![]() The authors included 4 studies and concluded that in term and postterm pregnancies, IO was associated with an increased risk of obstetrical interventions but not with adverse neonatal outcome. Fourteen years later, in 2013, Rossi and Prefumo published a systematic review and MA focusing on perinatal outcomes of IO. The authors confirmed oligohydramnios to be associated with a significant increase in the risk of Cesarean delivery for fetal distress (risk ratio 2.2) and a low 5-min Apgar score (risk ratio 5.2). performed a meta-analysis (MA) evaluating the association between AFI and adverse perinatal outcome. Therefore, the question is whether the observed associated adverse perinatal outcome reflects the sequelae of these comorbidities, the medical management, or whether they are a direct result of the reduced AF volume (AFV) itself. However, original reports elucidating the association between oligohydramnios and adverse perinatal outcome included fetuses with structural anomalies, growth restriction and postmaturity syndrome, as well as mothers with various underlying medical conditions, and, thus, may not apply in cases of IO. ![]() Therefore, recommendations for labor induction at term have evolved in an attempt to reduce the incidence of these adverse outcomes. It is well established that oligohydramnios is associated with an increased incidence of adverse perinatal outcome, possibly as a result of umbilical cord compression, an associated utero-placental insufficiency, and/or meconium-stained AF (MSAF). When IO is diagnosed at term (>37 complete weeks of gestation), it is commonly considered a solid indication for labor induction. The incidence of IO ranges from 0.5 to 5% depending on the definition used and the population studied. Isolated oligohydramnios (IO) refers to the presence of oligohydramnios without fetal structural and chromosomal abnormalities, without fetal growth restriction, without intrauterine infection, and in the absence of known maternal disease. Hence, the identification of oligohydramnios usually mandates close fetal surveillance. It is considered a risk factor for adverse fetal outcome, as well as an indicator of the possible presence of maternal and/or fetal comorbidities. ![]() Oligohydramnios is most commonly defined as an amniotic fluid index (AFI) ≤5 cm or the largest vertical pocket measuring ≤2 cm. Conclusion: Isolated oligohydramnios at term is associated with significantly higher rates of labor induction, Cesarean sections, and short-term neonatal morbidity. In the single randomized trial comparing induction of labor with expectant management, no differences were found in any significant maternal or neonatal outcomes. There were no significant differences in cord pH <7.1 and meconium-stained amniotic fluid. There were higher rates of an Apgar score <7 at 1 and 5 min (OR 1.53, CI 1.03-2.26, and OR 2.01, CI 1.3-3.09, respectively) and admission to the neonatal intensive care unit (OR 1.47, CI 1.17-1.84). Patients with isolated oligohydramnios had significantly higher rates of labor induction and Cesarean sections (OR 2.07, CI 1.77-2.41). Results: Twelve studies were included with 35,999 women: 2,414 (6.7%) with isolated oligohydramnios and 33,585 (93.29%) with normal amniotic fluid index. Each outcome was analyzed separately, performing a comparative analysis between the study and control groups. We included studies that evaluated isolated oligohydramnios at term and perinatal outcome. Study Design: We searched databases from inception to May 2015. ![]() Objective: To investigate whether isolated oligohydramnios at term is associated with increased rates of perinatal morbidity and mortality and whether induction of labor in term pregnancies with isolated oligohydramnios is superior to conservative management in reducing perinatal morbidity and mortality.
0 Comments
Leave a Reply. |