Abstract | OBJECTIVE: Several trials aimed at evaluating the efficacy of maternal hydration (MH) in increasing amniotic-fluid-volume (AFV) in pregnancies with isolated oligohydramnios or normohydramnos have been conducted. Unfortunately, no evidences support this intervention in routine-clinical-practice. The aim of this systematic-literature-review and meta-analysis was to collect all data regarding proposed strategies and their efficacy in relation to each clinical condition for which MH- therapy was performed with the aim of increasing amniotic-fluid (AF) and improving perinatal outcomes. MATERIALS AND METHODS: A systematic literature search was conducted in electronic-database MEDLINE, EMBASE, ScienceDirect and the Cochrane-Library in the time interval between 1991 and 2014. Following the identification of eligible trials, we estimated the methodological quality of each study (using QADAS-2) and clustered patients according to the following outcome measures: route of administration (oral versus intravenous versus combined), total daily dose of fluids administered (<2000 versus >2000), duration of hydration therapy: (1 day, >1 day but <1 week, >1 week), type of fluid administered (isotonic versus hypotonic versus combination). RESULTS: In isolated- oligohydramnios (IO), maternal oral hydration is more effective than intravenous hydration and hypotonic solutions superior to isotonic solutions. The improvement in AFV appears to be time-dependent rather than daily-dose dependent. Regarding normohydramnios pregnancies, all strategies seem equivalent though the administration of hypotonic-fluid appears to have a slightly greater effect than isotonic-fluid. Regarding perinatal outcomes, data is fragmentary and heterogeneous and does not allow us to define the real clinical utility of MH. CONCLUSIONS: Available data suggests that MH may be a safe, well-tolerated and useful strategy to improve AFV especially in cases of IO. In view of the numerous obstetric situations in which a reduced AFV may pose a threat, particularly to the fetus, the possibility of increasing AFV with a simple and inexpensive practice like MH- therapy may have potential clinical applications. Considering the various strategies of maternal hydration implemented in the treatment of IO, better results were observed when treatment was based on a combination of intravenous (for a period of 1 day) and oral (for a period of at least 14 days) hypotonic fluids (≥2000ml).
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Authors | Salvatore Gizzo, Marco Noventa, Amerigo Vitagliano, Andrea Dall'Asta, Donato D'Antona, Clive J Aldrich, Michela Quaranta, Tiziana Frusca, Tito Silvio Patrelli |
Journal | PloS one
(PLoS One)
Vol. 10
Issue 12
Pg. e0144334
( 2015)
ISSN: 1932-6203 [Electronic] United States |
PMID | 26658482
(Publication Type: Journal Article, Meta-Analysis, Review, Systematic Review)
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Chemical References |
- Hypotonic Solutions
- Isotonic Solutions
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Topics |
- Administration, Intravenous
- Administration, Oral
- Amniotic Fluid
(metabolism)
- Clinical Trials as Topic
- Female
- Fluid Therapy
- Humans
- Hypotonic Solutions
(administration & dosage)
- Isotonic Solutions
(administration & dosage)
- Oligohydramnios
(therapy)
- Pregnancy
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