Oligohydramnios

Ans. is A. i.e. Both Assertion and Reason are true, and Reason is the correct explanation for Assertion

• Oligohydramnios is the condition where the liquor amnii is deficient in the amount to the extent of less than 200 ml at term.
• Sonographically, oligohydramnios is defined when the maximum vertical pool of liquor is less than 2 cm or when the amniotic fluid index (AFI) is less than 5 cms.
• LUTO(Lower urinary tract obstruction)on ultrasonography, in a male fetus, is almost always due to posterior urethral valves.
• The classical evidence on ultrasonography of LUTO is the presence of severe oligohydramnios, a grossly distended urinary bladder with an increase in bladder wall thickness. The so-called “keyhole” sign can be demonstrated if the proximal urethra is distended.
• MANAGEMENT: At 37 weeks, fetal lung usually attains maturity. As there is severe oligohydramnios, the delivery of the baby is appropriate in the given situation.

Ans. is D. i.e. Renal agenesis

Oligohydramnios is defined as an AFI of 5 cm or less, or liquor is deficient in the amount to the extent of <200 ml at term. 

• Amnionic band syndrome
• Cardiac: Fallot tetralogy, septal defects
• Central nervous system: holoprosencephaly, meningocele, encephalocele, microcephaly
• Chromosomal abnormalities: triploidy, trisomy 18, Turner syndrome
• Cloacal dysgenesis
• Cystic hygroma
• Diaphragmatic hernia
• Genitourinary: renal agenesis, renal dysplasia, urethral obstruction, bladder exstrophy, Meckel-Gruber syndrome, ureteropelvic junction obstruction, prune-belly syndrome
• Hypothyroidism
• Skeletal: sirenomelia, sacral agenesis, absent radius, facial clefting
• TRAP (twin reversed arterial perfusion) sequence
• Twin-twin transfusion
• VACTERL (vertebral, anal, cardiac, tracheoesophageal, renal, limb) association

• Amniotic band syndrome
• Cardiac: Fallot tetralogy, septal defects
• Central nervous system: holoprosencephaly, meningocele, encephalocele, microcephaly
• Chromosomal abnormalities: triploidy, trisomy 18, Turner syndrome
• Cloacal dysgenesis
• Cystic hygroma
• Diaphragmatic hernia
• Genitourinary: renal agenesis, renal dysplasia, urethral obstruction, bladder exstrophy, Meckel-Gruber syndrome, ureteropelvic junction obstruction, prune-belly syndrome
• Hypothyroidism
• Skeletal: sirenomelia, sacral agenesis, absent radius, facial clefting
• TRAP (twin reversed arterial perfusion) sequence
• Twin-twin transfusion
• VACTERL (vertebral, anal, cardiac, tracheoesophageal, renal, limb) association

• Oligohydramnios is defined as an amniotic fluid index of 5 cm or less.
• It is almost always present when there is either obstruction of the fetal urinary tract or renal agenesis. 

• Amniotic band syndrome
• Septal defects and tetralogy of Fallot
• Holoprosencephaly, meningocele, encephalocele, microcephaly.
• Chromosomal triploidy, trisomy 18, Turner syndrome.
• Cloacal dysgenesis
• Cystic hygroma
• Diaphragmatic hernia
• Renal agenesis, renal dysplasia.
• Twin-twin transfusion syndrome.

Ans. is D, i.e. Oligohydramnios

• Oligohydramnios is not associated with Rh-isoimmunization whereas the other 3 are the maternal complications of Rh isoimmunization.

Causes of Oligohydramnios

Mnemonic-Dil Mein Ppaar (read as Pyaar)

• D-Drug ( Prostaglandin Synthetase inhibitors like indomethacin and ACE inhibitors).
• I-IUGR (Intrauterine Growth Restriction)
• L-Leaking of fluid following amniocentesis or chorionic villus sampling.
• Mein-Maternal conditions like hypertension and preeclampsia.
• P-Post-term pregnancy
• P-Premature rupture of membrane
• A -Abruptio chronic
• A -Amnion Nodosum  and chromosomal anomaly like triploidy
• R-Renal anomalies of the fetus (leading to decreased urine production):

– Renal agenesis

– Urethral obstruction (posterior urethral valve)

– Prune-Belly syndrome

-Bilateral multicystic dysplastic kidneys.

• M/C cause of mild oligohydramnios-idiopathic
• M/G cause of severe oligohydramnios is Gross Congenital anomaly-Renal anomalies.

Ans. is D. i.e. Oligohydramnios

Fetal urine is the main contributor of Amniotic fluid beyond 20 weeks, therefore. In the case of Renal agen­esis –) decrease / no urine oligohydramnios.

Extra Edge :

• The assessment of amniotic fluid is an integral part of antepartum fetal assessment.
• Techniques used for measurement of Amniotic fluid – ultrasonographically :

Amniotic fluid index (AFI): is calculated by dividing the uterus into four quadrants and measuring the largest vertical pocket of liquor in each of the four quadrants. The sum of the four measurements is the AFI in cm. The range of 5 – 25 cm is considered normal. Less than 5 is considered significant oligohydramnios.

Single deepest pocket (SDP): is the depth of a single cord-free pocket of amniotic fluid. The normal range is 2 – 8 cm. Over 8 cm is considered polyhydramnios. Less than 2 cm is considered as oligohydramnios.

Ans. is C. i.e. Renal agenesis

The other 3 are the causes of polyhydramnios.

Causes of Oligohydramnios

Mnemonic-Dil Mein Ppaar (read as Pyaar)

• D-Drug ( Prostaglandin Synthetase inhibitors like indomethacin and ACE inhibitors).
• I-IUGR (Intrauterine Growth Restriction)
• L-Leaking of fluid following amniocentesis or chorionic villus sampling.
• Mein-Maternal conditions like hypertension and preeclampsia.
• P-Post-term pregnancy
• P-Premature rupture of membrane
• A -Abruptio chronic
• A -Amnion Nodosum  and chromosomal anomaly like triploidy
• R-Renal anomalies of the fetus (leading to decreased urine production):

– Renal agenesis

– Urethral obstruction (posterior urethral valve)

– Prune-Belly syndrome

-Bilateral multicystic dysplastic kidneys.

• M/C cause of mild oligohydramnios-idiopathic
• M/C cause of severe oligohydramnios is Gross Congenital anomaly-Renal anomalies.

Ans. is B. i.e. Rh incompatibility

Causes of Oligohydramnios

Mnemonic-Dil Mein Ppaar (read as Pyaar)

• D-Drug ( Prostaglandin Synthetase inhibitors like indomethacin and ACE inhibitors).
• I-IUGR (Intrauterine Growth Restriction)
• L-Leaking of fluid following amniocentesis or chorionic villus sampling.
• Mein-Maternal conditions like hypertension and preeclampsia.
• P-Post-term pregnancy
• P-Premature rupture of membrane
• A -Abruptio chronic
• A -Amnion Nodosum  and chromosomal anomaly like triploidy
• R-Renal anomalies of the fetus (leading to decreased urine production):

– Renal agenesis

– Urethral obstruction (posterior urethral valve)

– Prune-Belly syndrome

-Bilateral multicystic dysplastic kidneys.

• M/C cause of mild oligohydramnios-idiopathic
• M/G cause of severe oligohydramnios is Gross Congenital anomaly-Renal anomalies.

Ans. is B. i.e. Oligohydramnios

Maternal complications of twin pregnancy:

• Anemia
• Pre-eclampsia (25%)
• Polyhydramnios (10%)
• Malpresentations
• Preterm labor (50%)
• Early rupture of membranes
• Prolonged labor
• Postpartum hemorrhage due to uterine atony
• Sub-involution of uterus
• Antepartum hemorrhage

Ans. is D. i.e. Chorioangioma

Causes of Oligohydramnios

Mnemonic-Dil Mein Ppaar (read as Pyaar)

• D-Drug ( Prostaglandin Synthetase inhibitors like indomethacin and ACE inhibitors).
• I-IUGR
• L-Leaking of fluid following amniocentesis or chorionic villus sampling.
• Mein-Maternal conditions like hypertension and preeclampsia.
• P-Post-term pregnancy
• P-Premature rupture of membrane
• A -Abruptio chronic
• A -Amnion Nodosum and chromosomal anomaly like triploidy
• R-Renal anomalies of the fetus (leading to decreased urine production):

– Renal agenesis

– Urethral obstruction (posterior urethral valve)

– Prune-Belly syndrome

-Bilateral multicystic dysplastic kidneys.

• M/C cause of mild oligohydramnios-idiopathic
• M/G cause of severe oligohydramnios is Gross Congenital anomaly-Renal anomalies.

Ans. is D. i.e. Labetalol 

Causes of Oligohydramnios

Mnemonic-Dil Mein Ppaar (read as Pyaar)

• D-Drug ( Prostaglandin Synthetase inhibitors like indomethacin and ACE inhibitors).
• I-IUGR ( Intrauterine Growth Restriction )
• L-Leaking of fluid following amniocentesis or chorionic villus sampling.
• Mein-Maternal conditions like hypertension and preeclampsia.
• P-Post-term pregnancy
• P-Premature rupture of membrane
• A -Abruptio chronic
• A -Amnion Nodosum and chromosomal anomaly like triploidy
• R-Renal anomalies of the fetus (leading to decreased urine production):

– Renal agenesis

– Urethral obstruction (posterior urethral valve)

– Prune-Belly syndrome

-Bilateral multicystic dysplastic kidneys.

• M/C cause of mild oligohydramnios-idiopathic
• M/G cause of severe oligohydramnios is Gross Congenital anomaly-Renal anomaly

Ans.B. Renal pathway obstruction

Urinary tract obstruction is an important cause of oligohydramnios.

Causes of Oligohydramnios

Mnemonic-Dil Mein Ppaar (read as Pyaar)

• D-Drug ( Prostaglandin Synthetase inhibitors like indomethacin and ACE inhibitors).
• I-IUGR
• L-Leaking of fluid following amniocentesis or chorionic villus sampling.
• M-Maternal conditions like hypertension and preeclampsia.
• P-Post-term pregnancy.
• P-Premature rupture of membrane.
• A -Abruptio chronic.
• A -Amnion Nodosum and chromosomal anomaly like triploidy.
• R-Renal anomalies of the fetus (leading to decreased urine production).

– Renal agenesis.

– Urethral obstruction (posterior urethral valve).

– Prune-Belly syndrome.

-Bilateral multicystic dysplastic kidneys.

• M/C cause of mild oligohydramnios-idiopathic
• M/G cause of severe oligohydramnios is Gross Congenital anomaly-Renal anomalies.