Low amniotic fluid & induction - questions

[scarcelyodd]

I'm 39+3 with second daughter (first born at 38 weeks, easy labour, no complications). My bump has measured small all along & I've been for extra scans but there haven't been problems with the baby's size. (DD1 was exactly on target all the way through.)

At my 36wk my bump measured 33cm but at 38wks with GP it was only 30 so I was sent for a scan. No problem with size (est at 6lb11oz) but the amniotic fluid was low (around 5th centile).

I have to go for a follow up scan & assessment next Mon (40+2). The Dr I saw said they'd probably start talking about induction fairly soon after that.

If they do plan to induce does anyone have any idea how soon they'd want to do it? I'd rather avoid induction if possible but am worried about the baby's health. Although I do want to give birth sooner rather than later - I was lucky to miss out on this hanging about waiting last time and I have killer backache/SPD and am fed up of being able to do nothing but lie on my side!

Any advice/talk about similar situations would be welcome, thanks!

Some info here
www.babycentre.co.uk/pregnancy/complications/oligohydramnios/
A little like growth scans, the tests for low amniotic fluid are not always accurate.
Risks depend on the reasons for low amniotic fluid (could your waters have been leaking?)
It can (rarely) be due to problems with babies kidnetys (not weeing).
I looked into this for one of my friends, she declined induxction and baby was born without problems.
Some info I found-

"* OLIGOHYDRAMNIOS IS DIFFICULT TO ASSESS
True oligohydramnios can be difficult to confirm due to the questionable accuracy of amniotic fluid measurement by ultrasound. There is controversy, for example, about whether (and how) to include pockets of amniotic fluid containing umbilical cord. studies continue to question to what extent the AFI reflects actual amniotic fluid volume.
AFI measurements may vary with the amount of pressure applied to the abdomen and with fetal position or movement. (16)
Serial measurements taken by the same ultrasound operator have been shown to differ from the true volume by 1 cm, or 10.8%; serial measurements taken by multiple operators have differed by as much as 2 cm, or 15.4%. (17,18)"

I would suggest you drink lots of water, especially before being scanned again, as this can rasise amniotic fluid level.

"Kirkpatrick demonstrated a 30% increase in amniotic fluid compared with controls in women of unspecified gestational age with oligohydramnios given 2 liters of oral water 2 to 5 hours before repeat amniotic fluid index (LOE: 3). (13)
A randomized trial in women with normal amniotic fluid demonstrated a 16% increase in amniotic fluid index 4 to 6 hours after hydration with 2 liters of oral water, compared with an 8% decrease after fluid restriction during the same period. (8)
A recent study of daily oral hydration in women with amniotic fluid volume

Wow! Thanks for all the info, Selina, that's really helpful. I'm off to drink lots of water!

No worries, sorry its abit 'Sciency'. Make sure you drink 2 litres of water 4 hours before you're repeat scan on Monday too.
I would question induction if they suggest it, if you have no other risk factors and they have no other concerns about your baby.
You could always print out those two abstracts above and ask your doctor their opinion on wether induction is likely to improve the situation in your case.
Selina x

No, the 'sciencier' the better as far as I'm concerned! I think avoiding an induction is definitely sensible at the moment.

Do you have any sense of how quickly they'd want to do an induction, i.e. will they just say let's do it immediately or do they typically schedule it later?

I think it will depend on how low your reading is at the scan.
Also they will probably do a non-stress test and biophysical profile to check your babies condition and that your placenta is functioning.
They can't be incredibly worried to leave it a week.
Make sure you see a senior consultant and you can always ask for a second opinion.
They would probably want to schedule it for the next day or so, they wouldn't usually suggest starting one immediately.
I've seen people in this scenario end up waiting in hospital for a couple of days because there is no space to induce them (they can't be very worried then I always feel!)
You could consider a sweep from your midwife to encourage labour top start.
Selina

Thanks so much, Selina, this has been really helpful & reassuring. I feared they'd just kind of whisk me off for an immediate indusction but now I feel I'm better informed & can hopefully wait & see what happens.

I'm seeing my MW on Thursday so I'll talk it over with her too.

No worries, I work in public health as well as being a doula so enjoy researching pregnancy related info!
Good luck, hope all goes well.
S x

Found another useful site for you-
www.glorialemay.com/blog/?p=60
Let me know how you get on if you get a chance.
Selina x

Thanks, Selina. I thought this post was interesting too:
www.glorialemay.com/blog/?p=306

Do you know of any evidence that being in a more 'medicalised' environment leads to more (unnecessary) intervention? I know it's probably hard to tell because obviously any intervention will be in a more medical setting by definition.

My MW said that because of this issue I might be pushed towards delivering in the hospital delivery suite rather than the MW-led unit even if I don't end up being induced. I'd rather be in the MW unit but DH feels that we might be better off with more Drs etc. around (the two places are only a matter of 3 floors apart!). If there are any hard facts to help bolster my case that would be much appreciated!

Thanks again
Liz

Hi Selina

Had my scan on Mon; consultant wasn't worried about amount of fluid but I'm not sure if that was bcz there was more - she didn't take so many measurements.

Anyway, was sent home to wait so here I am...

Thanks again for all the info; it really helped me feel confident about the whole thing.
Liz

Hi Liz,
Glad to hear all is well with you and your baby.
I hope they will not push you into having your baby on the delivery suite instead of the Midwife led unit.
There is evidence to suggest a more medicalised environment does lead to more intervention and many practices are 'protocol' on delivery suite because they are used to dealing with high risk births (like constant electronic foetal monitoring) which restricts your ability to move round and can slow labour down.
I would definetely argue against this if anyone suggests it!
Hope labour starts naturally for you soon, and best wishes for a lovely birth.
Selina x

Just a quick update to say that Evelyn was born on Thursday! No need for any induction or a sweep - I started having labour pains in the late afternoon and she was born at 9pm. It all happened too fast for the midwife unit so we were in the delivery suite but I was past caring by the time we got to the hospital!

She was 7lb 8oz so not undersized at all. There were some concerns about her not weeing so they put a catheter in on Sat & dislodged some uric crystals which seemed to cure the problem & she's fine now. This was possibly linked to the low amniotic fluid but they are not sure & aren't now worried abut it.

Thanks for helping me relax a bit more about the whole thing, Selina.
Liz

Congratulations!
Glad all is well. Evelyn is a lovely name. Hope you are home enjoying getting to know her.
Selina x