Oligohydramnios: a prospective study of fetal, neonatal and maternal outcomes in low-middle income countries

Lester Figueroa, Elizabeth M McClure, Jonathan Swanson, Robert Nathan, Ana L Garces, Janet L Moore, Nancy F Krebs, K Michael Hambidge, Melissa Bauserman, Adrien Lokangaka, Antoinette Tshefu, Waseem Mirza, Sarah Saleem, Farnaz Naqvi, Waldemar A Carlo, Elwyn Chomba, Edward A Liechty, Fabian Esamai, David Swanson, Carl L Bose, Robert L Goldenberg, Lester Figueroa, Elizabeth M McClure, Jonathan Swanson, Robert Nathan, Ana L Garces, Janet L Moore, Nancy F Krebs, K Michael Hambidge, Melissa Bauserman, Adrien Lokangaka, Antoinette Tshefu, Waseem Mirza, Sarah Saleem, Farnaz Naqvi, Waldemar A Carlo, Elwyn Chomba, Edward A Liechty, Fabian Esamai, David Swanson, Carl L Bose, Robert L Goldenberg

Abstract

Background: Oligohydramnios is a condition of abnormally low amniotic fluid volume that has been associated with poor pregnancy outcomes. To date, the prevalence of this condition and its outcomes has not been well described in low and low-middle income countries (LMIC) where ultrasound use to diagnose this condition in pregnancy is limited. As part of a prospective trial of ultrasound at antenatal care in LMICs, we sought to evaluate the incidence of and the adverse maternal, fetal and neonatal outcomes associated with oligohydramnios.

Methods: We included data in this report from all pregnant women in community settings in Guatemala, Pakistan, Zambia and the Democratic Republic of Congo (DRC) who received a third trimester ultrasound as part of the First Look Study, a randomized trial to assess the value of ultrasound at antenatal care. Using these data, we conducted a planned secondary analysis to compare pregnancy outcomes of women with to those without oligohydramnios. Oligohydramnios was defined as measurement of an Amniotic Fluid Index less than 5 cm in at least one ultrasound in the third trimester. The outcomes assessed included maternal morbidity and fetal and neonatal mortality, preterm birth and low-birthweight. We used pairwise site comparisons with Tukey-Kramer adjustment and multivariable logistic models using general estimating equations to account for the correlation of outcomes within cluster.

Results: Of 12,940 women enrolled in the clusters in Guatemala, Pakistan, Zambia and the DRC in the First Look Study who had a third trimester ultrasound examination, 87 women were diagnosed with oligohydramnios, equivalent to 0.7% of those studied. Prevalence of detected oligohydramnios varied among study sites; from the lowest of 0.2% in Zambia and the DRC to the highest of 1.5% in Pakistan. Women diagnosed with oligohydramnios had higher rates of hemorrhage, fetal malposition, and cesarean delivery than women without oligohydramnios. We also found unfavorable fetal and neonatal outcomes associated with oligohydramnios including stillbirths (OR 5.16, 95%CI 2.07, 12.85), neonatal deaths < 28 days (OR 3.18, 95% CI 1.18, 8.57), low birth weight (OR 2.10, 95% CI 1.44, 3.07) and preterm births (OR 2.73, 95%CI 1.76, 4.23). The mean birth weight was 162 g less (95% CI -288.6, - 35.9) with oligohydramnios.

Conclusions: Oligohydramnos was associated with worse neonatal, fetal and maternal outcomes in LMIC. Further research is needed to assess effective interventions to diagnose and ultimately to reduce poor outcomes in these settings.

Trial registration: NCT01990625.

Keywords: Low and middle-income countries; Oligohydramnios; Pregnancy outcomes; Ultrasound.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
CONSORT diagram

References

    1. Cunningham FG, Williams JW (John W. Williams Obstetrics. McGraw-Hill Medical; 2010. .
    1. Fischer RL. Amniotic fluid: physiology and assessment. Glob Libr Women’s Med. 2009. 10.3843/GLOWM.10208.
    1. Brace RA. Physiology of amniotic fluid volume regulation. Clin Obstet Gynecol. 1997;40:280–289. doi: 10.1097/00003081-199706000-00005.
    1. Locatelli A, Zagarella A, Toso L, Assi F, Ghidini A, Biffi A. Serial assessment of amniotic fluid index in uncomplicated term pregnancies: prognostic value of amniotic fluid reduction. J Matern Neonatal Med. 2004;15:233–236. doi: 10.1080/14767050410001668671.
    1. Han CS. Fetal Biophysical Profile. Obstet Imaging Fetal Diagnosis Care [Internet]. Elsevier; 2018;537–540.e1. [cited 2020 Jan 12]. Available from: .
    1. Coady AM. Amniotic Fluid. Twining’s Textb Fetal Abnorm [Internet]. Churchill Livingstone; 2015;81–99. [cited 2020 Jan 12]. Available from: .
    1. Boubred F, Simeoni U. Neonatology. Cham: Springer International Publishing; 2017. Pathophysiology of fetal and neonatal kidneys; pp. 1–15.
    1. Patel A, Patel HV. Role of amniotic fluid index in pregnancy outcome. 2015. pp. 1–12.
    1. Voxman EG, Tran S, Wing DA. Low amniotic fluid index as a predictor of adverse perinatal outcome. J Perinatol. 2002;22:282–285. doi: 10.1038/sj.jp.7210697.
    1. Mathuriya G, Verma M, Rajpoot S. Comparative study of maternal and fetal outcome between low and normal amniotic fluid index at term. Int J Reprod contraception. Obstet Gynecol. 2017;6:640.
    1. Rabie N, Magann E, Steelman S, Ounpraseuth S. Oligohydramnios in complicated and uncomplicated pregnancy: a systematic review and meta-analysis. Ultrasound Obstet Gynecol. 2017;49:442–449. doi: 10.1002/uog.15929.
    1. Madhavi K, Pc R, Professor A. Clinical study of oligohydramnios, mode of delivery and perinatal outcome. IOSR J Dent Med Sci. 2015;14:2279–2861.
    1. Butt FT, Ahmed B. The role of antepartum transabdominal amnioinfusion in the management of oligohydramnios in pregnancy. J Matern Fetal Neonatal Med. 2011;24:453–457. doi: 10.3109/14767058.2010.497574.
    1. Turhan NÖ, Atacan N. Antepartum prophylactic transabdominal amnioinfusion in preterm pregnancies complicated by oligohydramnios. Int J Gynecol Obstet. 2002;76:15–21. doi: 10.1016/S0020-7292(01)00504-5.
    1. Hesson A, Langen E. Outcomes in oligohydramnios: the role of etiology in predicting pulmonary morbidity/mortality. J Perinat Med. 2018;46:948–950. doi: 10.1515/jpm-2017-0281.
    1. Melamed N, Pardo J, Milstein R, Chen R, Hod M, Yogev Y. Perinatal outcome in pregnancies complicated by isolated oligohydramnios diagnosed before 37 weeks of gestation. Am J Obstet Gynecol. 2011;205:241. doi: 10.1016/j.ajog.2011.06.013.
    1. McClure EM, Nathan RO, Saleem S, Esamai F, Garces A, Chomba E, et al. First look: a cluster-randomized trial of ultrasound to improve pregnancy outcomes in low income country settings. BMC Pregnancy Childbirth. 2014;14:73. doi: 10.1186/1471-2393-14-73.
    1. Goldenberg RL, Nathan R, Swanson D, Saleem S, Mirza W, Esamai F, et al. Routine antenatal ultrasound in low- and middle-income countries: first look - a cluster randomised trial. BJOG. 2018;125:1591–1599. doi: 10.1111/1471-0528.15287.
    1. Nathan R, Swanson JO, Marks W, Goldsmith N, Vance C, Sserwanga NB, et al. Screening obstetric ultrasound training for a 5-country cluster randomized controlled trial. Ultrasound Q. 2014;30:262–266. doi: 10.1097/RUQ.0000000000000096.
    1. Nathan RO, Swanson JO, Swanson DL, McClure EM, Bolamba VL, Lokangaka A, et al. Evaluation of focused obstetric ultrasound examinations by health care personnel in the Democratic Republic of Congo, Guatemala, Kenya, Pakistan, and Zambia. Curr Probl Diagn Radiol. 2017;46:210–215. doi: 10.1067/j.cpradiol.2016.11.001.
    1. Swanson JO, Plotner D, Franklin HL, et al. Web-based quality assurance process drives improvements in obstetric ultrasound in 5 low- and middle-income countries. Glob Heal Sci Pract. 2016;4:675–683. doi: 10.9745/GHSP-D-16-00156.
    1. Bose CL, Bauserman M, Goldenberg RL, Goudar SS, McClure EM, Pasha O, et al. The Global Network Maternal Newborn Health Registry: a multi-national, community-based registry of pregnancy outcomes. Reprod Health. 2015;12(2):S1. doi: 10.1186/1742-4755-12-S2-S1.
    1. Gizzo S, Noventa M, Vitagliano A, Dall'Asta A, D'Antona D, Aldrich CJ, et al. An update on maternal hydration strategies for amniotic fluid improvement in isolated Oligohydramnios and Normohydramnios: evidence from a systematic review of literature and meta-analysis. PLoS One. 2015;10:e0144334. doi: 10.1371/journal.pone.0144334.
    1. Umber A, Chohan MA. Intravenous maternal hydration in third trimester oligohydramnios: effect on amniotic fluid volume. J Coll Physicians Surg Pak. 2007;17:336–339.
    1. Haws RA, Yakoob MY, Soomro T, Menezes EV, Darmstadt GL, Bhutta ZA. Reducing stillbirths: screening and monitoring during pregnancy and labour. BMC Pregnancy Childbirth. 2009;9(Suppl 1):S5. doi: 10.1186/1471-2393-9-S1-S5.

Source: PubMed

Sponsor e collaboratori

Condizioni mediche

Interventi farmacologici

3
Sottoscrivi