L ARGININE IN OLIGOHYDRAMNIOS BY DR SHASHWAT JANI

L ARGININE IN OLIGOHYDRAMNIOS BY DR SHASHWAT JANI

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 : [phone].
E-mail : [email protected]

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.’

8. L- Arginine is a
Nitric Oxide Donor

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.

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 …

17. THANK
YOU…!!!