Last updated on April 29th, 2023 at 11:44 pm
Oligohydramnios is a condition wherein an abnormally low amniotic fluid level of below the 5th percentile for gestational age is found upon assessment. The 5th percentile is approximately 7 cm while the mean amniotic fluid index (AFI) should be at 12 to 14 cm.
The amniotic fluid is necessary for the proper growth and development of the fetus. It cushions the baby from physical trauma, provides a barrier against infection, maintains consistent body temperature, and permits fetal lung growth.
Amniotic fluid volume increases at 800 to 1000ml from 33-38 weeks gestation and declines at term at approximately 500 ml. Oligohydramnios affects about 4.5% of pregnant women and 12% with pregnancy after 40 weeks.
Signs and Symptoms of Oligohydramnios
Certain conditions are contributing to oligohydramnios that may cause symptoms. Some of the most common signs and symptoms of low amniotic fluid volume are:
- low amniotic fluid on ultrasound
- a sudden drop in fetal heart rate
- fetal size is smaller than what is normal for gestational age
- Abnormal findings on the fetal monitor such as fetal distress
- abdominal discomfort
- leaking fluid
- preterm premature rupture of membranes (PPROM)
- fundal height smaller with the age of gestation
- limited to no fetal movement, or decreasing fetal movement
- low or unchanged maternal weight
Causes of Oligohydramnios
The volume of amniotic fluid is from the fluid production and fluid movement out of the sac. It consists of fetal urine output, and some fetal respiratory secretion, along with hydrostatic and osmotic transport of maternal plasma small through the placenta.
The fetus swallows and breathes the amniotic fluid which is voided after, and the cycle repeats. Any problems affecting the production of urine, the pathway or structure, or a rupture of the membrane can lead to oligohydramnios. Several factors can contribute are:
- Maternal problems. Dehydration, diabetes, hypertension, and pre-eclampsia can greatly affect the amniotic fluid levels from uteroplacental insufficiency. It also correlates with certain drugs that pregnant women take to treat these conditions.
- Potter’s syndrome. The fetal kidneys fail to develop or have malformation such as the absence of one or both kidneys (renal agenesis).
- Placental insufficiency. The blood from the placenta is redistributed to the fetal brain rather than the abdomen and kidneys, causing decreased fetal urine output.
- Fetal gastrointestinal anomalies. Fetal swallowing and intramembranous absorption problems can result in oligohydramnios.
- Fetal genitourinary abnormalities. Problems like dysplastic kidneys or bladder outlet obstruction can cause oligohydramnios because the majority of amniotic fluid production comes from fetal urine.
- Post-term. Amniotic fluid significantly decreases by half after 40 weeks of gestation.
- Premature rupture of membranes. A leak or tear in the membrane can cause oligohydramnios even before the labor begins.
- Twin-to-twin transfusion syndrome. It is a serious placenta-related condition, where one twin is surrounded with too little amniotic fluid while the other twin has too little amniotic fluid.
Risk Factors to Oligohydramnios
Most pregnant women who develop oligohydramnios do not have any identifiable risk factors, which is why the primary care physician is stressing the importance of regular prenatal appointments to monitor the amniotic fluid levels throughout the pregnancy. The following are the risk factors associated with oligohydramnios:
- Maternal hypertension or pre-eclampsia. These conditions cause a decrease in placental perfusion due to the limited blood supply to the placenta and fetus. This may result in less oxygen and nutrients to the fetus resulting in oligohydramnios.
- Maternal diabetes. The excess glucose that builds up in the blood can cause the kidneys to work overtime to filter and absorb the excess glucose. When the kidneys can’t keep up it can cause dehydration from the excess glucose excreted in the urine along with the fluids from body tissues.
- Maternal dehydration. Lack of water can cause nutritional deficiencies and poor tissue perfusion affecting the health of the pregnant women and the developing baby.
- Hypoxia. Maternal and fetal hypoxic hypoxia and anemic hypoxia are both associated with placental dysfunction. It can also cause decreased renal perfusion in the fetus thereby reducing urine production. Chronic hypoxia can result in the shunting of fetal blood away from the kidneys to more vital organs.
- Placental issues. Uteroplacental insufficiency is a condition in which oxygen and nutrients are not sufficient enough for the fetus via the placenta and the fetus may stop recycling fluid causing oligohydramnios.
Complications of Oligohydramnios
Oligohydramnios in the first six months of pregnancy is generally more dangerous and can affect the baby’s development. These complications include:
- Preterm birth. This is due to the microbial invasion of the amniotic cavity from premature rupture of the membrane.
- Miscarriage or stillbirth. Miscarriage is when a fetus dies in the womb before 20 weeks of gestation and stillbirth is after 20 weeks of gestation. This is due to the amniotic fluid’s essential role in fetal lung development.
- Deformities. The baby may develop contractures or tightness in the joints due to the inability to stretch and move from a very low amniotic fluid.
- Infection. The microbial invasion in the amniotic cavity may cause fetal infection and the development of fetal inflammatory response syndrome.
Low amniotic fluid in the last trimester of pregnancy can cause problems during labor and delivery such as:
- Fetal growth restriction. This is due to reduced renal perfusion and urinary output.
- Umbilical cord compression. Amniotic fluid cushions the baby’s umbilical cord to prevent compression, which obstructs blood flow, oxygen, and nutrients to the baby.
- Underdeveloped lungs. The amniotic fluid plays an essential role in lung development, where it pushes the air sacs to open and stimulates them to grow. A very low amniotic fluid may result in a few lung tissues causing breathing trouble upon delivery.
- Premature or cesarean delivery. Having a very low amniotic fluid can cause intrauterine growth restriction and umbilical cord constriction which can cause fetal distress resulting in premature or cesarean delivery.
Diagnosis of Oligohydramnios
Diagnosis should usually be confirmed by:
- Patient history. A thorough maternal and family history including past medical history, previous pregnancy, or medication use can screen for conditions associated with oligohydramnios.
- Physical examination. Asking for symptoms like urinary incontinence, feeling damp, or leaking fluid. An assessment like measurement of fundal height or a speculum examination can be done to check for decreased fundal size or pooling of fluid in the perineum.
- Imaging. This test confirms the diagnosis of oligohydramnios:
- Ultrasound. Quantitative measurement of amniotic fluid volume is done using AFI or MPV. Amniotic Fluid Index (AFI) is the sum of the vertical depth of fluid in each quadrant of the uterus with a normal range from >5 to <24cm. Maximum Vertical Pocket (MPV) is the measurement of the deepest pocket of amniotic fluid with a normal range of >2 to <8cm.
- Doppler ultrasound. Measure the blood flow to fetal blood vessels, assessing the exchange between the placenta and the fetus.
- Karyotyping. It is a test used to detect genetic problems or predisposing factors of severe congenital renal anomalies.
- Dipstick test. Usually done at the bedside for a patient with suspected premature rupture of membranes. A pelvic examination will be done to check for amniotic fluid pooling, then a swab of that fluid is done to check for the following:
- Insulin-like Growth Factor Binding Protein-1 (IGFBP-1). It is a major protein marker of the amniotic fluid.
- Placental Alpha-Microglobulin-1 (PAMG-1). Is also a protein found in amniotic fluid with high accuracy at all gestational ages.
Treatment for Oligohydramnios
There is no long-term treatment for oligohydramnios but there are a few things that can temporarily increase amniotic fluid levels. Having oligohydramnios near the end of the pregnancy may not require treatment but will be closely monitored weekly to check the amount of amniotic fluid. These includes:
- Supportive therapy. These techniques are temporary and do not treat the underlying cause of oligohydramnios.
- Fluid therapy. Increasing the patient’s fluid intake may help increase the amount of amniotic fluid. Oral hydration is usually advised, however, some cases may need intravenous hydration.
- Bed rest. This is advised to help improve the blood flow to the placenta, which can help increase the amniotic fluid.
- Tissue sealants. This is an investigational therapy using a combination of hydration and DDAVP (desmopressin), and other methods to increase the amniotic fluid levels.
- Monitoring. These procedures are often used in combination to assess the well-being of the high-risk fetus. Usually performed after 28 weeks of gestation and done once or twice a week.
- Biophysical profile. This procedure monitors the baby’s movement, muscle tone, heart rate, breathing, and the amount of amniotic fluid surrounding the fetus in the uterus.
- Non-stress test. This test will check the baby’s heart rate during activity and rest.
- Medication. If the oligohydramnios is due to the premature rupture of membranes, the following medications can be given.
- Antibiotics. This medication will reduce the risk of ascending infection.
- Steroids. A course of steroids can aid in fetal lung development.
- Procedure. Always mention something about the subtopic even if just one sentence.
- Amnioinfusion. Introduction of saline solution into the uterus through the patient’s cervix which can help prevent umbilical cord compression.
- Labor induction or Cesarean delivery. In situations where fetal circulation can be compromised or if the fetal heart rate becomes abnormal, the fetus may need to be delivered to prevent birth injuries.
Nursing Diagnosis for Oligohydramnios
Oligohydramnios Nursing Care Plan 1
Nursing Diagnosis: Risk for Injury (Fetal) related to possible preterm labor secondary to oligohydramnios.
Desired Outcomes:
- The fetus will remain safe while attempting to maintain the pregnancy for at least 37 weeks gestation.
- The patient will adhere to the treatment regimen to keep the baby in the uterus without any complications.
Oligohydramnios Nursing Interventions
Assess the mother’s condition and evaluate for signs of labor. Monitor and document the duration, frequency, and intensity of uterine contractions. Check cervical dilation and effacement along with the status of the membrane.
This assessment will help the healthcare team determine if interventions to prevent early delivery are possible.
Assess the fetus for distress by checking the fetal heart rate and movement.
Any increase or decrease in the fetal heart rate and movement can indicate fetal distress that may require further assessment.
Monitor the patient’s amniotic fluid level regularly. Check for fluid pooling in the perineum.
The patient may not notice a leaking amniotic fluid, so regular monitoring of the amniotic fluid level is needed.
Assist the patient in a side-lying position with pillows between the knees or under the belly. Encourage bed rest.
This position is advised to help improve the blood flow to the placenta, which can help increase the amniotic fluid to cushion the baby. Bed rest can help improve the patient’s blood flow, reduce pressure on the cervix, and prevent premature labor.
Provide and encourage adequate hydration.
Giving adequate oral or intravenous hydration can help make the uterus less active and increase the amniotic fluid level. Dehydration stimulates the pituitary gland to secrete an antidiuretic hormone which may also trigger oxytocin release.
Educate the patient about the treatment plan and medication. Administer medications as prescribed such as beta-agonist, corticosteroids, magnesium sulfate, and tocolytics.
Informing the patient will help decrease anxiety and increase compliance with the treatment plan. Beta-agonists stop uterine contractions, corticosteroids help the baby’s lungs to develop, magnesium sulfate protects the fetal brain from injury, and tocolytics are used to delay delivery.
Oligohydramnios Nursing Care Plan 2
Nursing Diagnosis: Risk for Ineffective Thermoregulation related to low birth weight secondary to oligohydramnios.
Desired Outcomes:
- The newborn will be able to maintain a normal body temperature between 36.5 to 37.5 OC.
- The newborn will avoid developing cold stress and exhibit normal vital signs and Apgar score.
Oligohydramnios Nursing Interventions
Assess and monitor the newborn’s body temperature. For a hypothermic baby, the rectal temperature should be taken.
Taking the temperature rectally is advised for an accurate and quick reading of the baby’s core temperature.
Perform an Apgar scoring at one minute and five minutes after birth.
This is done to assess the heart rate, respiratory effort, muscle tone, reflexes, and skin color of the baby.
Prepare the environment by warming the delivery room. Prepare all the supplies needed and organize nursing care.
Adjust the room temperature to keep the newborn warm, without open windows or fans. Supplies needed should be organized and within reach for prompt care.
Provide skin-to-skin contact immediately after birth by placing the baby on the mother’s abdomen.
Skin-to-skin contact prevents heat loss.
Place a cover on the head and a warm towel to cover the baby’s body while drying thoroughly.
The baby’s head is the largest surface area in a newborn which can cause a great amount of heat loss through evaporation. They also lose a lot of body heat as the amniotic fluid on their skin evaporates.
Place the newborn under a radiant heat source or an incubator. Cover all the surfaces with warm blankets where the newborn is placed.
This will help the newborn conserve heat and prevent heat loss. Covering surfaces will prevent heat loss through conduction.
Educate the patient about the importance of postponing bathing and the importance of breastfeeding.
Bathing the newborn immediately after birth will cause a drop in the body temperature. Breastfeeding promotes skin-to-skin contact and nutrition for the baby.
Oligohydramnios Nursing Care Plan 3
Nursing Diagnosis: Risk for Infection related to loss of protective barrier secondary to oligohydramnios.
Desired Outcomes:
- The fetus will be free from any signs of infection.
- The patient will be able to adhere to measures to prevent complications.
Oligohydramnios Nursing Interventions
Assess the mother’s condition and evaluate for signs of infection. Check the perineum for fluid pooling along with the status of the membrane using sterile gloves.
This will help the nurse identify early signs of infection and evaluate the amount of amniotic fluid loss if any while minimizing the risk of infection by wearing sterile gloves.
Assess and monitor the fetal status including fetal heart rate and movement.
Any increase or decrease in the fetal heart rate and movement can indicate fetal distress that may require further assessment.
Assess and record the patient’s weight daily along with the intake and output.
This will help the nurse identify the amount of amniotic fluid loss.
Encourage bed rest and position the patient on a side-lying position with pillows between the knees or under the belly.
Bed rest can help reduce pressure on the cervix, reduce amniotic fluid loss, and prevent premature labor.
Educate the patient about the importance of hand washing and proper washing of the perineum after bladder or bowel movement.
This greatly reduces ascending infection.
Provide adequate hydration and nutritious food.
Nutrient-rich food can boost the mother’s immune system to fight infection.
Educate the patient about the importance of refraining from any type of sexual intercourse and tampon use during this time.
It is essential to protect the fetus from any risk of infection and complete rupture of the membranes.
Administer prophylactic antibiotics as prescribed.
This will prevent infection while waiting for the fetus to be born.
Oligohydramnios Nursing Care Plan 4
Nursing Diagnosis: Deficient Knowledge related to misinformation secondary oligohydramnios as evidenced by inaccurate execution of the given task.
Desired Outcomes:
- The patient will verbalize understanding of the condition, prognosis, management, and potential complications of oligohydramnios.
- The patient will accurately perform techniques and tasks given to manage the condition at home.
Oligohydramnios Nursing Interventions
Assess the patient’s knowledge about oligohydramnios.
This will help the nurse in identifying the focus of her teaching and the information to give to the patient.
Assess the patient’s readiness to learn.
Information given can be easily remembered if the patient is ready and motivated.
Encourage the involvement of significant others in the teaching-learning process.
Having a supportive partner during this time significantly decreases maternal stress and overwhelming feelings of helplessness.
Provide information about oligohydramnios, signs, and symptoms to watch out for, possible complications, and management.
Giving adequate information will reduce the patient’s anxiety about the situation. Having a clear mind in sudden unexpected situations will keep them in control and equip them all the time.
Demonstrate self-assessments or measures to do in different kinds of situations such as premature rupture of membrane or preterm labor.
Self-monitoring can be helpful to keep the patient in control of the situation.
Review activities of daily living and schedule alternating activities and rest.
Modification of daily activities may help prevent the occurrence of complications. Having adequate rest can improve maternal well-being significantly.
Educate the patient about the importance of strict adherence to the treatment plan, nutritional requirements, and self-monitoring at home.
This will ensure the success of the treatment plan while keeping both the mother and baby safe.
Provide information about resources and services available in case of urgent situations.
Working as a team will promote healthy pregnancy and safe delivery of the baby.
Oligohydramnios Nursing Care Plan 5
Nursing Diagnosis: Anxiety related to a perceived threat to self and the fetus secondary to oligohydramnios as evidenced by verbalization of feeling helpless.
Desired Outcomes:
- The patient will be able to demonstrate interventions that will control and reduce anxiety.
- The patient will verbalize understanding of the current situation and adhere to the treatment plan.
Oligohydramnios Nursing Interventions
Assess the patient’s level of anxiety. Taking note of the patient’s facial expression and body language.
Stress and anxiety can greatly affect the body system and hormone levels, potentially causing fetal distress.
Establish a connection and build the trust of the patient.
This will promote expression and open communication between the nurse and the patient.
Encourage the involvement of significant others.
Having a supportive partner during this time significantly decreases maternal stress and overwhelming feelings of helplessness.
Educate the patient about the condition, signs, and symptoms to watch out for, possible complications, and management.
Giving adequate information will reduce the patient’s anxiety and keep them in control of their situation.
Encourage verbalization of fears or concerns about the situation.
Discussions about concerns and feelings are taught to be positive birth imagery.
Encourage relaxation techniques such as deep breathing, soothing music, light back rubs, and an environment with minimal stimuli.
These techniques significantly reduce anxiety levels.
Assist the patient and significant others in planning for future situations like preterm labor and delivery.
Allowing them to plan and provide choices can help them be prepared if the situation is imminent.
Referral to a group of women with the same situation or psychotherapy upon consent. Involves a supportive approach focusing on the patient’s emotions and direct needs through empathic immersion.
Nursing References
Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier. Buy on Amazon
Gulanick, M., & Myers, J. L. (2022). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon
Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2020). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier. Buy on Amazon
Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier. Buy on Amazon
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