Evidence Based Management of Oligohydramnios

Background: Oligohydramnios, or abnormally decreased amount of amniotic fluid, complicates approximately 1 to 2 percent of pregnancies. It poses a risk to the fetus by contributing to perinatal morbidity and mortality, and due to iatrogenic preterm delivery. An increase in operative delivery increases the risk to the mother. Oligohydramnios may result from known etiological factors or it may accompany other pregnancy complications. When no etiological factor or association is identified, it is termed “Isolated Oligohydramnios'. Treatment strategies: This review presents the various treatment options for oligohydramnios in the light of current available evidence. Maternal hydration whether orally or by intravenous route is perhaps the most well studied intervention. Many therapeutic agents have also been tried. Of these, L-arginine and sildenafil have been supported by several studies but conclusive evidence for the same could not be identified Conclusions: In cases of isolated oligohydramnios, therapeutic intervention is desirable to prolong the pregnancy so as to avoid preterm delivery and to prevent adverse perinatal outcome. Based on present scientific evidence we recommend that oral hydration therapy should be offered to the eligible women. Use of sildenafil citrate for this purpose cannot be recommended till its safety is well established in view of the recent reports of adverse fetal outcome.