Efficacy of inhaled Desmopressin in pregnant women with idiopathic oligohydramnios - a randomized controlled trial.

The aim of this study was to investigate the therapeutic effect of inhaled Desmopressin (DDAVP) in pregnant women with idiopathic oligohydramnios. This randomized, double-blind clinical trial involved 44 pregnant women at 28-37 weeks of gestation with idiopathic oligohydramnios admitted in 2 academic hospitals in Mashhad, Iran, from 2018 to 2019. In the intervention group, 10µg DDAVP was nasally sprayed. The control group received intravenous maintenance fluid. The hematocrit, electrolytes, blood pressure and urine-specific gravity were evaluated at baseline and 3, 8, and 24 hours later. Amniotic fluid index (AFI) was measured using ultrasound at baseline, 24 and 48 hours later. There was no significant difference in the basic characteristics (age, body mass index, and gestational age) between the two groups. The pattern of changes of AFI (baseline, 24 and 48 hours later) increased in the intervention (4.16±0.86, 7.08±1.453 and 7.76±1.62, p<0.001) and control groups (4.23±0.70, 5.39±1.079 and 5.68±1.10, p<0.001). Serum sodium levels significantly declined in the intervention group (p<0.001) but not in the control group (p=0.07). There were no significant differences in potassium (p=0.89), hematocrit (p=0.23), systolic blood pressure (p=0.21) and diastolic blood pressure (p=0.97). However, urine-specific gravity had an increasing pattern in the intervention group (p<0.001) and a decreasing pattern in the control group (p<0.001). This study showed that Desmopressin inhalation could increase the AFI and urine specific gravity, enhancing oligohydramnios treatment in pregnant women, compared to serum administration.

Inhaled Nitric Oxide in Preterm Neonates with Refractory Hypoxemia Associated to Oligohydramnios.

BACKGROUND: Therapy with inhaled nitric oxide (iNO) is effective in the management of pulmonary hypertension and severe hypoxemia. However, these benefits have not been demonstrated in preterm infants (<34 weeks). The objective of this report is to present the experience of eight cases of preterm neonates with respiratory distress syndrome (RDS) and refractory hypoxemia, with oligohydramnios history. METHODS: We evaluated the clinical feature of 8 preterm neonates with severe hypoxemia who had maternal antecedents of oligoamnios, mainly due to premature rupture of membranes. They were treated with conventional management, with poor clinical response. Therefore, these neonates were treated with iNO, as a rescue strategy. iNO has been used with a dosage of 5 - 10 ppm. An echocardiogram was performed to determine the presence of structural malformations or persistent ductus arteriosus. RESULTS: All the infants showed improvement in oxygenation. The neonates had signs of low flow pulmonary, confirmed by echocardiogram. Five preterm infants survived without complications associated with the therapy. Two died from pulmonary bleeding secondary to ductus arteriosus and another for pneumothorax. CONCLUSION: iNO therapy can be useful in a subgroup of preterm infants with a high risk of death secondary to hypoxemia. Although this report is based on a small number of cases, it follows the directions of other studies that suggest that iNO therapy can benefit preterm neonates, particularly those exposed to oligohydramnios.

Danshen extract regulates the expression of aquaporin 3 in human amniotic epithelial cells.

Danshen extract has been used in the treatment of oligohydramnios, however, the mechanism of its action has not been elucidated. Previously, we demonstrated that down-regulation of AQP3 in fetal membranes may contribute to the development of oligohydramnios. In this study, we investigated the effects of Danshen extract on AQP3 expression in human amniotic epithelial cells from term pregnancies with oligohydramnios or those with those with (those with) normovolemic amniotic fluid. Human amniotic epithelial cells from the oligohydramnios group expressed a lower level of AQP3 mRNA and protein than those with normovolemia. Tweleve hour (Twelvehours) of treatment with Danshen extract, in a dose dependent manner, significantly increased the expression of AQP3 in the two groups. However, human amniotic epithelial cells from the oligohydramnios patients showed a greater sensitivity to the treatment of Danshen extract. These data provide a molecular basis for the treatment of patients with oligohydraminos.

Linking expression of aquaporin 3 to activation of JNK pathway.

Aquaporin 3 (AQP3) has been shown to be low in the amnion and chorion tissues of patients with oligohydramnios and that S. miltiorrhiza, a Chinese herbal medicine, results in increased AQP3 in human amniotic epithelial cells (hAECs). Here, we provide evidence for the involvement of the JNK pathway in AQP3 regulation in isolated oligohydramnios tissues in vitro, in hAECs derived from normal amniotic fluid and fluid from patients with isolated oligohydramnios. Phosphorylation of JNK was suppressed by pretreatment of cells with JNK-specific inhibitor (SP600125) and was up-regulated by S. miltiorrhiza; S. miltiorrhiza combined with SP600125 prevented SP600125-induced down-regulation of phospho-JNK both in normal amniotic fluid volume and in isolated oligohydramnios. In isolated oligohydramnios, AQP3 expression was significantly suppressed by SP600125 in a concentration- and time-dependent mannner, while its expression was up-regulated by S. miltiorrhiza. S. miltiorrhiza combined with SP600125 inhibited the increased expression of AQP3 relative to the S. miltiorrhiza treated group. Together, the data suggest that c-jun N-terminal kinase (JNK) pathway unerlies the regulation of AQP3 by S. miltiorrhiza amnion and chorion tissues.

Early-onset fetal growth restriction treated with the long-acting phosphodiesterase-5 inhibitor tadalafil: a case report.

BACKGROUND: Severe early-onset fetal growth restriction occurs in 0.4 % of all pregnancies, and the prognoses of these patients are dismal. Severely growth-restricted fetuses (far below 500 g) are thought to be nonviable. Since there have not been effective treatments for such fetal patients, obstetricians have simply tried to identify the optimal timing for their delivery. There are a few reports suggesting that the phosphodiesterase type 5 inhibitor sildenafil has some limited beneficial effects on fetal growth, but there are no such reports on tadalafil, another derivative phosphodiesterase type 5 inhibitor which has a much longer half-life than sildenafil. Here we present a case in which the administration of tadalafil to the mother revived the arrested growth and severe oligohydramnios of the very prematurely growth-restricted fetus. CASE PRESENTATION: We describe a case of early-onset fetal growth restriction with oligohydramnios in a 41-year-old primigravida Japanese woman who was treated with tadalafil (20-mg tablet daily) from 22 weeks' gestational age. Ten days after the initiation of the tadalafil therapy, the amniotic fluid level rose and the weight of the fetus began to increase. A 1024-g baby boy was delivered by cesarean at 32 weeks' gestation. The z-score for fetal head circumference had increased from -2.2 to -1.2, whereas the z-score of the femur legth was decreased to -4.3, indicating that tadalafil preferentially increased the blood flow to important organs. CONCLUSIONS: We achieved two positive results by administering tadalafil to the mother carrying a severely growth-restricted fetus with oligohydramnios. First, the z-scores of head circumference and abdominal circumference had at first declined but started to rise after the tadalafil administration. Second, the amniotic fluid, which was emptied before the tadalafil treatment, recovered to normal range with this treatment. Tadalafil administration to mothers could be a promising therapy to reverse severe fetal growth restriction and oligohydramnios.

A case of fetal hyperthyroidism treated with maternal administration of methimazole.

Prenatal ultrasonography of a pregnant woman with a past history of total thyroidectomy for Graves' disease detected fetal tachycardia, fetal growth restriction and oligohydramnios at 30 weeks gestation. Because a high titer of thyroid-stimulating hormone receptor antibody was noted in maternal serum and the fetal goiter was detected on ultrasonography, fetal hyperthyroidism was strongly suspected and subsequently confirmed with cordocentesis at 31 weeks gestation. After treatment of fetal hyperthyroidism through oral maternal administration of methimazole (MMI) starting at 33 weeks gestation, fetal heart rate and amniotic fluid volume returned to normal ranges. Complete resolution of the fetal goiter was observed at 35 weeks gestation. A male infant was born at 35 weeks 6 days gestation via cesarean section in the absence of thyrotoxic findings; however, cord blood chemical analysis at birth indicated iatrogenic fetal hypothyroidism. In the present report, maternal therapy using MMI to resolve symptoms of fetal thyrotoxicosis, including fetal tachycardia and oligohydramnios, was successfully conducted.

Effects of maternal retinoic acid administration on lung angiogenesis in oligohydramnios-exposed fetal rats.

BACKGROUND: All-trans retinoic acid (ATRA) induces in vitro angiogenesis and vascular endothelial growth factor (VEGF) secretion. Prenatal administration of vitamin A tends to increase the pulmonary and plasma levels of VEGF in the developing mouse. The aims of this study were to examine the effects of maternal retinoic acid treatment on lung VEGF expression and angiogenesis in oligohydramnios-exposed fetal rats. METHODS: On day 16 of gestation, pregnant Sprague-Dawley rats were randomly assigned to either the retinoic acid group (intragastric ATRA at 10 mg/kg body weight) or the vehicle group. We punctured each uterine sac to produce oligohydramnios, and fetuses in the opposite uterine horn served as controls. On day 21 of gestation, the fetuses were delivered by cesarean section. RESULTS: Rats exposed to oligohydramnios exhibited lower lung weights and lung/body weight ratios, and ATRA exhibited no effects on the body or lung weights of oligohydramnios-exposed rats. Lung microvessel density decreased in oligohydramnios-exposed rats of maternal vehicle-treated dams. Microvessel density was comparable between the oligohydramnios + retinoic acid group and the control + retinoic acid group. VEGF expression was comparable among control and oligohydramnios-exposed rats of maternal vehicle- or retinoic acid-treated dams. CONCLUSION: Maternal retinoic acid treatment did not increase lung VEGF expression or enhance lung development in oligohydramnios-exposed fetal rats. These results do not support the use of maternal retinoic acid to prevent oligohydramnios-induced pulmonary hypoplasia in the pseudoglandular stage.

Uso do trastuzumabe na gravidez / Use of trastuzumab during pregnancy

O uso do trastuzumabe, anticorpo antimonoclonal contra o receptor do fator de crescimento epidérmico HER-2, tem sido utilizado no tratamento do carcinoma mamário de pacientes que superexpressam esta proteína. Relatos de casos divergem quanto à presença ou ausência de efeitos adversos na gravidez. Quando presentes, os mais encontrados no feto foram: oligo ou anidrâmnio, insuficiência renal, síndrome de angústia respiratória e óbito fetal/neonatal. Esta revisão discutiu as vias etiopatológicas possíveis deste fármaco em causar tais efeitos e sugeriu uma propedêutica de seguimento dessas pacientes.

The use of trastuzumab, a monoclonal antibody against human epidermal growth factor receptor type 2, has been a useful therapy in the treatment of breast cancer patients that overexpress such protein. Published case reports with different results regarding the presence or absence of adverse effects in pregnancy are shown. If present, the most reported ones were: oligo or anydramnios, renal insufficiency, respiratory distress syndrome, and fetal/neonatal death. This review discussed the ethiopathologic pathways of this drug in causing such effects and suggested a follow-up protocol for these patients.

Reversible acute fetal renal failure due to maternal exposure to angiotensin receptor blocker.

We report on a case of fetal toxicity due to maternal treatment with olmesartan medoxomil. At 29 weeks' gestation, oligohydramnios was found, although the fetus had normal kidneys on ultrasound evaluation. Withdrawal of olmesartan medoxomil, maternal rehydration, and a single dose of furosemide reversed the renal impairment. After term delivery, the neonate was confirmed to have normal renal function. The case suggested that fetal renal impairment due to olmesartan medoxomil may be reversible.

Retinoic acid fails to reverse oligohydramnios-induced pulmonary hypoplasia in fetal rats.

All-trans retinoic acid (ATRA) stimulates platelet-derived growth factor (PDGF)-A expression and enhances alveolarization in rat lungs. On d 16 of gestation, pregnant Sprague-Dawley rats were randomly assigned to either a retinoic acid group (intragastric ATRA at 10 mg/kg body weight) or a vehicle group. We punctured each amniotic sac, and fetuses in the opposite uterine horn served as controls. On d 21 of gestation, the fetuses were delivered by cesarean section. Rats subjected to oligohydramnios exhibited significantly lower lung weights and lung/body weight ratios, and ATRA had no effects on the body or lung weights of oligohydramnios-exposed rats. Lung PDGF-A and -B mRNA expression was significantly lower in oligohydramnios-exposed rats compared with control littermates of maternal vehicle-treated dams. Maternal retinoic acid treatment significantly increased PDGF-A and -B mRNA expression in control and oligohydramnios-exposed rats compared with all rats and oligohydramnios-exposed rats of maternal vehicle-treated dams, respectively. Rats exposed to oligohydramnios exhibited a significantly lower generation of alveolar saccules than did control rats in the maternal retinoic acid- and vehicle-treated groups. In this model, maternal retinoic acid treatment showed no positive effects on oligohydramnios-induced pulmonary hypoplasia in the pseudoglandular stage.

[Significance of infusion of sodium bicarbonate in amniotic cavity under continuous internal fetal heart rate monitoring for management of fetal distress during labor].

OBJECTIVE: To investigate the effect of infusion of sodium bicarbonate in amniotic cavity and exchange of amniotic fluid for fetus with distress and acidosis. METHODS: The patients included 40 cases of oligohydramnios with mild and serious abnormality of fetal heart rate and amniotic fluid contamination of degree II or more during the labor. The 40 cases had exchange of amniotic fluid with infusion under continuous monitoring. Twenty of them had infusion with 5% sodium bicarbonate into amniotic cavity; the other 20 cases received 5% sodium bicarbonate intravenous in fusion. After the labor all the patients had test of arterial blood gas in umbilical cord and the fetuses were evaluated with Apgar score. RESULTS: (1) the effective rate was 88% in the group of infusion into amniotic cavity and 85% in the group of exchange of amniotic fluid. (2) The arterial blood pH, PO(2), HCO(3)(-), ABE, SBE in the group of amniotic cavity infusion with 5% sodium bicarbonate were all higher than group of IV infusion, however PCO(2) was significantly lower than the group of IV (P < 0.05). CONCLUSION: Infusion into amniotic cavity and exchange of amniotic fluid is effective therapy for fetal distress due to oligohydramnios and can prevent meconium aspiration syndrome; infusion of antacids medicine (5% sodium bicarbonate) into amniotic cavity is effective and safe therapy for fetus with acidosis.

Transabdominal amnioinfusion treatment of severe oligohydramnios in preterm premature rupture of membranes at less than 26 gestational weeks.

OBJECTIVE: To evaluate the efficacy of transabdominal amnioinfusion on feto-neonatal and maternal morbidity and feto-neonatal mortality. METHODS: We studied 71 patients with preterm premature rupture of membranes (pPROM) at <26 weeks of gestational age. Thirty-four patients were managed expectantly and 37 underwent serial transabdominal amnioinfusion with saline every 7 days in case of persistent oligohydramnios. RESULTS: Latency period pPROM delivery, week of delivery (26.0 vs. 22.4, p<0.001), neonatal weight (922 vs. 602, p<0.01) and the percentage of intrauterine fetal survival were higher in treated than in control groups (64.8 vs. 32.3%, p<0.01). In amnioinfusion-treated patients, we did not note a higher rate of complications from infection during both pregnancy and puerperium. In the amnioinfusion group, fluid loss within 6 h after infusion is the main variable in predicting pulmonary hypoplasia and neonatal survival. CONCLUSIONS: Our data suggest that amnioinfusion seems to be a low fetal and maternal risk technique that modifies the natural history of pPROM, improving fetal intrauterine stay and survival.

[Amnioinfusion: techniques, indications, and controlled retrospective study of 55 cases]. / Amnioinfusione: tecniche, indicazioni e studio retrospettivo controllato di 55 casi.

Amnioinfusion is a relatively recent procedure introduced among fetal medicine techniques. Its applications focus on two different methods: transcervical and transabdominal. The first procedure usually is carried out during "intrapartum amnioinfusion" to prevent or treat fetal heart rate (FHR) decelerations related to oligohydramnios or to dilute thick meconium staining of the amniotic fluid. The latter method used during "antepartum amnioinfusion" is usually indicated for severe oligohydramnios in order to avoid the complications related such as pulmonary hypoplasia, deforming effects of oligohydramnios, variable FHR decelerations and intraventricular hemorrhages. Antepartum amnioinfusion, also used to improve ultrasound visualisation in presence of oligohydramnios, is less employed as compared to intrapartum amnioinfusion, therefore its risks are not well established. In order to study possible adverse effects on the mother or foetus, fifty five patients affected by oligohydramnios at 17th-34th week of gestational age were submitted to antepartum amnioinfusion (1-5 procedures) and were matched retrospectively with forty seven women with the same characteristics treated with the conservative and expectant management. The trend of pregnancy was the same for both groups in relation to maternal fever > 38 degrees (10.9% in the amnioinfused group vs 17.0% in control group ns), leukocyte count > 18,000/mm3 (25.5% vs 21.3%, ns), C-reactive protein > 10 ng/ml (10.9% vs 6.4%, ns). The latency period between admission and delivery was significantly longer in the amnioinfused group than in the control one [21 (range 1-98) vs 9 days (range 0-72); p < 0.001] and the frequency of Apgar score < 7 at the 5th min was less represented in the amnioinfused group than in the control group (32.3% vs 66.6%; p < 0.001). In conclusion, it was interesting to note that antepartum amnioinfusion seems to increase the latency period between premature rupture of membranes and delivery, but it remains to clarify if this procedure is as much safe for the fetus as for the mother.

Successful outcome after antibiotic treatment of postamniocentesis membrane rupture and chorioamnionitis in multiple pregnancy.

Postamniocentesis chorioamnionitis is usually managed with induction of labor to prevent maternal sepsis and related morbidity and mortality. We report a case of chorioamnionitis in a triplet pregnancy after midtrimester genetic amniocentesis, in which multiple antibiotic treatment (ampicillin 2 g i.v. loading dose followed by 1 g i.v. every 6 hr; clindamycin 900 mg i.v. every 8 hr; gentamicin 120 mg i.v. loading dose followed by 100 mg i.v. every 8 hrs; and erythromycin 500 mg i.v. every 6 hr) for 7 days and delivery of the presumably infected triplet A successfully reversed the clinical symptomatology, allowing prolongation of pregnancy until 26 weeks and survival of the remaining fetuses. At age 2 years, both infants are doing well and are meeting their developmental milestones. The viable outcome of this management strategy suggests that antibiotic treatment and expectancy may be an option in selected cases of postamniocentesis chorioamnionitis in multiple pregnancies.

[The pressure of amniotic cavity during pregnancy and treatment of unruptured oligohydramnios with antepartum amnioinfusion].

OBJECTIVES: To measure the pressure of the amniotic cavity during pregnancy and to study the effects of antepartum amnioinfusion on oligohydramnios with intact membranes. METHOD: We used an improved three-way switch apparatus to measure 110 women during pregnancy, and treated 97 oligohydramnios with antepartum amnioinfusion or intravenous infusion as controls. RESULTS: The pressure of the amniotic cavity was 1.69 +/- 0.23 kPa, which was close to the normal value in pregnancy. In oligohydramnios, it was 1.1 +/- 0.3 kPa, and in polyhydramnios 3.2 +/- 0.3 kPa(P < 0.01-0.001). When 300 ml fluid was amnioinfused, the amniotic fluid index (AFI) increased by 5.0 +/- 1.8 cm, the pressure of amniotic cavity increased by 0.18 +/- 0.2/kPa and the incidence of vaginal delivery was 87.9%, whereas that of the control group was 12.1%. There were no fetal distress, asphyxia neonatorum, amnionitis or ruptured membrane. CONCLUSIONS: The pressure of the amniotic cavity during normal pregnancy was stable, but changed with AFI. Antepartum amnioinfusion for unruptured oligohydramnios resulted in a marked increase in incidence of vaginal delivery, a decreased ratio of cesarean section and a reduction of perinatal morbidity. These differences are highly significant.

Amnioinfusion for prevention of pulmonary hypoplasia in second-trimester rupture of membranes.

We conducted a study to evaluate the feasibility and benefits of transabdominal amnioinfusion in preterm premature rupture of membranes with persistent oligohydramnios for the prevention of pulmonary hypoplasia. To this purpose, we designed a cohort study in which the pregnancy outcome of women with rupture of membranes at < or = 25 weeks and persistent (> or = 4 days) oligohydramnios managed with serial amnioinfusions (n = 18) was compared with that of a historic cohort group (controls) with similar characteristics but managed expectantly (n = 16). Pulmonary hypoplasia was diagnosed at birth in the presence of strict radiological and pathological criteria. No amnioinfusion-related complications occurred. The prevalence of pulmonary hypoplasia was significantly lower among the amnioinfused cases compared with the controls (46% [6 of 13] vs 86% [12 of 14], odds ratio [OR] = 0.4, 95% confidence interval [CI] 0.2-0.9), despite a lower gestational age at rupture of membranes in the treated group. Within the group undergoing amnioinfusions, those in which the infused solution was rapidly lost had a higher rate of pulmonary hypoplasia compared with those in which amnioinfusion alleviated oligohydramnios for > 48 hours (considered successful) (0 of 4 vs. 6 of 9, OR = 2.3, 95% CI 1-5.5). Cases of successful amnioinfusion had a longer interval between membrane rupture and appearance of oligohydramnios than those in which the procedure failed to correct oligohydramnios, even though both groups had similar gestational age at appearance of oligohydramnios. This suggests that the rate of loss of amniotic fluid after membrane rupture may predict the rate of loss of the infused solution, and therefore identify a subset of patients who may benefit from the procedure.

Serial intravaginal prostaglandin E2 gel cervical ripening in preterm pregnancies.

OBJECTIVE: To determine if prostaglandin (PG) E2 cervical ripening is safe and effective in high-risk preterm pregnant women who do not have an indication for immediate delivery. METHODS: This was a retrospective case-control study of preterm pregnant women treated with sequential PGE2 gel between 3/1/92 and 3/1/95. Study subjects were between 24 and 36 weeks gestation, had intact membranes, and complications requiring inpatient monitoring but not immediate delivery. PGE2 gel was inserted serially until either maternal or fetal deterioration required intervention, fetal maturity was achieved, a Bishop > or = 7 was reached, or the patient improved and was discharged. Control subjects were matched for inclusion criteria and diagnoses on admission. RESULTS: A total of 22 study and 22 control patients were evaluated. The gestational age at admission was 32.3 +/- 2.8 versus 31.8 +/- 2.9 weeks. The mean number of PGE2 gel applications was 11.6 over a mean of 5.0 days. Intervention during ripening was required in 11 (50%). A Bishop score > or = 7 without labor was achieved in 11 (50%), and labor during the ripening process occurred in 2 (9%). The mean time from Bishop > or = 7 to delivery was 2.6 days. The total cesarean delivery rate was 10 (45%) versus 15 (68%), in the control group (P = NS). Neonatal outcomes were similar. CONCLUSIONS: Sequential PGE2 gel cervical ripening when used in preterm pregnant women improves the Bishop score, and has a low incidence of spontaneous preterm labor.

Transabdominal amnioinfusion in oligohydramnios at term before induction of labor with intact membranes: a randomized clinical trial.

OBJECTIVE: Our purpose was to determine the effectiveness of transabdominal amnioinfusion before induction of labor in reducing the incidence of fetal distress in pregnancies with oligohydramnios at term. STUDY DESIGN: Between June 1991 and September 1994 primiparous women with ultrasonographic evidence of oligohydramnios at term, intact membranes, and unripe cervix (Bishop score < or = 6), candidates for induction of labor with cervical or vaginal prostaglandin E2 gel, were randomly selected to receive transabdominal amnioinfusion (amnioinfused group, n = 39) or to proceed with direct labor induction (control group, n = 40). Inclusion criteria were (1) singleton gestation, (2) vertex presentation, (3) ultrasonographic estimation of fetal weight > or = 2500 gm, and (4) reactive nonstress test. Fetoneonatal outcome variables were compared between the two groups. Statistical analysis used contingency tables, Student t test, or Wilcoxon rank-sum tests, where applicable. RESULTS: Amnioinfusion was successfully performed in 100% of the patients randomized for the procedure. The incidence of severely abnormal fetal heart rate tracings was significantly higher in the control than in the amnioinfused group (42% [17/33] vs 5% [2/37], relative risk 12.9, 95% confidence interval 2.4 to 56.4). The rate of cesarean sections performed for fetal distress was fivefold higher in the control group (25% [10/40] vs 5% [2/39], relative risk 4.9, 95% confidence interval 1.1 to 32.4). No bleeding complications or fetomaternal infectious morbidity were noticed. CONCLUSION: Transabdominal amnioinfusion is a safe, effective option for the prevention of fetal distress in pregnancies with oligohydramnios at term with intact membranes and unripe cervix.

Treatment of oligohydramnios with maternal 1-deamino-[8-D-arginine] vasopressin-induced plasma hypoosmolality.

OBJECTIVE: Maternal 1-deamino-[8-D-arginine] vasopressin (a selective antidiuretic agonist) and oral water loading decrease maternal and fetal plasma osmolality and markedly increase fetal urine flow in sheep. We hypothesized that a titrated reduction in maternal plasma osmolality would increase human amniotic fluid volume. STUDY DESIGN: Pregnant women (n = 5) with oligohydramnios at term were administered oral water loading (20 ml/kg) and intravenous 1-deamino-[8-D-arginine] vasopressin (2 micrograms) to induce antidiuresis. Maternal plasma and urine osmolality and urine production were measured hourly, and water replacement was titrated for 8 hours to reduce plasma osmolality by 15 to 20 mOsm/kg. The amniotic fluid index determined by ultrasonography was measured at baseline, 8 hours, and 24 hours. A control group of pregnant women (n = 5) with oligohydramnios at term was observed for 8 hours with maintenance intravenous hydration. RESULTS: In 1-deamino-[8-D-arginine] vasopressin-treated women, maternal urine flow increased with oral water loading, decreased with 1-deamino-[8-D-arginine] vasopressin administration, and remained reduced for 8 hours. Maternal plasma osmolality significantly decreased (285 +/- 4 to 265 +/- 4 mOsm/kg) and the amniotic fluid index significantly increased (4.1 +/- 0.6 to 8.2 +/- 1.5 cm) at 8 hours. Although maternal urine osmolality returned to basal values at 24 hours, plasma osmolality was reduced and the amniotic fluid index remained significantly increased (8.2 +/- 1.3 cm). There was no change in the amniotic fluid index (4.3 +/- 0.4 to 4.7 +/- 0.7 cm) in control patients observed with maintenance intravenous hydration. CONCLUSIONS: Maternal 1-deamino-[8-D-arginine] vasopressin and oral water administration can reduce and stabilize plasma osmolality and increase amniotic fluid volume. 1-Deamino-[8-D-arginine] vasopressin therapy has potential for the prevention and treatment of oligohydramnios.