Oligohydramnion in the First Half of Pregnancy in the Fetuses with Congenital Abnormalities: Ultrasound Diagnostics and Obstetric Outcomes

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Abstract

Background. Oligohydramnion in the first half of pregnancy, combined with congenital abnormalities in the fetus has objective difficulties in diagnosis. The morphology features and type of defects associated with oligohydramnion, which manifests in the first half of pregnancy, are not sufficiently studied at the present stage. 

Aims — to evaluate the clinical significance of diagnosing oligohydramnion in the first half of pregnancy in women with congenital fetal malformations. 

Materials and methods. The analysis of the course of pregnancy and perinatal outcomes in 77 women with low water content in combination with congenital malformations of the fetus and 72 patients with a normal amount of amniotic fluid and no congenital malformations of the fetus was performed. The patients of the main group were divided into two subgroups depending on the severity of oligohydramnion: the 1st subgroup (n = 54) —patients with severe oligohydramnion and the 2nd subgroup (n = 23) — patients with moderate oligohydramnion. The amount of amniotic fluid was determined by 3D/4D ultrasound (13–21 weeks of gestation) and the structure of fetal abnormalities associated with oligohydramnion was analyzed. We evaluated perinatal outcomes in women with congenital malformations of the fetus in combination with oligohydramnion and the effect of its severity on the outcome of pregnancy. 

Results. In the main group (n = 77), fetal abnormalities were detected in patients: urinary system — 39 (50.6%), respiratory system — 4 (5.2%), heart — 1 (1.3%), chromosomal and genetic abnormalities — 14 (18.2%), central nervous system — 3 (3.9%), osseous system — 3 (3.9%), multiple — 13 (16.9%). In the main group (n = 77), pregnancy was terminated for medical indications in 47 (61%) cases, in 6 (7.8%) spontaneous miscarriage occurred, in 5 (6.5%) — antenatal fetal death. 19 (24.7%) children were born alive, and surgical treatment in the neonatal period was required in 8 (10.4%) cases. In the 1st subgroup (n = 54) in 53 (98.1%) cases, there was a loss of the fetus, in 1 (1.9%) — the newborn died on the 9th day. In the 2nd subgroup (n = 23), fetal death occurred in 5 (21.7%) cases, 18 (78.3%) children were born alive, and 8 (44.4%) newborns were operated on in the neonatal period. In the control group, all pregnancies ended with the birth of healthy children. A decrease in ultrasound imaging of internal organs in the fetus was observed when a pregnant woman was obese (BMI more than 35). 

Conclusions. Oligohydramnion in the first half of pregnancy in combination with fetal malformation should be considered an extremely unfavorable clinical sign for the prognosis of pregnancy and the health of the fetus and newborn. 3D/4D ultrasound scanning allows you to reliably determine oligohydramnion in the first half of pregnancy, and the degree of its severity to assume the nature of complications.

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About the authors

Sergey M. Voevodin

A.I. Evdokimov Moscow State University of Medicine and Dentistry

Email: voevod37@yandex.ru
ORCID iD: 0000-0001-8048-3185
SPIN-code: 3615-0906

MD, PhD, Professor

Russian Federation, Moscow

Tatiana V. Shemanaeva

I.M. Sechenov First Moscow State Medical University

Email: t.shemanaeva@rambler.ru
ORCID iD: 0000-0002-0731-4788
SPIN-code: 6537-9667

MD, PhD, Professor

Russian Federation, Moscow

Alyona V. Serova

Tver State Medical University; Regional Clinical Perinatal Center Named after E.M. Bakunina

Author for correspondence.
Email: serovaaleona@yandex.ru
ORCID iD: 0000-0003-1412-1965
SPIN-code: 9171-7167

Assistant

Russian Federation, 4 Sovetskaja str., 170100, Tver; Tver

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Supplementary files

Supplementary Files
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1. Fig. 1. Echogram 3D / 4D. VOCAL mode. Pregnancy 14-15 weeks. Confirmed congenital malformation of the fetus: autosomal recessive polycystic kidney disease. Contour of the zone of interest (yellow line) and automatic acquisition of the volume of the maximum pocket of amniotic fluid. The volume of the maximum pocket of amniotic fluid is 6.5 cm3 (lack of water). A, B, C - three mutually perpendicular planes for determining the volume of the maximum pocket of amniotic fluid. D - volumetric model of the maximum pocket of amniotic fluid

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2. Fig. 2. Echogram 2D. Pregnancy 17 weeks. Confirmed congenital malformation of the fetus. Cystic dysplasia of the kidneys in the fetus. Malnutrition

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3. Fig. 3. Echogram 3D / 4D. Multi-plan mode. Pregnancy 16 weeks Confirmed congenital malformation of the fetus. Bilateral internal hydrocephalus. Low water. A, B, C - three mutually perpendicular planes of images of the fetal brain. D - surface mode

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4. Fig. 4. Echogram 3D / 4D. Multi-plan mode. Pregnancy 23 weeks. Confirmed congenital malformation of the fetus. Spina bifida (sacral department). Meningomyelocele. Low water. A, B, C - three mutually perpendicular planes of images of the fetal spine and meningomyelocele. D - surface mode

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