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Oligohydramnios is a condition in pregnancy characterized by a deficiency of amniotic fluid. It is the opposite of polyhydramnios.

Clinical features

The common clinical features are smaller symphysiofundal height, fetal malpresentation, undue prominence of fetal parts and reduced amount of amniotic fluid.

Causes

The cause is not known but is often associated with some:

fetal chromosomal anomalies
intra uterine infections
drugs; PG inhibitors, ACE inhibitors
renal agenesis or obstruction of the urinary tract (posterior urethral valve in male fetus)of the fetus preventing micturation
intrauterine growth restriction (IUGR) associated with placental insufficiency
amnion nodosum; failure of secretion by the cells of the amnion covering the placenta
postmaturity (dysmaturity)

Diagnosis

uterine size is much smaller than the period of amenorrhoea
less fetal movements,
the uterus "full of fetus" because of scanty liquid,
malpresentation (breech)
evidences of IUGR of the fetus,
sonographic diagnosis is made when largest liquid pool is less than 2 cm,
visualization of normal filling and emptying of fetal bladder essentially rule out urinary tract abnormality,
Oligohydramnios with fetal symmetric growth retardation is associated with increased chromosomal abnormality.

Complications

Complications may include cord compression, musculoskeletal abnormalities such as facial distortion and clubfoot, pulmonary hypoplasia and intrauterine growth restriction. Amnion nodosum is frequently also present (nodules on the fetal surface of the amnion).^[1]

The use of oligohydramnios as a predictor of gestational complications is controversial.^[2]^[3]

Potter syndrome is a condition caused by oligohydramnios. Affected fetuses develop pulmonary hypoplasia, limb deformities, and characteristic facies. Bilateral agenesis of the fetal kidneys is the most common cause due to the lack of fetal urine.

Treatment

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."^[4]

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.^[5]

In case of congenital lower urinary tract obstruction, fetal surgery seems to improve survival, according to a randomized yet small study.^[6]

References

^ Adeniran AJ, Stanek J, (2007). "Amnion nodosum revisited: clinicopathologic and placental correlations". Arch Pathol Lab Med 131 (12): 1829–33. doi:10.1043/1543-2165(2007)131[1829:ANRCAP]2.0.CO;2. PMID 18081444.
^ Johnson JM, Chauhan SP, Ennen CS, Niederhauser A, Magann EF (2007). "A comparison of 3 criteria of oligohydramnios in identifying peripartum complications: a secondary analysis". Am. J. Obstet. Gynecol. 197 (2): 207.e1–7; discussion 207.e7–8. doi:10.1016/j.ajog.2007.04.048. PMID 17689653.
^ Elsandabesee D, Majumdar S, Sinha S (2007). "Obstetricians' attitudes towards 'isolated' oligohydramnios at term". Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and Gynaecology 27 (6): 574–6. doi:10.1080/01443610701469669. PMID 17896253.
^ Hofmeyr GJ, Gülmezoglu AM (2000). Novikova, Natalia, ed. "Maternal hydration for increasing amniotic fluid volume in oligohydramnios and normal amniotic fluid volume". Cochrane Database of Systematic Reviews (Online) (2): CD000134. doi:10.1002/14651858.CD000134. PMID 10796151.
^ Oligohydramnios at the National Institute for Health and Clinical Excellence. Based on the overview Therapeutic amnioinfusion for oligohydramnios during pregnancy (excluding labour) 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. doi:10.1016/S0140-6736(13)60992-7.

External links

00435 at CHORUS

UpToDate Contents

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1. 羊水過少 oligohydramnios
2. 羊水量の評価 assessment of amniotic fluid volume
3. 胎児肺の成熟度評価 assessment of fetal lung maturity
4. 羊水量調節の生理学 physiology of amniotic fluid volume regulation
5. 先天性腎尿路異常（CAKUT）の評価 evaluation of congenital anomalies of the kidney and urinary tract cakut

English Journal

Maternal serum ferritin as a clinical tool at 34-36 weeks' gestation for distinguishing subgroups of fetal growth restriction.

Akkurt MO1, Akkurt I2, Altay M3, Coskun B3, Erkaya S4, Sezik M1.
The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians.J Matern Fetal Neonatal Med.2017 Feb;30(4):452-456. Epub 2016 Apr 28.
OBJECTIVE: To compare maternal ferritin levels across pregnancies with fetal growth restriction including SGA and IUGR compared to appropriate for gestational age (AGA).METHODS: Three groups were enrolled: AGA, SGA (birth weight below 10th percentile for gestational age with no placental insufficien
PMID 27049175

Doppler velocimetry and adverse outcome in labor induction for late IUGR.

Simeone S1, Marchi L2, Canarutto R1, Pina Rambaldi M1, Serena C1, Servienti C1, Mecacci F1.
The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians.J Matern Fetal Neonatal Med.2017 Feb;30(3):323-328. Epub 2016 Apr 19.
BACKGROUND: Late onset intrauterine growth restriction (IUGR) represents one of the main causes of perinatal morbidity/mortality. No guidelines are available on labor induction in IUGRs, even if delivery at 37/38 weeks is suggested. This study aims to assess maternal-fetal variables related to adver
PMID 27020201

Antenatal fetal surveillance "Assessment of the AFV".

Hughes DS1, Magann EF2.
Best practice & research. Clinical obstetrics & gynaecology.Best Pract Res Clin Obstet Gynaecol.2017 Jan;38:12-23. doi: 10.1016/j.bpobgyn.2016.08.004. Epub 2016 Sep 16.
The evaluation of amniotic fluid volume (AFV) is an established part of the antenatal surveillance of pregnancies at risk for an adverse pregnancy outcome. The two most commonly used ultrasound techniques to estimate AFV are the amniotic fluid index (AFI) and the single deepest pocket (SDP). Four st
PMID 27756534

Japanese Journal

Diabetes Insipidus Presenting with Oligohydramnios and Polyuria During Pregnancy

日医大誌 85(3), 191-193, 2018
NAID 130007437542

異なる経過をたどった慢性早剥羊水過少症候群の2症例

産婦の進歩 70(2), 134-142, 2018
NAID 130007412853

Chronic abruption-oligohydramnios sequence (CAOS)の実際 : 長引く性器出血と羊水過少に遭遇したら (第13回和歌山県母性衛生学会学術集会)

和歌山母性衛生学会誌 = Journal of Wakayama Society of Maternal Health 2, 6-9, 2017-03
NAID 40021475387

「羊水過少症」

Oligohydramnios
Classification and external resources
Specialty	obstetrics
ICD-10	O41.0
ICD-9-CM	658.0
DiseasesDB	9202
eMedicine	radio/898
Patient UK	Oligohydramnios
MeSH	D016104

　　[★]

英: oligoamnios, oligohydramnios
同: 羊水過少(臨床所見を認めないもの。臨床所見を認めるものが羊水過少症)
関: 羊水

概念

疾患	最大羊水深度	羊水インデックス
疾患	MVP	AFI
羊水過多症	≧8cm	≧24cm
羊水過少症	≦2m	≦5cm

原因

1.羊水の流出

前期破水、卵膜欠損部位からの持続的羊水の漏出

2.胎児尿産生減少

胎児奇形：腎無形成、腎低形成、嚢胞性腎疾患、閉塞性尿路疾患
胎盤機能不全：胎児発育遅延(IUGR)、過期妊娠
子宮内胎児死亡

胎児合併症

1. 臍帯の圧迫：胎児ジストレス
2. 子宮壁による圧迫：肺低形成、四肢変形、関節拘縮
3. 羊膜との密着：羊膜索症候群

母体合併症

微弱陣痛による遷延分娩
常位胎盤早期剥離

治療

特にない
分娩時に臍帯圧迫などによる変動一過性徐脈が認められたら人口羊水の注入をすることがある。

参考

1. 〔よりよい妊娠管理を目指して（その1）〕羊水過多（症），羊水過少（症）の管理 - 日産婦誌５１巻１号

http://www.jsog.or.jp/PDF/51/5101-009.pdf

2.

http://www.jsog.or.jp/PDF/54/5403-039.pdf

国試

099E002、100A001

[pmid18081444-1] Adeniran AJ, Stanek J, (2007). "Amnion nodosum revisited: clinicopathologic and placental correlations". Arch Pathol Lab Med 131 (12): 1829–33. doi:10.1043/1543-2165(2007)131[1829:ANRCAP]2.0.CO;2. PMID 18081444.

[pmid17689653-2] Johnson JM, Chauhan SP, Ennen CS, Niederhauser A, Magann EF (2007). "A comparison of 3 criteria of oligohydramnios in identifying peripartum complications: a secondary analysis". Am. J. Obstet. Gynecol. 197 (2): 207.e1–7; discussion 207.e7–8. doi:10.1016/j.ajog.2007.04.048. PMID 17689653.

[pmid17896253-3] Elsandabesee D, Majumdar S, Sinha S (2007). "Obstetricians' attitudes towards 'isolated' oligohydramnios at term". Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and Gynaecology 27 (6): 574–6. doi:10.1080/01443610701469669. PMID 17896253.

[pmid10796151-4] Hofmeyr GJ, Gülmezoglu AM (2000). Novikova, Natalia, ed. "Maternal hydration for increasing amniotic fluid volume in oligohydramnios and normal amniotic fluid volume". Cochrane Database of Systematic Reviews (Online) (2): CD000134. doi:10.1002/14651858.CD000134. PMID 10796151.

[5] Oligohydramnios at the National Institute for Health and Clinical Excellence. Based on the overview Therapeutic amnioinfusion for oligohydramnios during pregnancy (excluding labour) in 2006

[Morris2013-6] 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. doi:10.1016/S0140-6736(13)60992-7.

匿名

検索

案内

案内

oligohydramnios