Oligohydramnios is one of the possible complications during pregnancy. In this case, the amniotic sac has too little amniotic fluid.
What is oligohydramnios?
Oligohydramnios is when there is a reduction of amniotic fluid inside the amniotic sac to less than 500 milliliters during pregnancy. This pregnancy complication is seen in about 0.5 to 4 percent of all pregnant women. In the last third of pregnancy, the trimester, too little amniotic fluid is seen in 3 to 5 percent of all pregnancies. The production of amniotic fluid takes place from the 12th to 14th day of pregnancy. It is initially composed of water that comes from the mother. From the 20th week of pregnancy, the urine of the fetus then serves as the main component. For the unborn child, the amniotic fluid is vital, as it is needed for the development of the organs and provides protection against shocks. For this reason, pregnant women should have the amount of their amniotic fluid checked at regular intervals.
Causes
The causes of oligohydramnios are either in the mother or in the baby. If the reduction in amniotic fluid is due to the baby, malformations of the kidneys or the urinary tract, such as malformations of the urethra or ureter, are usually responsible. A more common malformation of the kidneys is Potter syndrome. In this case, the kidneys are no longer capable of producing urine. Sometimes, in Potter’s syndrome, the kidneys do not form at all. Similarly, polycystic kidneys and narrowing of the urethra or ureters can cause oligohydramnios. The malformations cause the child to be unable to produce urine or to excrete urine in the form of amniotic fluid into the amniotic cavity. The loss of urine results in a decrease in amniotic fluid. It is not uncommon for oligohydramnios to occur as part of identical twin pregnancies and multiple pregnancies. The reason for this is an imbalance in the exchange of blood between the children. Thus, one child receives too little blood, causing not enough amniotic fluid to form, while the other receives an excess of blood, causing too much amniotic fluid to form. The maternal causes of oligohydramnios include, first and foremost, hypertension. This leads to damage to the placenta. The placenta is then no longer able to fulfill its function. Gynecologists refer to such cases as placental insufficiency. Another possible cause is premature rupture of the membranes. This is associated with the loss of amniotic fluid. Another maternal cause of oligohydramnios may be dehydration of the mother, which also causes the baby to receive less fluid and produce less urine.
Symptoms, complaints, and signs
Oligohydramnios is often noticeable by decreased movement of the unborn child. For example, the mother feels less frequent movements of her baby, which is due to the reduced amount of amniotic fluid. In addition, the pregnant woman’s abdomen hardly grows any larger. Possible consequences of an oligohydramnios can be an intrauterine forced posture, a hacking foot or a torticollis. There is also an increased risk of childbirth.
Diagnosis and course of the disease
If the mother feels fewer movements of her child, it is advisable to visit the gynecologist. During the examination, this doctor usually determines that the uterus is too small for the week of pregnancy. An ultrasound examination (sonography) can detect a reduction of the amniotic fluid. It is important to exclude a rupture of the membranes that occurred some time ago as the cause of the oligohydramnios. If the complication occurs between the 14th and 26th week of pregnancy, the doctor uses sonography to look for possible malformations of the child, as these can trigger the amniotic fluid deficiency. The amniotic fluid index serves as a measure of the amount of amniotic fluid. A value between 8 and 18 centimeters is considered normal. However, if the value is lower, an oligohydramnios must be assumed. The course of an oligohydramnios depends on the extent of amniotic fluid loss. In most cases, the complications can be well treated or even resolved medically.
Complications
In general, oligohydramnios is already a complication.This can have a very negative effect on a pregnancy and also on the further development of the child. For this reason, early diagnosis and treatment is necessary in this disease to avoid further complications. The risk of miscarriage increases enormously due to oligohydramnios, so that in the worst case the child may die at birth, putting the mother’s life at risk. Likewise, oligohydramnios can lead to the development of various malformations, so that those affected suffer from a hack toe or torticollis after birth. In most cases, oligohydramnios can be treated relatively well. Complications do not occur. If the condition is diagnosed early enough, all malformations of the child can usually be avoided. The birth itself usually takes place by cesarean section. This is especially the case if vaginal birth would be too risky for the life of the child. If the treatment and birth are successful, no further symptoms or complications occur and the life expectancy of the child and the mother is not reduced due to the disease.
When should you go to the doctor?
Women should generally attend all offered preventive and control examinations at a gynecologist during pregnancy, so that the well-being of the offspring but also the health of the expectant mother are checked. Changes and developments are documented. Thus, immediate action can be taken in case of discrepancies. In particular, women who have a multiple pregnancy should be especially vigilant in case of irregularities. If signs of an unusual change occur outside of the scheduled appointments to check the developmental status of the fetus, an immediate visit to the doctor for clarification is advisable. If the baby moves very little or not at all in the womb, the observations should be discussed with a physician. If the expectant mother experiences anxiety or has a vague feeling that something might be wrong, it is necessary to consult a doctor. If there is any malaise, sleep disturbance or inner turmoil, consultation with a physician should be sought. Sudden abnormalities or irregularities during pregnancy should be investigated as soon as possible. If there is pain, bleeding, or a disturbance in sensation, clarification of the health of the mother and child is indicated. Fluid discharge from the vagina during gestation is considered a warning signal of the organism. A visit to the doctor should take place so that if action is needed, it can be taken immediately and medical care can be initiated.
Treatment and therapy
There is no specific treatment for oligohydramnios. Usually, the precipitating causes cannot be reversed. In the case where only a small amount of amniotic fluid is missing, it may often be sufficient to provide the mother with more fluids such as water. In the case of a loss of larger amounts of amniotic fluid, there are also treatment options. These include amniotic infusion, the filling of the amniotic sac with a solution of sugar and saline. For this purpose, the doctor punctures the abdominal wall of the pregnant woman with a needle, which he carefully advances to the fetal amniotic sac via a catheter. He uses ultrasound to check the course of the needle. If the child has already developed far enough to survive outside the mother’s body, preparations are made for an early delivery. Depending on how far the pregnancy has progressed, lung maturation induction takes place. In a normal vaginal delivery, changes in the baby’s heart sounds usually occur due to the lack of amniotic fluid. Due to the tighter space conditions, the baby squeezes its own umbilical cord. Because of this, there is an interruption of blood flow between the placenta and the baby. If a vaginal birth is not possible or too risky, a cesarean section is performed.
Outlook and prognosis
Further health outcomes are tied to the severity of the disease. In some cases, the prognosis is extremely favorable. If a small amount of amniotic fluid is missing, it may be sufficient for the expectant mother to consume additional fluid. Water intake changes the amount of amniotic fluid available. There is a possibility of spontaneous healing and no further complications.If health discrepancies have already occurred in the unborn child, the prognosis deteriorates considerably. Acquired malformations can no longer be corrected with current treatment methods. The individual expression of the existing complaints decides decisively on the further development. Lifelong impairments may occur. Likewise, secondary disorders are possible due to the health discrepancies. Physicians focus on symptomatic therapy. Without medical care, oligohydramnios can take a fatal course. In case of an unfavorable development, the survival of the fetus is at risk. At the same time, the expectant mother is at increased risk of long-term health disorders. Often, when insufficient amniotic fluid is detected, immediate cesarean section is considered. This depends on the time of diagnosis and the developmental status of the fetus. If the cesarean section proceeds without further complications, there is a good chance of saving the life of both mother and child.
Prevention
It is difficult to prevent oligohydramnios. However, because it often affects pregnant women who smoke, tobacco use during pregnancy is discouraged.
Follow-up
In most cases, those affected by oligohydramnios have only a few or limited measures of direct aftercare available to them. For this reason, a physician should be consulted early on to prevent further complications or discomfort from this condition. Self-cure cannot occur, so a physician should be contacted at the first signs or symptoms. Most patients are dependent on surgical intervention for oligohydramnios, through which the symptoms can be permanently alleviated. Afterwards, strict bed rest should be maintained, also refraining from exertion or from physical and stressful activities. After the birth of the child, it must be subjected to regular checks and examinations in order to detect and treat further damage to the body and internal organs at an early stage. Often, the support and care provided by one’s own family is also very important, which can sometimes prevent the development of depression and other psychological upsets. In rare cases, oligohydramnios reduces the life expectancy of both mother and child.
Here’s what you can do yourself
If oligohydramnios has been diagnosed, adequate fluid intake is usually enough to compensate for the amniotic fluid deficiency. To compensate for mineral excretion, attention should be paid to a balanced diet. The gynecologist can suggest a suitable diet or refer the patient to a nutritionist. In the case of oligohydramnios, the affected woman should be examined so that any developmental or genetic disorders of the child can be ruled out. To reduce the stress associated with it, various relaxation techniques from yoga or progressive muscle relaxation, for example stretching exercises or autosuggestion in conjunction with physical exercises, are recommended. Pregnant women who have been diagnosed with a reduced amount of amniotic fluid should always consult their gynecologist. Often, sufficient amniotic fluid forms by itself and no further measures are necessary. In principle, the individual assessment of the physician should be awaited before further measures are taken. If oligohydramnios occurs only in the last stages of pregnancy, a specialized clinic should be visited for further clarification so that the child is not endangered by the lack of amniotic fluid.
