Bangal V B et. al.

/ JPBMS, 2011, 12 (05)

Available online at www.jpbms.info

ISSN NO- 2230 7885
Research article CODEN JPBSCT

JPBMS

JOURNAL OF PHARMACEUTICAL AND BIOMEDICAL SCIENCES

Incidence of oligohydramnios during pregnancy and its effects on maternal and

perinatal outcome
* Vidyadhar B. Bangal1, Purushottam A. Giri2, Bhushan M. Sali3
1Professor and Head, Dept. of Obstetrics and Gynaecology (OBGY), Rural Medical College & Pravara Rural Hospital of
Pravara Institute of Medical Sciences (Deemed University), Loni, Dist. Ahmednagar, Maharashtra, India.
2Assistant Professor, Dept. of Community Medicine (PSM), Rural Medical College & Pravara Rural Hospital of

Pravara Institute of Medical Sciences (Deemed University), Loni Dist. Ahmednagar, Maharashtra, India.
3Postgraduate student, Dept. of Obstetrics and Gynaecology (OBGY), Rural Medical College & Pravara Rural Hospital of

Pravara Institute of Medical Sciences (Deemed University), Loni Dist. Ahmednagar, Maharashtra, India.

Abstract: Oligohydramnios or reduced amount of amniotic fluid volume is a commonly observed obstetric problem
during third trimester of pregnancy. It accompanies a broad range of reproductive disorders including anomalies of fetus
and functional disorders of mother, fetus and placenta. Reduced amniotic fluid volume is associated with adverse perinatal
outcome. A prospective hospital based study of total 100 cases of oligohydramnios coming for delivery to Pravara Rural
Hospital, Loni was undertaken over a period of two years from October 2007 to September 2009. The information
regarding bio-social characteristics, maternal and perinatal outcome were collected and results were analyzed by using
percentage and proportion. In the present study, the majority of the cases( 78%) were unbooked and belonged to the age
group of 20-30 years and had associated maternal or fetal complications. Postdated pregnancy, pregnancy induced
hypertension and fetal congenital anomalies were the commonest complications associated with oligohydramnios. Forty
four percent cases were delivered by caesarean section. Overall perinatal mortality was 24%. Cases with severe
oligohydramnios and anhydramnios were associated with intrapartum fetal heart rate abnormalities, (16%) low Apgar
score and (8%) meconium aspiration syndrome. Every case of oligohydramnios needs careful evaluation, parental
counseling and individualized decision regarding timing and mode of delivery. Continuous intrapartum fetal monitoring
and good neonatal care support is essential for optimum perinatal outcome.

Keywords: Maternal outcome, perinatal outcome, Oligohydramnios

Introduction:
Oligohydramnios or reduced volume of amniotic fluid
poses challenge to obstetrician, when it is diagnosed
before term. Oligohydramnios can develop in any
trimester, although it is more common in third trimester.
[1] About 12% of women, whose pregnancies continue for
two weeks beyond expected date of delivery; develop
oligohydramnios due to declining placental function.
Oligohydramnios accompanies a broad range of
reproductive disorders including anomalies of fetus and
functional disorders of mother, fetus and placenta.
Decreased amount of amniotic fluid, particularly in third
trimester, has been associated with multiple fetal risks
like, pulmonary hypoplasia and intrauterine growth
restriction. Oligohydramnios may cause compression of
umbilical cord, leading to fetal distress during labour.
Oligohydramnios is found to be associated with an
increased risk of caesarean delivery for fetal distress, low
Apgar score and high perinatal morbidity and mortality [2].
Hence, the present study was carried out to find out the
incidence of oligohydramnios during pregnancy and its
effect on maternal and perinatal outcome.
Material & Methods:
A retrospective hospital based study was carried out in the
department of Obstetrics and Gynaecology of Rural
Medical College and Pravara Rural Hospital- a tertiary
level health care referral centre in Loni, Maharashtra,
India over a period of 2 years from October 2007 to
September 2009. Hundred pregnant women in 3rd
trimester of pregnancy, diagnosed as oligohydramnios
with amniotic fluid index (AFI) less than 5 cm and intact
membranes were included in the study. Findings were
analyzed with the special emphasis on bio-social
characteristics of the patient and maternal and perinatal
outcome. The ethical committee of the institute had
approved the study. Results were analyzed by using
percentage and proportion.
Results:
It was observed (table 1) that, 78% women with
oligohydramnios were in the age group of 20-29 years.
The mean ( SD) maternal age was 22.8 4.2 years. By
gestational age, 22% of women were in the gestational
age group of 34-36 weeks followed by 20% women in 38-
40 and >40 weeks. The mean gestational age was 36.7
4.1 weeks. By parity, 54% women were primigravidas
followed by 46% multigravidas.
It was observed that (table 2), pregnancy induced
hypertension (16%), postdated pregnancy (16%) and

1 Journal of Pharmaceutical and Biomedical Sciences (JPBMS), Vol. 12, Issue 12

 Bangal V B et. al. / JPBMS, 2011, 12 (05)
anhydramnios (10%) were commonly seen in women with [5]found that the mean maternal age were 23.6 6.5 years,
oligohydramnios. As regards to mode of delivery, it was 28.4 3.4 years and 23.8 5.7 years respectively.
observed that, 56% had spontaneous vaginal delivery and The mean gestational age in the present study was 36.7
44% had operative/assisted delivery. Birth asphyxia 4.1 weeks. Similar studies by Jun Zhang et. al. [4], Casey B et
(Apgar score of <7 at one minute and five minute) was al .[6] , Everett F et. al. [5] and Iffath A et. al.[ 7] found that, the
more common in the babies delivered in cases of mean gestational age were 38.1 3.3 weeks, 37.5 2
oligohydramnios. Neonatal morbidity was mainly due to weeks, 34.3 2.1 weeks, and (mean SD) was 36.3 2
meconium aspiration and neonatal sepsis. High perinatal weeks respectively. These findings indicate that the
mortality (24%) was observed in the present study. problem of oligohydramnios was more common in the
later part of pregnancy. It is mainly due to physiological or
Bio-social characteristics Oligohydramnios women pathological causes of reduced placental perfusion near
(n=100) term.
1. Maternal age
<20 yrs 16 In the present study, the incidence of oligohydramnios
20 - 29 yrs 78 was 0.67%. Similar study by Jun Zhang et. al. [4] reported
30 yrs 06 the incidence as 1.5%. Divon M et. al. [8] found
Mean SD 22.88 yrs 4.24 yrs oligohydramnios in 1.2% in their cases. Casey B et al.6
2. Gestational age
30-32 weeks 08
found that 2.3% cases were complicated by
32-34 weeks 14 oligohydramnios. Elliot H et. al. [9] found that, the incidence
34-36 weeks 22 of oligohydramnios was 3.9% in their study. Varma T R et.
36-38 weeks 16 al. [10] found that, the incidence was 3.1% in their study.
38-40 weeks 20
>40 weeks 20
Chauhan P et. al. [19] studied two groups of patients. First
Mean SD 36.72 weeks 4.11 weeks group had AFI less than 5cm and second with AFI less than
3. By Amniotic Fluid Index 5th percentile for that gestational age. The mean amniotic
0 10 fluid index was 3.9 2.1 cm (AFI less than 5th percentile)
1 06 and 3 1.5 cm in patients with AFI less than 5cm.
2 28
3 06 The mean amniotic fluid index (AFI) in the present study
4 30 was 3.00 1.04cm. Sadovsky Y et. al. [20] in their study,
5 20 found that the mean amniotic fluid index was 2.9 cm.
Mean SD 3.00 1.04 Obstetrical complications frequently associated with
4. By birth weight oligohydramnios were pregnancy induced
<1000 gms 02 hypertension(PIH), postdatism, intrauterine growth
1000-2000 gms 38 restriction, fetal renal anomalies, prematurity and
2000-3000 gms 58
>3000 gms 02 intrauterine death of the fetus. In the present study 78%
Mean SD 2140.00 gms 0.51 gms cases had associated obstetrical complications; acting
5. Parity singly or in combination for causing oligohydramnios. PIH
Primigravidas 54 was present in 16% cases. Golan A et al.12 in his study,
Multigravidas 46
Mean SD 1.2 1.5
found maternal hypertension in 22.1% cases. Cesarean
(Data indicates both number and percentage) section was performed in 35.25% of these cases. Mercer L
J et. al. [13] found that preeclampsia was present in 24.7%
Table 2: Maternal and perinatal outcome in of cases with decreased fluid. Study by Chauhan P et. al. [3]
oligohydramnios (n=100) reported, preeclampsia in 12% cases. They concluded that
Variables No. of cases the incidence of oligohydramnios ranges from 10 to 30 %
1. Maternal complications in hypertensive patients requiring hospitalization. Sixteen
Pregnancy induced hypertension 16
percent cases had postdated pregnancies in the present
Postdate 16
Intrauterine growth restriction 14 study. Clement D et. al. [21] studied six cases of postdatism,
Preterm delivery 14 in which amniotic fluid volume diminished abruptly over
Anhydramnios 10 24 hours. Bowen Chattoor JS et. al. [22], in their study
Fetal anamolies 08
evaluated the relationship between amniotic fluid index
2. Mode of delivery
Spontaneous vaginal delivery 56 and perinatal outcomes in fifty five postdate pregnancies.
Operative/assisted delivery 44 Oligohydramnios was noted in four (7.2%) cases. In the
3 Neonatal morbidity present study, intra uterine growth restriction was
Meconium aspiration 04 present in 20% cases and the rate of caesarean section
Neonatal sepsis 04
was 44% and that of vaginal delivery was 56%. Study by
4. Apgar score (< 7)
At 1 minute 10 Casey B et. al. [6] found that, there was increased rate of
At 5 minute 16 induction of labour (42%) and Cesarean section (32%) in
5. Perinatal mortality oligohydramnios cases. Jun Zhang et al.4 found that, the
Still births 08 overall cesarean delivery rates were similar between
Early neonatal death 16
women with oligohydramnios and the controls (24% Vs
(Data indicates both number and percentage) 19%). Golan A et. al. [12] et al found that, the cesarean
section was performed in 35.2% of pregnancies. In the
Discussion:
present study, the apgar score was noted at 1 and 5
In the present study, 78% of cases were in the age group minutes after birth. Sixteen babies (16%) had low Apgar
20 to 29 years, as compared to other age groups, reflecting score (less than 7 at 5 min). Out of 16 babies with low
the child bearing age of most of the women with the mean Apgar score, eight died during neonatal period. Three
(SD) maternal age of 22.8 4.2 years. Similar studies by babies with low Apgar score were delivered by caesarian
Chauhan P et. al. [3], Jun Zhang et. al. [4] and Everett F et. al.
2 Journal of Pharmaceutical and Biomedical Sciences (JPBMS), Vol. 12, Issue 12
 Bangal V B et. al. / JPBMS, 2011, 12 (05)
section. Out of these 3 babies, one died during neonatal
period due to non-immune hydrops fetalis. In a similar
study by Casey B et. al.[6] (6%) babies had Apgar score of
less than 3 at 5 minute. Out of these nine babies, seven
died during neonatal period. Jun Zhang et. al. [4] found that
an Apgar score of <7 at 1 minute was present in fifteen Six
babies had Apgar score of <7 at 5 minute. Desai P et. al. [14]
found that three babies with Apgar score less than 7 at 5
minute as against only one in control group. In a similar
study by Locatelli A et. al. [15] of 341 patients with
oligohydramnios, found no significant difference for Apgar
score of less than 7 at 5 minute in study and control group.
In the present study, four (8%) babies developed
meconium aspiration. All four babies were admitted in
NICU for further management. Three babies were
delivered by caesarean section and one by vaginal route.
Two babies died in neonatal period. Causes of deaths were
meconium aspiration syndrome and development of
septicemia. Babies who died due to meconium aspiration
syndrome were of 37.5 weeks and 39.3 weeks of gestation
with birth weight of 1.3 kg and 2.5kg respectively. Casey B
et. al. [6] studied 6423 patients, who underwent
ultrasonography at more than 34 weeks gestation and
found that 147 (2.3%) cases were complicated by
oligohydramnios. Meconium stained amniotic fluid was
identified, less often in pregnancies complicated by
oligohydramnios (6% vs. 15%, P=0.004). Notably; the
incidence of meconium aspiration syndrome in infants
with oligohydramnios was significantly higher despite the
diminished identification of meconium stained amniotic
fluid.
Bowen Chattoor JS et. al. [22] studied perinatal outcome in
55 postdate pregnancies. Oligohydramnios was noted in
four patients. All 4 babies were admitted with meconium
aspiration. One died due to this complication.
In the present study, there were 92% live births and 8%
still births. Sixteen percent babies died in neonatal period.
The gross perinatal mortality was 24% in present study.
Out of 12 perinatal deaths, 11 deaths were seen in
unregistered cases. Chhabra S et. al. [16] reported very high
(87.7%) perinatal mortality in their study. Wolff F et. al.
[17] found that the perinatal mortality in their study was
7.2%. Apel-Sarid L et. al. [18] found that the perinatal
mortality was 9.9%. Chamberlin PF et. al. [23] calculated the
gross and corrected perinatal mortality rate in patients
with decreased qualitative amniotic fluid volume and
found it to be 188/1000 and 109/1000 respectively.
Overall, the perinatal mortality is markedly increased in
patients with oligohydramnios. The lack of amniotic fluid
allows compression of fetal abdomen, which limits the
movement of the diaphragm.
Conclusion:
Oligohydramnios is being detected more often these days,
due to routinely performed obstetric ultrasonography.
Pregnancy induced hypertension and post dated
pregnancies are the commonest causes of reduced
amniotic fluid during third trimester of pregnancy.
Anomalies of the fetal renal system are responsible for
oligohydramnios in second and third trimester. The time
and mode of delivery of these cases depends on severity of
oligohydramnios and status of fetal wellbeing. Caesarean
section is mostly required for cases with anhydramnios
and intrapartum fetal heart rate abnormalities. Babies are
relatively more prone for certain complications, like
3 Journal of Pharmaceutical and Biomedical Sciences (JPBMS), Vol. 12, Issue 12
intrapartum fetal distress, meconium aspiration syndrome
and birth asphyxia. Adverse perinatal outcome can be
avoided by careful intrapartum fetal heart rate
monitoring. Every case of oligohydramnios needs careful
antenatal evaluation, parental counseling, individualized
decision regarding timing and mode of delivery.
Continuous intrapartum fetal monitoring and good
neonatal care are necessary for better perinatal outcome.
Acknowledgement:
We acknowledge the cooperation extended by
Management of Pravara Medical Trust and The Principal,
Rural Medical College, Loni, Maharashtra, India
References:
1.Park K. Preventive medicine in obstetric, Paediatrics and
geriatrics: Park's Text Book of Preventive and Social
Medicine. 20th edition. Jabalpur: M/S Banarasi Das Bhanot;
2009; 479-483.
2.D. C. Dutta: Textbook of Obstetrics, 6th edition 2004:37.
3.Chauhan SP, Hendrix NW: Intrapartum oligohydramnios
does not predict adverse peripartum outcome among high
risk parturient. Am J Obstet Gynecol, 1997; 176(6):1130-
1136.
4.Jun Zhang, James Troendle: Isolated oligohydramnios is
not associated with adverse perinatal outcome. Int J
Gynaecol Obstet Mar 2004;3:220-225.
5.Everett FM, Thomas EN: Measurement of amniotic fluid
volume-Accuracy of ultrasonography technique. Am J
Obstet Gynecol 1992; 167:1533-7.
6.Casey Brian M, Donald D McIntire: Pregnancy outcomes
after antepartum diagnosis of oligohydramnios at or
beyond 34 weeks' gestation. Am J Obstet Gynecol, April
2000; 182(4): 909-912.
7.Hoskins IA, Friden FJ: Variable deceleration in reactive
non stress test with decreased amniotic fluid index
predicts fetal compromises. Am J Obstet Gynecol 1991;
165(4):1094-1098.
8.Divon MY, Marks, Henderson CE: Longitudinal
measurement of amniotic fluid index in post term
pregnancies and its association with fetal outcome. Am J
Obstet Gynecol 1995; 172:142.
9.Elliot H. Phillipson, Robert J. Sokol: Oligohydramnios
Clinical association and predictive value for intrauterine
growth retardation. Am J Obstet Gynecol 1983; 146:271.
10.Varma TR, Bateman S: Ultrasound evaluation of
amniotic fluid -outcome of pregnancies with severe
oligohydramnios. Int J Gynaecol Obstet Oct 1988;
27(2):185-92.
11.Corosu R, Moretti S: Clinical considerations on
oligohydramnios. Minerva Ginecol Jun 1999; 51(6):219-
22.
12.Golan A, Lin G : Oligohydramnios - maternal
complications and fetal outcome in 145 cases. Gynecol
Obstet Invest 1994; 37(2):91-5.
13.Mercer Lane, L.G. Brown: A survey of pregnancies
complicated by decreased amniotic fluid. Am J Obstet
Gynecol 1984; 149:355-361.
14.Desai P, Patel P, Gupta A: Decreased amniotic fluid
index in low risk pregnancy Any significance? J Obstet
Gynecol Int Sep 2004; 54(5): 464:466.
15.Locatelli A, Vergani P et al: Perinatal outcome
associated with oligohydramnios in uncomplicated term
pregnancies. Arch Gynecol Obstet 2004; 269(2):130-133.
 Bangal V B et. al. / JPBMS, 2011, 12 (05)
16.Chhabra S, Dargan R : Oligohydramnios - a potential
marker for serious obstetric complications. J Obstet
Gynecol Oct 2007; 27(7):680-3.
17.Wolff F, Schaefer R: Oligohydramnios-perinatal
complications and diseases in mother and child.
Geburtshilfe Frauenheilkd Mar.1994; 54(3):139-43.
18.Apel-Sarid L, Levy A: Placental pathologies associated
fetal growth restriction; complicated with and without
oligohydramnios. Arch Gynecol Obstet Feb 2009.
19.Chauvan SP, Nancy W. Hendrix: Perinatal outcome and
amniotic fluid index in the antepartum and intrapartum
periods A meta analysis. Am J Obstet Gynecol 1999;
181:1473.
Conflict of Interest: - None
Source of funding: - Not declared
*Corresponding Author:-
Dr. Vidyadhar B. Bangal.,
Professor and Head,
Dept. of Obstetrics and Gynaecology (OBGY),
Rural Medical College, Loni, Dist. Ahmednagar,
Maharashtra, India Pin- 413736
Contact no- (+91) 02422- 273600, 09822096723.
.
4 Journal of Pharmaceutical and Biomedical Sciences (JPBMS), Vol. 12, Issue 12
20.Sadovsky Y, Christensen MW: Cord containing amniotic
fluid pocket-a useful measurement in the management of
oligohydramnios. Obstet Gynecol Nov. 1992; 80 (5):775-7.
21.Clement D, Barry MD: Acute oligohydramnios in
postdate pregnancy. Am J Obstet Gynecol 1987; 157:884-
886.
22.Browen-Chatoor JS, Kulkarni SK: Amniotic fluid index
in the management of postdates pregnancy. West Indian
Med J Jun 1995; 44(2):64-6.
23.Chamberlin PF, Manning FA et al: Ultrasound
evaluation of amniotic fluid volume. The relationship of
marginal and decreased amniotic fluid volume to perinatal
outcome. Am J Obstet Gynecol 1984; 150:245.
Quick response code (QR- Code) for mobile user to
Assess JPBMS website electronically.