Intravenous Versus Oral Maternal Hydration Therapy for Increasing Amniotic Fluid Volume

Abstract

Objective:  To determine wether one (intravenous) route of maternal hydration is advantageous over the other (oral) to increase amniotic fluid volume in patients with third trimester oligohydramnios?

Study Design:  Quassi experimental study.

Place and Duration of Study:  Department of Obs & Gynae Unit III, Sir Ganga Ram Hospital, Lahore, in one year period from May 2002 to Apr 2003.

Material and Methods:  Fifty women with third trimester oligohydramnios (AFI £ 5.0 cm) were prospectively recruited for this study. Study inclusion criteria was, singleton pregnancy, well established gestational age, intact membranes, no maternal complication (moderate to severe anemia, cardiac disease, renal disease, moderate/severe pre-eclampsia or hypertension and diabetes), no fetal structural malformation and no evidence of fetal distress. These fifty patients were randomized by pro-bability sampling technique into two groups (intravenous hydration group and oral hydration group). Maternal urine specific gravity and amniotic fluid index were determined before and after hydration therapy by infusing 2 L of 5% D/W in 2 hours in intravenous hydration therapy group, and by asking them to drink 2 liters of water in 2 hours in oral hydration therapy group; and recorded on printed proformas. The data analysis was computer based using statistical package SPSS version 10.0 and sample independent "t" test was used to compare the mean AFI and urine specific gravity, and the post treatment AFI - pretreatment AFI (Delta AFI).

Results:  Maternal hydration increased amniotic fluid volume in intravenous hydration group (mean change in amniotic fluid index 4.5 cm ± 1.25, C.I 4.00 to 5.00; P value < 0.05); as well as in oral hydration group (mean change in Amniotic fluid index 4.3 ± 1.23, C.I 3.80 to 4.79; P value < 0.05). However, percentage increase in mean AFI was 58.6% in the intravenous hydration group, which was not significantly greater (P value > 0.05) than the percentage increase of 58.2% in oral hydration group. Maternal hydration was associated with decrease in urine specific gravity in both groups.

Conclusion:  Maternal intravenous as well as oral hydration increases AFV in women with oligohydramnios but neither appears to be advantageous over the other to increase amniotic fluid volume and both routes may be beneficial in the mana-gement of oligohydramnios.

Key Words:  Maternal hydration, oligohydramnios.