The fetus is protected in the mother’s womb for nine months by the amniotic fluid during pregnancy. But sometimes, the mother may have a condition called oligohydramnios or low amniotic fluid. This may be worrisome because this fluid protects and nurtures the baby. Although having low amniotic fluid is worrisome, good care and constant health checkups ensure the wellness of the mother and the fetus. In this post, we talk about the causes, diagnosis, risks, treatment of oligohydramnios, and also preventive measures.
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 single deepest pocket (SDP) 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 less than 5cm being less fluid and more than 25cm being excess.
Symptoms associated with Oligohydromnios:
- Leaking fluid could be a cause of oligohydromnios
- Lack of baby movements
- Fluid levels less than 5cm (or 5th percentile) on ultrasound
- Absence of fluid pockets 2-3cm in depth
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:
In certain conditions where placenta does not supply adequate blood and nutrients (placental insufficiency) like subplacental haematoma,maternal diabetes, hypertension etc. 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 (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 the amniotic 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 complication (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
- Fetal growth restriction (FGR)I
During labor, oligohydramnios can cause complications such as:
- Abnormal position such as Breech position, transverse lie 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 heart rate abnormalities, accumulation of carbon dioxide in the blood, and brain damage in the baby (11) (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:
Ultrasound is the mainstay for the diagnosis of oligohydromnios, which can be an incidental finding on a routine ultrasound or asked for by your obstetrician after a clinical suspicion of decreases liquor on clinical examination.
By doind an ultrasound, the doctor wants to know:
- Liquor volume either by measuring amniotic fluid index (AFI) or single verticle pocket (described earlier)
- Any abnormality in the baby such as any bladder, ureteral or abnormal kidneys can lead to oligohydromnios.
- To detect any placental insufficiency by using doppler (13).
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 (14).
2. 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 any leaking (15).
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 (16).
- 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 (17) (18).
- 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 (19).
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 (20).
- 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 (21)
- 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.
Frequently Asked Questions
1. How can I check my amniotic fluid at home?
- Leaking amniotic fluid may be checked at home in the following way (22):
- Empty the bladder and collect the fluid that continues to leak on a pad.
- If it is yellow, it could be urine as amniotic fluid is relatively pale and does not smell.
- Hold the pelvic floor muscle tight as in a Kegel exercise. If the fluid stops leaking, it could be urine.
2. Does caffeine affect amniotic fluid?
A study has found coffee (containing caffeine) consumption can increase amniotic fluid. Caffeine has been found to pass through the placenta into the amniotic fluid, fetal urine, and fetal plasma (23).
Low amniotic fluid can harm your baby if not taken care of immediately. This is usually diagnosed during ultrasounds and may be more severe if it occurs during the first half of pregnancy. Therefore ensure to stay up to date with your routine OB/GYN visits. Although the condition may not be preventable, drinking plenty of fluid, maintaining a healthy diet, and exercising can help reduce low amniotic fluid risk factors.
- Paolo Rosati et al.; (2015); A comparison between amniotic fluid index and the single deepest vertical pocket technique in predicting adverse outcome in prolonged pregnancy.
- Laura A. Geer et al.; (2014); Use of Amniotic Fluid for Determining Pregnancies at Risk of Preterm Birth and for Studying Diseases of Potential Environmental Etiology.
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- E F Magann et al.; (2001); Ultrasound estimate of amniotic fluid volume: color Doppler overdiagnosis of oligohydramnios.
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- Tito Silvio Patrelli et al.; (2012); Maternal hydration therapy improves the quantity of amniotic fluid and the pregnancy outcome in third-trimester isolated oligohydramnios: a controlled randomized institutional trial.
- Drinking Water Can Help Increase Amniotic Fluid.
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- Ilknur Col Madendag et al.; (2020); Effect of coffee consumption on fetal renal artery blood flow and amniotic fluid volume in third trimester of pregnancy.