- Severe reduction of amniotic fluid volume (typically less than 500 ml at term); highly concentrated urine.
- Possibility of prolonged, dysfunctional labor (usually beginning before term).
- Fetal risk: renal anomalies, pulmonary hyperplasia, hypoxia, increased skeletal deformities, and wrinkled, leathery skin.
- Exact cause is unknown.
- Any condition that prevents the fetus from making urine or that blocks urine from going into the amniotic sac.
- Contributing factors: uteroplacental insufficiency, premature rupture of membranes prior to labor onset, maternal hypertension, maternal diabetes, intrauterine growth restriction, postterm pregnancy, fetal renal genesis, polycystic kidneys, and urinary tract obstructions.
- Lagging fundal height growth.
- Ultrasonography reveals no pockets of amniotic fluid larger than 1 cm.
- Close medical supervision of the mother and fetus.
- Fetal monitoring
- Amnioinfusion (infusion of warmed sterile normal saline or lactated Ringer’s solution) to treat or prevent variable decelerations during labor.
- Monitor maternal and fetal status closely, including vital signs and fetal heart rate patterns.
- Monitor maternal weight gain pattern, notifying the health care provider if weight loss occurs.
- Provide emotional support before, during, and after ultrasonography.
- Inform the patient about coping measures if fetal anomalies are suspected.
- Instruct her about signs and symptoms of labor, including those she’ll need to report immediately.
- Reinforce the need for close supervision and follow up.
- Assist with amnioinfusion as indicated.
- Encourage the patient to lie on her left side.
- Ensure that amnioinfusion solution is warmed to body temperature.
- Continuously monitor maternal vital signs and fetal heart rate during the amnioinfusion procedure.
- Note the development of any uterine contractions, notify the health care provider, and continue to monitor closely.
- Maintain strict sterile technique during amnioinfusion.