Oligohydramnios is the most common indication for cesarean section. Around 25 (14.36%) of the women underwent repeat cesarean section. Conclusions: The rate of cesarean section was quite high in our study and further studies are recommended for understanding of causes and other associated factors with it.
Is isolated oligohydramnios at term an indication for labor induction?
Isolated oligohydramnios at term is associated with significantly higher rates of labor induction, Cesarean sections, and short-term neonatal morbidity. Isolated Oligohydramnios at Term as an Indication for Labor Induction: A Systematic Review and Meta-Analysis
Is oligohydramnios an indication for C-section?
Oligohydramnios was the indication for 14% of C-section in this study. However, a prospective cohort study done in Pakistan has documented that isolated oligohydramnios is not associated with adverse perinatal outcome such as high rate of birth asphyxia or admission to intensive care unit compare to women having normal amniotic fluid.
What is the prognosis of oligohydramnios at term?
Isolated oligohydramnios at term is associated with significantly higher rates of labor induction, Cesarean sections, and short-term neonatal morbidity. Isolated oligohydramnios at term is associated with significantly higher rates of labor induction, Cesarean sections, and short-term neonatal morbidity.
Is isolated oligohydramnios associated with adverse neonatal outcomes?
Although small and insufficiently powered, these studies suggest that isolated oligohydramnios does not appear to be associated with adverse outcomes, but it may cause fetal intolerance of labor, which does result in higher cesarean rates. Expectant management may have equally good neonatal outcomes, yet that approach is not widely used.
Does oligohydramnios require C section?
Babies with oligohydramnios can be delivered vaginally. They are, however, at increased risk during delivery of being in an abnormal position (not “presenting” head first) and of having temporary drops (decelerations) in their heart rate. Either of those situations may require a Cesarean section.
When do you deliver oligohydramnios?
In summary, it is recommended to deliver women with intact membranes and oligohydramnios at 340/7 to 366/7 weeks, unless an RCT concludes otherwise.
Is oligohydramnios an indication for induction of labor?
Oligohydramnios is associated with an increased risk of perinatal morbidity and mortality. To prevent antepartum stillbirth, the American College of Obstetricians and Gynecologists (ACOG) recommends induction of labor between 36 0/7 and 37 6/7 weeks in pregnancies complicated by oligohydramnios.
What are the fetal indications for cesarean delivery?
The most common indications for primary cesarean delivery include, in order of frequency, labor dystocia, abnormal or indeterminate (formerly, nonreassuring) fetal heart rate tracing, fetal malpresentation, multiple gestation, and suspected fetal macrosomia.
What is the management of oligohydramnios?
What is the treatment of oligohydramnios? It depends on how far along you are in your pregnancy and if you've been diagnosed with other pregnancy complications. If you're close to full term (37 weeks of pregnancy), your healthcare provider may decide that inducing labor early is the safest option for your baby.
Is oligohydramnios considered high risk?
Oligohydramnios, a decrease in the levels of amniotic fluid, is a serious health risk to the baby.
Is normal delivery possible with low amniotic fluid at 37 weeks?
If you have low amniotic fluid and you're 36 to 37 weeks pregnant, the safest option might be delivering the baby.
What happens if amniotic fluid is low at 38 weeks?
Low levels of amniotic fluid can cause problems with how well your baby's lungs develop because pressure on your baby's tummy stops the diaphragm and lungs from moving properly . It's also linked to other complications, such as fetal distress, heart problems and slow growth .
What happens if amniotic fluid is low at 40 weeks?
Most women diagnosed with low amniotic fluid in the third trimester will have a completely normal pregnancy. If there are very low levels of amniotic fluid for your baby to float around in, there is a slight risk of intrauterine growth restriction and umbilical cord constriction during birth.
What does C-section without indication mean?
Cesarean delivery on maternal request is defined as a primary cesarean delivery on maternal request in the absence of any maternal or fetal indications.
When is cesarean section typically performed?
A cesarean section, also called a c-section, is a surgical procedure performed when a vaginal delivery is not possible or safe, or when the health of the mother or the baby is at risk. During this procedure, the baby is delivered through surgical incisions made in the abdomen and the uterus.
Which of the following is considered to be an absolute indication for performing a cesarean section?
The absolute indications are comparatively simple: (1) a contracted pelvis, with a conjugate at the brim of less than 7 cm., or with other measurements so small that delivery could be accomplished in no other way; (2) complete obstruction of the pelvic canal by a fibroid tumor, ovarian cyst or tumor of the sacrum; (3) ...
Is normal delivery possible with low amniotic fluid at 37 weeks?
If you have low amniotic fluid and you're 36 to 37 weeks pregnant, the safest option might be delivering the baby.
What happens if amniotic fluid is low at 38 weeks?
Low levels of amniotic fluid can cause problems with how well your baby's lungs develop because pressure on your baby's tummy stops the diaphragm and lungs from moving properly . It's also linked to other complications, such as fetal distress, heart problems and slow growth .
What happens if amniotic fluid is low in third trimester?
Most women diagnosed with low amniotic fluid in the third trimester will have a completely normal pregnancy. If there are very low levels of amniotic fluid for your baby to float around in, there is a slight risk of intrauterine growth restriction and umbilical cord constriction during birth.
What is considered low amniotic fluid at 36 weeks?
The sonographer will measure the largest pockets of amniotic fluid in four different sections of your uterus and add them together to see where you rate on the amniotic fluid index (AFI). A normal measure for the third trimester is between 5 and 25 centimeters (cm). A total of less than 5 cm is considered low.
What percentage of C sections are oligohydramnios?
Oligohydramnios was the indication for 14% of C-section in this study. However, a prospective cohort study done in Pakistan has documented that isolated oligohydramnios is not associated with adverse perinatal outcome such as high rate of birth asphyxia or admission to intensive care unit compare to women having normal amniotic fluid. Thus elective C-section for possible perinatal morbidity due to oligohydramnios is not recommended for any instance [ 43 ]. Moreover, it has been reported that estimated rate of oligohydramnios could be up to six percent [ 44] and majority of the cases the superfluous results of low amniotic fluid comes from subjective variation on sonography [ 45] Higher C-section for oligohydramnios in this study raises issues regarding validity of ultra-sonographic results which is common in current practice context in Bangladesh. Nevertheless, serial sonography in all four World Health Organization (WHO) recommended ANC visits are crucial to detect congenital fetal anomaly responsible for oligo hydramnions and also to identify potential threat for many fetal complication in advance. [ 46 ]. But the data from recent national demographic survey suggest that only 31% of the women in Bangladesh are receiving 4+ ANC. [ 9 ]. Furthermore, several studies have reported the poor quality of ANC mostly due to lack of physical infrastructure, more waiting time, less supportive behaviour from service providers and lack of Standard Operating Procedure (SOPs) and evidence based practice like counselling, health education [ 47, 48 ].
What is a C section?
Caesarean section (C-section) is a major obstetric intervention for saving lives of women and their newborns from pregnancy and childbirth related complications. Un-necessary C-sections may have adverse impact upon maternal and neonatal outcomes.
What was the C section rate in 2013?
During 2013, facility delivery rate was 84% and population based C-section rate was 35% of all deliveries in icddr,b service area. Of all C-sections, only 1.4% was conducted for Absolute Maternal Indications (AMIs). Major indications of C-sections included: repeat C-section (24%), foetal distress (21%), prolonged labour (16%), oligohydramnios (14%) and post-maturity (13%). More than 80% C-sections were performed in for-profit private facilities. Probability of C-section delivery increased with improved socio-economic status, higher education, lower birth order, higher age, and with more number of Antenatal Care use and presence of bad obstetric history. Eight maternal deaths occurred, of which five were delivered by C-section.
What is the safe C section rate?
One recent ecological study has argued that the safe upper limit of population based C-section rate could be 19% [ 19 ]. Referring to this findings, WHO in their recent strategic document [ 28] has emphasized more on monitoring indications rather than concentrating on appropriate C-section rates [ 29, 30 ]. The five most common indications explored in this study have also contributed for global excess of C-section rates. One study has explored that in 2001, 30% of C-sections in developed countries were for repeat C-sections [ 31 ]. Another study in Bangladesh reported that in government hospitals 35% of C-sections were actually repeat C-sections [ 32 ]. National Institute for Health and Clinical Excellence [ 33] and the American College of Obstetricians and Gynaecologists [ 34] have clearly instructed that previous C-section should not be an indication in absence of any obstetric emergencies. There is also proof that the success rate for vaginal birth after C-section (VBAC) was much higher (80%) and morbidity rate was much lower than those with repeat C-section [ 29, 31 ]. Thus the priority should focus on reducing primary C-section rate through engaging both client and providers in informed decision making process [ 29, 32 ].
What are the strengths of the C section study?
The strength of the study is that the data comes from an established and long standing health and demographic surveillance system which has enabled retrieval of entire birth cohort data for with no missing values for required analysis. All C-section indications could be captured from multiple sources. All these are strengths of the study. There was the chance for recall bias for getting indication from women where data were unavailable from facility records, given that interviews occurred one year after the birth events. However interviews were conducted by trained obstetrician with similar experiences and collected data using well-designed interview guideline and were validated with referral notes and discharge certificates available with women to overcome this weakness.
What is the second leading cause of C section?
Fetal distress, identified as the second leading cause of C-section (20.6%) in this study population, has a reported global prevalence of about 20% [ 35] and was accounted for about 16% C-section at tertiary level hospitals in Bangladesh [ 32, 36 ]. There is a range of medical intervention, from simple maternal left lateral position, oxygen inhalation, to para-cervical amnio-infusion [ 37] for restoration of fetal heart rate. The reported success rate for para cervical amnio-infusion was about 70% even in limited resource setting [ 35] and therefore it is imperative to encourage care-givers to practice these interventions before opting for emergency C-section for fetal distress .
What is the difference between a repeat C section and a primary C section?
Primary C-section group included women having C-section for the first time, while repeat C-section group included women with one or more C-section prior to current birth.
What are the consequences of oligohydramnios?
The clinical consequences of oligohydramnios, which can range from stillbirth or perinatal asphyxia due to severe, prolonged umbilical cord compression to intermittent but inconsequential fetal heart rate decelerations during labor, are more frequent in cases of severely decreased amniotic fluid volume.
What is the term for a reduction in amniotic fluid volume?
Severe reduction in amniotic fluid volume in this period is usually associated with premature rupture of membranes (PROM) or absence/obstruction of fetal urinary flow (renal agenesis, bladder outlet obstruction). PROM occurring prior to 20 weeks, termed previable rupture of membranes, typically leads to advancing maternal chorioamnionitis, periviable delivery (23-27 weeks) and the morbidities of extreme prematurity for the neonate. Perinatal survival rates are approximately 50%.
How long should I hydrate after amniotic fluid?
Intravenous infusions are less effective than oral hydration. At least 2 hours should be allowed after 2 L of hydration before remeasuring amniotic fluid volume in order to maximize the likelihood of observing a beneficial effect.
What happens to a fetus in the third trimester?
Third trimester oligohydramnios may evolve as part of the sequence of progressive placental insufficiency which evolves from increasingly severe fetal growth restriction accompanied by reduced fetal renal perfusion and urinary flow which can lead to decreases in amniotic fluid volume. When oligohydramnios appears in this setting, reductions in fetal oxygen delivery are also frequent, significantly increasing the risk of in utero fetal death or perinatal asphyxia. Conversely, a small for dates fetus with normal amniotic fluid suggests an intrinsic growth problem such as chromosomal anomaly or TORCH infection. In cases of FGR complicated by oligohydramnios, intensive fetal surveillance is indicated, which may include hospitalization, twice weekly Doppler and biophysical testing and administration of antenatal corticosteroids.
How to measure amniotic fluid?
Normal amniotic fluid volume. Amniotic fluid volume is estimated using ultrasound to measure vertical pockets of fluid. Fluid pocket measurements must be obtained in the vertical plane, be clear of any fetal or umbilical echoes and at least 1 cm wide. The amniotic fluid index is the sum of the single deepest pockets (SDP) in each of four quadrants of the uterus. An average (50th percentile) value near term for the AFI is approximately 10 cm and for SDP is 4 cm but both the AFI and SDP trend downward significantly toward the EDD – from 12.9 cm (AFI) and 4.8 cm (SDP) at 34 weeks to 8.6 (AFI) and 3.9 cm at 40 weeks (Table I).
What is the median latency of chorioamnionitis?
Median latency is 30 days but the range is wide. Among those expectantly managed, the incidence of chorioamnionitis is 70-90% . The mean gestational age at delivery is 23-25 weeks with a very wide range, neonatal survival is 30-50% but morbidity in the newborns (intraventricular hemorrhage, cerebral palsy) is high. Although small randomized trials suggest improvement in these outcomes with prophylactic amnioinfusion, this should be considered investigational.
How much amniotic fluid is normal?
According to studies utilizing direct or dye-dilution methods, there is a wide range of normal amniotic fluid volume: at term, average amniotic fluid volume is approximately 700 ml, with a relatively wide range of from 300 ml to 1200 ml (10-90th percentiles). Further, there is a strong negative influence of gestational age on volume. Thus reference to gestational age specific tables is recommended.
How to treat oligohydramnios during labor?
One approach to treating oligohydramnios during labor is to perform an amniotomy followed by amnioinfusion to increase the fluid inside the uterus. [ 5] . However, if expectant management is desired, maternal hydration can increase the AFI. Oral or IV maternal hydration has been studied as a treatment for oligohydramnios in women ...
How to manage oligohydramnios?
Oligohydramnios at term may be managed actively via induction of labor or expectantly via hydration and fetal surveillance, and/or regular ultrasounds assessing amniotic fluid volume. [ 2, 4] While both options exist, active management is the common approach for women with term pregnancies with or without maternal or fetal obstetric risk factors. [ 4, 12, 14]
How long did it take to deliver an isolated oligohydramnios?
In the case presented here, the woman had isolated oligohydramnios at 41 weeks' gestation with no other risk indications or risk factors for maternal-fetal adverse outcomes. The result of her induction of labor was a cesarean section for arrest of descent because of maternal exhaustion, not for non-reassuring fetal status. The duration of time from admittance to delivery was 37 hours. No intervention or observational testing occurred during the first 12 hours of hospital admission.
What is maternal hydration?
Oral or IV maternal hydration has been studied as a treatment for oligohydramnios in women with otherwise healthy term pregnancies. [ 5] . In the second trimester of pregnancy, the majority of the amniotic fluid is produced through fetal urine production and is reabsorbed through fetal swallowing.
Does oligohydramnios cause labor intolerance?
Although small and insufficiently powered, these studies suggest that isolated oligohydramnios does not appear to be associated with adverse outcomes, but it may cause fetal intolerance of labor, which does result in higher cesarean rates. Expectant management may have equally good neonatal outcomes, yet that approach is not widely used.
Can oligohydramnios be used in labor?
Inducing labor in women with low-risk pregnancies with isolated oligohydramnios is the most common practice, although it is not found to improve perinatal outcome. [ 4, 12, 14] In a small prospective, randomized pilot study (N = 54), Ek et al. [ 14] found that active versus expectant management of oligohydramnios in women with uncomplicated pregnancies at term resulted in no difference in maternal or neonatal outcomes. Because of the small number of women in the study group, this study did not have sufficient power to determine a significant relationship between oligohydramnios and neonatal outcomes. Conversely, a prospective study by Alchalabi et al. [ 4] divided 180 women between 37 and 42 weeks' gestation who were admitted for induction of labor into 2 groups: the women in one group had an AFI ≤5 cm (n = 66) and the women in the other group had an AFI of >5 cm. Although the 2 groups had comparable demographic and obstetric characteristics prior to induction, the women in the low AFI group had an increased rate of cesarean section secondary to fetal distress (27.3% vs 5.5%; OR 6.75, 95% CI 1.8-23.2; P = .004). [ 3] Conway et al. [ 13] randomized 61 otherwise healthy women with isolated oligohydramnios (AFI ≤5 cm) at term to expectant management or induction and found no differences in maternal or neonatal outcomes. These authors concluded that expectant management with twice weekly fetal surveillance is a sensible alternative to labor induction, and that the majority (67%) of women will go into labor spontaneously within 3 days after diagnosis. [ 13] Although small and insufficiently powered, these studies suggest that isolated oligohydramnios does not appear to be associated with adverse outcomes, but it may cause fetal intolerance of labor, which does result in higher cesarean rates. Expectant management may have equally good neonatal outcomes, yet that approach is not widely used. [ 14]
Is oligohydramnios associated with adverse perinatal outcome?
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. Many questions remain regarding how we measure and assess fetal intolerance of labor.
When is a Caesarean section planned?
Elective Caesarean sections are usually planned after 39 weeks of pregnancy to reduce respiratory distress in the neonate – known as Transient Tachypnoea of the Newborn. For those where delivery needs to be expedited prior to 39 weeks’ gestation, the administration of corticosteroids to the mother should be considered.
Why is a woman positioned with a left lateral tilt of 15°?
The woman is positioned with a left lateral tilt of 15° – to reduce the risk of supine hypotension due to aortocaval compression.
Why are Caesarean sections increasing?
The reason for this is multifactorial, but relates in part to a rise in medicolegal cases, alongside greater access to healthcare and the equipment and expertise needed.
Where is the Caesarean section?
A Caesarean section is the delivery of a baby through a surgical incision in the abdomen and uterus.
How long does it take for a baby to be born in a Category 1 section?
The Royal College of Obstetricians and Gynaecologists (RCOG) recommends that when a Category 1 section is called, the baby should be born within 30 minutes (although some units would expect 20 minutes).
How many layers are there in the uterus?
The uterine cavity is ensured empty, then closed with two layers. The rectus sheath is then closed and then the skin (either with continuous/interrupted sutures or staples).
What is a maternal medical condition?
Maternal medical conditions (e.g. cardiomyopathy) – where labour would be dangerous for the mother.
What is the DVP of oligohydramnios?
Oligohydramnios (DVP <2cm) isolated and uncomplicated : 36w0d – 37w6d (or at time of diagnosis if later)
What is ACOG guidance?
ACOG has developed important guidance on the timing of medically indicated late-preterm and early-term deliveries in collaboration with SMFM. The recommendations are based on placental, fetal and maternal complications.
How early can you deliver a baby after stillbirth?
“…maternal anxiety with a history of stillbirth should be considered and may warrant an early term delivery (37 0/7 weeks to 38 6/7 weeks) in women who are educated regarding, and accept, the associated neonatal risks”.
When is the Obg project 2021?
Fees for participating and receiving CME credit for this activity are as posted on The ObG Project website. During the period from Feb 19 2019 through Feb 19 2021, participants must read the learning objectives and faculty disclosures and study the educational activity.
Can late preterm delivery be delayed?
Medically indicated late-preterm delivery should not be delayed for administration of corticosteroids
How long does it take to deliver a cesarean?
ACOG has recommended that any facility providing obstetric care have the capability of performing a cesarean delivery within 30 minutes of the decision. Despite this recommendation, a decision to delivery time of more than 30 minutes is not necessarily associated with a negative neonatal outcome. [ 55]
Does HAART lower neonatal transmission?
In women who are being treated with highly active antiretroviral therapy (HAART), cesarean delivery (before labor or without prolonged rupture of membranes) appears to further lower the risk for neonatal transmission, particularly among those with viral counts above 1,000.
What Every Clinician Should Know
Diagnosis and Differential Diagnosis
- Normal amniotic fluid volume. Amniotic fluid volume is estimated using ultrasound to measure vertical pockets of fluid. Fluid pocket measurements must be obtained in the vertical plane, be clear of any fetal or umbilical echoes and at least 1 cm wide. The amniotic fluid index is the sum of the single deepest pockets (SDP) in each of four quadrants of the uterus. An average (50th pe…
Management
- Options to correct amniotic fluid volume and thus reduce the morbidities associated with prolonged premature rupture of membranes (PROM), including extremity deformations and pulmonary hypoplasia, are extremely limited. Renal agenesis should be considered lethal as should bilateral multicystic displastic kidneys when severe oligohydramnios (SDP less than 2 c…
Complications
- Severe reduction in amniotic fluid volume in this period is usually associated with premature rupture of membranes (PROM) or absence/obstruction of fetal urinary flow (renal agenesis, bladder outlet obstruction). PROM occurring prior to 20 weeks, termed previable rupture of membranes, typically leads to advancing maternal chorioamnionitis, periviable delivery (23-27 w…
Prognosis and Outcome
- Previable PROM. Latency (the time from membrane rupture until delivery) is proportional to the residual AFI, with higher AFI having better prognosis. Median latency is 30 days but the range is wide. Among those expectantly managed, the incidence of chorioamnionitis is 70-90%. The mean gestational age at delivery is 23-25 weeks with a very wide range, neonatal survival is 30-50% bu…
What Is The Evidence For Specific Management and Treatment Recommendations
- Magann, EF, Sanderson, M, Martin, JN. “The amniotic fluid index, single deepest pocket, and two-diameter pocket in normal human pregnancy”. Am J Obstet Gynecol. vol. 182. 2000. pp. 1581-8. (This paper provides normative data for AFI and SDP.) Moore, TR, Cayle, JE. “The amniotic fluid index in normal human pregnancy”. Am J Obstet Gynecol. vol. 162. 1990. pp. 1168-73. (This is th…