- Ron Beloosesky, MD
Ron Beloosesky, MD
- Assistant Professor, Obstetrics and Gynecology Department
- Rambam Medical Center at the Technion Faculty of Medicine, Haifa, Israel
- Michael G Ross, MD, MPH
Michael G Ross, MD, MPH
- Distinguished Professor of Obstetrics and Gynecology
- David Geffen School of Medicine at UCLA
- Section Editors
- Charles J Lockwood, MD, MHCM
Charles J Lockwood, MD, MHCM
- Section Editor — Obstetrics
- Senior Vice President, USF Health
- Dean, Morsani College of Medicine
- Professor, Obstetrics and Gynecology
- University of South Florida
- Deborah Levine, MD
Deborah Levine, MD
- Section Editor — Imaging
- Professor of Radiology
- Director of Ob/Gyn Ultrasound
- Department of Radiology
- Beth Israel Deaconess Medical Center
Oligohydramnios refers to amniotic fluid volume that is less than expected for gestational age. It is typically diagnosed by ultrasound examination and may be described qualitatively (eg, normal, reduced) or quantitatively (eg, amniotic fluid index [AFI] ≤5). Methods of amniotic fluid volume assessment are reviewed separately. (See "Assessment of amniotic fluid volume".)
An adequate volume of amniotic fluid is critical to allow normal fetal movement and growth, and to cushion the fetus and umbilical cord. Oligohydramnios may inhibit these processes and can lead to fetal deformation, umbilical cord compression, and death.
Reported rates of oligohydramnios are influenced by variations in diagnostic criteria, the population studied (low or high risk, screening or indicated ultrasound examination), the threshold used, and the gestational age at the time of the ultrasound examination (preterm, term, or postterm).
A study of 3050 uncomplicated pregnancies with singleton non-anomalous fetuses between 40 and 41.6 weeks of gestation noted oligohydramnios (defined as AFI ≤5 cm) in 11 percent . The incidence is high in laboring women, largely due to rupture of fetal membranes during or just before labor [2-4].
The volume of amniotic fluid is ultimately determined by the volume of fluid flowing into and out of the amniotic sac. Fetal urination, lung fluid, and swallowing all make important contributions to fluid movement in late gestation, with minimal contributions from other sources. Fetal disorders that affect any of these processes will affect the amniotic fluid volume. As an example, growth restricted fetuses may redistribute blood flow away from their kidneys, which decreases fetal urine production, resulting in oligohydramnios .
- Locatelli A, Zagarella A, Toso L, et al. Serial assessment of amniotic fluid index in uncomplicated term pregnancies: prognostic value of amniotic fluid reduction. J Matern Fetal Neonatal Med 2004; 15:233.
- Rutherford SE, Phelan JP, Smith CV, Jacobs N. The four-quadrant assessment of amniotic fluid volume: an adjunct to antepartum fetal heart rate testing. Obstet Gynecol 1987; 70:353.
- Sarno AP Jr, Ahn MO, Brar HS, et al. Intrapartum Doppler velocimetry, amniotic fluid volume, and fetal heart rate as predictors of subsequent fetal distress. I. An initial report. Am J Obstet Gynecol 1989; 161:1508.
- Mercer LJ, Brown LG, Petres RE, Messer RH. A survey of pregnancies complicated by decreased amniotic fluid. Am J Obstet Gynecol 1984; 149:355.
- Yoshimura S, Masuzaki H, Gotoh H, Ishimaru T. Fetal redistribution of blood flow and amniotic fluid volume in growth-retarded fetuses. Early Hum Dev 1997; 47:297.
- Underwood MA, Gilbert WM, Sherman MP. Amniotic fluid: not just fetal urine anymore. J Perinatol 2005; 25:341.
- Bromley B, Harlow BL, Laboda LA, Benacerraf BR. Small sac size in the first trimester: a predictor of poor fetal outcome. Radiology 1991; 178:375.
- Tadmor OP, Achiron R, Rabinowiz R, et al. Predicting first-trimester spontaneous abortion. Ratio of mean sac diameter to crown-rump length compared to embryonic heart rate. J Reprod Med 1994; 39:459.
- Nazari A, Check JH, Epstein RH, et al. Relationship of small-for-dates sac size to crown-rump length and spontaneous abortion in patients with a known date of ovulation. Obstet Gynecol 1991; 78:369.
- Dickey RP, Olar TT, Taylor SN, et al. Relationship of small gestational sac-crown-rump length differences to abortion and abortus karyotypes. Obstet Gynecol 1992; 79:554.
- Rowling SE, Coleman BG, Langer JE, et al. First-trimester US parameters of failed pregnancy. Radiology 1997; 203:211.
- Shipp TD, Bromley B, Pauker S, et al. Outcome of singleton pregnancies with severe oligohydramnios in the second and third trimesters. Ultrasound Obstet Gynecol 1996; 7:108.
- Dyer SN, Burton BK, Nelson LH. Elevated maternal serum alpha-fetoprotein levels and oligohydramnios: poor prognosis for pregnancy outcome. Am J Obstet Gynecol 1987; 157:336.
- Richards DS, Seeds JW, Katz VL, et al. Elevated maternal serum alpha-fetoprotein with oligohydramnios: ultrasound evaluation and outcome. Obstet Gynecol 1988; 72:337.
- Koontz WL, Seeds JW, Adams NJ, et al. Elevated maternal serum alpha-fetoprotein, second-trimester oligohydramnios, and pregnancy outcome. Obstet Gynecol 1983; 62:301.
- Los FJ, Hagenaars AM, Cohen-Overbeek TE, Quartero HW. Maternal serum markers in second-trimester oligohydramnios. Prenat Diagn 1994; 14:565.
- Peipert JF, Donnenfeld AE. Oligohydramnios: a review. Obstet Gynecol Surv 1991; 46:325.
- Los FJ, Beekhuis JR, Marrink J, et al. Origin of raised maternal serum alpha-fetoprotein levels in second-trimester oligohydramnios. Prenat Diagn 1992; 12:39.
- Bronshtein M, Blumenfeld Z. First- and early second-trimester oligohydramnios-a predictor of poor fetal outcome except in iatrogenic oligohydramnios post chorionic villus biopsy. Ultrasound Obstet Gynecol 1991; 1:245.
- Cheng EY, Luthy DA, Hickok DE, et al. Transcervical chorionic villus sampling and midtrimester oligohydramnios. Am J Obstet Gynecol 1991; 165:1063.
- Feldman I, Friger M, Wiznitzer A, et al. Is oligohydramnios more common during the summer season? Arch Gynecol Obstet 2009; 280:3.
- Zhu XQ, Jiang SS, Zhu XJ, et al. Expression of aquaporin 1 and aquaporin 3 in fetal membranes and placenta in human term pregnancies with oligohydramnios. Placenta 2009; 30:670.
- Magann EF, Perry KG Jr, Chauhan SP, et al. The accuracy of ultrasound evaluation of amniotic fluid volume in singleton pregnancies: the effect of operator experience and ultrasound interpretative technique. J Clin Ultrasound 1997; 25:249.
- Chauhan SP, Magann EF, Morrison JC, et al. Ultrasonographic assessment of amniotic fluid does not reflect actual amniotic fluid volume. Am J Obstet Gynecol 1997; 177:291.
- Dildy GA 3rd, Lira N, Moise KJ Jr, et al. Amniotic fluid volume assessment: comparison of ultrasonographic estimates versus direct measurements with a dye-dilution technique in human pregnancy. Am J Obstet Gynecol 1992; 167:986.
- Magann EF, Nolan TE, Hess LW, et al. Measurement of amniotic fluid volume: accuracy of ultrasonography techniques. Am J Obstet Gynecol 1992; 167:1533.
- Magann EF, Nevils BG, Chauhan SP, et al. Low amniotic fluid volume is poorly identified in singleton and twin pregnancies using the 2 x 2 cm pocket technique of the biophysical profile. South Med J 1999; 92:802.
- Rutherford SE, Smith CV, Phelan JP, et al. Four-quadrant assessment of amniotic fluid volume. Interobserver and intraobserver variation. J Reprod Med 1987; 32:587.
- Zaretsky MV, McIntire DD, Reichel TF, Twickler DM. Correlation of measured amnionic fluid volume to sonographic and magnetic resonance predictions. Am J Obstet Gynecol 2004; 191:2148.
- Moore TR, Cayle JE. The amniotic fluid index in normal human pregnancy. Am J Obstet Gynecol 1990; 162:1168.
- Mabie WC, Gonzalez AR, Sibai BM, Amon E. A comparative trial of labetalol and hydralazine in the acute management of severe hypertension complicating pregnancy. Obstet Gynecol 1987; 70:328.
- Phelan JP, Ahn MO, Smith CV, et al. Amniotic fluid index measurements during pregnancy. J Reprod Med 1987; 32:601.
- Crowley P, O'Herlihy C, Boylan P. The value of ultrasound measurement of amniotic fluid volume in the management of prolonged pregnancies. Br J Obstet Gynaecol 1984; 91:444.
- Kehl S, Schelkle A, Thomas A, et al. Single deepest vertical pocket or amniotic fluid index as evaluation test for predicting adverse pregnancy outcome (SAFE trial): a multicenter, open-label, randomized controlled trial. Ultrasound Obstet Gynecol 2016; 47:674.
- Magann EF, Doherty DA, Ennen CS, et al. The ultrasound estimation of amniotic fluid volume in diamniotic twin pregnancies and prediction of peripartum outcomes. Am J Obstet Gynecol 2007; 196:570.e1.
- Reddy UM, Abuhamad AZ, Levine D, et al. Fetal imaging: executive summary of a joint Eunice Kennedy Shriver National Institute of Child Health and Human Development, Society for Maternal-Fetal Medicine, American Institute of Ultrasound in Medicine, American College of Obstetricians and Gynecologists, American College of Radiology, Society for Pediatric Radiology, and Society of Radiologists in Ultrasound Fetal Imaging workshop. Obstet Gynecol 2014; 123:1070.
- Aladangady N, Leung T, Costeloe K, Delpy D. Measuring circulating blood volume in newborn infants using pulse dye densitometry and indocyanine green. Paediatr Anaesth 2008; 18:865.
- Kusaka T, Okubo K, Nagano K, et al. Cerebral distribution of cardiac output in newborn infants. Arch Dis Child Fetal Neonatal Ed 2005; 90:F77.
- Leung TS, Aladangady N, Elwell CE, et al. A new method for the measurement of cerebral blood volume and total circulating blood volume using near infrared spatially resolved spectroscopy and indocyanine green: application and validation in neonates. Pediatr Res 2004; 55:134.
- Pryde PG, Hallak M, Lauria MR, et al. Severe oligohydramnios with intact membranes: an indication for diagnostic amnioinfusion. Fetal Diagn Ther 2000; 15:46.
- Fisk NM, Ronderos-Dumit D, Soliani A, et al. Diagnostic and therapeutic transabdominal amnioinfusion in oligohydramnios. Obstet Gynecol 1991; 78:270.
- Vikraman SK, Chandra V, Balakrishnan B, et al. Impact of antepartum diagnostic amnioinfusion on targeted ultrasound imaging of pregnancies presenting with severe oligo- and anhydramnios: An analysis of 61 cases. Eur J Obstet Gynecol Reprod Biol 2017; 212:96.
- Turhan NO, Atacan N. Antepartum prophylactic transabdominal amnioinfusion in preterm pregnancies complicated by oligohydramnios. Int J Gynaecol Obstet 2002; 76:15.
- Locatelli A, Ghidini A, Verderio M, et al. Predictors of perinatal survival in a cohort of pregnancies with severe oligohydramnios due to premature rupture of membranes at <26 weeks managed with serial amnioinfusions. Eur J Obstet Gynecol Reprod Biol 2006; 128:97.
- Nicksa GA, Yu DC, Kalish BT, et al. Serial amnioinfusions prevent fetal pulmonary hypoplasia in a large animal model of oligohydramnios. J Pediatr Surg 2011; 46:67.
- Gizzo S, Noventa M, Vitagliano A, et al. An Update on Maternal Hydration Strategies for Amniotic Fluid Improvement in Isolated Oligohydramnios and Normohydramnios: Evidence from a Systematic Review of Literature and Meta-Analysis. PLoS One 2015; 10:e0144334.
- Flack NJ, Sepulveda W, Bower S, Fisk NM. Acute maternal hydration in third-trimester oligohydramnios: effects on amniotic fluid volume, uteroplacental perfusion, and fetal blood flow and urine output. Am J Obstet Gynecol 1995; 173:1186.
- Ross MG, Nijland MJ, Kullama LK. 1-Deamino-[8-D-arginine] vasopressin-induced maternal plasma hypoosmolality increases ovine amniotic fluid volume. Am J Obstet Gynecol 1996; 174:1118.
- Nijland MJ, Ross MG, Kullama LK, et al. DDAVP-induced maternal hyposmolality increases ovine fetal urine flow. Am J Physiol 1995; 268:R358.
- Maher MA, Sayyed TM, Elkhouly N. Sildenafil Citrate Therapy for Oligohydramnios: A Randomized Controlled Trial. Obstet Gynecol 2017; 129:615.
- Chamberlain PF, Manning FA, Morrison I, et al. Ultrasound evaluation of amniotic fluid volume. I. The relationship of marginal and decreased amniotic fluid volumes to perinatal outcome. Am J Obstet Gynecol 1984; 150:245.
- Petrozella LN, Dashe JS, McIntire DD, Leveno KJ. Clinical significance of borderline amniotic fluid index and oligohydramnios in preterm pregnancy. Obstet Gynecol 2011; 117:338.
- Ulkumen BA, Pala HG, Baytur YB, Koyuncu FM. Outcomes and management strategies in pregnancies with early onset oligohydramnios. Clin Exp Obstet Gynecol 2015; 42:355.
- Moore TR. Superiority of the four-quadrant sum over the single-deepest-pocket technique in ultrasonographic identification of abnormal amniotic fluid volumes. Am J Obstet Gynecol 1990; 163:762.
- Mercer LJ, Brown LG. Fetal outcome with oligohydramnios in the second trimester. Obstet Gynecol 1986; 67:840.
- Morris JM, Thompson K, Smithey J, et al. The usefulness of ultrasound assessment of amniotic fluid in predicting adverse outcome in prolonged pregnancy: a prospective blinded observational study. BJOG 2003; 110:989.
- Magann EF, Doherty DA, Chauhan SP, et al. Dye-determined amniotic fluid volume and intrapartum/neonatal outcome. J Perinatol 2004; 24:423.
- Sarno AP Jr, Ahn MO, Phelan JP. Intrapartum amniotic fluid volume at term. Association of ruptured membranes, oligohydramnios and increased fetal risk. J Reprod Med 1990; 35:719.
- Chauhan SP, Sanderson M, Hendrix NW, et al. Perinatal outcome and amniotic fluid index in the antepartum and intrapartum periods: A meta-analysis. Am J Obstet Gynecol 1999; 181:1473.
- Alchalabi HA, Obeidat BR, Jallad MF, Khader YS. Induction of labor and perinatal outcome: the impact of the amniotic fluid index. Eur J Obstet Gynecol Reprod Biol 2006; 129:124.
- Rabie N, Magann E, Steelman S, Ounpraseuth S. Oligohydramnios in complicated and uncomplicated pregnancy: a systematic review and meta-analysis. Ultrasound Obstet Gynecol 2017; 49:442.
- Ashwal E, Hiersch L, Melamed N, et al. The association between isolated oligohydramnios at term and pregnancy outcome. Arch Gynecol Obstet 2014; 290:875.
- Vink J, Hickey K, Ghidini A, et al. Earlier gestational age at ultrasound evaluation predicts adverse neonatal outcomes in the preterm appropriate-for-gestational-age fetus with idiopathic oligohydramnios. Am J Perinatol 2009; 26:21.
- Shrem G, Nagawkar SS, Hallak M, Walfisch A. Isolated Oligohydramnios at Term as an Indication for Labor Induction: A Systematic Review and Meta-Analysis. Fetal Diagn Ther 2016; 40:161.
- Clark SL, Sabey P, Jolley K. Nonstress testing with acoustic stimulation and amniotic fluid volume assessment: 5973 tests without unexpected fetal death. Am J Obstet Gynecol 1989; 160:694.
- Nageotte MP, Towers CV, Asrat T, Freeman RK. Perinatal outcome with the modified biophysical profile. Am J Obstet Gynecol 1994; 170:1672.
- Miller DA, Rabello YA, Paul RH. The modified biophysical profile: antepartum testing in the 1990s. Am J Obstet Gynecol 1996; 174:812.
- Carroll BC, Bruner JP. Umbilical artery Doppler velocimetry in pregnancies complicated by oligohydramnios. J Reprod Med 2000; 45:562.
- Skotnicki MZ, Rybaczuk M, Urban J. [Doppler examination of fetal cerebral circulation in pregnancies complicated with idiopathic oligohydramnios]. Ginekol Pol 2004; 75:128.
- Bannerman CG, Chauhan SP. Oligohydramnios at 34-36 weeks: observe or deliver. Am J Obstet Gynecol 2011; 205:163.
- Ek S, Andersson A, Johansson A, Kublicas M. Oligohydramnios in uncomplicated pregnancies beyond 40 completed weeks. A prospective, randomised, pilot study on maternal and neonatal outcomes. Fetal Diagn Ther 2005; 20:182.
- Bastide A, Manning F, Harman C, et al. Ultrasound evaluation of amniotic fluid: outcome of pregnancies with severe oligohydramnios. Am J Obstet Gynecol 1986; 154:895.
- Zhang J, Troendle J, Meikle S, et al. Isolated oligohydramnios is not associated with adverse perinatal outcomes. BJOG 2004; 111:220.
- Danon D, Ben-Haroush A, Yogev Y, et al. Prostaglandin E2 induction of labor for isolated oligohydramnios in women with unfavorable cervix at term. Fetal Diagn Ther 2007; 22:75.
- Driggers RW, Holcroft CJ, Blakemore KJ, Graham EM. An amniotic fluid index < or =5 cm within 7 days of delivery in the third trimester is not associated with decreasing umbilical arterial pH and base excess. J Perinatol 2004; 24:72.
- Sherer DM. A review of amniotic fluid dynamics and the enigma of isolated oligohydramnios. Am J Perinatol 2002; 19:253.
- Conway DL, Adkins WB, Schroeder B, Langer O. Isolated oligohydramnios in the term pregnancy: is it a clinical entity? J Matern Fetal Med 1998; 7:197.
- Rainford M, Adair R, Scialli AR, et al. Amniotic fluid index in the uncomplicated term pregnancy. Prediction of outcome. J Reprod Med 2001; 46:589.
- Magann EF, Kinsella MJ, Chauhan SP, et al. Does an amniotic fluid index of </=5 cm necessitate delivery in high-risk pregnancies? A case-control study. Am J Obstet Gynecol 1999; 180:1354.
- Magann EF, Doherty DA, Field K, et al. Biophysical profile with amniotic fluid volume assessments. Obstet Gynecol 2004; 104:5.
- Kreiser D, el-Sayed YY, Sorem KA, et al. Decreased amniotic fluid index in low-risk pregnancy. J Reprod Med 2001; 46:743.
- Elsandabesee D, Majumdar S, Sinha S. Obstetricians' attitudes towards 'isolated' oligohydramnios at term. J Obstet Gynaecol 2007; 27:574.
- Manzanares S, Carrillo MP, González-Perán E, et al. Isolated oligohydramnios in term pregnancy as an indication for induction of labor. J Matern Fetal Neonatal Med 2007; 20:221.
- Magann EF, Chauhan SP, Kinsella MJ, et al. Antenatal testing among 1001 patients at high risk: the role of ultrasonographic estimate of amniotic fluid volume. Am J Obstet Gynecol 1999; 180:1330.
- Spong CY, Mercer BM, D'alton M, et al. Timing of indicated late-preterm and early-term birth. Obstet Gynecol 2011; 118:323.
- American College of Obstetricians and Gynecologists. ACOG committee opinion no. 560: Medically indicated late-preterm and early-term deliveries. Obstet Gynecol 2013; 121:908.
- Chauhan SP, Hendrix NW, Morrison JC, et al. Intrapartum oligohydramnios does not predict adverse peripartum outcome among high-risk parturients. Am J Obstet Gynecol 1997; 176:1130.
- Moses J, Doherty DA, Magann EF, et al. A randomized clinical trial of the intrapartum assessment of amniotic fluid volume: amniotic fluid index versus the single deepest pocket technique. Am J Obstet Gynecol 2004; 190:1564.
- Johnson JM, Chauhan SP, Ennen CS, et al. A comparison of 3 criteria of oligohydramnios in identifying peripartum complications: a secondary analysis. Am J Obstet Gynecol 2007; 197:207.e1.
- First trimester
- Second trimester
- Third trimester
- CLINICAL MANIFESTATIONS AND DIAGNOSIS
- Multiple gestation
- EVALUATION OF PREGNANCIES WITH OLIGOHYDRAMNIOS
- METHODS OF INCREASING AMNIOTIC FLUID VOLUME
- Maternal hydration
- - Water and DDAVP
- Fetal membrane sealants
- Investigational therapies
- PROGNOSIS AND MANAGEMENT
- First trimester
- Second trimester
- Third trimester
- Timing of delivery
- SUMMARY AND RECOMMENDATIONS