Case Study: Oligohydramnios

4.

Oligohydramnios

Severe reduction of amniotic fluid volume

(typically less than 500 ml at term); highly
concentrated urine.
Possibility of prolonged, dysfunctional labor
(usually beginning before term).
Fetal risk: renal anomalies, pulmonary
hyperplasia, hypoxia, increased skeletal
deformities, and wrinkled, leathery skin.
Causes
Exact cause is unknown.
Any condition that prevents the fetus from
making urine or that blocks urine from
going into the amniotic sac.
Contributing
factors:
uteroplacental
insufficiency, premature
rupture
of
membranes prior to labor onset, maternal
hypertension,
maternal
diabetes, intrauterine growth restriction,
postterm pregnancy, fetal renal genesis,
polycystic kidneys, and urinary tract
obstructions.

of

Nursing Interventions
closely,

and

including vital

fetal

status

signs and fetal

heart rate patterns.

2.

Monitor maternal weight gain pattern,

notifying the health care provider if weight
loss occurs.

3.

Provide

emotional

about

coping

5.

Instruct her about signs and symptoms

of labor, including those shell need to
report immediately.

6.

Reinforce the need for close supervision

and follow up.

7.

Assist with amnioinfusion as indicated.

8.

Encourage the patient to lie on her left

side.

9.

Ensure that amnioinfusion solution is

warmed to body temperature.

10. Continuously monitor maternal vital signs

and

fetal

heart

rate

during

the

amnioinfusion procedure.
11. Note the development of any uterine
contractions,

notify

the

health

care

strict sterile

technique during

amnioinfusion.

Treatment
Close medical supervision of the mother
and fetus.
Fetal monitoring
Amnioinfusion
(infusion
of
warmed
sterile normal saline or lactated Ringers
solution) to treat or prevent variable
decelerations during labor.

maternal

patient

measures if fetal anomalies are suspected.

12. Maintain

Test result
Ultrasonography reveals no pockets
amniotic fluid larger than 1 cm.

Monitor

the

provider, and continue to monitor closely.

Assessment
Asymptomatic
Lagging fundal height growth.

1.

Inform

support

during, and after ultrasonography.

before,

Oligohydramnios
When a woman has oligohydramnios, the
level of amniotic fluid surrounding the
baby is too low. To understand how this
can affect your health and the health of
your baby, it's helpful to first understand
the role amniotic fluid plays in a healthy
pregnancy.
What you need to know about
amniotic
fluid
The amniotic fluid that surrounds your
baby plays an important role in your
baby's growth and development. This
clear-colored liquid protects the baby and
provides it with fluids. Your baby breathes
this fluid into its lungs and swallows it.
This helps your baby's lungs and digestive
system grow strong. Your amniotic fluid
also allows the baby to move around,
which helps it to develop its muscles and
bones.

The amniotic sac that contains your baby

begins to form about 12 days after
conception. Amniotic fluid begins to form
at that time, too. In the early weeks of
pregnancy, amniotic fluid is mainly made
up of water supplied by the mother. After
about 20 weeks, your baby's urine makes
up most of the fluid.
The amount of amniotic fluid increases
until about 36 weeks of pregnancy. At that
time you have about 1 quart of fluid. After
that time, the level begins to decrease.
What you need to know about
oligohydramnios
Oligohydramnios (too little amniotic fluid)
occurs in about 4 out of every 100
pregnancies. It is most common in the last
trimester of pregnancy, but it can develop
at any time in the pregnancy. About 1 out
of 8 women whose pregnancies last 2
weeks past the due date develops
oligohydramnios.
This
happens
as
amniotic fluid levels naturally decline.
Oligohydramnios
is
diagnosed
with
ultrasound. The causes of this condition
are not completely understood. Some
pregnant
women
who
develop
oligohydramnios never know the cause.
Some causes are:

Certain birth defects in the baby

Ruptured membranes (breaks or
tears in the sac that holds the amniotic
fluid)
A pregnancy that goes 2 weeks
past the due date
A health condition in the pregnant
woman, such as high blood pressure,
diabetes or lupus
Birth defects involving the kidneys
and urinary tract can cause this
problem. That's because babies with
these birth defects produce less urine,
which makes up most of the amniotic
fluid.
Oligohydramnios may affect you, your
baby, and your labor and delivery in
different ways. The effects depend on the
cause, when the problem occurs, and how
little fluid there is.

In the first two trimesters, too little

amniotic fluid may result in birth defects
of the lungs and limbs. During this period,
oligohydramnios
increases
the
risk
of miscarriage, preterm birth and stillbirth.
When oligohydramnios occurs in the third
trimester, it is linked to poor fetal growth,
complications during labor and birth, and
increased risk of cesarean section.
Women
with
otherwise
normal
pregnancies who develop oligohydramnios
near their due date probably need no
treatment. Their babies are likely to be
born healthy. Even so, your provider may
want to watch you closely. When
treatment is needed, the amniotic fluid
may need to be replaced with an artificial
substitute.
What
you
can
do
The best thing you can do is to go to all
your prenatal
care appointments.
Your
health care provider can monitor the size
of your belly and how much amniotic fluid
is in your womb. If you have a problem,
your provider can take steps to help
prevent complications in you and your
baby.
Women with high blood pressure, diabetes
and lupus are at increased risk for
oligohydramnios. If you have any of these
conditions, be sure to let your health care
provider know.
If you have high blood pressure:
Talk to your health care provider before
pregnancy (or as soon as you think you
are
pregnant).
Be sure any medications you are taking
are
safe
during
pregnancy
Be sure your blood pressure is well
controlled.
If you have oligohydramnios, be sure to
eat a healthy and nutritious diet, drink lots
of fluids (water is best), get plenty of rest,
avoid smoking, and report any signs of
preterm labor to your health care provider
right
away.

MAS can affect the baby's breathing in a

number of ways, including chemical
irritation to the lung tissue, airway
obstruction by a meconium plug, infection,
and the inactivation of surfactant by the
meconium (surfactant is a natural
substance that helps the lungs expand
properly).
The severity of MAS depends on the
amount of meconium the baby inhales as
well as underlying conditions, such as
infections
within
the
uterus
or
postmaturity (when a baby is overdue, or
more than 40 weeks' gestational age).
Generally, the more meconium a baby
inhales, the more serious the condition.

MAS can happen before, during, or after

labor and delivery when a newborn inhales
(or aspirates) a mixture of meconium and
amniotic fluid (the fluid in which the baby
floats inside the amniotic sac). Meconium
is the baby's first feces, or poop, which is
sticky, thick, and dark green and is
typically passed in the womb during early
pregnancy and again in the first few days
after birth.
The inhaled meconium can partially or
completely block the baby's airways.
Although air can flow past the meconium
trapped in the baby's airways as the baby
breathes in, the meconium becomes
trapped in the airways when the baby
breathes out. And so, the inhaled
meconium irritates the baby's airways and
makes it difficult to breathe.

Normally, fluid is moved in and out of only

the trachea (the upper portion of the
airway) when there's breathing activity in
the fetus. Meconium can be inhaled into
the lungs when the baby gasps while still
in the womb or during the initial gasping
breaths after delivery. This gasping
typically happens when there has been a
problem (i.e., an infection or compression
of the umbilical cord) that causes the baby
to have difficulty getting enough oxygen in
the womb.
Causes
MAS is often related to fetal stress. Fetal
stress can be caused by problems in the
womb, such as infections, or by difficulties
during the labor process. A distressed
baby may experience hypoxia (decreased
oxygen), which may make the baby's
intestinal activity increase and may cause
relaxation of the anal sphincter (the
muscular valve that controls the passage
of feces out of the anus). This relaxation
then moves meconium into the amniotic
fluid that envelops the baby.
But meconium passage during labor and
delivery isn't always associated with fetal
distress. Occasionally, babies who aren't
distressed during the birth process pass

meconium before birth. In either case, a

baby that gasps or inhales meconium can
develop MAS.
Additional risk factors for MAS include:

a difficult delivery
advanced gestational age (or
postmaturity)

a mother who smokes cigarettes

heavily or who has diabetes,high blood
pressure (hypertension), or chronic
respiratory or cardiovascular disease

umbilical cord complications

poor intrauterine growth (poor

growth of the baby while in the uterus)
Prematurity is not a risk factor. In fact,
MAS is rare in babies born before 34
weeks.
Signs and Symptoms
At birth, the doctor will likely notice one or
more symptoms of MAS, including:

meconium or dark green streaks or

stains in the amniotic fluid
discoloration of the baby's skin
either blue (cyanosis) or green (from
being stained by the meconium)
problems
with
breathing

including rapid breathing (tachypnea),

labored
(difficulty)
breathing,
or
suspension of breathing (apnea)
low heart rate in the baby before
birth
low Apgar score (the Apgar test is
given to newborns just after birth to
quickly evaluate color, heartbeat,
reflexes, muscle tone, and breathing)
limpness in the baby
postmaturity (signs that a baby is
overdue such as long nails)

Diagnosis
If a baby is thought to have inhaled
meconium, treatment will begin during
delivery. If the baby has any depression in
breathing, the doctor taking care of the
baby will insert a laryngoscope into the

babys trachea to remove any meconium

that might be present. The doctor will also
probably listen to the baby's chest with a
stethoscope for sounds in the lungs that
are common in infants with MAS.
The doctor may also order tests a blood
test (called a blood gas analysis) that
helps determine if the baby is getting
enough oxygen and a chest X-ray that can
show patches or streaks on the lungs that
are found in babies with MAS.
Babies with MAS may be sent to a special
care nursery or aneonatal intensive care
unit (NICU) to be closely monitored for the
next few days. Treatments may include:

oxygen therapy by oxygen hood or

ventilation

antibiotics

use of surfactant

nitric oxide

obtaining
blood
routinely
to
determine if the baby is receiving
enough oxygen
Severe Aspiration
Babies who have severe aspiration and
require mechanical ventilation are at
increased risk for bronchopulmonary
dysplasia, a lung condition that can be
treated with medication or oxygen.
Another complication associated with MAS
is a collapsed lung. Also known as
pneumothorax, a collapsed lung is treated
by reinflating the lung (inserting a tube
between the ribs, allowing the lung to
gradually re-expand).
Although rare, a small percentage of
babies with severe MAS develop aspiration
pneumonia. If this occurs, the doctor may
recommend
advanced
lung
rescue
therapy.
Three therapies are currently used to treat
aspiration pneumonia and severe forms of
MAS:

1.

Surfactant therapy: An artificial

surfactant is instilled into the baby's
lungs, which helps to keep the air sacs
open.
2.
High-frequency oscillation: This
special ventilator vibrates air enriched
with extra oxygen into the baby's
lungs.
3.
Rescue therapy: Nitric oxide is
added to the oxygen in the ventilator. It
dilates the blood vessels and allows
more blood flow and oxygen to reach
the baby's lungs.
If one of these therapies (or a combination
of them) doesn't work, there is another
alternative. Extra corporeal membrane
oxygenation (ECMO) is a form of
cardiopulmonary bypass, meaning that an
artificial heart and lung will temporarily
take over to supply bloodflow to the
baby's body. ECMO reduces the fatality
rate for these severely distressed infants
from 80% to 10%. Not all hospitals are
ECMO centers, so babies that require
ECMO might need to be moved to another
hospital.
Babies with severe cases of MAS may
come home from the hospital on oxygen.
They may be more likely to have wheezing
and lung infections during their first year,
but lungs can regenerate new air sacs, so
the long-term prognosis for their lungs is
excellent.

It's important for a pregnant woman to tell

her doctor immediately if meconium is
present in the amniotic fluid when her
water breaks, or if the fluid has dark green
stains or streaks. Doctors also use a fetal
monitor during labor to observe the baby's
heart rate for any signs of fetal distress.
In some cases doctors may recommend
amnioinfusion, the dilution of the amniotic
fluid with saline, to wash meconium out of
the amniotic sac before the baby has a
chance to inhale it at birth.
Although MAS is a frightening complication
for parents to face during the birth of their
child, the majority of cases are notsevere.
Most infants are monitored for fetal
distress during labor, and doctors pay
careful attention to any signs that would
indicate meconium aspiration. If it does
occur, treatment will begin immediately.
For most infants who have inhaled
meconium, early treatment can prevent
further complications and help to reassure
anxious new parents.
oligohidramnion
Ketika

seorang

wanita

memiliki

oligohidramnion, tingkat cairan ketuban

yang mengelilingi bayi terlalu rendah.
Untuk memahami bagaimana hal ini dapat

Possible Long-Term Complications

Severely affected babies are at risk for
developing chronic lung disease and may
also have developmental abnormalities
and hearing loss. Babies diagnosed with
MAS will be screened at the hospital for
hearing problems or neurological damage.

mempengaruhi

kesehatan

Anda

dan

kesehatan bayi Anda, sangat membantu

untuk pertama memahami peran drama
cairan

ketuban

pada

kehamilan

yang

sehat.
Apa yang perlu Anda ketahui tentang
cairan ketuban

Although very rare, severe cases of MAS

may be fatal. Studies have indicated that
deaths
from
MAS
have
decreased
significantly through interventions such as
suctioning and reducing the number of
post-term births.

Cairan ketuban yang mengelilingi bayi

Anda memainkan peran penting dalam
pertumbuhan
Anda.

cairan

dan

perkembangan

bening

berwarna

bayi
ini

melindungi bayi dan menyediakan itu

Prevention

dengan cairan. Bayi Anda bernafas cairan

ini ke paru-paru dan menelannya. Hal ini

Ruptur membran (istirahat atau air mata

membantu

di

paru-paru

bayi

Anda

dan

kantung

yang

memegang

cairan

sistem pencernaan tumbuh kuat. cairan

ketuban)

ketuban Anda juga memungkinkan bayi

Sebuah kehamilan yang berlangsung 2

untuk bergerak di sekitar, yang membantu

minggu terakhir tanggal jatuh tempo

untuk mengembangkan otot dan tulang.

Kondisi kesehatan pada wanita hamil,

Kantung ketuban yang berisi bayi Anda

seperti tekanan darah tinggi, diabetes

mulai terbentuk sekitar 12 hari setelah

atau lupus

pembuahan.

Cacat lahir yang melibatkan ginjal dan

cairan

ketuban

terbentuk pada waktu itu juga.

mulai
Pada

saluran

kemih

dapat

menyebabkan

minggu-minggu awal kehamilan, cairan

masalah ini. Itu karena bayi dengan cacat

ketuban terutama terdiri dari air yang

lahir ini menghasilkan kurang urin, yang

disediakan oleh ibu. Setelah sekitar 20

membuat sebagian besar cairan ketuban.

minggu,

Oligohidramnion

urin

bayi

Anda

membuat

dapat

mempengaruhi

sebagian besar cairan.

Anda, bayi Anda, dan tenaga kerja dan

Jumlah meningkat cairan ketuban sampai

pengiriman dengan cara yang berbeda.

sekitar 36 minggu kehamilan. Pada saat

Efek tergantung pada penyebab, ketika

itu Anda memiliki sekitar 1 liter cairan.

masalah terjadi, dan betapa sedikit cairan

Setelah itu, tingkat mulai menurun.

yang ada.

Apa yang perlu Anda ketahui tentang

Di dua trimester pertama, terlalu sedikit

oligohidramnion

cairan ketuban dapat menyebabkan cacat

Oligohidramnion

(terlalu

sedikit

cairan

lahir dari paru-paru dan anggota badan.

ketuban) terjadi pada sekitar 4 dari setiap

Selama

100 kehamilan. Hal ini paling sering terjadi

meningkatkan risiko keguguran, kelahiran

pada trimester terakhir kehamilan, tetapi

prematur dan lahir mati.

dapat berkembang pada setiap saat dalam

Ketika

kehamilan. Sekitar 1 dari 8 wanita yang

trimester ketiga, hal ini terkait dengan

kehamilan berlangsung 2 minggu terakhir

pertumbuhan yang buruk janin, komplikasi

tanggal

selama

jatuh

tempo

berkembang

periode

ini,

oligohidramnion

persalinan

dan

oligohidramnion

terjadi

pada

kelahiran,

dan

oligohidramnion. Hal ini terjadi karena

peningkatan risiko operasi caesar.

tingkat

Wanita dengan kehamilan normal lain

cairan

ketuban

secara

alami

menurun.

yang

Oligohidramnion didiagnosis dengan USG.

dekat

Penyebab kondisi ini tidak sepenuhnya

mungkin tidak memerlukan pengobatan.

dipahami. Beberapa wanita hamil yang

bayi

mengembangkan

sehat.

pernah

tahu

oligohidramnion

penyebabnya.

penyebabnya adalah:
cacat lahir tertentu pada bayi

tidak

Beberapa

mengembangkan
tanggal
mereka
Meski

jatuh

oligohidramnion
tempo

kemungkinan
begitu,

mereka

akan

penyedia

lahir
Anda

mungkin ingin menonton Anda erat. Ketika

pengobatan dibutuhkan, cairan amnion

mungkin perlu diganti dengan pengganti

Jika Anda memiliki tekanan darah tinggi:

buatan.

Bicara dengan dokter Anda sebelum

Apa yang dapat Anda lakukan

hamil (atau segera setelah Anda pikir

Hal terbaik yang dapat Anda lakukan

Anda sedang hamil).

adalah pergi ke semua janji pemeriksaan

Pastikan setiap obat yang kita pakai

kehamilan

aman selama kehamilan

Anda.

penyedia

layanan

kesehatan Anda dapat memantau ukuran

Pastikan tekanan darah Anda terkontrol

perut Anda dan berapa banyak cairan

dengan baik.

ketuban dalam rahim Anda. Jika Anda

Jika

memiliki masalah, penyedia Anda dapat

pastikan untuk makan makanan sehat dan

mengambil

untuk

bergizi, minum banyak cairan (air yang

pada

terbaik), mendapatkan banyak istirahat,

membantu

langkah-langkah
mencegah

komplikasi

Anda dan bayi Anda.

Wanita
diabetes

dengan
dan

tekanan
lupus

Anda

memiliki

oligohidramnion,

menghindari merokok, dan melaporkan

darah

tinggi,

setiap tanda-tanda persalinan prematur

berada

pada

untuk penyedia layanan kesehatan Anda

peningkatan risiko untuk oligohidramnion.

Jika Anda memiliki kondisi ini, pastikan
untuk membiarkan dokter tahu.

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