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Objective: To investigate the association between prolonged oligohydramnios and a composite outcome of death or severe neurodevelopmental impairment (NDI) at 3 years of age., Methods: This single-center retrospective cohort study enrolled infants born at 22-29 weeks of gestational age without major congenital anomalies. The patients were classified into three groups depending on the existence and duration of oligohydramnios: no/non-prolonged oligohydramnios (no or 0-7 days of oligohydramnios), prolonged oligohydramnios (8-14 days), and very prolonged oligohydramnios (> 14 days). The primary outcome was a composite of death or severe NDI, which was defined as severe cerebral palsy, developmental delay, severe visual impairment, or deafness at age 3., Results: Out of the 843 patients, 784 (93 %), 30 (3.6 %), and 29 (3.4 %) were classified into the no/non-prolonged, prolonged, and very prolonged oligohydramnios groups, respectively. After excluding patients lost to follow-up, the adverse composite outcome at 3 years of age was observed in 194/662 (29 %), 7/26 (27 %), and 8/23 (35 %) in the corresponding groups. The composite outcome showed no significant trend with the duration of oligohydramnios (P = 0.70). In a logistic regression model controlling the known predictors of gestational age, birth weight, small-for-gestational-age, male sex, multiple pregnancy, hypertensive disorders of pregnancy, antenatal corticosteroids, and the number of family-social risk factors, the duration of oligohydramnios was not independently associated with the composite outcome; odds ratio 1.3 (95 % confidence interval, 0.78-2.0)., Conclusion: Prolonged oligohydramnios was not associated with the composite outcome of death or severe NDI at 3 years of age., Competing Interests: Declaration of competing interest The authors have no conflicts of interest to declare., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Importance: Early anhydramnios during pregnancy, resulting from fetal bilateral renal agenesis, causes lethal pulmonary hypoplasia in neonates. Restoring amniotic fluid via serial amnioinfusions may promote lung development, enabling survival., Objective: To assess neonatal outcomes of serial amnioinfusions initiated before 26 weeks' gestation to mitigate lethal pulmonary hypoplasia., Design, Setting, and Participants: Prospective, nonrandomized clinical trial conducted at 9 US fetal therapy centers between December 2018 and July 2022. Outcomes are reported for 21 maternal-fetal pairs with confirmed anhydramnios due to isolated fetal bilateral renal agenesis without other identified congenital anomalies., Exposure: Enrolled participants initiated ultrasound-guided percutaneous amnioinfusions of isotonic fluid before 26 weeks' gestation, with frequency of infusions individualized to maintain normal amniotic fluid levels for gestational age., Main Outcomes and Measures: The primary end point was postnatal infant survival to 14 days of life or longer with dialysis access placement., Results: The trial was stopped early based on an interim analysis of 18 maternal-fetal pairs given concern about neonatal morbidity and mortality beyond the primary end point despite demonstration of the efficacy of the intervention. There were 17 live births (94%), with a median gestational age at delivery of 32 weeks, 4 days (IQR, 32-34 weeks). All participants delivered prior to 37 weeks' gestation. The primary outcome was achieved in 14 (82%) of 17 live-born infants (95% CI, 44%-99%). Factors associated with survival to the primary outcome included a higher number of amnioinfusions (P = .01), gestational age greater than 32 weeks (P = .005), and higher birth weight (P = .03). Only 6 (35%) of the 17 neonates born alive survived to hospital discharge while receiving peritoneal dialysis at a median age of 24 weeks of life (range, 12-32 weeks)., Conclusions and Relevance: Serial amnioinfusions mitigated lethal pulmonary hypoplasia but were associated with preterm delivery. The lower rate of survival to discharge highlights the additional mortality burden independent of lung function. Additional long-term data are needed to fully characterize the outcomes in surviving neonates and assess the morbidity and mortality burden., Trial Registration: ClinicalTrials.gov Identifier: NCT03101891.

Objective: To compare outcomes of hospitalized preterm infants following previable prelabour rupture of membranes (PPROM) at≤23 weeks of gestation., Methods: Retrospective cohort study of preterm infants admitted for intensive care, between January 2006 and December 2016 following PPROM, was conducted. Short term clinical outcomes included severity of respiratory morbidity, length of hospital stay and mortality. Neurodevelopment in survivors was assessed using Bayley's Scales of Infant Development (3rd edition) at 24 months corrected age., Results: A total of 82 preterm infants were admitted following PPROM at < 23 weeks and were grouped as: Group 1 (n = 28) with PPROM < 20 weeks and Group 2 (n = 54) with PPROM between 20-22 + 6 weeks. Median latency following PPROM was significantly longer in Group 1 infants [69(Interquartile range (IQR): 43-74; Range (R): 25-100 vs. 29(IQR: 10-53; R: 2-72) days, p < 0.001]. Median gestation at delivery was 27.4 weeks (Group 1) vs. 25.1 weeks (Group 2). Group 1 had a significantly higher incidence of oligohydramnios [13(46.4%) vs. 8(14.8%), p = 0.002], lower Apgar scores (<7) at 5 minutes [19(67.9%) vs. 24(44.4%), p = 0.044], increased pulmonary hypoplasia [13(46.4%) vs. 5(9.3%), p < 0.001], joint contractures [3(10.7%) vs. 0, p = 0.037] and mortality [10(35.7%) vs. 7(13.0%), p = 0.016]. Neurodevelopmental outcomes at 24 months corrected age were comparable in the 36 surviving infants (9/18 vs. 27/547)., Conclusion: Morbidity and mortality is high in infants born after previable PPROM; specifically, in those with PPROM < 20 weeks although early childhood neurodevelopmental outcomes were comparable. Larger prospective studies focussing on long term neonatal outcomes are needed to confirm these findings.

Objective: To evaluate risk factors associated with neonatal morbidity and mortality in pregnant women with preterm prelabor rupture of membranes (PPROM) after cervical cerclage., Methods: A retrospective cohort study of singleton pregnancies with cervical insufficiency was conducted at a tertiary referral center in Taiwan from May 1, 2000 to July 31, 2017. Patients with PPROM after cerclage and delivered between 20 0/7 days and 36 6/7 days were recruited. Logistic and linear regression analyses were performed to evaluate various risk factors., Results: Overall, 109 women were included. Mothers with a higher white blood cell count, a higher C-reactive protein (CRP) level, a lower amniotic fluid index, and chorioamnionitis were significantly associated with neonatal morbidity. Neonatal mortality was related to oligohydramnios (adjusted odds ratio [aOR] 2.98, 95% confidence interval [CI] 1.11-8.01) and chorioamnionitis (aOR 3.17, 95% CI 1.03-9.69). An elevated CRP level was associated with a shorter PPROM to delivery latency (adjusted B -16.64, 95% CI -29.88 to -3.41), but cerclage retention more than 12 hours after PPROM was associated with a prolonged latency (adjusted B 17.21, 95% CI 3.25-31.18)., Conclusion: Oligohydramnios and chorioamnionitis are associated with neonatal mortality., (© 2019 International Federation of Gynecology and Obstetrics.)

Objective: To describe the natural history and perinatal outcomes of monochorionic diamniotic twins with midtrimester isolated oligohydramnios (iOligo)., Materials and Methods: We performed a retrospective study of iOligo patients who were initially referred for the management of evolving twin-twin transfusion syndrome (TTTS) or selective intrauterine growth restriction (sIUGR). iOligo was defined as a maximum vertical pocket of amniotic fluid of ≤2 cm in the iOligo twin's sac and normal fluid level (>2 and <8 cm) in the co-twin's sac. "Group A" patients did not subsequently develop TTTS or sIUGR Type II (umbilical artery persistent absent or reversed end-diastolic flow), and "Group B" patients did develop TTTS or sIUGR Type II. Results are reported as median (range)., Results: Of the 828 patients with complicated monochorionic twin gestations referred for possible TTTS or sIUGR, 36 (4.3%) were initially diagnosed with iOligo. After initial consultation, two patients terminated and one was lost to follow-up, resulting in a final study population of 33. Group A had 10 patients (30.3%) and Group B had 23 patients (69.7%). In Group A, nine of the 10 were expectantly managed, resulting in a median gestational age (GA) at delivery of 34.7 (18.0-36.4) weeks, a 30-day perinatal survival of at-least-one twin of 88.9% (8/9), and dual 30-day survivors in 8/9 (88.9%). In Group B, 12 (52.2%) developed TTTS and 11 (47.8%) developed sIUGR Type II. Fifteen Group B patients had laser surgery, resulting in a median GA at delivery of 33.7 (26.4-37.1) weeks, a 30-day perinatal survival of at-least-one twin of 100% (15/15), and dual survivorship of 46.7% (7/15)., Conclusions: Our findings show that the majority of patients with midtrimester iOligo have fetal growth restriction of the affected twin and subsequently progress to TTTS or sIUGR Type II.

Objective: To assess the effectiveness of amnioinfusion in women with second-trimester preterm prelabor rupture of membranes., Methods: We performed a nationwide, multicenter, open-label, randomized controlled trial, the PPROM: Expectant Management versus Induction of Labor-III (PPROMEXIL-III) trial, in women with singleton pregnancies and preterm prelabor rupture of membranes at 16 0/7 to 24 0/7 weeks of gestation with oligohydramnios (single deepest pocket less than 20 mm). Participants were allocated to transabdominal amnioinfusion or no intervention in a one-to-one ratio by a web-based system. If the single deepest pocket was less than 20 mm on follow-up visits, amnioinfusion was repeated weekly until 28 0/7 weeks of gestation. The primary outcome was perinatal mortality. We needed 56 women to show a reduction in perinatal mortality from 70% to 35% (β error 0.20, two-sided α error 0.05)., Results: Between June 15, 2012, and January 13, 2016, we randomized 28 women to amnioinfusion and 28 to no intervention. One woman was enrolled before the trial registration date (June 19, 2012). Perinatal mortality rates were 18 of 28 (64%) in the amnioinfusion group vs 21 of 28 (75%) in the no intervention group (relative risk 0.86, 95% CI 0.60-1.22, P=.39)., Conclusion: In women with second-trimester preterm prelabor rupture of membranes and oligohydramnios, we found no reduction in perinatal mortality after amnioinfusion., Clinical Trial Registration: NTR Dutch Trial Register, NTR3492.

Introduction: We aimed to clarify the survival rate without brain abnormalities (BA) after fetoscopic laser photoco-agulation (FLP) for monochorionic diamniotic twin gestations (MCDA) with selective intrauterine growth restriction (sIUGR) accompanied by abnormal umbilical artery (UA) Doppler waveforms and isolated oligohydramnios in the sIUGR twin., Materials and Methods: This retrospective study included 52 cases that underwent FLP. The main outcome was survival rate without BA of the twins at age 28 days. BA was defined as severe intraventricular hemorrhage and periventricular leukomalacia on postnatal ultrasonography., Results: Median gestational age at FLP was 20 (16-24) weeks. Ten cases were classified as type III based on Doppler for the UA. For all cases, including 20 cases of anterior placenta, FLP was completed without major intraoperative complications. Amnioinfusion was required in 49 cases for better fetoscopic visualization. Fetal loss occurred in 29 sIUGR twins and two larger twins, whereas one larger twin experienced neonatal death. Survival rates without BA were 44% (n = 23) for sIUGR twins and 94% (n = 49) for the larger twins., Discussion: FLP for MCDA with sIUGR presenting with oligohydramnios in the sIUGR twin might be considered a prenatal treatment option., (© 2018 S. Karger AG, Basel.)

Background: Previous studies on renal oligohydramnios (ROH) report highly variable outcome and identify early onset of ROH and presence of extrarenal manifestations as predictors of adverse outcome in most cases. Data on termination of pregnancy (TOP) and associated parental decision-making processes are mostly missing, but context-sensitive for the interpretation of these findings. We provide here a comprehensive analysis on the diagnosis, prenatal decision-making and postnatal clinical course in all pregnancies with ROH at our medical centre over an 8-year period., Methods: We report retrospective chart review data on 103 consecutive pregnancies from 2008 to 2015 with a median follow-up of 554 days., Results: After ROH diagnosis, 38 families opted for TOP. This decision was associated with onset of ROH (p < 0.001), underlying renal disease (p = 0.001) and presence of extrarenal manifestations (p = 0.02). Eight infants died in utero and 8 cases were lost to follow-up. Of the 49 liveborn children, 11 received palliative and 38 underwent active care. Overall survival of the latter group was 84.2% (n = 32) corresponding to 31% of all pregnancies (32 out of 103) analysed. One third of the surviving infants needed renal replacement therapy during the first 6 weeks of life., Conclusions: Over one third of pregnancies with ROH were terminated and the parental decision was based on risk factors associated with adverse outcome. Neonatal death was rare in the actively treated infants and the overall outcome promising. Our study illustrates that only careful analysis of the whole process, from prenatal diagnosis via parental decision-making to postnatal outcome, allows sensible interpretation of outcome data.

Nowadays most renal disorders, especially urinary tract malformations and renal cystic disease, are diagnosed antenatally. In cases of severe bilateral disease, intrauterine renal dysfunction may lead to renal oligohydramnios (ROH), resulting in pulmonary hypoplasia which affects perinatal mortality and morbidity as well as the long-term outcome. However, some infants may only have mild pulmonary and renal disease, and advances in postnatal and dialysis treatment have resulted in improved short- and long-term outcome even in those infants with severe ROH. Here, we review the current state of knowledge and clinical experience of patients presenting antenatally with severe bilateral renal disorders and ROH. By addressing underlying mechanisms, intrauterine tools of diagnosis and treatment as well as published outcome data, we hope to improve antenatal counselling and postnatal care. KEY SUMMARY POINTS: 1. Nowadays most renal disorders are diagnosed antenatally, especially urinary tract malformations and renal cystic disease. 2. Severe kidney dysfunction may lead to renal oligohydramnios, which can cause pulmonary hypoplasia and is a risk factor of perinatal mortality and postnatal renal outcome. However, as considerable clinical heterogeneity is present, outcome predictions need to be treated with caution. 3. Advances in postnatal and dialysis treatment have resulted in improved short- and long-term outcomes even in infants with severe renal oligohydramnios. 4. A multidisciplinary approach with specialist input is required when counselling a family with an ROH-affected fetus as the decision-making process is very challenging.

Background: To investigate maternal and neonatal outcomes of previable preterm premature rupture of membranes (PPROM) and compare outcome between previable PPROM before and after 20 weeks of pregnancy, with data from one single center., Patients: All women with singleton or twin pregnancies, from 2002 through 2011, who presented with PPROM before 24 weeks of gestation., Method: A retrospective cohort study in a university teaching hospital in the Netherlands. Data were analyzed and compared between pregnancies with previable PPROM before and after 20 weeks of pregnancy. Main outcome measures were maternal and neonatal morbidity and mortality., Results: A total of 160 women (164 fetuses) were included. 90 women (56.2%) developed complications (intra-uterine infection, retained placenta, placental abruption or sepsis). There was no maternal mortality. 68 neonates were admitted after birth. PPHN (64.7%, p=0.001) and contractures (58.8%, p<0.001) occurred significantly more in neonates born after PPROM<20 weeks of pregnancy. Eventually 38.4% of the neonates survived. Neonates born after previable PPROM > 20 weeks had a greater likelihood of being alive at discharge (22.7 vs. 46.9%, p=0.008)., Discussion: This study of previable PPROM shows that more than 50% of the mothers develop one or more complications. Neonates have a high mortality rate, especially neonates born after PPROM<20 weeks of pregnancy. In particular neonates born after PPROM<20 weeks of pregnancy should be watched closely for PPHN and contractures., Conclusion: This large single center study can provide good foundation for counseling parents on previable PPROM, especially the prognosis of PPROM<20 weeks of pregnancy is of additional value., (© Georg Thieme Verlag KG Stuttgart · New York.)

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., Study Design: We searched databases from inception to May 2015. We included studies that evaluated isolated oligohydramnios at term and perinatal outcome. Each outcome was analyzed separately, performing a comparative analysis between the study and control groups., 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. Patients with isolated oligohydramnios had significantly higher rates of labor induction [odds ratio (OR) 7.56, confidence interval (CI) 4.58-12.48] and Cesarean sections (OR 2.07, CI 1.77-2.41). 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). There were no significant differences in cord pH <7.1 and meconium-stained amniotic fluid. In the single randomized trial comparing induction of labor with expectant management, no differences were found in any significant maternal or neonatal outcomes., Conclusion: Isolated oligohydramnios at term is associated with significantly higher rates of labor induction, Cesarean sections, and short-term neonatal morbidity., (© 2016 S. Karger AG, Basel.)

Objective: The aim of the present study was to identify predictive data on the short-term outcomes of fetuses with oligohydramnios., Materials and Methods: A retrospective study of all pregnancies diagnosed with oligohydramnios was performed., Results: A total of 17 fetuses (seven males, seven females, and three unknown) with oligohydramnios were treated from 2004 to 2011. Oligohydramnios was first diagnosed at a 21.6 ± 4.2 weeks gestation. Terminations of pregnancy before 22 weeks were identified in five cases, and intrauterine fetal deaths occurred in two cases. Ten neonates were born alive, five cases survived over 28 days, and five cases died within 48 hours. Prognostic factors for survival included birth weight (2,457 ± 480 grams in survivors vs. 1973 ± 124 grams in non-survivors; p < 0.05) and the mean amniotic fluid index (AFI) (2.32 ± 1.19 cm in survivors vs. 0.46 ± 0.68 cm in non-survivors;p < 0.05)., Conclusion: All patients who survived had a mean AFI > 1.0 cm.

Aim: This study aimed to clarify the feasibility and perinatal outcomes of fetoscopic laser photocoagulation (FLP) for monochorionic twin gestation with selective intrauterine growth restriction (sIUGR) accompanied by both abnormal umbilical artery Doppler waveforms and isolated severe oligohydramnios of the sIUGR twin., Methods: In this prospective clinical trial, which included 10 cases with absent or reversed end-diastolic flow in the umbilical artery and severe oligohydramnios of the sIUGR twin, the main outcomes investigated were the feasibility of FLP and the rate of severe FLP-related maternal complications. The survival rate and incidence of neurological abnormalities of the twins at 28 days of age were also evaluated., Results: FLP was completed for all cases without major intraoperative maternal complications, although one case experienced threatened preterm labor requiring intensive treatment after the procedure. Three sIUGR and 10 larger twins were alive without neurological abnormalities at 28 days of age, while intrauterine fetal death occurred in the remaining seven sIUGR twins., Conclusion: FLP for monochorionic twins with sIUGR, especially when accompanied by abnormal Doppler and severe oligohydramnios of the sIUGR twin, appears to be feasible and potentially beneficial for the larger twin, as well as for some sIUGR twins., (© 2015 Japan Society of Obstetrics and Gynecology.)

Background: Measurements of amniotic fluid volume are used for pregnancy surveillance despite a lack of evidence for their predictive ability., Objective: To evaluate the association and predictive value of ultrasound measurements of amniotic fluid volume for adverse pregnancy outcome., Search Strategy: Electronic databases (inception to October 2011), reference lists, hand searching of journals, contact with experts., Selection Criteria: Studies comparing measurements of amniotic fluid volume with adverse outcome, excluding pre-labour ruptured membranes or congenital/structural anomalies., Data Collection: Data on study characteristics, design, quality. Random effects meta-analysis to estimate summary odds ratios (prognostic association) and summary sensitivity, specificity and likelihood ratios (predictive ability)., Main Results: Forty-three studies (244,493 fetuses) were included demonstrating a strong association between oligohydramnios (varying definitions) and birthweight <10th centile (summary odds ratio [OR] 6.31, 95% confidence interval [95% CI] 4.15-9.58; high-risk population [author definition] n = 6 studies, 28,510 fetuses), and mortality (neonatal death any population summary OR 8.72, 95% CI 2.43-31.26; n = 6 studies, 55,735 fetuses; and perinatal mortality high-risk population summary OR 11.54, 95% CI 4.05-32.9; n = 2 studies, 27;891 fetuses). There was a strong association between polyhydramnios (maximum pool depth >8 cm or amniotic fluid index ≥25 cm) and birthweight >90th centile (OR 11.41, 95% CI 7.09-18.36; n = 1 study, 3960 fetuses). Despite strong associations, predictive accuracy for perinatal outcome was poor., Author's Conclusion: Current evidence suggests that oligohydramnios is strongly associated with being small for gestational age and mortality, and polyhydramnios with birthweight >90th centile. Despite strong associations with poor outcome, they do not accurately predict outcome risk for individuals., (© 2014 Royal College of Obstetricians and Gynaecologists.)

Purpose of Review: Nearly 1% of pregnancies are affected by some type of midtrimester oligohydramnios. Evidence is currently accumulating that suggests the better efficacy of the new therapeutic procedures relative to conventional management. This review summarizes the available evidence., Recent Findings: The prolongation of the period between the diagnosis of oligohydramnios and delivery following amnioinfusion and amniopatch techniques appears to be strongly associated with the gestational age and whether the situation was based on rupture of the membranes or not. Case series reveal that amnioinfusion significantly improves the perinatal outcome and prolongs the pregnancy in severe second-trimester oligohydramnios in both idiopathic cases and those involving rupture of the amniotic membranes [preterm prelabor rupture of the membranes (PPROM)]. There is clear evidence of a lower frequency of perinatal complications and successfully prolonged gestation in iatrogenic PPROM after the amniopatch technique relative to population controls., Summary: Identification of potentially modifiable risk factors for the successful prolongation of pregnancy complicated with midtrimester oligohydramnios, and previable PPROM is needed for the improvement of treatment strategies and prognosis. Randomized trials are needed to determine whether amniotic fluid-replenishing strategies can improve pregnancy outcomes.

Aim: to assess whether the incidence of angiotensin II-receptor type 1 antagonist (AT1-antagonist)– or ACE-inhibitor induced cases of oligohydramnios sequence (OHS) in 2011 was reduced after intensive alerts as to the causal association between AT1-antagonist /ACE-inhibitor and OHS in the German medical literature., Method: 3 sources of information were used: A nationwide active surveillance of OHS in German paediatric hospitals (ESPED); Embryotox, (Berlin Institute for Clinical Teratology and Drug Risk Assessment in Pregnancy) and screening of pubmed (AT1-antagonist/ACE-inhibitor induced OHS)., Results: 45 cases of OHS were identified, no case due to maternal AT1-antagonist/ACE-inhibitor treatment. Causes for OHS were: premature rupture of membranes (PPROM) (n = 28), congenital anomalies of fetal kidneys and urinary tract(CAKUT (n = 15), placental insufficiency (n = 1),unknown cause (n = 1). Mortality until discharge was 37.8 % (32.1 % PPROM, 57.1 % CAKUT). Embryotox identified 3 exposures to AT1-antagonists in pregnancy, no case was associated with OHS. The pubmed search did not identify any case of OHS related to AT1-antagonist/ACE-inhibitor in pregnancy in Germany in 2011., Conclusion: Treatment of pregnant women with ACE inhibitors or AT1-antagonists still occurs but no cases of AT1-antagonist- or ACE-inhibitor induced OHS were reported in 2011 in Germany most likely due to repeated published alerts underlining the importance of consequent education. OHS remains a serious condition with high mortality despite modern intensive care.

Objective: To evaluate the outcome of fetuses with oligohydramnios due to kidney anomalies., Methods: A retrospective study was performed of all pregnancies diagnosed with oligohydramnios and associated kidney anomalies during the period 2000-2008. Outcome included pregnancy outcome, mortality, and morbidity. Morbidity included renal function based on the glomerular filtration rate (GFR) during follow-up., Results: A total of 71 pregnancies were evaluated; 36 fetuses presented on ultrasound with cystic dysplasia, 15 with polycystic kidney disease (PKD) and 20 with hydronephrosis. Twenty-three (32%) had associated anomalies. In 49 fetuses (69%), the diagnosis had been made before 24 weeks of gestational age (GA); 41 of those pregnancies were terminated. Twenty-five neonates were live born: 10 survived, 15 died. Prognostic factors for survival included GA at diagnosis (32.2 weeks for survivors vs 28.1 weeks for non-survivors; P = 0.02), diagnosis of hydronephrosis (7 in the survivors vs 4 in the non-survivors: P = 0.05), isolated anomaly (9 in the survivors vs 7 in the non-survivors: P = 0.04). Severity of oligohydramnios (1 case of anhydramnios in the survivors vs 7 in the non-survivors: P = 0.08) was not significant. The 1-year GFR was below 50 mL/min.1.73 m(2) in four of the ten survivors., Conclusion: The prognosis of early onset renal oligohydramnios is poor. Predictive determinants of survival are: GA at diagnosis, nature of renal anomaly (hydronephrosis vs other), and presence of associated anomalies., (Copyright © 2011 John Wiley & Sons, Ltd.)

Objective: The purpose of this study was to evaluate the role of transabdominal amnioinfusion in the management of oligohydramnios with the view to improving pregnancy outcome., Methods: The study consisted of a retrospective analysis of 17 pregnant women presenting with oligohydramnios who were treated with amnioinfusion during pregnancy in a period from 2003 to 2006., Results: The mean gestational age at first treatment was 24 weeks. The mean pre-procedure deepest pool of amniotic fluid was 1.8 cm and post-procedure was 3.8 cm. The mean number of infusions was 1.05. The mean first infusion to delivery interval was 31 days. Perinatal mortality was 88% and neonatal mortality was 35%, with only one baby surviving the neonatal period. There were three cases of chorioamnionitis, with one of these cases presenting with premature rupture of the membranes at the time of amnioinfusion., Conclusions: Transabdominal amnioinfusion is a useful procedure to reduce complications that result from oligohydramnios. Although the results show a high perinatal mortality, it must be borne in mind that most of these pregnancies had multiple fetal abnormalities with an already predicted poor outcome. Importantly, as this procedure increases the latency period, it may be useful in preterm pregnancies where prolonging the duration of the pregnancy may result in better perinatal outcome by improving important factors that influence survival including increased birthweight.

Objectives: The aim of this study was to evaluate the use of ultrasound assessment to predict risk of mortality in expectantly managed monochorionic twin fetuses with selective intrauterine growth restriction (sIUGR)., Methods: This was a retrospective study of 101 monochorionic twin pregnancies diagnosed with sIUGR before 26 weeks of gestation. All patients were under expectant management during the observation period. At the initial evaluation, the presence or absence of each of the following abnormalities was documented: oligohydramnios; stuck twin phenomenon; severe IUGR < 3(rd) centile of estimated fetal weight; abnormal Doppler in the umbilical artery; and polyhydramnios in the larger twin. The relationships between these ultrasound findings and mortality of sIUGR fetuses were evaluated using multiple logistic regression analysis., Results: Of 101 sIUGR twins, 22 (21.8%) fetuses suffered intrauterine demise and nine (8.9%) suffered neonatal death; 70 (69.3%) survived the neonatal period. Multiple logistic regression analysis revealed that the stuck twin phenomenon (odds ratio (OR): 14.5; 95% CI: 2.2-93.2; P = 0.006) and constantly absent diastolic flow in the umbilical artery (OR: 29.4; 95% CI: 3.3-264.0; P = 0.003) were significant risk factors for mortality., Conclusions: Not only abnormal Doppler flow in the umbilical artery but also severe oligohydramnios should be recognized as important indicators for mortality in monochorionic twins with sIUGR.

Background: Prolonged oligohydramnios following early preterm prelabour rupture of membranes (PPROM) is traditionally associated with high neonatal mortality and significant risk of pulmonary hypoplasia. However, recent evidence points to an apparent improvement in outcome., Aims: To document current neonatal outcomes following rupture of membranes prior to 25 weeks with severe persistent oligohydramnios and a latency to delivery of at least 14 days., Methods: A retrospective case note analysis over a 28-month period at Saint Luc University Hospital, Brussels., Results: From 23 pregnancies that were complicated by PPROM prior to 25 weeks, 15 infants were born after 24 weeks with a latency of more than 14 days and persistent oligohydramnios. Nine infants (60%) had severe respiratory failure and clinical signs compatible with pulmonary hypoplasia. Seven of these infants (78%) responded to high frequency ventilation and inhaled nitric oxide therapy with good clinical outcome but two died from severe respiratory failure. Five infants showed no clinical signs of pulmonary hypoplasia and responded to conventional neonatal management. One of these infants died at 77 days of age of necrotising enterocolitis. One infant was not resuscitated and died within minutes of birth, following prior discussion with the perinatal team and the parents. Survivors in this high-risk group (73%) had low morbidity at the time of discharge., Summary: The favourable neonatal survival and morbidity figures are in keeping with recent published evidence. This study confirms improved outcome even amongst the highest risk infants with documented persistent oligohydramnios.

We sought to determine if inhaled nitric oxide (iNO) administered to preterm infants with premature rupture of membranes (PPROM), oligohydramnios, and pulmonary hypoplasia improved oxygenation, survival, or other clinical outcomes. Data were analyzed from infants with suspected pulmonary hypoplasia, oligohydramnios, and PPROM enrolled in the National Institute of Child Health and Development Neonatal Research Network Preemie Inhaled Nitric Oxide (PiNO) trial, where patients were randomized to receive placebo (oxygen) or iNO at 5 to 10 ppm. Outcome variables assessed were PaO (2) response, mortality, bronchopulmonary dysplasia (BPD), and severe intraventricular hemorrhage (IVH) or periventricular leukomalacia (PVL). Twelve of 449 infants in the PiNO trial met criteria. Six infants received iNO and six received placebo. The iNO group had a mean increase in PaO (2) of 39 +/- 50 mm Hg versus a mean decrease of 11 +/- 15 mm Hg in the control group. Mortality was 33% versus 67%, BPD (2/5) 40% versus (2/2) 100%, and severe IVH or PVL (1/5) 20% versus (1/2) 50% in the iNO and control groups, respectively. None of these changes were statistically significant. Review of a limited number of cases from a large multicenter trial suggests that iNO use in the setting of PPROM, oligohydramnios, and suspected pulmonary hypoplasia improves oxygenation and may decrease the rate of BPD and death without increasing severe IVH or PVL. However, the small sample size precludes definitive conclusions. Further studies are required to determine if iNO is of benefit in this specific patient population.

Objective: To determine the usefulness of antepartum transabdominal amnioinfusion (APTA) in reducing perinatal morbidity and mortality due to oligohydramnios., Methods: In this case-control study of 100 pregnant women with oligohydramnios, 50 received APTA and 50 were treated conservatively. These controls were matched for age, parity, and pregnancy duration with the case patients., Results: There was a mean 4.02-cm increase in amniotic fluid index (AFI) after amnioinfusion. Only 18% of case patients required cesarean sections vs. 46% of controls. The perinatal mortality rate was 18% among controls and 4% among case patients, and the difference was significant., Conclusion: Antepartum amnioinfusion is a useful procedure to reduce complications resulting from decreased intra-amniotic volume. It is especially useful in preterm pregnancies, where the procedure allows for a better perinatal outcome by prolonging the duration of pregnancy.

Objective: To evaluate whether successful amnioinfusion is an independent predictor of perinatal survival in a cohort of cases with extreme and persistent oligohydramnios due to preterm premature rupture of membranes (pPROM) who reached viability and were managed with serial amnioinfusions., Study Design: We included all consecutive singleton pregnancies with pPROM at <26 weeks and oligohydramnios lasting >4 days between 1/1991 and 12/2001 and who consented to undergo amnioinfusion (n=77). Women received serial transabdominal amnioinfusions in an attempt to maintain a pocket of fluid >2 cm. The procedure was deemed successful if the median deepest pocket of fluid during the latency period was >2 cm. Excluded were miscarriages (n=10), fetal deaths before viability (24 weeks) (n=15), and cases that did not develop oligohydramnios (n=17). Prenatal predictors of outcome were compared between cases who survived the perinatal period and those who did not using Wilcoxon rank-sum test, Fisher's exact test and stepwise logistic regression analysis, with a two-tailed P<0.05 considered significant., Results: Of the 35 patients fulfilling the study criteria, 20 (57%) survived the perinatal period. Perinatal survivors had similar gestational age at pPROM (P=0.68) and at first amnioinfusion (P=0.53) as those who died in the perinatal period, but longer latency (P=0.013). Consequently, median gestational age at delivery [29.2 (25.4-35.3) weeks versus 26.1 (24.0-34.0) weeks, P<0.001] and median birth weight [1220 (650-2240) g versus 863 (520-2200) g, P=0.001] were significantly greater among survivors than among those who died. Significant predictors of survival at univariate analysis were entered into a stepwise logistic regression analysis in the chronological order in which they normally occur. The analysis demonstrated that successful amnioinfusion (OR=6.9, 95% CI 1.2-40.4) and administration of steroids (OR=14.6, 95% CI 1.5-144.1) were independent and significant predictors of perinatal survival., Conclusion: In a cohort of women with pPROM at <26 weeks and severe oligohydramnios managed with serial amnioinfusions, successful procedures and prenatal administration of corticosteroids are the only independent predictors of perinatal survival.

Unlabelled: Rupture of the membranes before the fetus has achieved viability within the womb is an event of enormous importance for both mother and physician. The potential outcome ranges from fetal death, a frequent occurrence, to a severely disabled life or a happy (but rare) birth without any mental or physical retardation for the child. The aim of the present investigation was to provide the consulting physician with valid data, enabling him/her to make a realistic assessment of the risks and to inform the patient accordingly., Method: In a retrospective analysis, we followed 36 cases with spontaneous rupture of the maternal membranes and development of oligo-/anhydramnios before 24 weeks of gestation. The patients had been treated between January 1994 and 2004. In a more detailed assessment, the patient cohort was divided into one group of women with rupture between 10 and 20 weeks of gestation and another group with a gestational age between start of week 21 and end of week 23., Results: Of the 36 children, seven (19.4%) survived initially, with two of the seven survivors dying subsequently. Among women with amniorrhexis before week 21 of gestation, only three of the 26 children survived, while four of 10 children survived among women with premature rupture of membranes between 21 and 23 weeks of gestation (p = 0.053) No case of mental retardation could be observed in the surviving children. Perinatal outcome was found to be significantly different in the presence of amnionitis (3/27) compared to the group without this event (4/9) (p = 0.028)., Conclusions: Because of the poor fetal outcome, termination of an ongoing pregnancy must also be considered in counseling the mother. If the mother decides to continue her pregnancy, amnionitis will be the most critical factor for ultimate termination of pregnancy.

Unlabelled: BACKGROUND/PATIENTS: A reverse flow in the umbilical artery and/or fetal aorta is associated with a higher perinatal and neonatal mortality. 30 fetuses showed a reverse flow using pulsed wave Doppler sonography (group I). A matched-pair control group including 30 fetuses with the same gestational age as well as a normal Doppler flow pattern in the umbilical artery and/or fetal aorta was taken for comparison (group II)., Results: In the group with reverse flow the rates of pregnancies with pre-eclampsia (n = 19/30, p < 0.0001), intrauterine growth retardation (n = 25/30, p < 0.0001), oligohydramnios (n = 21/30, p < 0.0001) and nicotine abuse (n = 15/30, p < 0.01) were significantly higher compared to the control group. Postnatal data showed significantly lower pH values in group I (p < 0.01). 40 % of the fetuses with reverse flow died in utero whereas in 67 % the reverse flow was accompanied by an insufficiency of the placenta (IUGR, oligohydramnios, histopathological abnormalities of the placenta). None of the fetuses in the control group died in utero. The incidence of IUGR (< 5ht percentile) was 83 % in group I but only 3 % in group II. The perinatal and overall mortality (including neonatal mortality 7 - 28 days after birth) amounted to 27 % and 53 % in group I, respectively, compared to 3 % and 0 % in the control group (p < 0.001). In addition cerebral anomalies could be found by ultrasound in 50 % of the neonates who presented a reverse flow prenatally. In 28 % of the surviving newborns an intracerebral hemorrhage (ICH) could be detected. None of the newborns of group II developed an ICH., Conclusions: Pregnancies with a reverse flow in the umbilical artery and/or fetal aorta have to be considered as a high risk group with a poor prognosis. The reverse flow is mainly caused by chronic placental insufficiency with IUGR. With respect to the further neuromotor development the incidence and severity of cerebral lesions in affected fetuses should be considered when discussing the perinatal situation with the parents.

Objective: The purpose of this study was to review consecutive pregnancies complicated by twin oligohydramnios-polyhydramnios sequence (TOPS) and to clarify the probable factors influencing the perinatal outcomes., Methods: Twenty-five pregnancies with a diagnosis of TOPS were treated with and without amniocentesis. A poor perinatal outcome was defined when either perinatal mortality or cerebral palsy was observed., Results: The mean gestational age at the time of diagnosis and of delivery was 27.8 (range 21-34) and 30.7 (range 23-35) weeks, respectively. Tocolytic therapy and therapeutic amniocentesis were done in 16 (64%) and 13 (52%) cases. Hydrops fetalis was present in 10 cases. The survival rate was 72%, and cerebral palsy was diagnosed in 8 of 36 infants (22%). The poor prognostic factors were gestational age at delivery (<30 weeks) and presence of symptomatic preterm labor and hydrops fetalis. Therapeutic amniocentesis did not influence the perinatal outcome., Conclusions: In this observational study, the long-term as well as the short-term perinatal outcome of pregnancy with TOPS seems to be poor. In addition, therapeutic amniocentesis in TOPS does not appear to affect fetal and neonatal outcomes., (Copyright 2002 S. Karger AG, Basel)

Objective: The aim of this study was to evaluate the role of transabdominal amnioinfusion in relieving oligohydramnios and improving pregnancy outcome., Study Design: Pregnant women with oligohydramnios amniotic fluid index (AFI<5) and premature rupture of membranes (PROM) from <27 weeks gestation were managed with serial transabdominal amnioinfusions. Under ultrasonic guidance, a 20-gauge needle was instilled in the uterine cavity and normal saline was infused until the AFI was normal. Repeat amnioinfusion was done weekly if oligohydramnios recurred. Amnioinfused cases were compared to cases with pPROM and oligohydramnios who had standard management., Results: The mean gestational age at first procedure was 22 weeks. The mean pre-procedure AFI was 1.1cm and post-procedure was 12 cm. The mean number of infusions was 2.4. The mean first infusion to delivery interval was 33 days. The amnioinfused group when compared to the control group had decreased perinatal mortality of 33% versus 83% (P=0.036, OR=0.4, 95% CI=0.17-0.93), neonatal mortality of 17% versus 71% (P=0.049, OR=0.26, 95% CI=0.07-0.97) and neonatal sepsis 86% versus 27%(P=0.049, OR=0.32, 95% CI=0.12-0.87) with no statistical difference in gestational age at rupture and delivery nor birthweight. Babies discharged home compared to non-survivors had a significant increase in gestational age at delivery, birthweight, NICU days and transabdominal amnioinfusions. Logistic regression showed that only transabdominal amnioinfusion and gestational age correlated with survival., Conclusion: In selected cases of oligohydramnios with pPROM, transabdominal amnioinfusions may be associated with fluid retention and improved neonatal survival.

Objective: To determine if unexplained changes in the amniotic fluid index or pulsatility indices of the fetal renal, middle cerebral, or umbilical artery are predictive of perinatal outcome in pregnancies complicated by oligohydramnios., Methods: Changes in amniotic fluid measurements and fetal vessel velocimetry in patients with oligohydramnios were evaluated for correlation with fetal outcome. Fourteen fetuses with oligohydramnios underwent serial sonography evaluating the amniotic fluid index and fetal middle cerebral, renal, and umbilical velocimetry. Matched controls and neonatal outcomes were obtained., Results: Change in amniotic fluid index and in renal artery pulsatility index were inversely correlated. Change in the middle cerebral artery pulsatility index was different in infants with normal outcome compared to infants with adverse outcome, Conclusions: Serial velocimetry of the middle cerebral artery may identify fetuses with oligohydramnios at risk for adverse outcomes.

Objective: We compare the maternal and perinatal outcomes between 69 patients with oligohydramnios and 49 patients with adequate fluid at the time of initial evaluation for PROM., Methods: One hundred and eighteen patients with spontaneous premature rupture of the membranes (PROM) at 18-28 weeks are included in the study. Inclusion criteria are singleton gestation, normal fetal anatomical survey and normal amniotic fluid prior to PROM, and absence of labor or abruption at the time of PROM. Oligohydramnios is defined as an amniotic fluid index (AFI) <5 cm of measurable pockets of amniotic fluid which are free of umbilical cord. Expectant management was carried during the 3-year period. The overall perinatal survival is 66%. Pulmonary hypoplasia is present in 18%, and skeletal deformities in 3% of all neonates., Results: There is no significant difference between the two groups in the mean gestational ages at PROM (172+/-17 d vs. 171+/-14 d), latency periods (9+/-14 d vs. 8+/-13 d), incidences of chorioamnionitis (48 vs. 39%), endometritis (19 vs. 14%), neonatal sepsis (11 vs. 13%), or skeletal deformities (6 vs. 0%). Patients with oligohydraminos have significantly higher incidences of fetal heart rate decelerations (59 vs. 38%) and C-section (38 vs. 16%) (P < 0.05) than patients with adequate amniotic fluid., Conclusions: After adjusting for confounding variables, neonates with oligohydramnios are twice as likely to develop pulmonary hypoplasia (20 vs. 10%) and more likely to experience neonatal death (30 vs. 20%) when compared to those with adequate fluid, even though the difference is not statistically significant.

Background: Pregnancies complicated by fetal cystic hygroma in the second and third trimesters are often associated with hydrops fetalis, oligohydramnios or intrauterine fetal death which may make genetic assessment more difficult. We investigated the roles of amniocentesis, postmortem chorionic villus sampling and cystic hygroma paracentesis in cytogenetic evaluation of cystic hygroma under such circumstances., Methods: Thirty-five fetuses of cystic hygroma associated with hydrops fetalis, oligohydrammos, or intrauterine fetal death were studied. All fetuses were delivered at Mackay Memorial Hospital, Taipei, Taiwan between January, 1987 and July, 1995. Data collected included maternal age, prenatal sonograms, gestational age at diagnosis, fetal karyotypes and diagnostic procedures., Results: Of 35 fetuses, all had hydrops fetalis, 19 had suffered IUFD at the time of diagnosis, and 10 had severe oligohydramnios. Cytogenetic studies were performed via amniocentesis, postmortem chorionic villus sampling, or cystic hygroma paracentesis. Successful karyotyping was achieved in 32 fetuses and the karyotype of 45,X was found in 24 fetuses. In cases with IUFD, successful karyotyping rates on cells from amniotic fluid, chorionic villi and cystic hygroma fluid were 88.9% (8 of 9), 69.2% (9 of 13) and 20% (1 of 5), respectively, whereas, in cases with living hydropic fetuses, successful karyotyping was achieved in 12 of 12 amniotic fluid and 5 of 5 cystic hygroma fluid samples., Conclusions: Amniocentesis is a better method for cytogenetic evaluation of fetal cystic hygroma associated with intrauterine fetal death than postmortem chorionic villus sampling and cystic hygroma paracentesis. However, in the case with a living hydropic fetus and oligohydramnios, cystic hygroma paracentesis appears to be a practical alternative for cytogenetic assessment.

Objective: Our purpose was to further evaluate the role of serial amniocentesis in pregnancies complicated by the "stuck twin" syndrome., Study Design: A cohort of 37 consecutive cases of stuck twin syndrome was followed up from 1986 through 1992. Evaluations included gestational age at diagnosis and at delivery, mean number of amniocenteses, volume of amniotic fluid withdrawn, placentation, perinatal complications, fetal survival, and neonatal follow-up., Results: Five pregnancies were terminated, five had no intervention, and 27 underwent serial amniocenteses. The mean number of amniocenteses was 3.4 (range 1 to 6), and mean total amniotic fluid volume withdrawn was 5.8 L (range 0.75 to 4.0). In the serial amniocentesis group mean gestational age was 23.1 weeks (range 16 to 30) at diagnosis and 31.5 weeks (range 20 to 38) at delivery. Eighty-two percent had monochorionic placentas, and 36% had marginal or velamentous cord insertions. Infant survival was 39 of 54 (74%) in the serial amniocentesis group compared with four of 10 (40%) in the nonintervention group (relative risk 0.46, 95% confidence interval 0.24 to 0.90)., Conclusion: Serial amniocentesis was associated with a 54% reduction in fetal and neonatal death in cases of stuck twin syndrome.

Oligohydramnios is a serious complication of pregnancy that is associated with a poor perinatal outcome. Eighty pregnancies complicated by oligohydramnios constitute the basis for this retrospective study. Forty patients had premature rupture of the membranes; of these, outcomes were good in 25. Twelve of 14 fetuses with oligohydramnios and intrauterine growth retardation survived. None of the nine fetuses with severe renal anomalies lived. None of the twins with twin-twin transfusion and oligohydramnios survived. Six pregnancies with oligohydramnios and premature separation of the placenta were identified; all of these resulted in fetal or neonatal death during the second trimester.