Oligohydramnios: The Risks of Low Amniotic Fluid
Oligohydramnios is a condition that occurs during pregnancy in which there is too little amniotic fluid. About 8% of pregnant women can have low levels of amniotic fluid and about 4% are diagnosed with oligohydramnios. Although, oligohydramnios can be treated and maintained, if not caught early on it can lead to detrimental consequences for the baby.About Oligohydramnios
During pregnancy, the body produces a fluid that is crucial to the development and survival of the fetus called amniotic fluid. Amniotic fluid surrounds the fetus in the uterus and performs various functions for the fetus: cushions and protects baby from external trauma; maintains a steady and safe temperature around the fetus; helps develop lungs, digestive system, muscles, and bones; and keeps the umbilical cord from being squeezed.
It is produced quickly after the amniotic sac is formed which is about 12 days after conception. Initially, the fluid is made up of water. Then, around 20 weeks, the fluid mainly becomes fetal urine. The fetus will move and turn in the uterus with the aid of the amniotic fluid. During the second trimester the baby will begin to breathe and swallow the amniotic fluid. In order for the amniotic fluid to perform the necessary functions, adequate volume of the fluid is required.Causes of Oligohydramnios
Often times the causes of oligohydramnios is unknown. When they are known, the general causes of oligohydramnios are due to:
- Birth Defects- If there are problems with the baby's kidneys or urinary tract, the baby may be producing not enough urine which, leads to low levels of amniotic fluid.
- Placental problems- If the baby is not able to receive enough blood nutrients from the placenta, then the baby may stop recycling fluid.
- Leaking or rupture of membranes- If there is a tear in the membrane, it may cause a gush or slow constant trickle of fluid.
- Post term pregnancy- A pregnancy that goes over 42 weeks may lead to low levels of amniotic fluid.
- Maternal Complication- Various factors including maternal dehydration, preeclampsia, diabetes, hypertension, and chronic hypoxia can contribute to low amniotic fluid levels.
- Certain medications- some medications such as medications used to treat high blood pressure may cause Oligohydramnios
The risks and complications associated with oligohydramnios vary depending on the point of pregnancy. In the first two trimesters, oligohydramnios can pose serious complications. Oligohydramnios in the first two trimesters can lead to birth defects, miscarriage, premature birth, and still birth. Although, the risks are not as severe if oligohydramnios develops in the third trimester, the complications it may pose for the baby and mother are still serious. Some risks include, the baby growing too slowly, problems during labor and birth, oxygen being caught off to the baby, and a need for emergency cesarean surgery.Symptoms of Oligohydramnios
Oligohydramnios are diagnosed by the doctor during prenatal checkups. The healthcare provider will use an ultrasound to measure the amount of amniotic fluid. There are two ways to measure the level of the fluid: (1) amniotic fluid index (AFI); and (2) maximum vertical pocket (MPV). If an AFI shows a fluid level of less than 5 centimeters, the absence of a fluid pocket 2-3 cm in depth, or a volume less than 500mL, then the doctor may suspect oligohydramnios.
In addition, the doctor may observe other factors that could indicate Oligohydramnios, such as the mother not gaining weight during her pregnancy or the baby growing too slowly. The mother should let her healthcare provider know if she is leaking fluid from her vagina during pregnancy. However, Oligohydramnios can only be detected and diagnosed by a doctor or healthcare provider so it is crucial that medical professionals maintain consistent and careful neonatal checkups with the expecting mother.Oligohydramnios and Medical Malpractice
As mentioned above, it is crucial for the healthcare provider to watch over the fetus throughout the pregnancy. Failing to diagnose and failing to act on the diagnosis of oligohydramnios can lead to severe and permanent damage to the baby.
Even if the mother is diagnosed with Oligohydramnios, major complications and risk can be avoided if the doctor acts quickly and efficiently. Many times, mothers diagnosed with oligohydramnios have babies that are born healthy with regular prenatal care and proper treatment from the doctor. However, in the unfortunate cases when there are consequences to the babies, it is often because the healthcare provider failed to recognize or treat the Oligohydramnios early on.Oligohydramnios Related Lawsuits - Settlements and Verdicts
Below are example verdicts and settlements from birth injury malpractices cases involving negligent management or treatment of oligohydramnios and resulting complications.
- Hunter v Bronx-Lebanon Hospital (New York 2017) $396,000: mother has high-risk pregnancy due to oligohydramnios which causes intrauterine growth restriction. During labor doctors and hospital staff do not continuously monitor fetal heart rate with electronic monitoring devices and by the time baby is born it has suffered HIE brain injury resulting in major neurologic damages. She sues hospital and doctors for negligently managing her oligohydramnios and resulting high-risk labor and delivery. Parties agreed to settle out of court for $396k.
- Griffith v. NYC Health and Hospitals Corp. (New York 2014) $200,000: infant sustained perinatal hypoxic brain damage, meconium aspiration syndrome and chronic lung disease after his mother was provided with prenatal care by defendant. The mother was admitted for emergency basis for pre-eclampsia. The plaintiff through his mother contended that defendant provided negligent prenatal care, negligently disregarded sonogram which indicated severe oligohydramnios. The two parties negotiated a settlement for $200,000.
- Abreu v. Bronx Lebanon Hospital (New York 2014) $1 million: female newborn suffered severe brain damage with developmental delays, mental retardation, a seizure disorder with truncal hypertonicity, poor head control and choreoathetosis; speech delays, learning disabilities, cognitive deficits as well as a bilateral club feet and mildly dysmorphic facial features. The plaintiff contends that the defendant failed to diagnose the oligohydramnios which led to the injuries. Although, the defendant denied liability, the parties reached a settlement of $1,055,692.
- Eli v. Cedars-Sinai Medical Center (New York 2009) $2.2 million: plaintiffs alleged that defendants failed to diagnose and treat signs of oligohydramnios and fetal distress, which resulted in plaintiff's delayed delivery and hypoxic-ischemic brain injury. The jury awarded the plaintiff $2,250,000.
- Bringas v. United States of America (Illinois 2010) $30 million: 35 year old plaintiff mother was pregnant with infant plaintiff. At 41 weeks of her term, ultrasounds demonstrated severe oligohydramnios. The plaintiff alleged that the defendant's doctor failed to immediately admit the plaintiff mother to the hospital for monitoring and delivery. Instead, the defendant's doctor did not admit the plaintiff until the following evening. Upon the arrival at the hospital, fetal monitoring indicated the fetus was in distress and defendants failed to perform an emergency Cesarean section. The lack of amniotic fluid and distress caused compression of the child's umbilical cord which cut off the supply of oxygen to the infant and caused brain damage. The child was diagnosed with cerebral palsy and partial paralysis. The court found in favor of the plaintiffs and entered a judgement for $30,240,058.
If your baby was born with a birth injury caused by the mishandling of your oligohydramnios (or another pregnancy complication) contact the birth injury lawyers at Miller & Zois for a free case evaluation. Call us at 800-553-8082 or request a consultation online.