How to keep an surveillanve on oligohydramnios in woman who is less than 32 weeks of lpregnavy-Conservative tr how long??

What will be  surveillance & Treatment of oligohydramnios  at 1) < 32 weeks or b) > 32 weeks  with or without ROM??

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The dictum:-By and large, if the AFI goes below 5 the usual policy is to intervene, But  one has to exercise great  caution if her gest age is < gestation is  32 weeks and there is PPROM. If one continue the preg than repeat USG within 2 days. If no leak then one can continue the pregnancy. Advice 1) plenty of  oral intake,   2)  DFMC, 3) CTG any deceleratiin , 4) Steroid cover ,5) to  Raise the foot end of bed(? Questionable benefit)  ,6)  Limited walking (Toilet facility permitted very much)    ,7)  weekly Doppler.8) Any sonology about IUGR? May rewuest sonologist about  Fetal kidneys, bladder –but such foetal organs may be difficult to image if gross hydramnios, To exclude any  other associated Medl/ Obstet risk factors. Therefore in absence of PPROM (only oligohydramnios & with or without FGR)  one can continue preg   with weekly DFMC. Alt day CTG, weekly or twice weekly   Doppler. One should induce induce if liquor becomes   less   than 4.

Take home message: such cases, that would help in making a decision as to how long u can wait. Also Persistent Uterine artery diastolic notch can help in deciding role of aspirin or heparin. Will a litmus paper test help in detecting leaky membranes-All oligohydramnios pts  should be  monitored  closely with twice weekly tests like NST/ Doppler/ Biophysical scoring and aim to take the pregnancy to 37 weeks before inducing. Till then to continue pregnancy with oral alamine, arginine high protein supplements, along with biweekly nst n weekly AFI .

The concurrent evaluation of fetal biometry, , heart rate patterns, arterial and venous Doppler, and biophysical variables  will allow the most comprehensive fetal evaluation in FGR in addition to low AFI.

. In the absence of successful intrauterine therapy, the timing of delivery is perhaps the most critical aspect of the antenatal management. A discussion of the fetal responses to placental insufficiency and a management protocol that accounts for multiple Doppler and biophysical parameters as well as gestational age is provided in this review. Change style to default