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INTRODUCTION
Amniotic fluid has crucial functions for the growing fetus. It's an ideal setting for the growth and development of a fetus. Because of its dampening and bacteriostatic qualities, it acts as a cushion against shocks and infections. Fetal movement is encouraged, which aids in the growth of the skeleton and muscles. It protects the fetus from vascular and nutritional damage by preventing umbilical cord and placental compression (1) .
One of the most crucial measurements taken during fetal screening is the amount of amniotic fluid present in the uterus. When the volume of the amniotic fluid is < 500 mL, the condition is called oligohydramnios, and when it is > 2000 Ml, the condition is called polyhydramnios (2) . Phelan's definition of oligohydramnios called for an amniotic fluid index (AFI) of < 5cm or an SDP of < 2cm. Between 34 and 42 weeks of pregnancy, oligohydramnios affects 1-5% of pregnancies. High rates of postnatal morbidity and mortality as well as pregnancy difficulties have been linked to oligohydramnios (3,4) .
Premature membrane rupture, fetal abnormalities, intrauterine growth retardation, postmaturity, hypertension, diabetes, autoimmunity, hypovolemia, and iatrogenic causes are common causes of oligohydramnios. Almost 7 percent of all cases of oligohydramnios are idiopathic. Around 4% to 5.5% of all pregnancies experience complications due to this, and these complications are often connected with negative results for the fetus. In oligohydramnios, the perinatal morbidity and death rates may rise to 56.5%. It also raises cesarean section (CS) rates by five to seven times. Furthermore, oligohydramnios is more likely in late-term pregnancies, as the AFV typically declines at term. It complicates up to 12% of pregnancies that last longer than 41 weeks (5) .
Amniotic fluid (AF) volume is the sum of fluids entering the amniotic space (from fetal urine and lung fluid) and fluids leaving the amniotic space (from fetal swallowing and intramembranous absorption) (6) . The condition of maternal hydration and maternal plasma osmolality influence amniotic fluid volume. Ruptured membranes can cause acute oligohydramnios. Chronic oligohydramnios develops in the fetus because of persistent fluid leakage, prerenal, renal, and post renal causes (7) . The umbilical artery of the fetus Doppler velocimetry evaluates the downward resistance to blood flow in the umbilical arteries. Umbilical artery anomaly Doppler velocimetry is correlated with increased perinatal problems because it is a marker of fetal peripheral vasoconstriction (8) . Doppler flowmetry of the umbilical artery in oligohydramnios revealed better sensitivity, specificity, and accuracy in diagnosing infant death when compared to assessing oligohydramnios and the Apgar score. Maternal hydration increases amniotic fluid volume in oligohydramnios patients by increasing uteroplacental perfusion, as evaluated by Doppler ultrasonography (9) .

PATIENTS AND METHODS
This was an interventional study on 50 pregnant women in their third trimester (from more than 32 weeks to 37 weeks) who were diagnosed with oligohydramnios via ultrasound and attended the outpatient clinic at Al-Azhar University Hospitals. It was completed from January 2022 till January 2023.
The Inclusion criteria were singleton pregnancy, viable fetus, gestational age > 32 week, AFI <5 cm, no cause for immediate delivery and intact membranes.
The Exclusion criteria were patients with ruptured amniotic membranes, multiple pregnancies, post-term pregnancy, maternal medical diseases (heart disease, renal disease, moderate or severe preeclampsia), gestational age < 32-week, dead fetus and fetal structural malformations.
All included cases were put through the following: Complete history taking, Clinical examination, Maternal Body Mass Index (BMI) was calculated, Abdominal Ultrasound examination, Intravenous hydration therapy. The following was done at baseline and after intravenous hydration: Amniotic fluid index Evaluation, Doppler velocimetry (Doppler velocimetry for the umbilical artery and Doppler velocimetry for Uterine artery), Hematocrit value (Macro-hematocrit method and Microhematocrit method) and Urine analysis for specific gravity. Evaluation of the pregnancy outcome as regards: Apgar score at the first and fifth minutes, Number of viable fetal births and still birth, Gestation age at delivery by New Ballard Score, Neonatal birth weight was measured using digital weight scale, Admission to (NICU) and any maternal or fetal complication.
Statistical Analysis: Statistical package for social sciences (SPSS) version 23 (IBM®, Armonk, USA) was used for data processing and was used to examine, enter, and analyze the data. Data were expressed as a number and a percentage for qualitative factors and as a mean ± standard deviation (SD) for quantitative variables. Paired quantitative variables were compared by paired samples "t" test. P value < 0.05 was set as the markers of significance.

RESULTS
In the current work, fifty females with oligohydramnios were included. Their age ranged between 25 and 34 years, most of them were multigravida (58.0%) and higher percentage were multiparous (70.0%). The GA at delivery ranged between 32 and 37 weeks of gestation ( Table 1).
The laboratory data showed a significant decrease of pulse, mean arterial pressure, temperature, hematocrit after hydration than before hydration. The birth weight ranged between 2765 and 3654 g ( Table 2). AF volume, AFI and uterine artery PI were significantly increased while umbilical artery PI was statistically decreased after hydration that corresponding values before hydration (Table 3). The mode of delivery was normal vaginal delivery among 34% and cesarean section among 66.0% and the mean Apgar score was 7.8±1.9 and 8.9±0.87 at the first and fifth minutes, respectively (Table  4).   8.9 ± 0.87

DISCUSSION
Amniotic fluid protects the fetus from harm and allows for the development of the skeleton and muscles. It serves as a thermal regulator and provides some nutrition, albeit not much. Ingesting or inhaling amniotic fluid may stimulate development and differentiation of gastrointestinal and pulmonary tissues (10) . With a prevalence of 2.3%, oligohydramnios is one of the most common disorders endangering fetal health. Chronic fetal hypoxia, fetal growth limitation, recurrent preterm birth, and respiratory distress syndrome are all linked to oligohydramnios. Fetal malpresentation, compressed cord, meconium staining, increased perinatal mortality, and surgical deliveries may all result from this syndrome (11) .
The current work was designed to assess the value of maternal hydration of pregnancy outcome for women with oligohydramnios. Overall, the maternal hydration yielded a significant difference in laboratory data, AFI and AF volume, with associated doppler indices. The pregnancy outcome showed premature delivery and increased cesarean deliveries. However, neonates were in good health condition, and none need admission to NICU.
Azarkish et al. (1) wanted to see how much of an impact intravenous (IV) hydration had on the amniotic fluid index in cases of oligohydramnios. An overall sample size of 61 women (31 in the experimental group and 30 in the placebo group) participated in the research. Maternal characteristics were comparable between the two groups. There were no reported shifts in blood pressure despite significant fluid intake. However, there were no statistically significant variations in the mean AFI between the intervention and control groups before the introduction of maternal IV hydration (P = 0.128). The mean AFI was significantly different between the groups 48 hours after fluid therapy were stopped. They concluded that AFI in women with oligohydramnios is greatly improved after maternal IV hydration.
Habib et al. (12) evaluated the results of intravenous hydration and amino-acid infusion for the treatment of isolated oligohydramnios, finding that the latter was more effective. In summary, 104 pregnant women with isolated oligohydramnios were participated, and half were given a saline infusion (Group-A) while the other half were given an amino-acid infusion (Group-B). In group-A vs group-B, the mean maternal age was 32.1±4.4 vs 31.0±5.5 years, mean GA was 29.1±2.9 vs 29.0±3.1 wks, Multigravida was the norm in both sample groups. The initial mean AFI was similar between the two groups (3.78±0.56 vs 3.73±0.36). By comparing groups, A and B, group B had a significantly higher mean AFI after six infusions (4.79 ±0.65 vs 6.82± 0.62 in A and B respectively). Group-B also had a significantly higher increase in AFI over group-A (3.09±0.70 vs 1.0±031). Therefore, they reasoned, intravenous amino acid treatment is useful in the management of isolated oligohydramnios and is effective at reducing AFI. Unfortunately, we did not include amino acids in the current work.
Malik et al. (13) confirmed our findings by investigating the impact of oral and intravenous fluids on the frequency with which oligohydramnios improved in the 3 rd trimester of pregnancy. The study involved 100 singleton pregnancy patients (50 in each group). The average age of the individuals in the oral and intravenous groups was 33.62 ± 5.45 years and 34.70 ± 4.76 years, respectively. Improvement was seen in 39 (78%) of the oral group and 22 (44%) of the intravenous group. Pre-hydration mean amniotic fluid index levels were 4.79 ±0.53 in the oral group and 4.87 ±0.36 in the intravenous group. The mean amniotic fluid index level after hydration was 6.79 ±1.22 and 5.97 ± 1.37 in the oral and intravenous groups, respectively. So, the concluded that oral hydration of pregnant women is more beneficial than intravenous hydration. The results are surprising for us. Oral rehydration may be better associated with stimulation of internal mechanisms to combat oligohydramnios than the intravenous route which usually overloads the circulation.
Also, Deshmukh et al. (14) performed a comparison of oral and intravenous hydration therapy on maternal and fetal outcome in oligohydramnios patients. The study enrolled 180 patients who received oral hydration and 120 patients received IV hydration therapy. Both groups were well matched as regards baseline data. Patients receiving oral hydration therapy had a mean AFI on admission of 4.86 cm, while those receiving intravenous hydration therapy had a mean AFI of 5.11 cm. The mean AFI in the oral and IV groups, 48 hours after hydration, was 6.02 and 5.70 cm, respectively. Researchers found that patients with oligohydramnios benefited from both oral and IV hydration therapies. A comparison of two treatments reveals no significant differences in mother and fetal outcome. Yet, in cases of low AFI and oligohydramnios, a simple, effective, cost-free, side-effect-free, readily available method of hydration therapy can serve both a therapeutic and preventative purpose. Furthermore, Khajotia et al. (15) aimed to determine the effects of hydration therapy on patients with oligohydramnios. The study enrolled 200 women, equally assigned to receive oral or intravenous hydration. All baseline data were well matched between the studied groups. The mean AFI in the IV group was 4.47±0.90 cm before hydration therapy and 7.16±1.57 cm after hydration therapy, representing a 60.18% rise in the oral group, the figures were 4.52±0.83 cm before hydration therapy and 7.48±1.56 cm after hydration therapy, representing a 65.48% increase in IV group. When the 2 groups are compared, however, the increases in mean AFI were not significant (p > 0.05). Nagina (16) sought to ascertain the percentage rise in mean amniotic fluid index in pregnant women following IV maternal hydration in third trimester oligohydramnios. There were 156 women with oligohydramnios in their third trimester who participated in the trial. Researchers found that cases of oligohydramnios saw an increase in amniotic fluid volume when mothers were given intravenous hydration. (Mean difference in AFI 2.9 cm, 95% CI). The typical increase in AFI was 87%±33.5. Kiran et al. (17) also reported that the acute maternal IV hydration increased the amniotic fluid volume. Lorzadeh et al. (18) found that maternal IV fluid therapy more significantly increased AFI when compared to oral therapy. Ali and Hebbar (19) reported a significant increase in AFI after IV infusion of one liter of fluid in amniorrhexis, although they were unable to explain the cause of the hydration-associated increase in AFI.
The heterogeneity in results of the previous studies may be related to different sample size, inclusion, and exclusion criteria.

Conclusion:
In the 3 rd trimester, IV maternal hydration therapy was found to be safe and effective (it increased the AFI) in pregnant cases with isolated oligohydramnios. The limiting steps of the current work include a small number of patients and absence of the comparison group. Thus, our findings need to be confirmed in larger studies with longer follow-up periods so that risk factors for negative outcomes may be identified.