A prospective study of critical methods of amniotic fluid volume assessment

Background: Adequate amniotic fluid volume (AFV) is required for fetal well-being and its assessment is taken as the single most important variable in fetal biophysical scoring system. I have critically evaluated various methods of amniotic fluid volume assessment keeping Amniotic Fluid Index (AFI) as the standard technique of Amniotic Fluid Volume (AFV) assessment.Methods: This was a prospective study where all patients were assessed for amniotic fluid volume at one sitting first by abdominal palpation followed by ultrasonographic assessment by various methods. Critical analysis of each individual method of amniotic fluid volume assessment was carried out for its sensitivity and specificity with regard to oligohydramnios, polyhydramnios and euamnios keeping AFI as the standard technique of AFV assessment. Effort was made to find out the best possible method of AFV assessment.Results: Almost all methods are reasonably effective in assessment of normal AFV. For assessment of oligohydraamnios 2cm x 2cm pocket and Maximum Vertical Pocket (MVP) depth (of 2 cm rule) methods are most suitable whereas other methods were found to be inappropriate. For assessment of polyhydramnios with regard to specificity MVP depth (>8cm) is reliable but with regard to sensitivity, subjective assessment and abdominal palpation are more reliable.Conclusions: When we compare all methods of AFV assessment, AFI and MVP depth (of 2 cm rule) have better correlation. Hence these methods are suggested for AFV studies in current clinical settings

A study on the perinatal outcome in cases of oligohydramnios

Background: Amniotic fluid has an important role in the fetal growth and development. It provides the fetus, with a protective low resistance environment which is suitable for the growth and development. With normal amount of amniotic fluid index ranging from 5 to 24 cms, Amniotic fluid index of 5 cms were taken. AFI >10 cms was considered to be normal. Various outcome measures recorded were, induced Vs spontaneous labor, gestational age at delivery, nature of amniotic fluid, FHR tracings, mode of delivery, indication for cesarean section or instrumental delivery Apgar score at one minute and five minutes, birth weight, admission to neonatal intensive care unit, perinatal morbidity and perinatal mortality.Results: Normal quantity of liquor amnii is essential for normal and successful outcome of pregnancy, as it provides a safe milieu interior for the foetus in utero. Deprivation of required quantity, will adversely affect the neonatal outcome. Oligohydramnios, in itself is enough to cause such damage, by creating chronic hypoxic situation.Conclusions: The fetal morbidity and mortality increases if additional antenatal complications of   preeclampsia and post-term pregnancy are present along with oligohyrdramnios

The effect of abnormal amniotic fluid volume (oligohydramnios) on maternal and fetal outcome: an observational study

Aims: To study the effects of abnormal amniotic fluid (oligohydramnios) on maternal and fetal outcome. Material and Methods: This prospective observational study was carried out in the Department of Obstetrics and Gynecology at Patna Medical College and Hospital Patna, Bihar India, from November 2017 to February 2019. All pregnant women having singleton pregnancy with cephalic presentation,at POG 34-40 weeks, presenting with abnormal liquor  (oligohydramnios ) AFI less than 5,were included in the present study.Results: 85% of patients were in 20-30 years age group and 9% patients were in above 30 years age group. Mean maternal age was 23.61 years. Incidence of oligohydramnios was more in primipara (55%) in our study. And operative morbidity was also more in primipara 54.55%. Most common cause of Oligohydramnios is idiopathic (55%). Second commonest cause is PIH (28.5%). Operative morbidity is highest in PIH (52.64%)). Operative morbidity was significantly higher in NST non-reactive (58.62%) group than NST reactive (27.46%) group. All patients underwent Doppler study. 10% were found with fetoplacental insufficiency. Most common reason to perform caesarean section  was fetal distress which was either due to cord compression or IUGR. Oligohydramnios was related to higher rate of growth retardation and NICU admission.Conclusion: Oligohydramnios is frequent occurrence and demands intensive fetal surveillance and proper antepartum and intrapartum care. Due to intrapartum complication and high rate of perinatal morbidity and mortality, rates of caesarean section are rising, but decision between vaginal delivery and caesarean section should be well balanced so that unnecessary maternal morbidity be  prevented and on the  other side timely intervention can reduce perinatal morbidity and mortality.   Keywords: Oligohydramnios, Maternal Outcome, Fetal Outcome

Perinatal outcome in cases of severe oligohydramnios

Background: Oligohydramnios is defined as when on ultrasonography the single largest pocket in horizontal and vertical diameter is less than 2cm or amniotic fluid index is less than 5cm. Normal amniotic fluid index is 5-25cm. The overall incidence is 0.5 to more than 5%. However, the incidence increases in post dated pregnancies as many as 11%. It is increasing these days because of changes in lifestyle and also reduced maternal fluid intake.Methods: A prospective randomized study was done in Dept of Obstetrics and Gynaecology, MGMMC and MYH, Indore during the period of 6 months from 1st July 2017 to 31st December 2017. It included 200 cases from all the antenatal patients attending Antenatal OPD in routine and emergency and who are admitted in MYH beyond 28 weeks of pregnancy.Results: Most of the perinatal cases nearly 64% of babies were handover, 26% were IUDs (intra uterine devices) and rest 10% requiring neonatal care in nursery. The color Doppler changes showed normal flow in 54% in cases with 26% showing early fetal hypoxia and 14% showing uteroplacental insufficiency. Rest of the 6% cases were IUD. Incidence of IUGR was 50% in babies most commonly being constitutionally small. About 8% cases were found to be associated with abruption and 24% cases were found to be associated with pregnancy induced hypertension. Most common mode of delivery was vaginal delivery in 68% cases. However, 32% cases underwent LSCS.Conclusions: There has been reported cases of sudden IUD in severe oligohydramnios presenting with loss of fetal movements

A clinical study on maternal and fetal outcome in pregnancy with oligohydromnios

Background: Oligohydramnios is associated with various maternal and fetal complication. It’s correlated fetal complications like FGR, increased risk of meconium aspiration syndrome, Birth asphyxia, low APGAR scores and increased congenital abnormalities in fetus. It’s also associated with maternal morbidities in view of operative interventions for delivery. To study effect of oligohydramnios in mother in form of, operative delivery and progress of labour. To study effect of oligohydramnios in fetus in form of fetal compromise i.e.  FGR, fetal distress, altered APGAR score, need for NICU admission. congenital anomaly and perinatal death.Methods: 50 patients with ≥ 28 weeks POG with oligohydramnios, confirmed by ultrasonographic measurement of AFI using four quadrant technique; were selected randomly after fulfilling inclusion and exclusion criteria.Results: Incidence of oligohydramnios were more found in primigravida (56%) in present study. Most common cause of oligohydramnios was idiopathic (62%) followed by PIH (20%). Most common cause of caesarean was fetal distress (23%) either due to cord compression or FGR. oligohydramnios was related to higher rate of Fetal Growth restriction and NICU admission (24%).Conclusions: Oligohydramnios is very common encounter during pregnancy, Because of its frequent occurrence; it demands intensive fetal monitoring and systemic approach to antepartum and intrapartum fetal surveillance. There is increased risk of intrapartum complication, perinatal morbidity, perinatal mortality; thus, the rate of caesarean increasing day by day.one should always know the fine line between vaginal delivery and caesarean section; move ahead with best option without hampering fetal wellbeing and avoid unnecessary operative morbidity

Perinatal outcome in oligohydramnios and borderline amniotic fluid index: a comparative study

Background: Oligohydramnios is associated with adverse perinatal outcome in the form of meconium staining, intrauterine growth restriction (IUGR), caesarean section for abnormal fetal heart rate tracing, low Apgar score and neonatal intensive care unit (NICU) admission.Methods: This was a prospective study of 100 singleton pregnancies beyond 28 weeks of gestation with AFI< 8 cm, delivered within seven days of admission. Patients were divided in two groups, those with AFI ≤ 5 cm and borderline AFI of 5.1 to 8 cm. Perinatal outcome was studied in the form of onset of labor, mode of delivery, fetal heart rate variations, meconium staining  and lower segment caesarean section (LSCS) for fetal distress, Apgar score, birth weight, NICU admission and neonatal mortality.Results: Patients with oligohydramnios with AFI ≤5 cm were significantly associated with IUGR and presence of abnormal umbilical artery Doppler velocimetry (p <0.05). Adverse perinatal outcome was seen in higher percentage of patients having AFI ≤5 cm than with borderline AFI. The difference was statistically significant for overall caesarean delivery rate and LSCS for fetal distress (p <0.05).Conclusions: Oligohydramnios with AFI of ≤5 cm is associated with high caesarean delivery rate and LSCS for fetal distress

The effect of intravenous hydration on latency period

Background and aims: Preterm delivery is associated with significant perinatal morbidity and mortality. This study aimed to determine the effects of intravenous (IV) hydration on time interval from rupture of membranes to delivery (latency period) in pregnant women with Preterm premature rupture of fetal membranes. Methods: 24 pregnant women during their 28 to 34 weeks of gestational age with singleton live pregnancy whose baseline amniotic fluid index (AFI) was ≥ 5 cm were randomized into 2 case and control groups. The study group (Amniotic Fluid Index) received one liter intravenous fluid bolus of isotonic Ringer serum during 30-minute period. The control group received expectant management. The time interval from rupture of membranes to delivery was studied. Independent t-test and paired t-test were used to compare 2 groups and mean latency period before and after hydration, respectively. Results: The results of this study demonstrated that AFI decreased significantly at 90 minutes in both control and study groups. The mean between time intervals and delivery was 196.41 h and 140.58 h in the study and control groups, respectively, But this differences were not statistically significant (95%: 75.9-316/9 CI 95% :10.2-270.9) (P=490). Conclusion: This study did not show any significant impact of hydration on AFI and consequently latency period as a prophylactic method. So, further studies with a larger sample size and at different time intervals seem to be needed to clarify the effect of hydration on latency period in PPROM

Ultrasound evaluation of pregnancies with oligohydramnios in third trimester and their feto-maternal outcome at tertiary care hospital

Background: Oligohydramnios presents a threat to the fetus due to increased risk of the umbilical cord getting compressed and resulting in impaired blood flow to the fetus. The objective of the study was to find out the significance of oligohydramnios during third trimester of pregnancy.Methods: A hospital based prospective study was conducted in the Department of Radiodiagnosis and Obstetrics and Gynaecology, Sir T. Hospital, Bhavnagar. Amniotic fluid index (AFI) estimation was done on 60 pregnant women in third trimester, who were selected after screening for inclusion and exclusion criteria. Women with AFI 5 cm as controls.Results: Maximum number of the patients were belonging to 20-25-year age group in normal AFI, oligohydramnios and borderline oligohydramnios group. Incidence of malpresentation was significantly higher in oligohydramnios (20%), borderline oligohydramnios (17.5%). In oligohydramnios common, etiological factors were PIH (27.5%), idiopathic factor (27.5%), postdatism (12.5%) and IUGR (7.5%), while borderline oligohydramnios group is commonly associated with idiopathic factors (52.5%) followed by PIH (17.5%). Incidence of caesarean section was significantly higher in oligohydramnios group (67.5%) than normal AFI (18%). In borderline oligohydramnios group rate is significantly higher (45%) than normal AFI, but it is less as compared to oligohydramnios.Conclusions: Identification of oligohydramnios can be done by a good clinical examination and confirmed by measuring AFI on ultrasonography. Poor fetal outcome in the form of preterm, IUD, LBW, low APGAR score at 5 minute and increased chances of still birth, NICU admission and neonatal death are seen with oligohydramnios in third trimester and more so if it is detected in early third trimester. Chances of induction of labour and risk of LSCS also increase. Thus, detection of oligohydramnios helps in proper management of the cases so that maternal and perinatal outcome can be improved

Correlation of reduced amniotic fluid index with neonatal outcome

Background: Amniotic fluid assessment is an essential part of evaluation of fetus health in terms of fetal distress, meconium aspiration, IUGR, Non-reassuring fetal heart rate patterns, birth asphyxia, low birth weight, low Apgar-scores and NICU Admissions.Methods: This prospective observational study included 200 antenatal patients of term gestation of which 100 cases with AFI<8 and 100 controls with AFI ≥8 but ≤ 15 were included in study. Ultrasonography and NST were done and results of both groups compared for the presence of meconium passage, non-reactive NST, birth asphyxia, low Apgar-scores, low birth weight, NICU admissions and neonatal deaths.Results: There was increased incidence of non-reactive NST (40% vs 12%), meconium stained (33% vs 10%) in oligohydramnios group. In cases 49% of patients had vaginal delivery while in controls 78%. 51% underwent LSCS in cases while in controls 22%. Apgar score <7 was found in 7% vs 4%. Birth weight was <2.5 kg in 35% vs 13%. NICU admissions in study group was 15% vs 11%. The neonatal death was similar in both cases groups.Conclusions: Oligohydramnios affect the neonatal outcome in terms of meconium stained liquor, non-reassuring fetal heart rate, low birth weight, birth asphyxia, low Apgar-scores and NICU Admissions and neonatal death but the difference was not statistically significant. Early detection of oligohydramnios and its management may help in reduction of perinatal morbidity and decreased caesarean deliveries