![]() ![]() ![]() Fig 2 - Ultrasound image of normal fetal kidney. Perform a speculum examination (can a 'pool' of liquor be seen in the vagina?).Viral infections (although may also cause polyhydramnios).Renal agenesis (known as Potter's syndrome).Placental insufficiency - resulting in the blood flow being redistributed to the fetal brain rather than the abdomen and kidneys.It gets processed, fills the bladder and is voided, and the cycle repeats. Problems with any of the structures in this pathway can lead to either too much or too little fluid.Īnything that reduces the production of urine, blocks output from the fetus, or a rupture of the membranes (allowing amniotic fluid to leak) can lead to oligohydramnios. The fetus breathes and swallows the amniotic fluid. It is predominantly comprised of the fetal urine output, with small contributions from the placenta and some fetal secretions (e.g. It plateaus from 33-38 weeks, and then declines - with the volume of amniotic fluid at term approximately 500ml. The volume of amniotic fluid increases steadily until 33 weeks of gestation. Polyhydramnios is over the 95th centile, oligohydramnios is below the 5th centile Pathophysiology Fig 1 - Amniotic fluid centiles during pregnancy. These proteins are found in amniotic fluid, and if detected, strongly suggest membrane rupture. ![]() When considering ruptured membranesas a cause for oligohydramnios, a bedside test can be performed to detect the presence of IGFBP-1 (insulin-like growth factor binding protein-1) or PAMG-1 (placental alpha-microglobulin-1) in the vagina. Karyotyping (if appropriate) – particularly in cases of early and unexplained oligohydramnios.Small babies can result from placental insufficiency, which also causes oligohydramnios. There may also be a rise in pulsatility index of the umbilical artery Doppler in placental insufficiency. Assess for liquor volume, structural abnormalities, renal agenesis and obstructive uropathy.Perform a speculum examination (can a ‘pool’ of liquor be seen in the vagina?).Inquire about symptoms of leaking fluid and feeling damp all the time (often described as new urinary incontinence).Therefore, the clinical assessment of the patient is directed at establishing any underlying cause: Oligohydramnios is a diagnosis made via ultrasound examination. ![]()
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