Treatment of oligohydramnios with maternal 1-deamino-[8-D-arginine] vasopressin-induced plasma hypoosmolality.
OBJECTIVE
Maternal 1-deamino-[8-D-arginine] vasopressin (a selective antidiuretic agonist) and oral water loading decrease maternal and fetal plasma osmolality and markedly increase fetal urine flow in sheep. We hypothesized that a titrated reduction in maternal plasma osmolality would increase human amniotic fluid volume.


METHODS
Pregnant women (n = 5) with oligohydramnios at term were administered oral water loading (20 ml/kg) and intravenous 1-deamino-[8-D-arginine] vasopressin (2 micrograms) to induce antidiuresis. Maternal plasma and urine osmolality and urine production were measured hourly, and water replacement was titrated for 8 hours to reduce plasma osmolality by 15 to 20 mOsm/kg. The amniotic fluid index determined by ultrasonography was measured at baseline, 8 hours, and 24 hours. A control group of pregnant women (n = 5) with oligohydramnios at term was observed for 8 hours with maintenance intravenous hydration.


RESULTS
In 1-deamino-[8-D-arginine] vasopressin-treated women, maternal urine flow increased with oral water loading, decreased with 1-deamino-[8-D-arginine] vasopressin administration, and remained reduced for 8 hours. Maternal plasma osmolality significantly decreased (285 +/- 4 to 265 +/- 4 mOsm/kg) and the amniotic fluid index significantly increased (4.1 +/- 0.6 to 8.2 +/- 1.5 cm) at 8 hours. Although maternal urine osmolality returned to basal values at 24 hours, plasma osmolality was reduced and the amniotic fluid index remained significantly increased (8.2 +/- 1.3 cm). There was no change in the amniotic fluid index (4.3 +/- 0.4 to 4.7 +/- 0.7 cm) in control patients observed with maintenance intravenous hydration.


CONCLUSIONS
Maternal 1-deamino-[8-D-arginine] vasopressin and oral water administration can reduce and stabilize plasma osmolality and increase amniotic fluid volume. 1-Deamino-[8-D-arginine] vasopressin therapy has potential for the prevention and treatment of oligohydramnios.
Ross
M G
MG
Department of Obstetrics and Gynecology, Harbor-University of California, Los Angeles Medical Center, Torrance, CA 90509, USA.
Cedars
L
L
Nijland
M J
MJ
Ogundipe
A
A
D000328:Adult; D000653:Amniotic Fluid / Q000378:metabolism; D003894:Deamino Arginine Vasopressin / Q000627:therapeutic use*; D004231:Diuresis / Q000187:drug effects; D004326:Drinking; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D007267:Injections; D007275:Injections, Intravenous; D016104:Oligohydramnios / Q000097:blood* / Q000000981:diagnostic imaging / Q000188:drug therapy*; D009994:Osmolar Concentration; D011247:Pregnancy; D012076:Renal Agents / Q000627:therapeutic use*; D014463:Ultrasonography; D014556:Urine / Q000737:chemistry; D014867:Water / Q000008:administration & dosage
D012076:Renal Agents; D014867:Water; D003894:Deamino Arginine Vasopressin