Citation Information :
Vijay C, George S. To Study the Association of Low Amniotic Fluid Index and Adverse Perinatal Outcomes in Third Trimester of Pregnancy. J South Asian Feder Obs Gynae 2023; 15 (2):153-158.
Background and objectives: Amniotic fluid is the complex fluid surrounding the fetus in utero and gives a low resistance environment needed for the growth and development of the fetus. Clinical estimation of amniotic fluid volume forms a major part of the fetal assessment and outcome of pregnancy. A strong association between oligohydramnios and increased lower segment cesarian section (LSCS) rates and low birth weight exists. As very few studies have looked into perinatal outcomes and AFI, we conducted a study wherein we measured the amniotic fluid index (AFI) in mothers between 28 and 40 weeks of gestational age (GA) and looked into its association with maternal and perinatal outcomes.
Methods: This was a descriptive observational study on 108 patients in the Department of Obstetrics and Gynaecology, St. Johns Medical College and Hospital, Bengaluru, Karnataka, India over a period of 2 years and we studied the association of AFI on maternal and perinatal outcomes. The data were collected from 6 November 2019 to 1 October 2021. Written and informed consent was obtained from patients agreeing to participate in the study. Ethical approval was obtained from the institutional ethics committee before the start of the study. Maternal and fetal outcomes were studied in the study subjects.
Results: This clinical study was conducted over a duration of 2 years on 108 pregnant women in the third trimester at St. John's Medical College and Hospital, Bengaluru, Karnataka, India. Nine patients were diagnosed with oligohydramnios. Hence, the prevalence of oligohydramnios was 8.3% in the study group. The most common presenting complaint or need for admission was safe confinement 48 (44.4%), followed by abdominal pain 40 (37%) and oligohydramnios 6 (5.6%). Majority of the pregnancies had a GA of 37–40 weeks (74.1%). The most mode of delivery was by LSCS (100%) in the AFI <5 cm group. In the AFI <5 cm group, 7 neonates had birth weight 2.5–4 kg.
Conclusion: Mode of delivery by LSCS seems to benefit the neonates in terms of lower incidence of non-reactive non-stress test (NST), low chance of meconium-stained liquor (MSL) and intrauterine death (IUD). Prompt decision for LSCS, even in the induced patients who are planned for vaginal delivery, is essential in preventing fetal morbidity such as MSL, fetal distress, and neonatal intensive care unit (NICU) admission.
Singhal SR, Gupta R, Sen J. Low amniotic fluid index as a predictor of adverse perinatal outcome: An Indian perspective. Clinics Mother Child Health 2015;12:2. DOI: 10.4172/2090-7214.1000201.
Bawa R, Neerja. The predictive value of the amniotic fluid index for adverse perinatal outcomes and a suggested plan of action. Int J Reprod Contracept Obstet Gynecol 2017;6:2952–2954. DOI: 10.18203/2320-1770.ijrcog20172914.
Ladelle S, Leung T, Cortez C. Effects of amniotic fluid index on perinatal outcomes in preterm premature rupture of membranes [37o]. Obstet Gynecol 2017;129:S162. DOI: 10.1097/01.AOG.00005 14786.52391.ba.
Morris RK, Meller CH, Tamblyn J, et al. Association and prediction of amniotic fluid measurements for adverse pregnancy outcome: Systematic review and meta-analysis. BJOG 2014;121:686–99. DOI: 10.1111/1471-0528.12589.
Bhagat M, Chawla I. Correlation of amniotic fluid index with perinatal outcome. J Obstet Gynecol India 2014;64(1):32–35. DOI: 10.1007/s13224-013-0467-2.
Bachhav AA, Waikar M. Low amniotic fluid index at term as a predictor of adverse perinatal outcome. J Obstet Gynecol India. 2014;64(2):120–123. DOI: 10.1007/s13224-013-0489-9.
Kapoor A, Taralekar V, Mehendale S. Association of amniotic fluid index with neonatal outcomes at a tertiary level hospital in Pune, India. Indian J Appl Res 2018;8(2). DOI: 10.36106/ijar.
Pandey VK, Aggarwal P, Kakkar R. Modified BG Prasad's socio-economic Classification-2018: The need of an update in the present scenario. Indian J Community Health 2018;30(1):82–84. DOI: 10.47203/IJCH.2018.v30i01.014.
Hill LM, Breckle R, Wolfgram KR, et al. Oligohydramnios: Ultrasonically detected incidence and subsequent fetal outcome. Am J Obstet Gynecol 1983;15:407–10. DOI: 10.1016/s0002-9378(16)32235-9.
Lin CC, Sheikh Z, Lopata RA. The association between oligohydramnios and intrauterine growth retardation. Obstet Gynecol 1990;1:1100–1104. PMID: 2234721.
Patel PK, Pitre DS, Gupta H. Pregnancy outcome in isolated oligohydramnios at term. Nat J Commun Med 2015;6(2):84–88. pISSN 0976 3325; eISSN 2229 6816.
Chauhan SP, Hendrix NW, Morrison JC, et al. Intrapartum oligohydramnios does not predict adverse peripartum outcome among high-risk parturients. Am J Obstet Gynecol 1997;1:1130–1138. DOI: 10.1016/s0002-9378(97)70326-0.
Garmel SH, Chelmow D, Sandra JS, et al. Oligohydramnios and the appropriately grown fetus. Am J Perinatol 1997;14(06):359–363. DOI: 10.1055/s-2007-994161.
Ghosh R, Oza H, Padhiyar B. Maternal and fetal outcome in oligohydramnios: study from a tertiary care hospital, Ahmedabad, India. Int J Reprod Contracept Obstet Gynecol 2018;7:907–911. DOI: 10.18203/2320-1770.IJRCOG20180864.
Janas P, Radoń–Pokracka M, Nowak M, et al. Effect of oligohydramnios on the accuracy of sonographic fetal weight estimation in at term pregnancies. Taiwan J Obstet Gynecol 2019;58(2):278–281. DOI: 10.1016/j.tjog.2019.01.020.
Jagatia K, Singh N, Patel S. Maternal and fetal outcome in oligohydramnios: Study of 10 cases. Int J Med Sci Public Health 2013;2:724–727. DOI: 10.5455/ijmsph.2013.070520132.
Chien LN, Chiou HY, Wang CW, et al. Oligohydramnios increases the risk of respiratory hospitalization in childhood: A population-based study. Pediatric Res 2014;75(4):576–581. DOI: 10.1038/pr.2013.247.
Sardana P, Sewalkar M. Pregnancy outcome in amniotic fluid index less than five in term low risk pregnancy at Pravara Rural Hospital, Loni. Indian J Basic Appl Med Res 2019;8:5–15. www.ijbamr.com.pISSN: 2250-284X, eISSN: 2250-2858.
Noor N, Raza SA, Parveen S, et al. Amniotic fluid index versus maximum vertical pocket measurement in predicting perinatal outcome at 40 weeks or beyond. Int J Reprod Contracept Obstet Gynecol 20181;7:4887–4891. https://go.gale.com/ps/advanced Search.do?method=doSearch&searchType=Advanced Search Form& userGroupName=anon%7Eabeee8e3&inputField Names% 5b0% 5d=AU&prodId=HRCA&inputFieldValues%5b0%5d=%22Nasreen+Noor%22. Accessed on: December, 2018.
Kumar A, Rao PS, Kumar S, et al. Perinatal outcome in pregnancy complicated with oligohydramnios at term. Int J Reprod Contracept Obstet Gynecol 2018;7:3936–3940. DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20184025.
Kumari S, Singh S. A case–control investigation of foetal outcome in a case of oligohydramnios after 34 weeks of pregnancy. European Journal of Molecular & Clinical Medicine 2020;7(9):3822–3828. ISSN: 2515-8260. Accepted date: 15-09-2020.
Shah SB, Mehendale M, Nayak AH. Study of maternal and fetal outcome in term oligohydramnios. Int J Biomed Adv Res 2018;9:200–204. https://doi.org/10.7439/ijbar.
Saxena R, Patel B, Verma A. Oligohydramnios and its perinatal outcome. International Journal of Reproduction, Contraception, Obstetrics and Gynecology 2020;9(12):4965–4970. https://dx.doi.org/10.18203/2320-1770.ijrcog20205230.
Thobbi VA, Sabahath S. A study of perinatal outcome in patients with low amniotic fluid index (AFI). Age 2017;20(40):60. firstname.lastname@example.org.
Chidanandaiah SK, Chandrashekhar K, Gaddi S, et al. Pregnancy outcome after diagnosis of oligohydramnios at term. Int J Reprod Contracept Obstet Gynecol 2013:2:23–26. DOI: 10.21276/obgyn.2017.4.1.8.
Kahkhaie KR, Keikha F, Keikhaie KR, et al. Perinatal outcome after diagnosis of oligohydramnious at term. Iran Red Crescent Med J 2014;16:e11772. DOI: 10.5812/ircmj.11772.
Zosangpuii WL. Prospective clinical study of pregnancy outcome in amniotic fluid index less than five in term low risk pregnancy. International Journal of Contemporary Medicine Surgery and Radiology 2019;4(3):C74–C78. DOI: http://dx.doi.org/10.21276/ijcmsr.2019.4.3.16.
Umber A. Perinatal outcome in pregnancies complicated by isolated oligohydramnios at. Ann King Edward Med Univ 2009;15(1):35.
Vasanthamani P, Ishwarya S, Meena TS, et al. A study on perinatal outcome in term oligohydramnios. International Journal of Clinical Obstetrics and Gynaecology 2019;3(2):214–216. DOI: https://doi.org/10.33545/gynae.2019.v3.i2d.37.
Nancy B, Robina M, Surender K, Reema K, Manjula S: A Study on Perinatal Outcome in Term Oligohydramnios. Int J Clin Obstet Gynaecol 2019;3(2):214–216. DOI: 10.33545/gynae.2019.v3.i2d.37.
Sharma M, Bhagwani DK, Chaurasia M, et al. Maternal and perinatal outcome in pregnancies with oligohydramnios in third trimester. Indian J Neonatal Med Res 2016, 4(3):1–5. DOI: 10.7860/IJNMR/2016/ 21559.2188.