Induction due to low amniotic fluid?

[Leax]

Hi, any advice/experience appreciated on this type of situation. Am 38weeks by dating scan done at 13 weeks, and am 39+3 by by own dates.

At 36 week check the amniotic fluid was on the low side of average but still within parameters. Today there is little fluid/very low around the baby. After long discussion the obs said he felt on balance he would feel that inducing me on the thursday may be the right way to go. Factors influencing his recommendation included that my dates are unclear (got pregnant on 1st cycle 4 months after birth of 1st child), that there is a decrease in fluid over the 2 weeks, that there has been a slight reduction in movements and reduced variation in heart-rate (could be due to ketones as i had severe stomage bug over weekend. that the longer the baby remains inside while not creating normal amounts of fluid around itself, the more likey signs of distress may happen during labour thus possibly increasing the likelihood of c-section
He offered a sweep which though it is so early i accepted, and I am very soft, fully effaced and 2cms dilated, so favourable i suppose if i am induced.

Has anyone experience of this type of situation? Is there anything i need to prepared for, any scenarios i am more at risk for with induction + low fluid levels.

Thanks for reading, any insights appreciated.

how would induction affect your baby if it is already a bit stressed? Are you more likely to have a crash section? Would elective be an option?

Hi Leax

I recently supported a woman with oligohydramnios in her 5th pregnancy. The concern over the low fluid levels was that it can be a sign of placental insufficiency, and I'm guessing that this is what the concern is with you, particularly taken alongside the reduced movements and variability in heart rate.

The woman I was supporting was also offered induction at 38 weeks but actually declined it, laboured spontaneously at 39 weeks and had a normal delivery.

If you're going to be induced, along with a question mark over how well the placenta is functioning I would guess that they will probably recommend that you have continuous electronic fetal monitoring. This can restrict your movement which can make pain harder to cope with and also affect how quickly labour progresses, so you might want to ask either for telemetry (wireless) monitoring or if this isn't available see if you can move around whilst being monitored. If your told it's difficult to get a good trace then see if you can get someone (miwdife, birth partner etc) to hold the pads in place.

I think keeping active would be a really good idea, as with less fluid around the baby may find it more difficult to get into a good position and movement can help with this. You might like to look at the spinning babies website on optimal fetal postioning.

Being induced may increase the likelihood of a c-section, although it sounds as though you're quite close to labour anyway, so you may go into labour before then. Along with the low fluid levels I think it is probably wise to keep in mind that a cesarean may be necessary. However, also try and think positively and relax and go with the flow of labour and believe that you can do this! Good luck.

Thanks for the replies, and for the link. I so want a natural spontaneous delivery, but also find it hard to rationalise deciding myself not to have the induction, i just hate the snowball effect of intervention that i see before me. I must ask re the telemetry.

I hope I didn't sound too negative Leax. There a lots of things in your favour - you've done this before, you're already favourable for induction etc. Have you considered hiring a doula or even having a friend who's on your wavelength and can advocate for you, as well as your partner with you? Let us know how you get on.

Hi Daisymoo, you weren't negative at all, but v helpful, thanks . I attend a hospital known to be very open to the wishes of parents and not focused on active management so hopefully that will help in my dialogue with them.

Questions i need to ask the obs are:

ARM: is this part of the induction plan at any point? Will ARM increase likelihood of fetal distress due to presence of oligohyramnios in recent weeks? Will ARM in this scenario increase risk of drop in fetal heart rate thus possibly precipitating inetrvention.

ARM: what are implications of this in light of me testing positive for group B strep?

(i know my waters may break spontaneously but just want to know if ARM is suggested while they are intact if i should decline)

What method of induction is used for someone with favourable cervix, Bishop score of circa 8?

Is there a method of induction more associated with effects on foetal heart rate, and am i more likely to have intervention even if induction progressing well if there are fluctuations than someone without oligohydramnios??

Continuous fetal monitoring- concern re rate of interventions based on interpretation. Can montitoring be intermittent in induction for oligohydramnios? Is telemetry monitoring available?

If you have any insights on the above or additional questions I should ask I'd be most grateful

Message withdrawn

It sounds like the hospital are quite, erm, enlightened which can only help!

As I understand it induction will normally be as follows: prostaglandin pessary until cervix favourable enough to ARM, ARM, then syntocinon drip. If your cervix is already favourable enough they may want to go straight yo ARM so you might want to discuss whether you want to do this or whether you can start off with the prostaglandin anyway in the hope that that will give you the nudge you need to go into labour. If it did you could then ask to stop the induction process if labour is progressing on its own, if that's what you want. Another thought - have you asked for a membrane sweep in the next day or two, might get things going on their own?

I would be surprised if ARM alonside oligohydramnios would increase the likelihood of fetal distress, because you're going to be reducing the fluid to more or less nothing, which would be the case even if there were normal levels of fluid IYSWIM. I guess ARM does increase the likelihood of transmitting the strep b infection to the baby and you are setting the clock ticking for the baby to be delivered. Are you having prophylactic ABs?

ISTR syntocinon is more associated with fetal distress than either ARM or prostaglandin. They won't put up syntocinon without ARM in any case. I think they would strongly advise continous monitoring if you had syntocinon, and I suspect they will advise it anyway as there is a suspcion that the baby may be compromised, hence the induction. Maybe you could negotiate (hate that term in this context, but you know what I mean I hope!) a combination of intermittant and continuous monitoring - 20 minutes on the CTG every hour and frequent intermittent ausculation in between for example?

Sorry, that was a bit of a ramble Have you discovered the UK midwifery yahoo group It might be worth posting your query there if you want some more thoughts.

Thanks so much for that , feel a bit more prepared. Am due another u/s to check placental blood flow on wednesday and another sweep before inducing on wednesday if nothing happens

happybiggirl thanks for your post and glad your delivery went well, that is what I hope for that the delivery goes 'my way' rather than the c-section route

daisy..are you a doula?

I've emailed you Lulu, let me know if it doesn't arrive! (Call me paranoid but I like to be as anon as possible on public forums!)

Good luck Leax, I hope everything goes well.

Leax, I was induced due to low fluid, though in my case there were no other indications of placental insufficiency.

Like you I had a fairly favourable cervix and although it was my first pregnancy I had just the pessary and ARM and then things progressed quickly so no need for drip. I was continuously monitored at first (just to check how my body took the pessary), then had intermittant monitoring during the first stage, then went back on continuous for the pushing stage, but I was able to stay upright throughout and had a fairly active labour.

The baby did get distressed right at the end of the pushing stage and they did a ventouse to speed things up but it was fine.

FWIW they never seemed to consider I was a particularly likely candidate for a section - for example they let me eat and drink throughout.

Good luck, hope you get the delivery you want.

quite understand daisy! did you use the hotmail addy?

lulumama 21 @ hotmail. com?

off to bed , so will check in the morning xx