Impact of Low Amniotic Fluid Levels Near Due Date

The effects of decreased amniotic fluid?

Dear Doctor, I am approaching my due date next week.
In my recent ultrasound examination, it was found that there is almost no amniotic fluid left.
Since the beginning of my pregnancy, the amniotic fluid levels have been adequate, but last week it started to decrease, and this week there is none.
Next week is my due date, and the examining physician mentioned that I should just monitor fetal movements.
What is your opinion? Since I am at full term, should I consider an early cesarean section instead of waiting for natural contractions? Thank you.

Amei, 30~39 year old female. Ask Date: 2010/09/18

Dr. Lü Lizheng reply Obstetrics and Gynecology

Dear A-mei,
Hello.

1.
Each physician has different criteria for assessing oligohydramnios.
Doctor A may consider the amniotic fluid to be insufficient, while Doctor B may deem it normal.
Generally, the depth of amniotic fluid is measured in four quadrants around the pregnant woman's umbilicus: right upper, right lower, left upper, and left lower.
If the total sum of these measurements is less than 5 centimeters, it is classified as oligohydramnios.
2.
Even if an ultrasound indicates low amniotic fluid, using more precise measurement methods reveals that only a small portion truly has insufficient amniotic fluid.
In other words, ultrasound measurements inherently have a significant margin of error.
3.
According to scholarly research, around the due date, up to 10% of pregnant women are diagnosed with oligohydramnios.
However, only a small fraction of this 10% actually has true oligohydramnios, and among those, only a minority are in genuinely dangerous situations.
4.
Therefore, the current focus is to determine whether your fetus is truly in a dangerous condition.
It is recommended to conduct the following further examinations:
1.
Fetal heart rate monitoring, also known as a non-stress test (NST).
2.
Biophysical profile (BPP).
3.
Doppler ultrasound umbilical artery flowmetry.

Generally, regional hospitals, including ours, should be able to perform these tests.
The examination time will not exceed one hour, there are no risks associated with the tests, and results will be available immediately.
5.
It is advisable to complete the examinations before making any decisions.
If there are indeed issues, then a cesarean section may be necessary.
If the results are normal, vaginal delivery remains an option.
Wishing you safety and health.
Sincerely,
Director Lu Li-Cheng, Department of Obstetrics and Gynecology, Taoyuan Hospital, Health Department

Reply Date: 2010/09/18

More Info

The presence of low amniotic fluid levels, also known as oligohydramnios, near the due date can have significant implications for both the mother and the fetus. Amniotic fluid plays a crucial role in fetal development, providing cushioning, facilitating movement, and allowing for the proper development of the lungs and digestive system. When the levels of amniotic fluid decrease significantly, it can lead to various complications.

In your case, it is concerning that the ultrasound has shown a drastic reduction in amniotic fluid levels as you approach your due date. The fact that your fluid levels were adequate throughout your pregnancy and have only recently dropped is noteworthy. This sudden change could indicate several issues, such as placental insufficiency, fetal distress, or other complications that may require closer monitoring.

The primary concern with low amniotic fluid levels is the potential for umbilical cord compression, which can lead to decreased oxygen supply to the fetus. This can manifest as changes in fetal heart rate patterns. Therefore, monitoring fetal movements is crucial, as decreased fetal movement can be a sign of distress. If you notice a significant decrease in fetal movements, it is essential to contact your healthcare provider immediately.

Regarding your question about whether to proceed with a cesarean section (C-section) rather than waiting for natural labor, this decision should be made collaboratively with your healthcare provider. If the healthcare provider assesses that the risks associated with low amniotic fluid levels outweigh the benefits of waiting for spontaneous labor, they may recommend an early delivery via C-section. Factors that may influence this decision include the baby's heart rate, overall health, and the presence of any other complications.

It is also important to consider that while some women can successfully deliver vaginally with low amniotic fluid, the risks associated with this approach may be higher. The healthcare team will evaluate the situation based on the most current information available, including fetal monitoring results and your overall health.

In summary, low amniotic fluid levels near your due date can pose risks to both you and your baby. Continuous monitoring of fetal movements and heart rate is essential. If there are any signs of distress or if your healthcare provider feels that the risks of waiting for natural labor are too high, they may recommend a C-section. It is crucial to maintain open communication with your healthcare provider and discuss all your concerns and options to ensure the best possible outcome for both you and your baby.

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