Oligohydramnios at Term: A Case Report

Maria L. Lanni, CNM, MS; Elizabeth A. Loveless, CNM, MS

Disclosures

J Midwifery Womens Health. 2007;52(1):73-76. 

In This Article

Conclusion

Adverse perinatal outcomes associated with oligohydramnios are: umbilical cord compression; uteroplacental insufficiency, which is related to fetal growth restriction, pre-eclampsia, and other maternal morbidities; and increased incidence of meconium stained amniotic fluid.[3,4,14] The adverse outcomes associated with oligohydramnios have led to recommendations of delivery following the diagnosis of oligohydramnios in pregnancies at or past 37 weeks.[2] However, Sherer[18] identifies a number of the original studies linking oligohydramnios with adverse perinatal outcomes that included fetuses with structural anomalies, small-for-gestational-age and FGR fetuses, postmaturity syndrome, and fetuses of mothers with various comorbidities, all of which may have affected AFI and led to the adverse outcomes. Thus, low AFI may be an epiphenomenon. The true number of adverse outcomes solely caused by isolated oligohydramnios is difficult to know.

The question of the best management for AFI remains. Individualized care, with consideration of the many maternal and fetal factors, including time of day, cervical readiness, and emotional readiness for labor, should be considered. While research has shown that expectant management with maternal hydration has comparable maternal and neonatal outcomes in women with isolated idiopathic oligohydramnios at term, clinicians may be reluctant to abandon the approach of active management. It is reasonable to begin with active maternal hydration prior to routine fetal surveillance of term pregnancies or for borderline AFIs. More research needs to be done on the effect of acute hydration prior to fetal surveillance. It may be beneficial for providers to encourage adequate hydration to our patients prior to assessment of AFI to decrease potentially unnecessary interventions.

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