans; Infusions, Parenteral; Oligohydramnios; Parents; Pregnancy; Pregnancy Outcome; Pregnancy Trimester, Second; Prognosis; Survival Analysis
PubMed: 24614021
DOI: 10.1097/GCO.0000000000000051 -
Akusherstvo I Ginekologiia 1995
Review
Topics: Female; Fetus; Humans; Oligohydramnios; Pregnancy; Prognosis
PubMed: 7485796
DOI: No ID Found -
Obstetrics and Gynecology Clinics of... Jun 2011The finding of oligohydramnios in pregnancy is problematic. The various mechanisms that control amniotic fluid, the inability to precisely measure and quantify the... (Review)
Review
The finding of oligohydramnios in pregnancy is problematic. The various mechanisms that control amniotic fluid, the inability to precisely measure and quantify the amount, and the relevance of a "decreased" amount of fluid make the management of this finding unclear. Given the limited amount of data, the single deepest vertical pocket may be a better method than the amniotic fluid index to define oligohydramnios. A large prospective study is needed to develop the most optimal management recommendations, especially for idiopathic oligohydramnios at or near term.
Topics: Amniotic Fluid; Female; Humans; Oligohydramnios; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Ultrasonography
PubMed: 21575807
DOI: 10.1016/j.ogc.2011.02.021 -
Fetal Diagnosis and Therapy 2016To investigate whether isolated oligohydramnios at term is associated with increased rates of perinatal morbidity and mortality and whether induction of labor in term... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To investigate whether isolated oligohydramnios at term is associated with increased rates of perinatal morbidity and mortality and whether induction of labor in term pregnancies with isolated oligohydramnios is superior to conservative management in reducing perinatal morbidity and mortality.
STUDY DESIGN
We searched databases from inception to May 2015. We included studies that evaluated isolated oligohydramnios at term and perinatal outcome. Each outcome was analyzed separately, performing a comparative analysis between the study and control groups.
RESULTS
Twelve studies were included with 35,999 women: 2,414 (6.7%) with isolated oligohydramnios and 33,585 (93.29%) with normal amniotic fluid index. Patients with isolated oligohydramnios had significantly higher rates of labor induction [odds ratio (OR) 7.56, confidence interval (CI) 4.58-12.48] and Cesarean sections (OR 2.07, CI 1.77-2.41). There were higher rates of an Apgar score <7 at 1 and 5 min (OR 1.53, CI 1.03-2.26, and OR 2.01, CI 1.3-3.09, respectively) and admission to the neonatal intensive care unit (OR 1.47, CI 1.17-1.84). There were no significant differences in cord pH <7.1 and meconium-stained amniotic fluid. In the single randomized trial comparing induction of labor with expectant management, no differences were found in any significant maternal or neonatal outcomes.
CONCLUSION
Isolated oligohydramnios at term is associated with significantly higher rates of labor induction, Cesarean sections, and short-term neonatal morbidity.
Topics: Adult; Amniotic Fluid; Cesarean Section; Delivery, Obstetric; Female; Humans; Labor, Induced; Odds Ratio; Oligohydramnios; Pregnancy; Pregnancy Outcome; Pregnancy Trimester, Third; Term Birth
PubMed: 27160748
DOI: 10.1159/000445948