Published: 2019-03-23

Efficacy of oral L-arginine on amniotic fluid index in pregnant women with oligohydramnios attending antenatal clinic in a tertiary care hospital in Telangana, India

Md Amirunnisa Begum, B. Krishna Sowmya, D. Shailendra, Y. Subbaratnam


Background: Oligohydramnios leads to feto-maternal morbidity and mortality. Though there is no specific treatment for oligohydramnios, use of L-arginine seems to be promising. As a nitric oxide donor, it causes vasodilatation, increases placental perfusion and finally increases amniotic fluid. However, data on the use of L-arginine for oligohydramnios is scarce. Hence, this study was aimed to evaluate the efficacy of oral L-arginine on Amniotic Fluid Index (AFI) and to document the pregnancy outcomes in women with oligohydramnios.

Methods: This was a prospective observational study conducted on pregnant women attending antenatal clinic (ANC) at Mediciti Institute of Medical Sciences (MIMS), Ghanpur, Telangana, India from 1st January 2018 to 30th June 2018.

Results: A total of 50 participants were enrolled and 4 participants among them were lost to follow- up. Mean age (SD) of the women enrolled was 23.3 (3.49) years. Mean gestational age (SD) at the time of diagnosis was 34.61 (1.53) weeks. Mean AFI (SD) at the time of diagnosis and after treatment with L-arginine were 6.8 (1.3) cm and 9.4 (2.82) cm respectively. After a mean treatment duration (SD) of 3.23 (1.38) weeks, a mean (SD) increase of AFI by 2.6 (1.57) cm (P <0.0001) was observed. An increase of AFI was noted in 84.78% of cases (P <0.0001). Mean (SD) Gestational age at the time of delivery was 38.25 (1.48) weeks. Only 37% of participants required operational deliveries. Mean (SD) birth weight of the new borns was 2.54 (0.47) kg. Neonatal Intensive Care Unit (NICU) admissions were required in 32.6% of new borns.

Conclusions: L-arginine is efficacious in improving AFI in oligohydramnios. AFI improvement could possibly lead to better neonatal outcomes by reducing preterm deliveries and operative interventions.


Amniotic fluid index (AFI), L-arginine, Pregnancy, Oligohydramnios

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Soni A, Garg S, Patel K, Patel Z. Role of L-arginine in oligohydramnios. J Obstetrics Gynecol Ind. 2016;66(1):279-83.

Mudaliar AL, Krishna Menon MK , Sarala Gopalan, Vanitha Jain, eds. Mudaliar and Menon's clinical obstetrics. 10th ed. Chennai; Orient longman pvt ltd; 2007 ;9788125028703.

Satyaprabha Siripurapu, Achanta Vivekanand, A Sarojini, Sethi Pruthwiraj. The role of amino acid infusion in isolated Oligohydramnios. Perspectives Med Res. 2015;3(1).

Sharma A, Dashora S, Sharma R, Chandra K, Gunawa MS. To study the effect of l-arginine in oligohydramnios to improve perinatal outcome. IOSR J Dental Med Sci (IOSR-JDMS). 2017;16(4):16-19.

Magann EF, Sandlin AT, Ounpraseuth ST. Amniotic fluid and the clinical relevance of the sonographically estimated amniotic fluid volume: oligohydramnios. J Ultrasound Med. 2011;30(11):1573-85.

Rutherford SE, Phelan JP, Smith CV, Jacobs NA. The four-quadrant assessment of amniotic fluid volume: an adjunct to antepartum fetal heart rate testing. Obstetrics Gynecol. 1987;70(3):353-6.

Baron C, Morgan MA, Garite TJ. The impact of amniotic fluid volume assessed intrapartum on perinatal outcome. Am J Obstetrics Gynecol. 1995;173(1):167-74.

Casey BM, McIntire DD, Bloom SL, Lucas MJ, Santos R, Twickler DM, et al. Pregnancy outcomes after antepartum diagnosis of oligohydramnios at or beyond 34 week’s gestation. Am J Obstetrics Gynecol. 2000;182(4):909-12.

Moore TR, Cayle JE. The amniotic fluid index in normal human pregnancy. Am J Obstetrics Gynecol. 1990;162(5):1168-73.

Magann EF, Sanderson M, Martin JN, Chauhan S. The amniotic fluid index, single deepest pocket, and two-diameter pocket in normal human pregnancy. Am J Obstetrics Gynecol. 2000;182(6):1581-8.

Oosterhof H, Haak MC, Aarnoudse JG. Acute maternal rehydration increases the urine production rate in the near-term human fetus. Am J Obstetrics Gynecol. 2000;183(1):226-9.

Chamberlain PF, Manning FA, Morrison I, Harman CR, Lange IR. Ultrasound evaluation of amniotic fluid volume: I. The relationship of marginal and decreased amniotic fluid volumes to perinatal outcome. Am J Obstetrics Gynecol. 1984;150(3):245-9.

Morris JM, Thompson K, Smithey J, Gaffney G, Cooke I, Chamberlain P, et al. The usefulness of ultrasound assessment of amniotic fluid in predicting adverse outcome in prolonged pregnancy: a prospective blinded observational study. BJOG: Inter J Obstetrics Gynaecol. 2003;110(11):989-94.

Jeng CJ, Lee JF, Wang KG, Yang YC, Lan CC. Decreased amniotic fluid index in term pregnancy. Clinical significance. J Reproductive Med. 1992;37(9):789-92.

Sreedharan R, Jajoo S. Effect of L-arginine on amniotic fluid index in oligohydramnios. Int J Reprod Contracept Obstet Gynecol. 2013;2:80-2.