water immersion in oligohydramnios
From: Kristen Olson (kristen.olson2@und.nodak.edu)
Sun, 17 Mar 2002 16:22:18 -0600 (CST)
My name is Kristen Olson and I am a University of North Dakota nursing
student. In a recent OB clinical, I observed a 32 gestational week
mother who was admitted with oligohydramnios and IUGR. She was placed
on bedrest and subtotal water immersion twice a day to potentially
increase the amniotic fluid volume. I am interested to hear if any
other facilities use this practice. According to Deka & Malhotra
(2000), a probable cause of increased amniotic fluid index (AFI) is
maternal osmotic change; which may improve uteroplacental perfusion due
to increased uterine artery flow. This correlates to Chandra,
Schiavello, & Lewandowski (2000), who stated that a low amniotic fluid
volume is related to maternal blood volume not expanding. Amniotic
fluid formation may positively affect uterine perfusion as a result from
expanded maternal plasma volume. Subtotal immersion is equivalent to 2
liters of isotonic saline solution given intravenously (Strong, 1993).
Further, Strong suggests that immersion “hydrostatically forces
extravascular fluid into the blood vessels.” The pressure effects the
uteroplacental blood flow due to the maternal intravascular infusion. In
5 cases of oligohydramnios undergoing water immersion, the AFI increased
by an average of 6 cm +/- 2.2 cm. Three women discontinued the therapy
once their amniotic fluid increased, and subsequently the amniotic fluid
index fell by an average of 4.7 cm. I would be interested to learn if
there are any more documented success stories on the use of immersion
for oligohydramnios.
References
Chandra, P.C., Schiavello, H.J., & Lewandowski, M.A. (2000). Effect of
oral and
intravenous hydration on oligohydramnios. The Journal of Reproductive
Medicine, 45(4), 337-341.
Deka, D., & Malhotra, B. (2000). Role of maternal oral hydration in
increasing amniotic
fluid volume in pregnant women with oligohydramnios. International
Journal of
Gynecology & Obstetrics, 73, 115-156.
Strong, T.H. (1993). Reversal of oligohydramnios with subtotal
immersion: A report of
five cases, American Journal of Obstetrics & Gynecology, 169(6),
1595-1597.
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