HEMODYNAMIC ALTERATION IN RENAL ARTERY OF PREGNANT WOMEN WITH REDUCED AMNIOTIC FLUID VOLUME DURING SECOND AND THIRD TRIMESTER
DOI:
https://doi.org/10.71000/ds17xp64Keywords:
Doppler Ultrasonography, Oligohydramnios, Placental Factors, Amniotic Fluid Index, Pregnancy Complications, Renal Artery, Vascular ResistanceAbstract
Background: Amniotic fluid plays a critical role in fetal development by maintaining a stable environment for growth, cushioning the fetus, and serving as a marker for maternal-fetal health. Oligohydramnios, defined as a reduced volume of amniotic fluid, is associated with adverse pregnancy outcomes and can result from placental insufficiency, fetal anomalies, or maternal conditions. Early detection through Doppler ultrasonography may assist in identifying circulatory changes indicative of this condition and allow timely clinical interventions.
Objective: To evaluate hemodynamic changes in the maternal renal artery in pregnancies complicated by oligohydramnios based on Doppler indices and compare them with normal pregnancies.
Methods: This cross-sectional study was conducted at Gillani Ultrasound Center, Pakistan, including 50 pregnant women selected via convenience sampling. Participants with diabetes, hypertension, critical illness, or fetal congenital anomalies were excluded. Oligohydramnios was defined by an amniotic fluid index (AFI) <5 cm, a single vertical pocket <2 cm, or an AFI below the 10th percentile for gestational age. Doppler ultrasonography was performed using a Toshiba Xario S100 with a 5–7 MHz convex probe to measure Resistive Index (RI), Pulsatility Index (PI), and Systolic/Diastolic (S/D) ratio of the renal artery. Data were analyzed using SPSS version 27.0, and independent samples t-tests were applied.
Results: Renal artery Doppler indices showed statistically significant differences between the normal and oligohydramnios groups. Mean RI was higher in oligohydramnios (0.625 ± 0.111) compared to normal pregnancies (0.575 ± 0.111). Similarly, PI was elevated in the oligohydramnios group (1.475 ± 0.111) versus normal (1.200 ± 0.111). The S/D ratio was also increased (2.975 ± 0.111 vs. 2.500 ± 0.111). All differences were statistically significant (p < 0.05).
Conclusion: Significant alterations in renal artery Doppler indices in oligohydramnios reflect impaired maternal hemodynamics, emphasizing the diagnostic value of Doppler ultrasonography in monitoring high-risk pregnancies.
References
Schmidt CT, Deligiannidis KM, Kittel-Schneider S, Frodl T, Spigset O, Paulzen M, et al. Transfer of anticonvulsants and lithium into amniotic fluid, umbilical cord blood & breast milk: A systematic review & combined analysis. Prog Neuropsychopharmacol Biol Psychiatry. 2023;124:110733.
Kennedy KM, de Goffau MC, Perez-Muñoz ME, Arrieta MC, Bäckhed F, Bork P, et al. Questioning the fetal microbiome illustrates pitfalls of low-biomass microbial studies. Nature. 2023;613(7945):639-49.
Miller JL, Baschat AA, Rosner M, Blumenfeld YJ, Moldenhauer JS, Johnson A, et al. Neonatal Survival After Serial Amnioinfusions for Bilateral Renal Agenesis: The Renal Anhydramnios Fetal Therapy Trial. Jama. 2023;330(21):2096-105.
Gallo DM, Romero R, Bosco M, Gotsch F, Jaiman S, Jung E, et al. Meconium-stained amniotic fluid. Am J Obstet Gynecol. 2023;228(5s):S1158-s78.
Magann EF, Whitham M, Whittington JR. Letter regarding the amniotic fluid index and oligohydramnios: a deeper dive into the shallow end. Am J Obstet Gynecol. 2023;228(5):597.
Pagan M, Magann EF, Rabie N, Steelman SC, Hu Z, Ounpraseuth S. Idiopathic polyhydramnios and pregnancy outcome: systematic review and meta-analysis. Ultrasound Obstet Gynecol. 2023;61(3):302-9.
Senesi G, Guerricchio L, Ghelardoni M, Bertola N, Rebellato S, Grinovero N, et al. Extracellular vesicles from II trimester human amniotic fluid as paracrine conveyors counteracting oxidative stress. Redox Biol. 2024;75:103241.
Azarkish F, Janghorban R, Bozorgzadeh S, Arzani A, Balouchi R, Didehvar M. The effect of maternal intravenous hydration on amniotic fluid index in oligohydramnios. BMC Res Notes. 2022;15(1):95.
Capone V, Persico N, Berrettini A, Decramer S, De Marco EA, De Palma D, et al. Definition, diagnosis and management of fetal lower urinary tract obstruction: consensus of the ERKNet CAKUT-Obstructive Uropathy Work Group. Nat Rev Urol. 2022;19(5):295-303.
Wang C, Chen Q, Wang Y. Correlation of amniotic fluid inflammatory markers with preterm birth: a meta-analysis. J Obstet Gynaecol. 2024;44(1):2368764.
Ding H, Ding Z, Zhao M, Ji B, Lei J, Chen J, et al. Correlation of amniotic fluid index and placental aquaporin 1 levels in terms of preeclampsia. Placenta. 2022;117:169-78.
Jha P, Raghu P, Kennedy AM, Sugi M, Morgan TA, Feldstein V, et al. Assessment of Amniotic Fluid Volume in Pregnancy. Radiographics. 2023;43(6):e220146.
Antepartum Fetal Surveillance: ACOG Practice Bulletin, Number 229. Obstet Gynecol. 2021;137(6):e116-e27.
Doktor F, Figueira RL, Fortuna V, Biouss G, Stasiewicz K, Obed M, et al. Amniotic fluid stem cell extracellular vesicles promote lung development via TGF-beta modulation in a fetal rat model of oligohydramnios. J Control Release. 2025;377:427-41.
Wax JR, Pinette MG. The amniotic fluid index and oligohydramnios: a deeper dive into the shallow end-reply to Magann et al. Am J Obstet Gynecol. 2023;228(5):598.
Wax JR, Pinette MG. The amniotic fluid index and oligohydramnios: a deeper dive into the shallow end. Am J Obstet Gynecol. 2022;227(3):462-70.
Figueroa, L., McClure, E. M., Swanson, J., Nathan, R., Garces, A. L., Moore, J. L., Krebs, N. F., Hambidge, K. M., Bauserman, M., Lokangaka, A., Tshefu, A., Mirza, W., Saleem, S., Naqvi, F., Carlo, W. A., Chomba, E., Liechty, E. A., Esamai, F., Swanson, D., & Bose, C. L. (2020). Oligohydramnios: a prospective study of fetal, neonatal and maternal outcomes in low-middle income countries. Reproductive Health, 17(1).
Farouk, H., Assar, T., & Elsawy, S. (2022). Fetal Renal Artery Indices of Second and Third Trimesters of Pregnancy in Idiopathic Oligohydrominos by Pulsed Wave Doppler Ultrasonography. Evidence Based Women's Health Journal, 12(2), 202-208.
Jabeen, Z., Bacha, R., Zain-ul-Hassan, Fatima, M., Manzoor, I., Ramzan, I., & Iyaz, M. (2021). Hemodynamic Changes in Umbilical Artery and Middle Cerebral Artery with Oligohydramnios in Third Trimester of Pregnancy. Journal of Diagnostic Medical Sonography, 875647932110519.
Medhat M. Refaa.t, Hamada M. Khater., Marian H. Helmy., (2022) Value of Fetal Renal Artery Doppler Indices in Idiopathic Oligohydramnios and Polyhydramnios. Benha Medical Journal, vol. 39, special issue (radiology).
Downloads
Published
Issue
Section
License
Copyright (c) 2025 Hafiza Maria Fawad, Ahmad attiqe, Eman Shahzadi, Hafiza Hijab Rehman, Momna Mansoor, Maliha yamin, Uzma Yousaf (Author)
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
