title: Severe midtrimester oligohydramnios: treatment strategies.
abstract: OBJECTIVE
  Nearly 1% of pregnancies are affected by some type of midtrimester oligohydramnios. Evidence is currently accumulating that suggests the better efficacy of the new therapeutic procedures relative to conventional management. This review summarizes the available evidence.
  
  
  RESULTS
  The prolongation of the period between the diagnosis of oligohydramnios and delivery following amnioinfusion and amniopatch techniques appears to be strongly associated with the gestational age and whether the situation was based on rupture of the membranes or not. Case series reveal that amnioinfusion significantly improves the perinatal outcome and prolongs the pregnancy in severe second-trimester oligohydramnios in both idiopathic cases and those involving rupture of the amniotic membranes [preterm prelabor rupture of the membranes (PPROM)]. There is clear evidence of a lower frequency of perinatal complications and successfully prolonged gestation in iatrogenic PPROM after the amniopatch technique relative to population controls.
  
  
  CONCLUSIONS
  Identification of potentially modifiable risk factors for the successful prolongation of pregnancy complicated with midtrimester oligohydramnios, and previable PPROM is needed for the improvement of treatment strategies and prognosis. Randomized trials are needed to determine whether amniotic fluid-replenishing strategies can improve pregnancy outcomes.
authors.affiliation: aDepartment of Obstetrics and Gynecology, Blekinge Hospital, Karlskrona, Sweden bDepartment of Obstetrics and Gynecology, Faculty of Medicine, Albert Szent-Györgyi Medical and Pharmaceutical Center, University of Szeged, Szeged, Hungary.
authors.forename: Zoltan
authors.initials: Z
authors.lastname: Kozinszky
authors.forename: János
authors.initials: J
authors.lastname: Sikovanyecz
authors.forename: Norbert
authors.initials: N
authors.lastname: Pásztor
mesh_terms: D000650:Amnion / Q000473:pathology*; D000653:Amniotic Fluid; D001792:Blood Platelets; D037001:Directive Counseling; D005169:Factor VIII / Q000627:therapeutic use*; D005260:Female; D005322:Premature Rupture of Fetal Membranes / Q000401:mortality / Q000628:therapy*; D005340:Fibrinogen / Q000627:therapeutic use*; D005865:Gestational Age; D006801:Humans; D007263:Infusions, Parenteral; D016104:Oligohydramnios / Q000401:mortality / Q000628:therapy*; D010290:Parents; D011247:Pregnancy; D011256:Pregnancy Outcome; D011262:Pregnancy Trimester, Second; D011379:Prognosis; D016019:Survival Analysis
chemical_list: C026912:cryoprecipitate coagulum; D005169:Factor VIII; D005340:Fibrinogen