Adverse Outcomes and Oligohydramnios – a Systematic Review & Meta-Analysis
In this study, Rabie et al. (Ultrasound in Obstetrics and Gynecology, 2017) analyze adverse pregnancy outcomes in the presence of oligohydramnios.
Systematic Review and Meta-Analysis
Oligohydramnios was diagnosed using an AFI of > 5.0 cm. Both low-risk (no pregnancy comorbidity) and high-risk (co morbidities such as chronic hypertension) were included. Studies that included causative fetal anomalies such as bladder outlet obstruction or preterm PROM were excluded. 15 trials were included, nine high-risk pregnancies (total 8,067 women) and six low-risk pregnancies (total 27,526 women). Low-risk (isolated) oligohydramnios was associated with significantly higher rates of infants with meconium aspiration syndrome (relative risk 2.83; 95% CI 1.38-5.77), C-section for fetal distress (relative risk 2.16; 95% CI 1.64-2.85) and admission to the NICU (relative risk 1.71; 95% CI 1.20-2.42). Patients with hi-risk (presence of comorbidities) oligohydramnios had a significantly higher risk of a low birth weight infant (relative risk 2.35; 95% CI, 1.27-4.34). The authors suggest that there is no conclusive evidence that early delivery for isolated oligohydramnios may improve stillbirth rates. They suggest that close monitoring, hydration and prolongation of pregnancy to 38-39 weeks may be an acceptable management plan. Furthermore, a contraction stress test on admission for induction may help identify patients that should perhaps undergo a non-urgent C-section. As for hi-risk pregnancies, the only major adverse event was that of low birth weight, likely related to the underlying comorbidity. Therefore, patient management should be guided by the underlying comorbidity rather than the presence of oligohydramnios.
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