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.
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L ARGININE IN OLIGOHYDRAMNIOS BY DR SHASHWAT JANI
1. L - Arginine In
Oligohydramnios
Dr. Shashwat Jani.
M. S. ( Obs â 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
ďś Oligohydramnios is one of the
prevalent threatening conditions to
fetal health
ďś Causes for Oligohydroamnios
- post-term pregnancy
- pregnancy induced hypertension
- fetal renal agenesis,
3. ďśConditions associated with oligohydramnios.
-Intrauterine growth restriction
-respiratory distress syndrome,
-post-maturity syndrome
- chronic fetal hypoxia
ďśOligohydroamnios may be responsible for
-fetal malpresentation
-umbilical cord compression
-meconium staining
-increased prenatal mortality and morbidity
-increased operative delivery.
4. ď Vascular tone is an essential target of the paracrine and
endocrine regulations during pregnancy.
ď The lowering of arteriolar tonicity precedes blood
volume expansion and seems to be the primary step in
the physiological hemodynamic modifications.
ď 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 toď
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 ď insufficient or incomplete
trophoblastic invasion of the spiral arteries in
the placental bed.
6. ď Oligohydramnios is associated with an
adverse perinatal and maternal outcome.
ď 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.
ď 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. â A recently propagated alternative
for the treatment of oligohydramnios
is the administration of L- arginine
which has been ď
found to be effective in
- cases of intrauterine growth
restriction
- Pregnancy Induced Hypertension.â
9. L â 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 byâŚ
⢠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. ď§ Neri et al evaluated the effects of L-arginine (ARG)
infusion, the nitric oxide substrate on the uteroplacental
circulation in the third trimester.
ď§ Three groups of nine women each were infused with 30
g ARG for 30 min.
ď One group served as a control.
ď remaining two groups had IUGR,
- one with increased resistance in uteroplacental circulation
- one without increased resistance.
ď§ The authors found no haemodynamic changes in the
utero-umbilical circulation.
ď§ 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; 75:208â212
13. Rytlewski et al. studied the influence of oral supplementation
with low dose of ARG on
⢠biophysical profile,
â˘Oligohydramnios,
⢠feto-placental circulation and
â˘neonatal outcome in preeclampsia.
â˘This was a randomized, placebo-controlled, double-blind,
clinical trial.
ď Oral therapy with 3 g of Arginine daily or placebo was given
as a supplement to standard therapy.
â˘The results
-L arginine treatment accelerated fetal weight gain and
-improved biophysical profile.
â˘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. ď The authors concluded that supplementary treatment
with oral ARG seems to be
ď 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):146â
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 âŚ.
ďź Very effective
ďź Cost effective
ďź Easily available
ďź No adverse effect on Mother & Fetus
ďź less side effects
ďź Prevents Oligohydramnios
ďź Treats Oligohydramnios
ďź Highly recommended âŚ