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Severe midtrimester oligohydramnios: treatment strategies

Kozinszky, Zoltana; Sikovanyecz, Jánosb; Pásztor, Norbertb

Current Opinion in Obstetrics & Gynecology: April 2014 - Volume 26 - Issue 2 - p 67–76
doi: 10.1097/GCO.0000000000000051
MATERNAL-FETAL MEDICINE: Edited by James F. Smith Jr

Purpose of review: Nearly 1% of pregnancies are affected by some type of midtrimester oligohydramnios. Evidence is currently accumulating that suggests the better efficacy of the new therapeutic procedures relative to conventional management. This review summarizes the available evidence.

Recent findings: The prolongation of the period between the diagnosis of oligohydramnios and delivery following amnioinfusion and amniopatch techniques appears to be strongly associated with the gestational age and whether the situation was based on rupture of the membranes or not. Case series reveal that amnioinfusion significantly improves the perinatal outcome and prolongs the pregnancy in severe second-trimester oligohydramnios in both idiopathic cases and those involving rupture of the amniotic membranes [preterm prelabor rupture of the membranes (PPROM)]. There is clear evidence of a lower frequency of perinatal complications and successfully prolonged gestation in iatrogenic PPROM after the amniopatch technique relative to population controls.

Summary: Identification of potentially modifiable risk factors for the successful prolongation of pregnancy complicated with midtrimester oligohydramnios, and previable PPROM is needed for the improvement of treatment strategies and prognosis. Randomized trials are needed to determine whether amniotic fluid-replenishing strategies can improve pregnancy outcomes.

aDepartment of Obstetrics and Gynecology, Blekinge Hospital, Karlskrona, Sweden

bDepartment of Obstetrics and Gynecology, Faculty of Medicine, Albert Szent-Györgyi Medical and Pharmaceutical Center, University of Szeged, Szeged, Hungary

Correspondence to Zoltan Kozinszky, MD, PhD, Utövägen 10/A, Karlskrona 37137, Sweden. Tel: +46 0730720835; e-mail: kozinszky@gmail.com

© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins