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Figueroa L, McClure EM, Swanson J, Nathan R, Garces AL, Moore JL, Krebs NF, Hambidge KM, Bauserman M, Lokangaka A, Tshefu A, Mirza W, Saleem S, Naqvi F, Carlo WA, Chomba E, Liechty EA, Esamai F, Swanson D, Bose CL, Goldenberg RL. Oligohydramnios: a prospective study of fetal, neonatal and maternal outcomes in low-middle income countries. Reprod Health 2020; 17:19. [PMID: 32000798 PMCID: PMC6993413 DOI: 10.1186/s12978-020-0854-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Accepted: 01/06/2020] [Indexed: 11/25/2022] Open
Abstract
Background Oligohydramnios is a condition of abnormally low amniotic fluid volume that has been associated with poor pregnancy outcomes. To date, the prevalence of this condition and its outcomes has not been well described in low and low-middle income countries (LMIC) where ultrasound use to diagnose this condition in pregnancy is limited. As part of a prospective trial of ultrasound at antenatal care in LMICs, we sought to evaluate the incidence of and the adverse maternal, fetal and neonatal outcomes associated with oligohydramnios. Methods We included data in this report from all pregnant women in community settings in Guatemala, Pakistan, Zambia and the Democratic Republic of Congo (DRC) who received a third trimester ultrasound as part of the First Look Study, a randomized trial to assess the value of ultrasound at antenatal care. Using these data, we conducted a planned secondary analysis to compare pregnancy outcomes of women with to those without oligohydramnios. Oligohydramnios was defined as measurement of an Amniotic Fluid Index less than 5 cm in at least one ultrasound in the third trimester. The outcomes assessed included maternal morbidity and fetal and neonatal mortality, preterm birth and low-birthweight. We used pairwise site comparisons with Tukey-Kramer adjustment and multivariable logistic models using general estimating equations to account for the correlation of outcomes within cluster. Results Of 12,940 women enrolled in the clusters in Guatemala, Pakistan, Zambia and the DRC in the First Look Study who had a third trimester ultrasound examination, 87 women were diagnosed with oligohydramnios, equivalent to 0.7% of those studied. Prevalence of detected oligohydramnios varied among study sites; from the lowest of 0.2% in Zambia and the DRC to the highest of 1.5% in Pakistan. Women diagnosed with oligohydramnios had higher rates of hemorrhage, fetal malposition, and cesarean delivery than women without oligohydramnios. We also found unfavorable fetal and neonatal outcomes associated with oligohydramnios including stillbirths (OR 5.16, 95%CI 2.07, 12.85), neonatal deaths < 28 days (OR 3.18, 95% CI 1.18, 8.57), low birth weight (OR 2.10, 95% CI 1.44, 3.07) and preterm births (OR 2.73, 95%CI 1.76, 4.23). The mean birth weight was 162 g less (95% CI -288.6, − 35.9) with oligohydramnios. Conclusions Oligohydramnos was associated with worse neonatal, fetal and maternal outcomes in LMIC. Further research is needed to assess effective interventions to diagnose and ultimately to reduce poor outcomes in these settings. Trial registration NCT01990625.
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Affiliation(s)
- Lester Figueroa
- Instituto de Nutrición de Centro América y Panamá (INCAP), Guatemala City, Guatemala
| | - Elizabeth M McClure
- Social Statistical and Environmental Health Sciences, RTI International, Durham, NC, USA.
| | - Jonathan Swanson
- Department of Radiology, University of Washington Medical Center, Seattle, WA, USA
| | - Robert Nathan
- Department of Radiology, University of Washington Medical Center, Seattle, WA, USA
| | - Ana L Garces
- Instituto de Nutrición de Centro América y Panamá (INCAP), Guatemala City, Guatemala
| | - Janet L Moore
- Social Statistical and Environmental Health Sciences, RTI International, Durham, NC, USA
| | - Nancy F Krebs
- Department of Pediatrics, University of Colorado, Denver, CO, USA
| | | | - Melissa Bauserman
- Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Adrien Lokangaka
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo
| | - Antoinette Tshefu
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo
| | - Waseem Mirza
- Department of Radiology, Aga Khan University, Karachi, Pakistan
| | - Sarah Saleem
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Farnaz Naqvi
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Waldemar A Carlo
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Elwyn Chomba
- Department of Pediatrics, University of Zambia, Lusaka, Zambia
| | - Edward A Liechty
- Department of Pediatrics, Indiana University, Indianapolis, IN, USA
| | | | - David Swanson
- Department of Radiology, Harborview Medical Center, University of Washington Medical Center, Seattle, WA, USA
| | - Carl L Bose
- Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC, USA
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Makimoto F, Watanabe K, Ushiroyama T, Akiyama J, Tsuji K, Tsuji K, Yoshikawa T, Nishioka Y, Endo T. The therapeutic effect of goreisan to oligohydramnios — Gorei-San increase the single deepest pocket in oligohydramnios —. HYPERTENSION RESEARCH IN PREGNANCY 2016. [DOI: 10.14390/jsshp.hrp2015-013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Fukashi Makimoto
- Department of Obstetrics and Gynecology, Akiyama Memorial Hospital
| | - Kazushi Watanabe
- Perinatal and Neonatal Medical Center, Aichi Medical University School of Medicine
| | - Takahisa Ushiroyama
- Endowment Department of Mibyou Science and Medicine of Salutogenesis, Health Science Clinic, Osaka Medical College
| | - Jitsuo Akiyama
- Department of Obstetrics and Gynecology, Akiyama Memorial Hospital
| | - Kazuhiko Tsuji
- Department of Obstetrics and Gynecology, Akiyama Memorial Hospital
| | - Kayo Tsuji
- Department of Obstetrics and Gynecology, Akiyama Memorial Hospital
| | - Toru Yoshikawa
- Department of Obstetrics and Gynecology, Akiyama Memorial Hospital
| | | | - Toshiaki Endo
- Department of Obstetrics and Gynecology, Sapporo Medical University, School of Medicine
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Dad N, Abushama M, Konje JC, Ahmed B. What is the role of amnioinfusion in modern day obstetrics? J Matern Fetal Neonatal Med 2015; 29:2823-7. [PMID: 26461043 DOI: 10.3109/14767058.2015.1105953] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Amniotic fluid (AF) is a dynamic medium that plays a significant role in fetal well-being. It is production and amount varies with gestational age. It plays a vital role in fetal life as it contains antimicrobial factors, growth factors and it help the fetal lung to grow and expand. Amnioinfusion can be performed either transabdominally or transvaginal. Amnioinfuion can be done antenatally and during labor. Aminoinfusion can be used for diagnostic purposes to enable better visualization of the fetus as liquor is very important acoustic widow for better fetal examination. Amnioinfusion have some therapeutic benefits in conditions like early premature rupture of membrane and may help cases of external cephalic version for breech presentation at term. Amnioinfusion has been shown to reduce the incidence of variable deceleration due to cord compression, reduces the risk of meconium aspiration and it will help reduce cesarean delivery.
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Affiliation(s)
- Nimra Dad
- a Weill Cornell Medical College Qatar , Ar-Rayyan , Qatar
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