A Prospective Observational Study of Maternal, Fetal and Neonatal Outcome in Singleton Term Pregnancies With Amniotic Fluid Index Between 5-8cm"

Abstract

Amniotic cavity is a fluid-filled medium necessary for foetal growth and development. The focus of modern obstetrics is on the health and welfare of the mother and the fetus. Identifying the foetuses at risk and choosing the best time and method of intervention, are the main issues when a fetus is at risk for death or injury in utero. Amniotic fluid quantification plays a significant role in the biophysical profile of the USG evaluation of fetal well-being at term.

BACKGROUND:

Amniotic fluid index (AFI) of 5 cm or less or a single deep pocket of 2 cm are characteristics of oligohydramnios. An AFI between 5 and 8 is considered borderline or low normal amniotic fluid volume. The incidence of oligohydramnios is 3-5 % of all pregnancies. It varies widely, from approximately 0.5% to 5%, depending on the study population. It is often associated with an increased risk of small for gestational age (SGA) and also increases the incidence of meconium- stained liquor, cesarean section, low Apgar score and Neonatal intensive care (NICU) admission. Hence, the identification of oligohydramnios usually mandates close fetal surveillance. This observational study was conducted to examine the outcome of labour and neonatal outcomes in a group of women with singleton pregnancies with cephalic presentation with AFI between 5-8cms.

AIM:

The aim of the study is to analyze the maternal, fetal and neonatal outcomes in singleton-term pregnancies with Amniotic fluid Index between 5-8 cm.

MATERIALS AND METHODS:

This is a prospective observational study conducted at Apollo Hospitals, Chennai in the Dept of Obstetrics and Gynecology. All the antenatal women with gestational age ≥37 weeks up to 40 weeks with AFI of 5-8 cms with intact membranes were screened, followed up on, and analyzed for maternal and perinatal outcomes.

RESULTS:

Based on this study, around 48% were induced due to reduced liquor and 67% had cesarean section. Around 61% babies had MSAF out of which 26% were induced deliveries.AFI of 5cm had the maximum number of induction and LSCS. There was no significant difference in fetal heart status and NICU admissions between the spontaneous labour and induced group. There was no significant association between maternal high risk factors and NICU admissions.

CONCLUSION:

This study showed that reduced AFI of 5-8cm presenting at term had a higher incidence of LSCS, especially after induction, compared to patients allowed to labour spontaneously. A higher incidence of MSAF was found in this study, although perinatal  morbidity and mortality did not change too much.