Journal of Krishna Institute of Medical Sciences University (Jan 2018)
A Randomized Controlled Trial to Compare the Efficacy of Three Different Methods of Maternal Hydration for Oligohydramnios
Abstract
Background: Oligohydramnios is defined as an Amniotic Fluid Index (AFI) of less than normal for that gestational age. It is mainly associated with increased perinatal morbidity and mortality due to cord compression, fetal distress, pulmonary hypoplasia. So, an effective medical therapy is very important to prevent the complications. Aim and Objectives: To compare efficacy of maternal hydration with oral water, 1Lof Ringer Lactate (RL) + 1Lof 5% Dextrose (5% D) and 2L of 0.45% Normal saline (0.45% NS) in increasing AFI in patients with oligohydramnios. Material and Methods: Patients who had been diagnosed as oligohydramnios (with AFI<8cm) by Ultrasonography (USG) were included in the study. Both Fetal Growth Restriction (FGR) with oligohydramnios and idiopathic oligohydramnios were studied. Totally 108 cases were allocated into 3 groups depending on the computer generated randomized table. Group A was given oral hydration i.e., 2L of water in 2 hours. Group B received 1L RL+ 1L 5% D in 2 hours intravenously and Group C was given 2L0.45% NS in 2 hours intravenously. AFI and Symphysiofundal Height (SFH) was assessed after 2 hours and 24 hours after the hydration therapy. Results: All the types of hydration therapy had significant increase in AFI and SFH at 2 hours and 24 hours. In group A, mean increased from 4.91 ± 1.58 to 5.88 ± 1.86 and 6.49 ± 2.22 at 2 hours and 24 hours respectively. Similarly in group B, mean increased from 4.98 ± 1.86 to 5.79 ± 1.89, 6.18 ± 2.23 at 2 and 24 hours respectively. In group C, mean value increased from 5.58 ± 1.31 to 7.32 ± 1.40, 8.32 ± 1.77 at 2 hours and 24 hours. There was significant increase in group C when compared to other two groups and there was no statistically significant difference between group A and group B. There was significant rise in SFH in all the three groups at 2 hours and 24 hours. Both FGR with oligohydramnios and idiopathic oligohydramnios responded well to any type of hydration, but 0.45% NS was significantly better in unexplained oligohydramnios. None of the patients had any major side effects. Conclusion: Both oral and IV hydration with hypotonic solution increases the level of amniotic fluid in cases of oligohydramnios. But 0.45% NS was shown to be significantly better than oral hydration and IV hydration with RL+5% D especially in idiopathic oligohydramnios. SFH can be used to assess the amount of amniotic fluid clinically whenever AFI by ultrasound is not feasible.
