L-arginine supplementation is an effective treatment for oligohydramnios. L-arginine increases nitric oxide levels, which causes vasodilation of the uterine arteries and improves uteroplacental blood flow. This helps overcome placental ischemia associated with oligohydramnios. Studies have found that L-arginine treatment accelerates fetal growth, improves biophysical profiles, and results in better neonatal outcomes compared to placebo or standard therapy alone. L-arginine is a promising treatment for oligohydramnios that is cost-effective, easy to administer, and has few side effects for both mother and fetus.
1. L - Arginine In
Oligohydramnios
Dr. Shashwat Jani.
M. S. ( Obs – Gyn )
Diploma in Advance Laparoscopy.
Consultant Assistant Professor,
Smt. N.H.L. Municipal Medical College.
Sheth V. S. General Hospital , Ahmedabad.
Mobile : 99099 44160.
E-mail : drshashwatjani@gmail.com
2. Introduction
Oligohydramnios is one of the
prevalent threatening conditions to
fetal health
Causes for Oligohydroamnios
- post-term pregnancy
- pregnancy induced hypertension
- fetal renal agenesis,
3. Conditions associated with oligohydramnios.
-Intrauterine growth restriction
-respiratory distress syndrome,
-post-maturity syndrome
- chronic fetal hypoxia
Oligohydroamnios may be responsible for
-fetal malpresentation
-umbilical cord compression
-meconium staining
-increased prenatal mortality and morbidity
-increased operative delivery.
4. Vascular tone is an essential target of the paracrine and
endocrine regulations during pregnancy.
The lowering of arteriolar tonicity precedes blood
volume expansion and seems to be the primary step in
the physiological hemodynamic modifications.
Poor placentation may be expressed in the persistence
of high impedance in the uteroplacental circulation
-assessed by the second trimester Doppler in the uterine
vessels,
represents a powerful predisposing factor to
IUGR
Oligohydramnios
Preeclampsia
5. Why …???
• The most common placental conditions are
alterations in the uteroplacental and fetal-
placental circulations.
• In the majority of these cases,
there is diminished maternal uteroplacental
blood flow,
caused by insufficient or incomplete
trophoblastic invasion of the spiral arteries in
the placental bed.
6. Oligohydramnios is associated with an
adverse perinatal and maternal outcome.
Ultrasound guided amnioinfusion is an
option for treatment commonly being
employed nowadays. Since it is an invasive
procedure there is an inherent risk of fetal
loss.
Another modality employed since a long
period of time is maternal hydration though
results have been varied and there is no
standard treatment protocol for the same.
7. ‘ A recently propagated alternative
for the treatment of oligohydramnios
is the administration of L- arginine
which has been
found to be effective in
- cases of intrauterine growth
restriction
- Pregnancy Induced Hypertension.’
9. L – Arginine
• L-arginine is a versatile amino acid with a
wide range of biological functions.
• It serves as a precursor not only
to proteins but also nitric oxide which has
been identified as endothelium-derived
relaxing factor.
Palmer RM, Ashton DS, Moncada S. Vascular endothelial cells synthesize nitric
oxide from L-arginine. Nature 1999;333:664-6.
10. Act by…
• L-arginine increases uteroplacental blood
flow through nitric oxide mediated dilatation
of vessels thereby increasing the supply of
nutrients to the fetus aiding its growth.
• L-Arginine improves Uteroplacental blood
flow to overcome placental ischemia by
increasing Nitric oxide.
• This results in vasodilation of uterine arteries.
11.
12. Neri et al evaluated the effects of L-arginine (ARG)
infusion, the nitric oxide substrate on the uteroplacental
circulation in the third trimester.
Three groups of nine women each were infused with 30
g ARG for 30 min.
One group served as a control.
remaining two groups had IUGR,
- one with increased resistance in uteroplacental circulation
- one without increased resistance.
The authors found no haemodynamic changes in the
utero-umbilical circulation.
They found that serum nitrites/nitrates as well as serum
growth hormone levels were significantly raised by ARGININE.
• Neri I, Mazza V, Galassi MC, et al. Effects of L-arginine on utero-placental circulation in growth related fetuses.
• Acta Obstetet Gynecol Scand. 1996; 75:208–212
13. Rytlewski et al. studied the influence of oral supplementation
with low dose of ARG on
• biophysical profile,
•Oligohydramnios,
• feto-placental circulation and
•neonatal outcome in preeclampsia.
•This was a randomized, placebo-controlled, double-blind,
clinical trial.
Oral therapy with 3 g of Arginine daily or placebo was given
as a supplement to standard therapy.
•The results
-L arginine treatment accelerated fetal weight gain and
-improved biophysical profile.
•Starting from the 3rd week of therapy,
- the umbilical artery pulsatility indices values were significantly
lower in the ARG group.
-Neonates in this group revealed higher Apgar scores.
14. The authors concluded that supplementary treatment
with oral ARG seems to be
promising in improving
- foetal well-being
- neonatal outcome
- prolonging pregnancy complicated with pre-eclampsia &
Oligohydramnios.
• Rytlewski K, Olszanecki R, Lauterbach R, et al. Effects of oralL-arginine on the foetal condition and
neonatal outcome in preeclampsia:a preliminary report. Basic Clin Pharmacol Toxicol.2006; 99(2):146–
152.
15. • Interestingly,
the incidence of
-intracranial hemorrhage,
-respiratory distress syndrome
-admission to NICU
are significantly lower in the
L-arginine supplemented patients.
16. L Arginine is ….
Very effective
Cost effective
Easily available
No adverse effect on Mother & Fetus
less side effects
Prevents Oligohydramnios
Treats Oligohydramnios
Highly recommended …