Oligohidramnios
Özet
Oligohidramnios, gebelik haftasına göre amniyotik sıvı hacminin beklenen seviyenin altında olmasıdır. Ultrasonda amniyotik sıvı indeksinin (ASİ) 5 cm veya daha az, tek en derin cebin (EDC) ise 2 cm'den küçük ölçülmesiyle tanı konur. Patogenezinde fetal idrar çıkışının azalması ve membran rüptürü en yaygın iki mekanizmadır. Vakaların büyük çoğunluğu üçüncü trimesterde ortaya çıkar ve idiyopatiktir. İkinci trimesterdeki oligohidramnios sıklıkla fetal anomalilerle ilişkiliyken, ilk trimesterde görülmesi oldukça nadirdir ve genellikle kötü prognozla, yani gebelik kaybıyla sonuçlanır. Oligohidramnios varlığında pulmoner hipoplazi, fetal deformasyon ve göbek kordonu sıkışması gibi riskler artar. Yönetimde detaylı ultrasonografik inceleme, maternal hidrasyon ve gerekli durumlarda tanısal amniyoinfüzyon gibi yöntemler kullanılır. İdiyopatik olgularda gebeliğin 36+0 ile 37+6 haftaları arasında doğum planlanması önerilmektedir.
Oligohydramnios is defined as a lower amniotic fluid volume than expected for the gestational age. Diagnosis is made via ultrasound when the amniotic fluid index (AFI) is 5 cm or less, or the single deepest pocket (SDP) is less than 2 cm. Decreased fetal urine output and membrane rupture are the two most common underlying mechanisms in its pathogenesis. The vast majority of cases occur in the third trimester and are idiopathic. While second-trimester oligohydramnios is frequently associated with fetal anomalies, its occurrence in the first trimester is rare and typically portends a poor prognosis, resulting in pregnancy loss. The presence of oligohydramnios increases risks such as pulmonary hypoplasia, fetal deformation, and umbilical cord compression. Management includes detailed ultrasonographic evaluation, maternal hydration, and diagnostic amnioinfusion when necessary. In idiopathic cases, delivery is recommended to be planned between 36+0 and 37+6 weeks of gestation.
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