This article from Medscape illustrates the folly of diagnosing oligohydramnios through ultrasound. True low amniotic fluid at full term is an extremely rare condition which can be diagnosed properly only by doing palpation of the pregnant belly. Thousands of women have been unnecessarily launched down the cascade of obstetrical interventions by being frightened by this erroneous diagnosis at 41 weeks gestation. It’s time to ditch the “Biophysicial Profile” as an indicator of pathology. It is not based on science and continues to cost women their births and good health. Gloria Lemay
Quote: “The AFI was introduced in 1987 as a technique to assess the amount of amniotic fluid in the amniotic sac. Although the AFI is widely accepted as the standard to diagnose oligohydramnios in the United States, many studies have found it to be an inaccurate method for assessing the actual amount of amniotic fluid, especially in the lower or higher ranges.[3,4,6-9]”. end of quote. Source, page 3 of the Medscape article http://www.medscape.com/viewarticle/551032_3
Oligohydramnios at Term
(From Journal of Midwifery & Women’s Health
Oligohydramnios at Term: A Case Report
Maria L. Lanni, CNM, MS; Elizabeth A. Loveless, CNM, MS
Posted: 02/07/2007; J Midwifery Womens Health. 2007;52(1):73-76. © 2007 Elsevier Science, Inc. )
In Conway’s retrospective, case-controlled study, women who were induced for oligohydramnios had an increased rate of cesarean section when compared women with oligohydramnios who were in spontaneous labor. The authors postulated that this increase was caused by the induction process itself. One may conclude that a woman who is at term with isolated oligohydramnios with reassuring fetal surveillance and the absence of maternal morbidity and evidence of FGR is not associated with adverse perinatal outcome. (End of except)
Conclusion (of Medscape article)
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. However, Sherer 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.
Related post: http://wisewomanwayofbirth.com/60/