Prolonged pregnancy is associated with obstetrical and neonatal adverse outcomes, and the risks appear to increase along a spectrum with the degree of prolongation. Prolonged pregnancy is considered as menstrual age ranged from 41 to 41 67 weeks of gestation, while a pregnancy beyond 42 07 weeks is defined postterm. This topic will discuss issues related to oligohydramnios. Is oligohydramnios in postterm pregnancy associated with. Location of clinic the clinic will be held on the birth centre. The terms postdate and prolonged pregnancy are illdefined and. Generally, oligohydramnios is less prevalent in early pregnancy and at this time it usually is associated with poor prognosis 1.
Oligohydramnios in complicated and uncomplicated pregnancy. Mar 11, 2016 the earlier in pregnancy that oligohydramnios occurs, the poorer the prognosis. Oligohydramnios refers to reduced amniotic fluid volume, often less than 500 ml at 3236 weeks of gestation. The earlier in pregnancy that oligohydramnios occurs, the poorer the prognosis. In fetuses with severe oligohydramnios between and 24 weeks, 51% have fetal abnormalities 1% are aneuploidy, 34% have preterm premature rupture of membranes, 7% abruption, and 5% growth restriction. Moreover, one study of 3050 uncomplicated pregnancies with singleton fetuses between 40 and 41. Idiopathic polyhydramnios appears to increase the risk of prolonged first stage of labour, nonvertex presentation, and cesarean.
There was no difference in the average fetal renal arterial pi. Oligohydramnios prolonged pregnancy fetal anomalies. Afp american family physician may 15, 2005 pubmed medline definition prolonged pregnancy postterm pregnancy it is one that has lasted longer than 42 weeks or 294 days beyond the first day of the last menstrual. In this article, we shall look at the aetiology, investigations and management of oligohydramnios. Earlier gestational age at ultrasound evaluation predicts adverse neonatal outcomes in the preterm appropriatefor. The women also had a higher rate of cs for socalled foetal distress. It complicates as many as 12% of pregnancies that last beyond 41 weeks.
Maternal obesity is defined as a body mass index bmi 30 kgm2 b. No other condition was found to be associated with a low volume of the amniotic fluid. Midtrimester oligohydramnios affects approximately 1% of pregnancies 2. Oligohydramnios gynecology and obstetrics merck manuals.
Prolonged pregnancy per st is not a pathological condition and shodd not be. Over 40 years ago a relationship was noted between the diminishing placental function of postmaturity and oligohydramnios elliot, 1961. A pregnancy that goes past 42 weeks is at risk of oligohydramnios because the amniotic fluid can decrease by half after this time. Patients suffering with type 1 disorder improve during pregnancy as the vwf levels increase up to the normal range. Oligohydramnios is more common in pregnancies beyond term, as the afv normally decreases at term.
The terms prolonged pregnancy, postdates and postdatism are synonymously used to describe the same condition. Oligohydramnios is a complication in approximately 4. These problems, caused by prolonged exposure to oligohydramnios, will be the focus of this article. Definition pregnancy which has extended beyond 42 weeks of gestation period 294 days incidence of postterm pregnancy is 414% generally 10% 3. Sep 20, 2017 rupture of the membranes is the most common cause of oligohydramnios. Patients suffering with type 1 disorder improve during pregnancy as. Prolonged pregnancy pregnancy evidence evidence based based valleria, sp. Postterm pregnancy postmaturity, prolonged pregnancy name. Oligohydramnios with fetal symmetric growth retardation is associated with increased chromosomal abnormality. In this period of pregnancy, amniotic fluid volume is considered an important predicting factor of fetal wellbeing. Oligohydramnios is associated with an increased risk for fetal or neonatal death, which may be related to the underlying cause of the reduced amniotic fluid volume or due to sequelae of the reduced amniotic fluid volume.
Frequently, postterm pregnancy is associated with oligohydramnios. Severe oligohydramnios, though not clearly defined, but clinically with an afi of less than 5 cm. However, the most common clinical features of a prolonged pregnancy include. It is defined by an amniotic fluid index that is below the 5th centile for the gestational age, and is thought to affect approximately 4. This complication is associated with high morbidity and mortality rates. Oligohydramnios refers to a low level of amniotic fluid during pregnancy. Management of pregnancy beyond 40 weeks gestation american. Including all grades of pre eclampsia, pregnancy induced hypertension and essential hypertension table 2. Early detection of oligohydramnios and its management may help in reduction of perinatal morbidity and mortality one side and decreased caesarean deliveries on the other side.
Prolonged pregnancy may be avoided by interventions to cause delivery prior to 294 days gestation, including complementary therapies, labour induction, or caesarean section. Contraindications gestational age 294 days incidence of postterm pregnancy is 414% generally 10% 3. A comparison between amniotic fluid index and the single. Prolonged pregnancy is a diagnosis based on the gestational age of the fetus, which is calculated by the first trimester ultrasound dating scan. Oligohydramnios causes, symptoms, treatment, prognosis and. It also keeps your babys body from compressing the umbilical cord against the uterine wall.
Oligohydramnios in complicated and uncomplicated pregnancies. Oligohydramnios is a deficient volume of amniotic fluid. Fetal breathing movements as predictor of favourable pregnancy outcome after oligohydramnios due to membrane rupture in second trimester. Bed rest may also help when pregnancyinduced hypertension pih is present, allowing prolongation of the pregnancy. Oligohydramnios is a disorder that occurs in pregnancy and is characterized by an amniotic fluid deficiency. Contraindications gestational age oligohydramnios occurs in about 1% to 5% of pregnancies at term. There may not be any prominently detectable signs in affected women.
Then infant is considered post mature or dysmature, especially if placental insufficiency has interfered with fetal growth. Oligohydramnios causes, symptoms, treatment, prognosis. However, because the amniotic fluid is primarily fetal urine in the latter half of the pregnancy, the absence of fetal urine production or a blockage in the fetuss urinary tract can also result in oligohydramnios. Oligohydramnios sequence, or potters syndrome, is a chain of events that result in severe. Throughout pregnancy, your amniotic fluid cushions your baby and allows him to grow and move.
Most of this mortality is a result of major congenital malformations and pulmonary hypoplasia secondary to prom before 22 weeks gestation. Complications of prolonged prom and oligohydramnios. Contraindications gestational age oligohydramnios was defined as afv prolonged pregnancy. Maternal bed rest and hydration promote the production of amniotic fluid by increasing the maternal intravascular space. Pdf p oligohydramnios is a threatening condition to fetal health and is associated with increased fetal morbidity. Labour and delivery during pregnancy there is a three to four fold increase in vwf. Gestational age estimation in women referred for suspected prolonged. If oligohydramnios happens in the first 2 trimesters first 6 months of pregnancy, it is more likely to cause serious problems than if it happens in the last trimester. Prediction of oligohydramnios in prolonged pregnancy. Causes of fetal death autopsy andor placental histological results. Birth defects problems with a babys body that are present at birth.
Dec 01, 2002 oligohydramnios and postterm pregnancy. The reduced renal artery enddiastolic velocity suggests that increased arterial impedance is an important factor in the development of oligohydramnios in prolonged pregnancies. Clinical abdominal palpation for predicting oligohydramnios. Sep 14, 20 oligohydramnios is a disorder that occurs in pregnancy and is characterized by an amniotic fluid deficiency. Scribd is the worlds largest social reading and publishing site. Is oligohydramnios is postterm pregnancy associated with. Problems during labor and birth, such as the umbilical cord being squeezed. In twin gestation with twintotwin transfusion, polyhydramnios may occur in the recipient twin, and oligohydramnios may occur in the donor. Bed rest may also help when pregnancy induced hypertension pih is present, allowing prolongation of the pregnancy. A term pregnancy is 38 to 42 weeks long, and a pregnancy that exceeds these limits is termed as post term pregnancy or prolonged pregnancy. Renal artery doppler was more predictive of oligohydramnios than the umbilical ri. Vihari vichakshana rajaguru group no 32 4th year 2nd semester 2016 2. Incidence of fetal risk factors oligohydramnios table 3.
In view of the scarcity of ultrasound in lowresource settings, to evaluate abdominal palpation for prediction of oligohydramnios in suspected prolonged pregnancy, using the ultrasoundobtained amniotic fluid index afi as a gold standard, taking into account maternal and fetal factors that may affect amniotic fluid volume. The occurrence of oligohydramnios complicating a pregnancy is seen in 0. Oligohydramnios and postterm pregnancy 20021201 ahc. Ounpraseuth2 1department of obstetrics and gynecology, university of arkansas for medical sciences, little rock, ar, usa.
Studies have shown a reduction in the number of preg. Mlc 10 guideline for the use of complementary therapy. Oligohydramnios is a condition during pregnancy where theres lowerthanexpected amniotic fluid surrounding a baby for his or her gestational age. The fetuses with this condition have less than 500 ml of amniotic fluid 1. The observed etiology of the relative reduction in amniotic fluid volume towards term and in uncomplicated postterm pregnancies remains unclear. Peters, md, and mary anne kelly, rn dallas, texas there is increasing evidence that implicates reduced amnionic fluid volume as a major determinant of fetal risk in prolonged pregnancy. Jan 07, 2016 oligohydramnios is a complication in approximately 4. Oligohydramnios sequence definition and patient education. Terms of postterm and prolonged pregnancy are poorly defined. Diagnosis is by ultrasonographic measurement of amniotic fluid volume. Oligohydramnios, a medical condition in pregnancy, is characterized by a lack of amniotic fluid. It is also characterized by maximum vertical pocket of less than 2 cm. Peters, md, and mary anne kelly, rn dallas, texas there is increasing evidence that implicates reduced amnionic fluid volume as. In fact, oligohydramnios is usually associated with an increased risk of fetal heart rate tracing abnormalities, meconiumstained amniotic fluid and caesarean sections for fetal distress 68.
Observations on the cause of oligohydramnios in prolonged. In the relatively few cases in which there is a long interval from rupture to delivery the latency period, complications may occur that are not specifically related to prematurity. If oligohydramnios happens in the third trimester of pregnancy, it can cause. Oligohydramnios and associated fetal complications fetal. In prolonged pregnancies, any nonreassuring testing or oligohydramnios should prompt. Observations on the cause of oligohydramnios in prolonged pregnancy kennethj. This document provides guidance for all maternity staff who encounters eligible women who may require induction of labour.
These pregnancies are at increased risk of umbilical cord compression from oligohydramnios, meconium aspiration, and shortterm neonatal complications such. Fetal swallowing, which occurs physiologically, reduces the. Thus, some prolonged pregnancies can have no clinical features at all. Management of severe oligohydramnios with antepartum. Oligohydramnios sequence is the condition that develops during pregnancy when oligohydramnios occurs. It is probably related to a decrease in placental function andor in fetal renal perfusion. Fetal mortality rates as high as 8090% have been reported with oligohydramnios diagnosed in the second trimester. Read more about symptoms, diagnosis, treatment, complications, causes and prognosis.
Oligohydramnios low amniotic fluid birth injury cases. The prevalence of this disease can be up to 6% of all pregnancies 2. Oligohydramnios refers to a low level of amniotic fluid during pregnancy it is defined by an amniotic fluid index that is below the 5th centile for the gestational age, and is thought to affect approximately 4. Is oligohydramnios is postterm pregnancy associated with redistribution of fetal blood flow. There is an acknowledged relationship between prolonged pregnancies 42 weeks and an increase in perinatal morbidity and mortality chamberlain, 1984.