Oligohydramnios

Women during their pregnancy and puerperium are advised to take Dhanwantaram gulika Gulika as a safety measure against giddiness, flatulence, nausea and dyspnea.Even without prescription pregnant women using Dhanwantharam Gulika/tab, believed that it is a safe ayurvedic herbal medicine. But you cannot find out any indication mentioned in Ayurveda to use it at time of pregnancy. They are using it because it gives them good relief from pregnancy related nausea and vomiting. Some side effects of Dhanwantharam Gulika / tab notified now a days. This review article tries to explain action of the different ingredients in the Dhanwantharam Gulika/tab.

Objective: The aim of the study was to determine the risk factors, prevalance, epidemiological parameters and maternal-perinatal outcome in pregnant women with hypertensive disorder. Materials and methods: A retrospective analysis was undertaken on 255 consecutive cases of hypertensive disorder in pregnancy who were managed at Kocaeli University, School of Medicine, Department of Obstetrics and Gynecology from June 1997 to November 2004. Demographic data involving age, parity, gestational week, clinical and laboratory findings were recorded from the medical files. Additionally delivery route, indications of cesarean section, fetal and maternal complications were determined. Statistical analysis was performed by SPSS programme using Kruskal Wallis nonparametric test, ANOVA (Analysis of variance) and chi-square tests. Results: Of 5,155 deliveries in our clinic during the defined period, 438 cases (8.49%) were managed as hypertensive disorder of pregnancy. Medical records of 255 cases could be avaliable. Of 255 cases, 138 patients (54.11%) were found to have severe preeclampsia while 88 cases (34.50%) were diagnosed as mild preeclampsia. Twenty-nine patients (11.37%) were suffering from chronic hypertension. Of 138 severely preeclamptic cases, 28 cases (11%) had eclamptic convulsion and another 28 patients (11%) were demonstrated to have HELLP syndrome. Intrauterine growth restriction, oligohydramnios, placental ablation were the obstetric complications in 75 (29.4%), 49 (19.2%), 19 (7.5%) cases, respectively. Additionally multiple pregnancy and gestational diabetes mellitus were noted in 5.9% (n:15) and 3.9% (n:10) of the patients. Delivery route was vaginal in 105 patients (41.2%) while 150 patients (58.8%) underwent cesarean section with the most frequent indication to be fetal distress in 69 cases (46%). Cesarean section rate seemed to be the lowest (48.3%) in chronic hypertensive women while the highest (63.8%) in severe preeclamptic patients. Maternal mortality occured in 3 cases (1.2%) and all of those cases were complicated with HELLP syndrome. Intracranial bleeding was the cause of maternal death in one case while the other two cases were lost due to acute renal failure and disseminated intravascular coagulation, respectively. Intrauterine fetal demise was recorded in 24 cases on admission. Ten fetuses died during the intrapartum period. Mean gestational age and birth weight were 28±3.5 and 1000±416 g, respectively in this group. In these ten women, five cases were diagnosed as HELLP syndrome, two were severely preeclamptic and three were eclamptic. Perinatal mortality rate was found to be 144/1,000 births Conclusion: Hypertensive disorder of pregnancy is associated with increased risk of maternal-perinatal adverse outcome. The complications of severe preeclampsia and eclampsia could be prevented by more widespread use of prenatal care, education of primary medical care personnel, prompt diagnosis of high-risk patients and timely referral to tertiary medical centers.

We observed a premature baby born after severe oligohydramnios who could not be ventilated efficiently even with very high pressures immediately after birth, but who, after cessation of resuscitation attempts, recovered spontaneous sufficient breathing during the following hour. After this experience we searched our case records for other newborns with dry lung syndrome using the following definition: (1) premature birth after prolonged leakage of amniotic fluid, (2) very high ventilatory requirement after birth, (3) dramatic improvement during the first 24 to 36 h and (4) respiratory distress syndrome and infection excluded. Among 93 prematures with rupture of membranes for 4 days or more we found 3, including the index case, matching this definition. Dry lung syndrome appears to be a distinct clinical entity that is possibly underrecognised but recognisable and that merits further study. Its pathogenesis may imply complete collapse of small airways to a degree that capillary forces impede distension by ordinary ventilatory pressures.

Background: Oligohydramnios is commonly observed obstetric problem in term pregnancy which accompanies
with increase incidence of meconium stained liqour, abnormal FHR tracing, low APGAR score, low birth weight,
NICU admission, birth asphyxia and cesarean section for fetal distress. Objective: To study the incidence and
fetomaternal outcome in women with singleton term pregnancy with AFI <5. Method and Material: A study of
total 100 cases of oligohydramnios at term pregnancy was done over a period of 6 months. Biosocial
characteristics, maternal and fetal outcome are collected and assessed in the form of percentage. Result: In present
study oligohydramnios with term pregnancy had incidence of 2.8%. 72% patients are in age group of 20-29. 48%
women are in 40-41 gestational age group. among these patients 9% had anhydramnios. The associated
complications are pregnancy induced hypertension in 26% patients, IUGR in 20%, Anemia in 18%. 56% women
were primigravida and 44% were multigravida. 48% delivered vaginally and 52% cesarean section was done.
Perinatal mortality was noted 19%. Neonatal sepsis and meconium aspiration syndrome were main cause of
perinatal morbidity. Conclusion: Oligohydramios has increasing incidence due to increasing age of the patients and
routinely performed obstetric ultrasonography. It is associated with significantly high incidence of cesarean section
for intrapartum fetal distress, low APGAR of neonate and NICU admission. Fetomaternal outcome can be
improved by careful antenatal evaluation and good neonatal care.
KEYWORDS: Oligohydramnios, fetomaternal outcome, AFI.

To determine ultrasonic estimations of amniotic fluid in diamniotic twins across gestation using the single deepest pocket (SDP) technique and correlate volumes to intrapartum and neonatal outcomes. Prospective observational study using diamniotic dichorionic and diamniotic monochorionic pregnancies. Intrapartum and neonatal outcomes were evaluated. Between April 2004 and April 2006, 299 women were recruited. There was no significant relationship between SDP and gestational age. Statistically significant differences by SDP groups (for low, normal, and high volumes) include preterm delivery (P = .043; 56, 62, and 86%), abnormal labor tracing (P = .013; 5, 8, and 27%), fetal labor intolerance (P = .026; 6, 9, and 27%), Apgar scores at 5 minutes (P = .028; 17, 10, and 27%) and any neonatal complications (P = .002; 28, 21, and 55%). The SDP is constant between 17 and 37 weeks. Fetal labor intolerance and adverse neonatal outcomes are greater in a twin with hydramnios.

Objective: Amniotic fluid has an important role during pregnancy' and labour. Maternal hydration was used in treatment of oligohydramnios. The aim of this study was to evaluate if maternal water immersion can change amniotic fluid index in normal pregnancies and can affect the amount of amniotic fluid volume in gestation at term. Methods: Amniotic fluid index evaluation was performcd in 178 healthy primigravidas: Ervtween 3841 weeks' gestation and 95 between 28-% weeks' gestation. All amniotic fluid index measurements were carried out by the same examiner. Patients 38 and 41 weeks' gestation were divided into two groups: the contml group and the group Of patients who bathed during their third trimester of pregnancy. Women between 2S and 36 weeks of gestation underwent amniotic fluid index measurements and after the period Of treatment: for the control group it was 45-55 min in laying position, and for thc treated group it consisted in immersion in deep water for 50-55 min. Results: At 28-36 weeks' gestation the amniotic fluid index of the control group had a mean of to 152 mm; and 146 to 181 mm (p: for the immersed group. Similarly, mean amniotic fluid index was different in gestations at term: 150 mm (immersed group) and 116 mm (control group) (p= 0.01K)). Conclusion: Water immersion causes an increase in amnio-tic fluid volume. The effect is significant after 50-55 min of immersion. Bathing during the third trimester of pregnancy may produce a greater volume of amniotic fluid in gestations at term.

To compare amniotic fluid index (AFI) with the single deepest pocket in the identification of actual abnormal amniotic fluid (AF) volumes. One hundred seventy-nine women with singleton pregnancies at the University of Mississippi between March 1994 and June 1999 had ultrasound estimations of AF volume sequentially using the AFI and single deepest pocket techniques. Each woman subsequently had ultrasound-directed amniocentesis with dye-dilution and spectrophotometric calculation of actual AF volume. Actual AF volumes were low (under 5% by volume for gestational age) in 62 women, normal (5-95%) in 100 women, and high (more than 95%) in 17 women. An AFI up to 5 cm (sensitivity 10%, specificity 96%) and a single deepest pocket up to 2 cm (sensitivity 5%, specificity 98%) were similarly inadequate in identifying dye-determined low AF volumes. Likewise, AFI above 20 (sensitivity 29%, specificity 97%) and a single-deepest pocket above 8 cm (sensitivity 29%, specificity 94%) were poor in id...

We report a case of feto-feto-fetal-transfusion-syndrome (FFFTS) in a spontaneous monochorionic triamniotic triplet pregnancy primarily diagnosed at 17 weeks of gestation. During the course of pregnancy, sequentially two triplets appeared as donor. Symptom of a recipient ( ...

Angiotensin-converting enzyme (ACE) inhibitors are widely used for controlling hypertension. Their use in women who are pregnant is not without risk to the fetus. We describe three infants exposed in utero to ACE inhibitors who had adverse outcomes. These cases, combined with other reports in the literature, suggest strongly that these drugs are fetotoxic. ACE inhibitor fetopathy is characterized by fetal hypotension, anuria-oligohydramnios, growth restriction, pulmonary hypoplasia, renal tubular dysplasia, and hypocalvaria. Although the true frequency of adverse fetal effects has yet to be determined, because of the debilitating and lethal nature of the fetal damage when it occurs, it is our recommendation that ACE inhibitors not be used in pregnancy, particularly in the second and third trimesters.

Twin-twin transfusion syndrome (TTTS) complicates one in five monochorionic pregnancies and is generally associated with high mortality and morbidity. One twin (the recipient) grows appropriately and has polyhydramnios while the other (the donor) may have a reduced growth velocity and severe oligohydramnios. The disparities in amniotic fluid volumes represent differences in fetal urine output. These differences occur secondary to hemodynamic changes, in which the vascular arrangement of placental anastomoses in TTTS leads to unidirectional flow from the donor to the recipient twin. A better understanding of the pathophysiology may contribute to improved management of this morbid condition. We studied three consecutive prospectively diagnosed stillborn twin pairs affected by early-onset TTTS. Renin gene expression was studied in sections of fetal kidneys with immunocytochemistry using a renin antiserum and with in situ hybridization using riboprobes complementary to renin mRNA, and renin-secreting cells (RCC) were counted. The overall maturation of the renal cortex was assessed by the percentage of immature glomeruli. The donor twin kidneys were smaller than those of the recipients, but the maturation of the renal cortex was not significantly different (28.2% immature glomeruli in the donor and 24.4% in the recipient kidney). The donor kidney showed increased renin gene expression with hyperplastic juxtaglomerular apparatuses (JGAs) that contained excess RCCs (median 20.02 [25th–75th centiles, 5.4, 25.1 RCCs per 100 glomeruli]). In contrast, the recipient kidney was virtually devoid of these cells (0.04 [0, 0.36] RCCs per 100 glomeruli; P In the donor kidney, increased renin release may, by a local action, contribute to renal vasoconstriction and oliguria. Increased renin and/or angiotensin II in the blood passing through the placental anastomoses may, by an endocrine action, suppress renin synthesis in the recipient kidney, thereby increasing renal blood flow and causing polyuria and polyhydramnios. These changes in the renal RAS could thus contribute to the pathogenesis of TTTS. The renal renin changes noted here may represent a contributory or compensating mechanism, the success of which may dictate the overall survival of the twin pregnancy and allow better understanding of the pathophysiology and perhaps therapy that may be employed in this condition.

We present a case series of pre-viable severe twin-twin transfusion syndrome (TTTS). In year 2000, there were 16,688 deliveries in KK Women&#39;s and Children&#39;s Hospital. Four cases that presented before 24 weeks gestation satisfied the sonographic criteria for severe TTTS: same-sex fetuses, absence of twin peak sign, thin intertwine membrane, polyhydramnios associated with large bladder in recipient twin, and oligohydramnios and small or absent bladder in donor twin. Amnioreduction, septostomy and termination of pregnancy were offered. In 1 case abortion was chosen. The follow-up was at least 18 months postnatal. There was 1 intrauterine death, 2 with severe neurological handicap and 3 with normal outcome. Pre-viable severe TTTS is associated with significant mortality and morbidity rates and should be diagnosed promptly and managed in a tertiary fetal medicine unit with multi-disciplinary input.

— This study was conducted to find out if AFI ≤ 5 cms has any clinical significance in identifying the subsequent fetal distress & associated maternal & perinatal outcomes, in pregnancies beyond 37 weeks. Methodology: This is a prospective case control study done from July 2010 to July 2012 (24 months) at Dr Vasantrao Pawar Medical College, Hospital and Research Center. Adgaon, Nashik. It study the pregnancy outcome comparison of 58 Anenatal Cases(ANCs)as Study Group with diangosis of oligohydramnios (AFI ≤ 5 cms) by ultrasound after 37 completed weeks of gestation w e r e compared with 58 ANCs (Control Group) with no oligohydramnios (AFI > 5 cms). These two groups were matched for other variables like age, parity, gestational age and any pregnancy complication. Results: There was significant difference between two groups. Hypertension and Preeclampsia were found significantly more in ANCs with oligohydramnios. FHR deceleration was also significantly higher in women with oligohydramnios. Women require LSCS were also significantly more in women with oligohydramnios. Newborn borned by women with oligohydramnios had significantly more chances to admit in NICU than in newborn born by women without oligohydramnios. Conclusion: It can be concluded from this study that women with oligohydramnios poor pregancy outcomes. Determination of AFI can be used as an adjunct to other fetal surveillance methods. Determination of AFI can be used as valuable screening test for predicting fetal distress in labour, requiring caesarean section.