- What is oligohydramnios and how to identify it?
- What causes low amniotic fluid?
- What are the risks of low amniotic fluid?
- How to diagnose oligohydramnios?
- How to increase amniotic fluid during pregnancy?
- How to prevent oligohydramnios?
The mother’s womb not only nurtures but also protects the baby for nine months. The amniotic fluid is one of the most important shields of protection as it prevents the baby from feeling any pressure, and cushions them too.
But what happens if the mother suffers from oligohydramnios or low amniotic fluid levels? While the condition is worrisome, MomJunction guides you in ensuring that your baby is safe and well protected. Read on to know more about the condition, causes, and preventive measures for oligohydramnios.
What Is Oligohydramnios And How To Identify It?
Oligohydramnios is a condition of having lower than normal amniotic fluid levels. While you may not know that you have low amniotic levels, the doctor may notice it during the periodic pregnancy scans.
Your OB/GYN, then, uses ultrasound waves to estimate the amniotic fluid volume. Two of the most used measurements are the amniotic fluid index (AFI) and deep pocket measurements (1).
The uterus is divided into four quadrants, and the fluid is measured in each quadrant. The measurements are then added to check the total amount of fluid in the uterus. The AFI rates the fluid in centimeters with 5cm being too little fluid and 25cm being excess.
If the doctor finds the following signs and symptoms along with certain measurements, it is diagnosed as oligohydramnios.
- Leaking fluid
- Lack of baby movements
- Fluid levels less than 5cm (or 5th percentile)
- Absence of fluid pockets 2-3cm in depth
- Fluid volume less than 500ml around 32 to 36 weeks of pregnancy
According to the March of Dimes, about 4% pregnant women are diagnosed with low amniotic fluid levels in the last trimester (2). So, what causes this condition?
What Causes Low Amniotic Fluid?
In most cases, doctors don’t know the exact cause of oligohydramnios. However, the speculated reasons include:
1. Leaking or rupture of membranes:
A small tear in the amniotic membrane at any point of pregnancy leads to fluid leakage. This is especially common as you near delivery. This condition can also increase the risk of infection in both the mom and baby as it offers a way for the bacteria to enter through the ruptured membrane. Only in extremely rare conditions does the tear heal on its own (3).
2. Placental problems:
If you have a condition such as partial abruption that prevents the placenta from supplying adequate blood and nutrients, you may develop oligohydramnios. In this case, the placenta is unable to take out the urine and wastes produced by the baby.
If the doctor diagnoses a problem in your placenta, yours and your baby’s health will be monitored and you will have to undergo regular scans to check the amniotic fluid levels (4).
3. Maternal complications:
Certain conditions such as maternal dehydration, pre-eclampsia, diabetes, lupus, and chronic hypoxia can affect amniotic fluid levels (5).
4. Carrying twins or multiples:
You are at a high risk of low fluid levels if you are carrying more than one fetus. Oligohydramnios is more likely to occur in case of twin-to-twin transfusion syndrome (TTTS), as the multiple fetuses share a common placenta (6).
5. Fetal abnormalities:
If you are diagnosed with low amniotic fluid levels in the first or second trimester, it means your baby could have kidneys or urinary system problems. If either of them is not developed properly, your baby will not be able to produce enough urine to maintain the amniotic fluid levels (7).
6. Certain medications:
Some medications, such as Ibuprofen and ACE inhibitors for high blood pressure, affect theamniotic fluid levels, causing them to drop. If you are pregnant, the doctor will not prescribe these medications, as they are likely to cause oligohydramnios. Ensure that you run all your medications through your doctor before taking them (8).
[ Read: Ibuprofen During Pregnancy ]
7. Pregnancy past due date:
In case your pregnancy exceeds your due date by two weeks or more, the amniotic fluid levels decrease to half. Around, 12 in 100 pregnancies face this complications (9).
As low amniotic fluid levels are detected only in ultrasound scans, you must go for your check-ups regularly. Oligohydramnios comes with associated risks.
What Are The Risks Of Low Amniotic Fluid?
The risk factors of amniotic fluid depend on:
- Gestation stage
- Deficit of fluid
- Cause of the condition
Low amniotic fluid affects the baby in various ways and at different stages.
So, during the first half of pregnancy, oligohydramnios can cause complications such as (10):
- Compression of fetal organs, resulting in birth defects
- Miscarriage – where the fetus dies within 20 weeks of pregnancy
- Stillbirth – where a baby dies 20 weeks after conception
- Premature birth – where a baby is born before 37 weeks of pregnancy
During the second half of pregnancy, oligohydramnios can cause severe complications such as:
- Preterm birth
- Slow baby growth
- Intrauterine growth restriction (IUGR) (11)
During labor, oligohydramnios can cause complications such as:
- Breech position of the baby – the insufficient levels of amniotic fluids restrict the baby’s movements
- The baby gets distressed releasing meconium (first motion), which when inhaled by the baby can lead to breathing problems in the baby
- Compression of umbilical cord leads to decreased heart rate, accumulation of carbon dioxide in the blood, and brain damage in the baby (12).
These risks can be mitigated if amniotic fluid levels are constantly monitored.
How To Diagnose Oligohydramnios?
The doctor will inquire about your health and any chronic problems. Also, you need to undergo some diagnostic tests to check for fetal abnormalities. Some of them are:
The scans allow the doctor to see you baby’s bladder and kidneys to rule out the possibility of ureteral obstruction, renal agenesis, and cystic dysplasia. Your doctor may also use Doppler ultrasound as it helps identify placental insufficiency (13).
[ Read: Ultrasound During Pregnancy ]
2. Amniotic fluid index (AFI):
AFI helps your doctor measure the volume of amniotic fluid in your uterus, and is the most commonly used test. Typically, it involves ultrasonography, which is a safe and reliable method for measuring the volume. The procedure helps the doctor measure the single deepest pocket of amniotic fluid to get a final reading of the volume.
This test requires you to lie flat on your back as the doctor runs the ultrasound transducer over your belly. Only an experienced doctor can perform this test as it is complex. Excessive pressure on the abdomen may result in a low measurement of the fluid and if the transducer is not held perpendicular to the floor, the measure will artificially increase (14).
3. Sterile speculum examination:
As mentioned earlier, you can develop oligohydramnios in case of a tear in the amniotic sac membranes. Your doctor may perform sterile speculum examination to check for cervical motion (15).
4. Maximum vertical pocket:
This diagnostic test lets the doctor check for amniotic fluid levels in the deepest part of the uterus. The doctor uses ultrasound to monitor the parts that are free of fetal parts and umbilical cord.
5. Blood test:
Blood tests can also give doctors an idea of low amniotic fluid. Tests such as maternal serum screening detect low amniotic fluid levels and indicate whether your baby has congenital problems such as spina bifida and Down’s syndrome (16).
6. Checking for amniotic wrinkle:
Amniotic wrinkle is when the intertwined amniotic membrane folds, resulting in reduced amniotic fluid for one of the twins. Sometimes, the wrinkle may manifest in the form of a cocoon or intrauterine sling. Here, one twin stays suspended in the amniotic space of the other twin, causing the suspended baby to have less fluid (17).
Depending on your situation, the doctor suggests the required treatment for the problem.
[ Read: Water Break During Pregnancy ]
How To Increase Amniotic Fluid During Pregnancy?
The treatment of low amniotic fluid levels depends on the gestational age.
If you are close to full term, you do not require any treatment. In such cases, your doctor checks for the fetal heart rate, lung development, and baby movements. And, delivery is the most appropriate management option at this stage.
If you are not close to delivery, then the doctor suggests other methods.
Medical Treatment And Management:
If you are not full term, you may require the following treatments.
- Amnioinfusion: It involves infusing sodium chloride solution into the amniotic sac through an intrauterine catheter. This maintains ideal amniotic fluid levels and lowers the chances of cesarean section (18).
- Vesico-amniotic shunt: If your baby has obstructive uropathy that is resulting in low levels of amniotic fluid, the doctor will divert your baby’s urine using vesico-amniotic shunts. This can effectively manage your low levels, but the shunts do not ensure a proper functioning of your baby’s lungs and kidneys (19).
- Fluid injections: Shots are given using amniocentesis before delivery. Though the conditions tend to revert within a few days of the injection, it allows your doctor to understand your baby’s anatomy better. This ensures that if you suffer from low levels in future, the doctors would know how to manage it (20).
- Maternal hydration: IV and oral fluids rehydrate the mother’s body to increase the amniotic fluid levels. So don’t be surprised if your doctor tells you to drink lots of water. This rehydration works well in cases of mild oligohydramnios (21).
Along with the medications, you can also indulge in a few homecare tips.
Home Remedies To Increase Amniotic fluid
It is imperative to bring back the lost fluid levels in your body. There are some natural measures to increase amniotic fluid.
- Drink more water: Have at least eight to ten glasses of water every day. This is the simplest measure to improve amniotic fluid levels. As you increase the water content in your body, the amniotic levels will also rise (22).
- Have foods with high water content: – Eat fruits and vegetables that have high water concentration.
- Add fruits such as watermelon (91.5%), strawberries (91.0%), cantaloupe (90.2%), grapefruit (90.5%), star fruit (91.4%) and tomatoes (94.5%)
- Vegetables, including cucumber (96.7%), celery (95.4%), green peppers (93.9%), iceberg lettuce (95.6%), radishes (95.3%), cauliflower (92.1%), baby carrots (90.4%), broccoli (90.7%) and spinach (91.4%), help increase water levels in the body.
- Lie on to the left side when relaxing: If you are asked to take complete bed rest, lie on to your left whenever possible. This way, the blood flows smoothly along the uterine blood vessels and allows the fetal blood to flow at a regular rate. It, therefore, causes a rise in the amniotic fluid index (23).
[ Read: Safe Sleeping Positions While Pregnant ]
- Indulge in light exercises: You can try non-weight bearing exercises every day as they stimulate the blood flow to all parts of the body. As the blood circulation increases in the uterus and placental regions, the amniotic fluid index fetal urine rate also increases. Walking, light hiking, swimming, and water aerobics are the best exercises you can take up. But, do ask your doctor if you can exercise.
How To Prevent Oligohydramnios?
Prevention is unlikely in some cases, but you can still lower the chances of developing the condition by following certain measures as given below:
- Abstain from smoking and consuming alcohol.
- Speak to your doctor before you take any medication – vitamin or herbal supplements. Herbal supplements (such as dandelion extract, celery seed, watercress, and parsley) can dehydrate you.
- Maintain a healthy diet. Check with a nutritionist to create a diet plan for you, especially if you are diabetic.
- Stick to your prenatal checkups so that your doctor can detect problems or fetal abnormalities early and take appropriate measures.
Low amniotic fluid will make it difficult for the fetus to have a healthy growth. While you cannot do much about it, you may take care of your health, have fluids and follow the instructions given by your doctor. Regular check-ups and utmost care may help you wade through the problem.
Have an experience to share? Let us know in the comment section.
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