Research article
JPBMS
JOURNAL OF PHARMACEUTICAL AND BIOMEDICAL SCIENCES
1Professor
and Head, Dept. of Obstetrics and Gynaecology (OBGY), Rural Medical College & Pravara Rural Hospital of
Pravara Institute of Medical Sciences (Deemed University), Loni, Dist. Ahmednagar, Maharashtra, India.
2Assistant Professor, Dept. of Community Medicine (PSM), Rural Medical College & Pravara Rural Hospital of
Pravara Institute of Medical Sciences (Deemed University), Loni Dist. Ahmednagar, Maharashtra, India.
3Postgraduate student, Dept. of Obstetrics and Gynaecology (OBGY), Rural Medical College & Pravara Rural Hospital of
Pravara Institute of Medical Sciences (Deemed University), Loni Dist. Ahmednagar, Maharashtra, India.
Abstract: Oligohydramnios or reduced amount of amniotic fluid volume is a commonly observed obstetric problem
during third trimester of pregnancy. It accompanies a broad range of reproductive disorders including anomalies of fetus
and functional disorders of mother, fetus and placenta. Reduced amniotic fluid volume is associated with adverse perinatal
outcome. A prospective hospital based study of total 100 cases of oligohydramnios coming for delivery to Pravara Rural
Hospital, Loni was undertaken over a period of two years from October 2007 to September 2009. The information
regarding bio-social characteristics, maternal and perinatal outcome were collected and results were analyzed by using
percentage and proportion. In the present study, the majority of the cases( 78%) were unbooked and belonged to the age
group of 20-30 years and had associated maternal or fetal complications. Postdated pregnancy, pregnancy induced
hypertension and fetal congenital anomalies were the commonest complications associated with oligohydramnios. Forty
four percent cases were delivered by caesarean section. Overall perinatal mortality was 24%. Cases with severe
oligohydramnios and anhydramnios were associated with intrapartum fetal heart rate abnormalities, (16%) low Apgar
score and (8%) meconium aspiration syndrome. Every case of oligohydramnios needs careful evaluation, parental
counseling and individualized decision regarding timing and mode of delivery. Continuous intrapartum fetal monitoring
and good neonatal care support is essential for optimum perinatal outcome.
Results:
Oligohydramnios women
(n=100)
Maternal age
<20 yrs
16
20 - 29 yrs
78
30 yrs
06
Mean SD 22.88 yrs 4.24 yrs
2. Gestational age
30-32 weeks
08
32-34 weeks
14
34-36 weeks
22
36-38 weeks
16
38-40 weeks
20
>40 weeks
20
Mean SD 36.72 weeks 4.11 weeks
3. By Amniotic Fluid Index
0
10
1
06
2
28
3
06
4
30
5
20
Mean SD 3.00 1.04
4. By birth weight
<1000 gms
02
1000-2000 gms
38
2000-3000 gms
58
>3000 gms
02
Mean SD 2140.00 gms 0.51 gms
5. Parity
Primigravidas
54
Multigravidas
46
Mean SD 1.2 1.5
(Data indicates both number and percentage)
Table
2:
Maternal
and
oligohydramnios (n=100)
perinatal
Variables
1. Maternal complications
Pregnancy induced hypertension
Postdate
Intrauterine growth restriction
Preterm delivery
Anhydramnios
Fetal anamolies
2. Mode of delivery
Spontaneous vaginal delivery
Operative/assisted delivery
3 Neonatal morbidity
Meconium aspiration
Neonatal sepsis
4. Apgar score (< 7)
At 1 minute
At 5 minute
5. Perinatal mortality
Still births
Early neonatal death
(Data indicates both number and percentage)
outcome
in
No. of cases
16
16
14
14
10
08
56
44
04
04
10
16
08
16
Discussion:
In the present study, 78% of cases were in the age group
20 to 29 years, as compared to other age groups, reflecting
the child bearing age of most of the women with the mean
(SD) maternal age of 22.8 4.2 years. Similar studies by
Chauhan P et. al. [3], Jun Zhang et. al. [4] and Everett F et. al.
2
found that the mean maternal age were 23.6 6.5 years,
28.4 3.4 years and 23.8 5.7 years respectively.
The mean gestational age in the present study was 36.7
4.1 weeks. Similar studies by Jun Zhang et. al. [4], Casey B et
al .[6] , Everett F et. al. [5] and Iffath A et. al.[ 7] found that, the
mean gestational age were 38.1 3.3 weeks, 37.5 2
weeks, 34.3 2.1 weeks, and (mean SD) was 36.3 2
weeks respectively. These findings indicate that the
problem of oligohydramnios was more common in the
later part of pregnancy. It is mainly due to physiological or
pathological causes of reduced placental perfusion near
term.
In the present study, the incidence of oligohydramnios
was 0.67%. Similar study by Jun Zhang et. al. [4] reported
the incidence as 1.5%. Divon M et. al. [8] found
oligohydramnios in 1.2% in their cases. Casey B et al.6
found that 2.3% cases were complicated by
oligohydramnios. Elliot H et. al. [9] found that, the incidence
of oligohydramnios was 3.9% in their study. Varma T R et.
al. [10] found that, the incidence was 3.1% in their study.
Chauhan P et. al. [19] studied two groups of patients. First
group had AFI less than 5cm and second with AFI less than
5th percentile for that gestational age. The mean amniotic
fluid index was 3.9 2.1 cm (AFI less than 5th percentile)
and 3 1.5 cm in patients with AFI less than 5cm.
The mean amniotic fluid index (AFI) in the present study
was 3.00 1.04cm. Sadovsky Y et. al. [20] in their study,
found that the mean amniotic fluid index was 2.9 cm.
Obstetrical complications frequently associated with
oligohydramnios
were
pregnancy
induced
hypertension(PIH), postdatism, intrauterine growth
restriction, fetal renal anomalies, prematurity and
intrauterine death of the fetus. In the present study 78%
cases had associated obstetrical complications; acting
singly or in combination for causing oligohydramnios. PIH
was present in 16% cases. Golan A et al.12 in his study,
found maternal hypertension in 22.1% cases. Cesarean
section was performed in 35.25% of these cases. Mercer L
J et. al. [13] found that preeclampsia was present in 24.7%
of cases with decreased fluid. Study by Chauhan P et. al. [3]
reported, preeclampsia in 12% cases. They concluded that
the incidence of oligohydramnios ranges from 10 to 30 %
in hypertensive patients requiring hospitalization. Sixteen
percent cases had postdated pregnancies in the present
study. Clement D et. al. [21] studied six cases of postdatism,
in which amniotic fluid volume diminished abruptly over
24 hours. Bowen Chattoor JS et. al. [22], in their study
evaluated the relationship between amniotic fluid index
and perinatal outcomes in fifty five postdate pregnancies.
Oligohydramnios was noted in four (7.2%) cases. In the
present study, intra uterine growth restriction was
present in 20% cases and the rate of caesarean section
was 44% and that of vaginal delivery was 56%. Study by
Casey B et. al. [6] found that, there was increased rate of
induction of labour (42%) and Cesarean section (32%) in
oligohydramnios cases. Jun Zhang et al.4 found that, the
overall cesarean delivery rates were similar between
women with oligohydramnios and the controls (24% Vs
19%). Golan A et. al. [12] et al found that, the cesarean
section was performed in 35.2% of pregnancies. In the
present study, the apgar score was noted at 1 and 5
minutes after birth. Sixteen babies (16%) had low Apgar
score (less than 7 at 5 min). Out of 16 babies with low
Apgar score, eight died during neonatal period. Three
babies with low Apgar score were delivered by caesarian
[5]
Conclusion:
Oligohydramnios is being detected more often these days,
due to routinely performed obstetric ultrasonography.
Pregnancy induced hypertension and post dated
pregnancies are the commonest causes of reduced
amniotic fluid during third trimester of pregnancy.
Anomalies of the fetal renal system are responsible for
oligohydramnios in second and third trimester. The time
and mode of delivery of these cases depends on severity of
oligohydramnios and status of fetal wellbeing. Caesarean
section is mostly required for cases with anhydramnios
and intrapartum fetal heart rate abnormalities. Babies are
relatively more prone for certain complications, like
3
Acknowledgement:
References: