Oligohydramnios: Antepartum fetal urine production and intrapartum fetal distress

Animal and human studies suggest that fetal oliguria is a normal physiologic response to hypoxemia. To assess the clinical significance of this observation, we studied (before their admission) 51 fetuses of women whose pregnancies were complicated by oligohydramnios at ≥38 weeks' gestation. We found that the mean hourly fetal urine production decreased significantly in relation to the severity of subsequent intrapartum fetal compromise. The mean antepartum rate was 95 ml/hr in the 21 fetuses with a normal intrapartum heart rate pattern; this fell to 59 ml/hr in the 18 fetuses who had an abnormal intrapartum heart rate pattern but who responded to intrauterine resuscitation. The rate was 33 ml/hr in the 12 fetuses who were delivered by cesarean section as a result of fetal distress. These findings suggest that oligohydramnios associated with fetal oliguria may be used to identify those fetuses who have less intrinsic or uteroplacental reserve than do those of women with oligohydramnios who have a higher rate of fetal urine production.