Arch Gynecol Obstet (2014) 290:875–881
DOI 10.1007/s00404-014-3292-7
MATERNAL-FETAL MEDICINE
The association between isolated oligohydramnios at term
and pregnancy outcome
Eran Ashwal · Liran Hiersch · Nir Melamed ·
Amir Aviram · Arnon Wiznitzer · Yariv Yogev 
Received: 7 April 2014 / Accepted: 21 May 2014 / Published online: 13 June 2014
© Springer-Verlag Berlin Heidelberg 2014
Abstract  logistic regression analysis, isolated oligohydramnios was
Purpose  As conflicting data exist concerning the implica-
tions of isolated oligohydramnios on pregnancy outcome
at term, we aimed to assess this association in low-risk
pregnancies.
Methods  A retrospective cohort study of term pregnan-
cies with sonographic finding of isolated oligohydramnios
(amniotic fluid index (AFI) <5 cm) between 2007 and
2012. Outcome was compared to a control group of preg-
nancies with normal AFI (5–25 cm). Pregnancies compli-
cated by thrombophilia, hypertension, diabetes, deviant
fetal growth or chromosomal/structural abnormalities were
excluded. Composite adverse outcome included CS/opera-
tive delivery due to non-reassuring heart rate (NRFHR),
low Apgar score, umbilical artery pH < 7.10, neonatal
intensive care admission, meconium aspiration syndrome,
intubation or hypoxic-ischemic encephalopathy.
Results  Overall, 987 pregnancies complicated by isolated
oligohydramnios were compared to 22,280 low-risk preg-
nancies with normal AFI. Isolated oligohydramnios was
associated with a higher rate of induction of labor (27.7
vs. 3.7 %, p < 0.001), CS due to NRFHR (2.3 vs. 1.1 %,
p < 0.01) and composite adverse outcome (9.7 vs. 7.1 %,
p < 0.01). However, after adjusting for potential confound-
ers as induction of labor and nulliparity using multivariable
E. Ashwal · L. Hiersch · N. Melamed · A. Aviram · A. Wiznitzer ·
Y. Yogev (*) 
Department of Obstetrics and Gynecology, Helen Schneider
Hospital for Women, Rabin Medical Center,
49100 Petah Tiqwa, Israel
e-mail: yarivyogev@hotmail.com
E. Ashwal · L. Hiersch · N. Melamed · A. Aviram · A. Wiznitzer ·
Y. Yogev  pregnancy outcome in cases of isolated oligohydramnios is
Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
not found to be independently associated with increased
risk for composite adverse outcome (OR 1.01, 95 % CI
0.80–1.27, p = 0.93).
Conclusion  Isolated oligohydramnios at term by itself is
not associated with increased obstetrical morbidity.
Keywords  Cesarean section · Induction of labor ·
Isolated oligohydramnios · Pregnancy
Introduction
The incidence of oligohydramnios (<5 cm) at term varies
greatly between different studies with a reported incidence
of 0.5–5 %, depending on the study population, gestational
age and the definition of oligohydramnios [1, 2].
Oligohydramnios can be related to pathologies such as
premature rupture of membranes, placental dysfunction
and chromosomal or structural anomalies. However, in
many cases, oligohydramnios is an isolated finding. There
is an intensive body of evidence suggesting that overall,
oligohydramnios is associated with an increased risk of
adverse pregnancy outcome [3, 4]. However, controversy
persists with regard to whether isolated oligohydramnios
by itself has a potential impact on pregnancy outcome. Sev-
eral studies reported an increased risk for cesarean deliv-
ery due to NRFHR, lower Apgar scores and a higher rate
of neonatal intensive care unit admission (NICU) [3–5].
On the other hand, others suggested that perinatal outcome
in cases of isolated oligohydramnios is comparable to that
of pregnancies with normal amniotic fluid [6–10]. Further-
more, it has been suggested that the higher rate of adverse
the result of the higher rate of medical interventions (i.e.,
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876
labor induction and cesarean delivery) rather than the result
of oligohydramnios by itself [11, 12].
As the optimal management of isolated oligohydramnios
at term had been addressed by only a small number of stud-
ies which are limited by a small sample size, variation in
the definition of oligohydramnios and lack of appropriate
control groups [11–13], we aimed to assess pregnancy out-
come of low-risk pregnancies complicated by isolated oli-
gohydramnios at term.
Methods
Study population
We conducted a retrospective cohort study of all single-
ton pregnancies at term (37 + 0 to 41 + 6 weeks) who
attempted vaginal delivery in a university-affiliated tertiary
hospital, between June 1st 2007 and December 31st 2012.
All gravid patients who are being assessed in the obstet-
rical follow-up clinic in our medical center undergo a sono-
graphic assessment of the amniotic fluid volume as an inte-
gral part of fetal assessment. Eligible women for the study
group were those with isolated oligohydramnios [amniotic
fluid index (AFI) <5 cm] according to ultrasound scan per-
formed between 37 + 0 and 41 + 6 weeks’ gestation. The
control group consisted of all low-risk term pregnancies
with a normal level of amniotic fluid (AFI 5–25 cm). All
women in both study and control groups had sonographic
documentation of AFI level within a week prior to the
delivery. The patient population included all women pre-
senting to our center for vaginal delivery regardless of site
of prenatal care.
Pregnancies complicated by any of the following condi-
tions at the time of initial evaluation were excluded from
both the study and control groups: known chromosomal or
structural anomalies, hypertensive disorders, diabetes, pol-
yhydramnios (AFI > 25 cm), suspected fetal growth restric-
tion defined as sonographically estimated fetal weight
below the 10th percentile according to local reference
curves [15], suspected chorioamnionitis or ruptured amni-
otic membranes. The local institutional review board (IRB)
approved the study.
Women who were diagnosed with oligohydramnios at
term underwent a meticulous workup in order to estab-
lish adequate dating of pregnancy (based on first trimester
ultrasound), and risk factors associated with oligohydram-
nios (i.e., maternal co-morbidities, hypertensive disor-
ders, major fetal anomalies, deviant fetal growth or rup-
ture of membranes). In addition, evaluation included fetal
monitoring (non-stress testing (NST), biophysical pro-
file (BPP) and measurement of AFI and Bishop score).
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Arch Gynecol Obstet (2014) 290:875–881
Oligohydramnios was determined to be isolated only if all
the above-mentioned workup was normal.
Women with isolated oligohydramnios at term and a
Bishop score ≥7 were offered induction of labor. Oth-
erwise, the pregnancy was managed expectantly until
41  + 4 weeks’ gestation. This date was chosen according
to our local management protocols. Expectant management
included instructions for daily maternal perception of fetal
movements, in addition to NST, BPP, AFI and Bishop score
assessment twice a week until 41 + 4 weeks of gestation.
Expectant management was allowed in condition that fetal
movements were adequate, reassuring NST and BPP of
8/8. During the follow-up duration, if Bishop score became
≥7, induction of labor was suggested as well. Of note,
prior to labor induction due to oligohydramnios, a repeat
sonographic assessment of AFI was undertaken in order to
ascertain the diagnosis.
At 41 + 4 weeks of gestation or more indicated induc-
tion of labor was suggested regardless the amniotic fluid
volume.
According to our local protocol, vaginal PGE2 tables
were considered as the first-line agent for cervical ripening.
In cases in which more than two contractions per 10 min
were monitored using tocodynamometer prior the induc-
tion, an extra-amniotic balloon was preferred.
In order to determine whether adverse pregnancy out-
come in the isolated oligohydramnios group was poten-
tially related to the presence of oligohydramnios per se
or whether it was the result of other confounders such as
induction of labor or nulliparity, we performed subgroups
analysis, stratifying outcome by parity and spontaneous vs.
induced labors.
Data collection
Data were obtained from our departmental electronic health
records. The following demographic and obstetrical vari-
ables were recorded: maternal age, gravidity, parity, smok-
ing, prior cesarean deliveries, indications for induction of
labor, gestational age at delivery, intra-partum characteris-
tics, such as meconium, mode of delivery and indication
for operative or cesarean delivery. The following perina-
tal outcomes were assessed: Apgar scores at 1 and 5 min,
birthweight and perinatal morbidity and mortality.
Definitions
Composite adverse outcome included one or more of the
following: CS or operative delivery due to NRFHR, Apgar
score at 5 min less than 7, umbilical artery pH < 7.10,
NICU admission, need for intubation, meconium aspiration
syndrome or hypoxic-ischemic encephalopathy.
Arch Gynecol Obstet (2014) 290:875–881 877
Fig. 1  Flow chart for study
selection. HTN hypertension,
IUGR intrauterine growth
restriction
Power calculations
The primary outcome parameter was defined as the rate of
the composite adverse outcome. According to our local sta-
tistics, expected percentage in the control group is approxi-
mately 3 %. Using Epi-Info™ software, in order to ensure
an 80 % power of detecting a difference of OR of 2 assum-
ing at least 1:4 ratio between the groups, a sample size of at
least 354 women in each group was estimated.
Statistical analysis
Data analysis was performed with the SPSS v19.0 pack-
age (Chicago, IL). Student’s t test and Mann–Whitney U
test were used to compare continuous variables between the
groups with and without normal distribution, respectively.
The Chi-square and Fisher’s exact tests were used for cat-
egorical variables. Multivariable logistic regression analysis
was used to adjust the risk for composite adverse outcome
associated with isolated oligohydramnios for potential con-
founders. Variables that were found to be different between
the groups (p < 0.05) in the bivariate analysis were entered to
the multivariable logistic regression model. Differences were
considered significant when p value was less than 0.05.
Results
Patient’s characteristics
Overall, 35,810 women attempted vaginal delivery between
37  + 0 and 41 + 6 weeks of gestation during the study
period, of them 987 (2.7 %) were diagnosed with isolated
oligohydramnios (study group) and 22,280 were consid-
ered as low-risk pregnancies with normal AFI (control
group) (Fig. 1).
Women in the isolated oligohydramnios group had a
higher rate of nulliparity (44.8 vs. 30.7 %, p < 0.001), need
for fertility treatments and lower gestational age at delivery
(Table 1).
Pregnancy and labor outcome
Women in the isolated oligohydramnios group were char-
acterized by a higher rate of labor induction (27.7 vs.
3.7 %, p < 0.001), operative vaginal delivery (11.4 vs.
9.1 %, p  = 0.01) and intra-partum cesarean delivery due
to NRFHR (2.3 vs. 1.1 %, p < 0.01) (Table 1). The rate of
meconium-stained amniotic fluid was similar between the
groups (Table 1).
Neonatal outcome
Neonates in the isolated oligohydramnios group were char-
acterized by a lower birthweight and a higher rate of com-
posite adverse outcome (9.7 vs. 7.1 %, p < 0.01) (Table 2).
Neonatal gender, 5-minute Apgar score, umbilical artery
cord pH < 7.10, need for intubation, meconium aspiration
syndrome, NICU admission and perinatal mortality were
similar between the groups (Table 2).
On multivariable logistic regression analysis, after con-
trolling for possible factors affecting perinatal adverse
outcome such as nulliparity, induction of labor, neuro-
axial analgesia and birthweight percentile, isolated
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878 Arch Gynecol Obstet (2014) 290:875–881

Table 1  Characteristics and Isolated oligo (N = 987) Normal AFI (N = 22,280) p value

labor and delivery outcome for
the study and control groups Maternal age (years) 30.0 ± 4.9 30.3 ± 5.0 0.04
Nulliparity 442 (44.8) 6,848 (30.7) <0.01
Previous CS 51 (5.2) 1,284 (5.8) 0.48
Fertility treatment 38 (3.9) 588 (2.6) 0.02
Mode of delivery
 NVD 810 (82.1) 19,565 (87.8) <0.001
 Operative vaginal delivery 113 (11.4) 2,021 (9.1) 0.01
  Prolonged second stage 86 (8.7) 1,547 (6.9) 0.03
  NRFHR 26 (2.6) 472 (2.1) 0.26
 CS 64 (6.5) 694 (3.1) <0.001
  Dystocia 37 (3.9) 414 (1.9) <0.001
  NRFHR 23 (2.3) 249 (1.1) <0.01
  Failed operative delivery 2 (0.2) 16 (0.1) 0.17
  Prolapse 2 (0.2) 16 (0.1) 0.17
  Suspected chorioamnionitis 0 (0.0) 3 (.00) 0.87
Values are presented as Epidural analgesia 776 (78.6) 14,980 (67.2) <0.001
mean ± SD or N (%) AROM 449 (45.5) 9,520 (42.7) 0.87
AROM artificial rupture of Induction of labor 273 (27.7) 824 (3.7) <0.001
membrane, CS cesarean section,
EAB extra-amniotic balloon,  PG 220 (22.3) 546 (2.5) <0.001
MOD mode of delivery, NVD  EAB 15 (1.5) 54 (0.2) <0.001
normal vaginal delivery,  Oxytocin 22 (2.2) 217 (1.0) 0.01
NRFHR non-reassuring fetal Meconium-stained amniotic fluid 108 (10.9) 2,351 (10.6) 0.67
heart rate, PG prostaglandin

Table 2  Neonatal outcome for Isolated oligohydramnios Normal AFI p value

the study and control groups (N = 987) (N = 22,280)

Adverse composite outcome 96 (9.7) 1,593 (7.1) <0.01

Gestational age at delivery (weeks) 39.8 ± 1.1 39.3 ± 1.1 0.04
Gender 0.13
 Male 478 (48.4) 11,337 (50.9)
 Female 509 (51.6) 10,943 (49.1)
Birthweight (g) 3,240.1 ± 366 3,321.6 ± 377 <0.01
Birthweight percentile 51.1 ± 24 58.9 ± 24 <0.01
Apgar 5 min <7 3 (0.3) 60 (0.3) 0.75
Stillbirth 1 (0.1) 23 (0.1) 0.73
NICU 45 (4.6) 795 (3.6) 0.11
RDS 0 (0.0) 2 (0.0) 0.91
TTN 5 (0.5) 124 (0.6) 0.53
Umbilical artery cord pH < 7.10 3 (0.3) 51 (0.2) 0.49
Sepsis 39 (4.0) 754 (3.4) 0.33
Seizure 5 (0.5) 61 (0.3) 0.20
HIE 6 (0.8) 117 (0.5) 0.29
Values are presented as
mean ± SD or N (%) IVH 0 (0.0) 10 (0.0) 0.65
BPD broncho-pulmonary Hypothermia 1 (0.1) 7 (0.0) 0.29
dysplasia, HIE hypoxic- Meconium aspiration syndrome 4 (0.4) 38 (0.2) 0.10
ischemic encephalopathy, IVH Intubation 4 (0.4) 60 (0.3) 0.35
intra-ventricular hemorrhage,
Jaundice 68 (6.9) 1,555 (7.0) 0.98
NA not applicable, NICU
neonatal intensive care unit, Hypoglycemia 5 (0.5) 118 (0.5) 0.58
RDS respiratory distress Phototherapy 37 (3.7) 774 (3.5) 0.66
syndrome, TTN transient Neonatal death 0 (0.0) 3 (0.0) NA
tachypnea of the newborn

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Arch Gynecol Obstet (2014) 290:875–881 879

oligohydramnios was not found to be significantly associ-
ated with composite neonatal adverse outcome (OR 1.01,
95 % CI 0.80–1.27, p = 0.93) (Table 3).
In order to further investigate the factors that are respon-
sible for the high rate of adverse neonatal outcome in
pregnancies complicated by isolated oligohydramnios, we
performed subgroups analysis, stratifying outcome by par-
ity and spontaneous vs. induced labors (Tables 4, 5). In the
subgroup of women who presents with spontaneous onset
of labor (i.e., excluding women who underwent induction
of labor), women with isolated oligohydramnios, either
nulliparous or multiparous, had a similar rate of operative
or cesarean delivery due to NRFHR, NICU admission,
Apgar score, umbilical artery cord pH < 7.10, need for
neonatal intubation, meconium aspiration syndrome and
composite adverse outcome in comparison to the normal
AFI group (15.7 vs. 12.1 %, p  = 0.06 and 4.8 vs. 4.6 %,
p  = 0.82 for nulliparous and multiparous, respectively)
(Table  4). Furthermore, in the subgroup of multiparous
women, the rate of operative or cesarean delivery due to
NRFHR, NICU admission, Apgar score, umbilical artery
Table 3  Multivariable logistic regression analysis for adverse com-
posite outcome in the study and control groups
OR 95 % CI
Isolated oligohydramnios 1.01 (0.80–1.27)
Nulliparity 2.90 (2.61–3.23)
Gestational age 1.06 (1.02–1.12)
Induction of labor 1.50 (1.23–1.84)
Birthweight percentile 0.99 (0.99–1.00)
Epidural analgesia 1.03 (0.91–1.16)
cord pH < 7.10, need for neonatal intubation, meconium
aspiration syndrome and composite adverse outcome was
similar between the groups (4.1 vs. 7.4 %, p = 0.18 and 4.8
vs. 4.6 %, p = 0.82 for induction of labor and spontaneous
delivery, respectively) (Table 5).
Discussion
The obstetrical outcome of pregnancies complicated with
isolated oligohydramnios is controversial [11, 12, 14]. In
the current study, the higher rate of adverse neonatal out-
come in pregnancies complicated by isolated oligohydram-
nios appeared to be mainly related to the higher rate of iat-
rogenic interventions and confounders such as nulliparity,
but not to the presence of isolated oligohydramnios per se.
Previous studies have shown that women with isolated
oligohydramnios had an increased risk for intra-partum
NRFHR and, subsequently, a higher rate of operative and
cesarean delivery due to NRFHR [3, 16]. Chauhan et al.
in a meta-analysis of 10,551 patients demonstrated that
antepartum diagnosis of oligohydramnios was associated
with a significantly increased risk of CS for fetal distress
(RR 2.2, 95 % CI 1.5–3.4). However, this review did not
stratify patients according to confounders that may affect
p value amniotic fluid volume, such as chronic maternal diseases,
0.93
birthweight, and status of amniotic membranes (either rup-
tured or intact) [3]. Similarly, Casey et al. retrospectively
<0.01
analyzed 6,423 patients with oligohydramnios (defined
<0.01
by an AFI < 5 cm) who underwent clinically indicated
<0.01
antepartum ultrasonography (i.e., uncertain gestational
<0.01
age, suspected deviant fetal growth or anomalies). Oli-
0.61
gohydramnios was significantly associated with increased

Table 4  Delivery and neonatal outcome for the subgroup of women presenting with spontaneous onset of labor, stratified by parity
Multipara without IoL Nullipara without IoL
Isolated oligo Normal AFI p value Isolated oligo Normal AFI p value
(N = 397) (N = 14,975) (N = 318) (N = 6,512)

Operative vaginal delivery due to NRFHR 3 (0.8) 174 (1.2) 0.63 14 (4.4) 274 (4.2) 0.88
CS due to NRFHR 6 (1.5) 132 (0.9) 0.17 9 (2.8) 92 (1.4) 0.05
5 min. Apgar <7 1 (0.3) 43 (0.3) NA 2 (0.6) 30 (0.5) 0.66
NICU admission 7 (1.8) 310 (2.1) 0.85 29 (9.1) 436 (6.7) 0.11
umbilical artery cord pH < 7.10 1 (0.3) 14 (0.1) 0.32 2 (0.6) 37 (0.6) 0.70
Intubation 1 (0.3) 30 (0.2) 0.55 2 (0.6) 28 (0.4) 0.65
HIE 4 (1.0) 90 (0.6) 0.31 2 (0.6) 29 (0.4) 0.65
Meconium aspiration syndrome 0 (0.0) 9 (0.1) NA 4 (1.3) 27 (0.4) 0.05
Adverse composite outcome 19 (4.8) 689 (4.6) 0.82 50 (15.7) 791 (12.1) 0.06

Values are presented as mean ± SD or N (%)

Women who underwent induction of labor were excluded from the analysis
CS cesarean section, HIE hypoxic-ischemic encephalopathy, IoL induction of labor, NICU neonatal intensive care unit, NA not applicable,
NRFHR non-reassuring fetal heart rate

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880 Arch Gynecol Obstet (2014) 290:875–881

Table 5  Labor and delivery characteristics of study and control groups after exclusion Nulliparity
Multipara with IoL Multipara without IoL
Isolated oligo Normal AFI p value Isolated oligo Normal AFI p value
(N = 148) (N = 485) (N = 397) (N = 14,975)

Operative vaginal delivery due to NRFHR 1 (0.7) 6 (1.2) 0.55 3 (0.8) 174 (1.2) 0.63
CS due to NRFHR 2 (1.4) 9 (1.9) 0.83 6 (1.5) 132 (0.9) 0.17
5 min. Apgar < 7 0 (0.0) 4 (0.8) 0.57 1 (0.3) 43 (0.3) NA
NICU admission 2 (1.4) 17 (3.5) 0.27 7 (1.8) 310 (2.1) 0.85
umbilical artery cord pH < 7.10 – – NA 1 (0.3) 14 (0.1) 0.32
Intubation – – NA 1 (0.3) 30 (0.2) 0.55
HIE 1 (0.7) 2 (0.4) 0.55 4 (1.0) 90 (0.6) 0.31
Meconium aspiration syndrome – – NA 0 (0.0) 9 (0.1) NA
Adverse composite outcome 6 (4.1) 36 (37.4) 0.18 19 (4.8) 689 (4.6) 0.82

Values are presented as mean ± SD or N (%)

CS cesarean section, HIE hypoxic-ischemic encephalopathy, IoL induction of labor, NICU neonatal intensive care unit, NA not applicable,
NRFHR non-reassuring fetal heart rate

risk for induction of labor, stillbirth, NRFHR, admission
to NICU, meconium aspiration syndrome, and neonatal
death. However, as only cases with a clinical indication
for sonographic examination were included in that study,
a selection bias may have been introduced and contributed
to the observed results [16], in contrary to our study which
included only cases with isolated oligohydramnios.
In the current study, we have found that isolated oligo-
hydramnios was not independently associated with adverse
neonatal outcome. This was demonstrated both by means of
multivariate regression analysis and subgroup analysis. Our
results were in concordance with previous reports [6]. In a
case–control study, Conway at el. matched low-risk women
at term with isolated oligohydramnios to control group of
similar parity and gestational age. Neonatal outcome did
not differ between the two groups. However, the subgroups
of women who were induced had significantly more cesar-
ean deliveries [11]. In contrary to our study, the comparison
was made between women with isolated oligohydramnios
who had their labor induced and women who presented in
spontaneous labor. Moreover, in a secondary analysis of
the data of the multicenter prospective RADIUS trial [6],
women who were diagnosed with isolated oligohydramnios
demonstrated similar fetal growth and perinatal outcomes
compared with pregnancies with a normal level of amni-
otic fluid. Of note, unlike our study, women were enrolled
at any gestational age and there was no distinction with
respect to the management and the rate of interventions,
especially induction of labor in these cases. In concord-
ance to our findings, Rossi et al. in a recent meta-analysis
included 4 studies providing 679 cases of isolated oligohy-
dramnios at 37–42 gestational weeks altogether. They sug-
gested that isolated oligohydramnios was associated with
increased risk of obstetrical interventions but outcome was
similar to that of pregnancies with normal levels of amni-
otic fluid [10]. Of note, when the meta-analysis was limited
to only low-risk pregnancies, perinatal outcome including
cesarean or operative deliveries for NRFHR was similar in
the isolated oligohydramnios and the control group, as was
found in our study after excluding for major confounders
such as nulliparity and induction of labor.
We found that oligohydramnios was not associated with
the presence of meconium-stained amniotic fluid or meco-
nium aspiration syndrome. Controversy exists regarding the
relationship between oligohydramnios and meconium pas-
sage, with some authors reported an increased incidence of
meconium-stained fluid in pregnancies with oligohydram-
nios [17, 18], whereas others did not [9, 19, 20]. The dis-
crepant findings can be attributed to differences in factors
such as gestational age, as published reports often included
women with a gestational age beyond 42 weeks [18]. The
lack of association between oligohydramnios and meco-
nium aspiration syndrome provides support to the evidence
that meconium characteristics have little impact on the risk
for meconium aspiration syndrome [20, 21].
We have found that the rate of labor induction was nearly
ninefold higher in the isolated oligohydramnios group
compared with controls. Our findings are consistent with
earlier results [13, 20]. Moreover, it was speculated that
the obstetricians’ attitude in cases of isolated oligohydram-
nios in otherwise normal pregnancies was toward interven-
tion. Elsandabesee et al. [22] demonstrated that even in the
absence of a specific institutional policy, approximately
half of low-risk women with isolated oligohydramnios
faced the risk of obstetrical interventions, mainly induction
of labor. However, in cases of isolated oligohydramnios at
term, induction of labor has never been demonstrated to be
beneficial for either the fetus or the neonate.

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The current study has several limitations including its
retrospective design. Although we have tried to adjust for
all potential confounders, the possibility of a selection bias
with respect to induction of labor (i.e., women who were
induced were a highest risk for adverse outcome) cannot be
ruled out. In addition, our local protocol for amniotic fluid
volume assessment requires summing four quadrants of fluid
pockets, even though some have shown that single deepest
vertical pocket measurement seems a better choice since the
use of the AFI increases the rate of diagnosis of oligohy-
dramnios and the rate of induction of labor without improve-
ment in peripartum outcomes [14]. Furthermore, due to the
retrospective design of our study, sequential sonographic
assessments for amniotic fluid volume were not necessarily
performed for all women. Information regarding certain con-
founders such as maternal body mass index (BMI) was not
available. In addition, several fetal and neonatal complica-
tions (as stillbirth or meconium aspiration syndrome) could
be adequately addressed due to their rarity. Nevertheless, the
current study represents one of the largest series published to
date on isolated oligohydramnios. In addition, as this was a
single-center study, the same obstetrical protocols were used
during the study period. Moreover, the comprehensive data-
base allowed us to determine the relationship between iso-
lated oligohydramnios and multiple outcomes of interest.
In conclusion, the findings of the current study suggest
that isolated oligohydramnios at term by itself is not associ-
ated with adverse perinatal outcome. Instead, it appears that
differences in the rate of interventions such as induction of
labor and obstetrical characteristics (especially nulliparity)
rather than low amniotic fluid volume per se are responsi-
ble for the observed differences in rates of adverse neonatal
outcome. It may be suggested that the routine induction of
labor in all cases of isolated oligohydramnios at term is not
warranted, and that the management of these cases should
be individualized. There is an urgent need for prospective
randomized controlled trials to confirm these observations.
Conflict of interest  None declared.
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