Hydration Therapy to Improve Amniotic Fluid Index and its Association with Improved Obstetric Outcome in a Teaching Hospital of Eastern India

Introduction: Oligohydramnios is associated with fetal complications and a higher incidence of maternal operative morbidity. A study was planned to determine the effect of hydration therapy in the correction of oligohydramnios in pregnancy and to assess if improvement in amniotic fluid index (AFI) is associated with better obstetric outcomes. MaterialsandMethods: Analytical study with a prospective design, conducted over 1 year from July 2020 to December 2021. Pregnant women in their third trimester with singleton pregnancy and intact membranes, diagnosed to have oligohydramnios were the participants. All women undertook oral rehydration therapy. The proportion of women achieving posthydration cutoff values of AFI and single deepest vertical pocket, was recorded by abdominal ultrasound examination at 24, 48, and 72 h. Adequacy of hydration was assessed by urinary specific gravity, before and after hydration therapy. Results: There were 120 participants. The mean age of the participants was 25.6 years (standard deviation = 5.7). Majority were multigravida. About 60%–80% of women improved with hydration therapy and the proportion of women showing improvement increased with time. Women with uncorrected AFI (<5 cm) at 24 and 48 h had significantly higher odds of preterm delivery, cesarean delivery, low‑birth‑weight baby, baby having 5 min Apgar score < 6, higher likelihood of Sick Newborn Care Unit admission and neonatal death. Conclusion: Maternal hydration therapy can be of value to improve the fetomaternal outcome in pregnancies with oligohydramnios by preventing preterm termination and reducing cesarean deliveries with good neonatal outcomes. Such simple intervention can be home based and assures universal health coverage

Prospective Study Of Efficacy And Perinatal Outcome Of Hydrotherapy In Oligohydroamnios Patients

Background:Oligohydramniosmeans a low level of amniotic fluid during pregnancy. It is defined by an amniotic fluid index that is below 5th percentile for the gestational age. It may cause IUGR, fetal anomalies, malpresentations and fetal distress in labour. Oral or intravenous fluid therapy may increase the amount of amniotic fluid and may improve perinatal outcome. Aims And Objectives:To study efficacy and perinatal outcome of hydrotherapy in patients with oligohydamnios. Material & Methods:A prospective observational study wascarried out at tertiary care centre for 6 months. 30 cases of oligohydramnios were enrolled in this study. Results:In present study, maximum (50%) patients admitted for oligohydramnios were between 28 –32 weeks gestational age and 66% were having severeoligohydramnios. After giving hydration therapy, difference in AFI, was 2.57±0.13, which was statistically significant. 83.3% patients were delivered after 36 weeks and 80% were delivered by normal vaginal delivery. 53.3% babies were live healthy, whereasothers needed resuscitation and admitted to NICU. Conclusion:Oligohydramnios has higher impact on perinalal outcome due to antenatal and intrapartum complication. Because of early diagnosis by ultrasonography or clinical analysis, fluid therapy is an option to increase amniotic fluid volume and so perinatal outcome may be improved.

Study on renal artery blood flow parameters of fetuses with isolated borderline oligohydramnios and maternal and infant pregnancy outcomes / 中华超声影像学杂志

Objective:To evaluate the changes of fetal renal artery blood flow parameters in fetuses with isolated borderline oligohydramnios (IBO) in the middle and third trimesters by Doppler ultrasound, and to assess its correlations with maternal and infant pregnancy outcomes.Methods:Twenty-seven IBO fetuses (IBO group) and 27 gestational age-matched normal fetuses (control group) from April to October 2019 in the Second Xiangya Hospital of Central South University underwent prenatal ultrasound examination during the middle and third trimesters. Renal artery blood flow parameters, including renal artery pulsatility index (RAPI), volume corrected renal artery pulsatility index (vcRAPI) and pregnancy outcomes were measured and compared between the two groups. Once diagnosed IBO, patients were recommended to the obstetric clinic for consultation and intervention. The correlation between RAPI, vcRAPI measured before intervention and prepartum amniotic fluid volume and pregnancy outcomes was analyzed, the ROC curve was plotted to find the better predictor.Results:The vcRAPI of the IBO group was higher than that of the control group ( P=0.015). In the IBO group, the vcRAPI measured before intervention was higer in those fetuses who were still IBO before delivery( P=0.048). In the IBO group, the correlation of the vcRAPI measured before intervention and IBO before delivery was statistically significant ( OR=2.41, 95% CI=1.06-5.43, P=0.035). The ROC curve showed that the sensitivity of vcRAPI to IBO was 0.67, the specificity was 0.75( P=0.002). Conclusions:Compared with RAPI, The vcRAPI may reflect the increase in fetal renal artery perfusion resistance of IBO group more timely. The higher vcRAPI before intervention in the IBO group have difficulty in recovering amniotic fluid volume before delivery.Increased vcRAPI is a better predictor of IBO before delivery.

Oral versus intravenous maternal hydration in isolated third trimester oligohydramnios

Background: To study the effect of oral and intravenous maternal hydration in patients with isolated oligohydramnios in terms of mean change in amniotic fluid.Methods: A total number of 38 patients included in the study which fulfill the selection criteria.  Patients were randomly divided in two groups. Amniotic fluid index (AFI) of all patients was measured before the hydration therapy according to the method of Phelan et al.  In maternal oral hydration (Group A), every patient was instructed to drink two liters of water over two hours daily for 1 week. In intravenous hydration (Group B), every woman infused two liters of 0.9% normal saline in two hour daily for 1 week. After 48 hours and 1 week of oral and intravenous hydration, the AFI was reassessed by the same observer. Patients were monitored closely for sign and symptoms of fluid overload. Data was stratified for mean difference in improvement in amniotic fluid index.Results: After oral hydration therapy AFI was 5.926±0.4593 after 48 hours and 8.286±0.6000 after 7 days in Group A. In Group B AFI was 5.784±0.4622 after 48 hours and 7.868±0.2810 after 7 days of intravenous hydration. P value after 48 hours is 0.348 and p=0.014 after 7 days means oral hydration therapy significantly increase amniotic fluid index.Conclusions: Oral maternal hydration significantly increase the amniotic fluid index in patients with isolated oligohydramnios. It is simple, safe and non-invasive method.

Perinatal outcome associated with oligohydramnios at term

Background: Oligohydramnios is a severe and common complication of pregnancy and its incidence is reported to be around 1 to 5% of total pregnancies. The aim of this study was to perinatal outcome of oligohydramnios (AFI <5) at term.Methods: A prospective study was conducted in which 200 patients at term with oligohydramnios AFI <5 cm with intact membranes were analyzed for perinatal outcome.Results: There were increased chances of FHR decelerations, thick meconium, increased LSCS, low Apgar score at 5 minutes, birth weight <2.5 kg, admission to NICU in pregnancy with oligohydramnios.Conclusions: An amniotic fluid index (AFI) of <5 cm detected after 37 completed weeks of gestation is an indicator of poor perinatal outcome. Determination of AFI can be used as an adjunct to other fetal surveillance methods that helps to identify those infants at risk of poor perinatal outcome.

Relationship between the amniotic fluid index at term and the perinatal outcome

Background: Amniotic fluid index (AFI) is commonly used to estimate amniotic fluid volume. A proper AFI is between 10 and 24 centimetres. If it is below 5 cm, it is can represent oligohydramnios, and in case AFI is above 24 cm, it can represent polyhydramnios. This study was undertaken to determine whether measuring AFI at term is useful in the prediction of perinatal outcome.Methods: A prospective study of 250 pregnant women with gestational age between 37 and 42 weeks was conducted at Sola Civil Hospital. AFI was measured in each patient using the Phelan’s technique and the perinatal outcome was studied. The results were analysed and presented in the form of tables and graphs.Results: Total 250 patients were studied. Out of them, 33 patients (13.2%) had AFI <=5, 215 (86%) had AFI between 6 and 24; and 2 patients (0.8%) had AFI >=25.19 out of 33 (57.57%) patients with AFI <= 5, had to undergo caesarean section, out of which, 12 caesarean sections (63.15%) were taken for non-reassuring foetal status. 36.27% (78/215) of patients with AFI between 6 and 24 underwent caesarean section, out of which 38.46% (30/78) underwent caesarean section for non-reassuring foetal status.Conclusions: In the presence of oligohydramnios, the rates of LSCS due to foetal distress, the occurrence of low Apgar score and of low birth weight are higher than in patients with normal liquor at term. Thus, measuring the amniotic fluid index at term can be helpful in the prediction of perinatal outcome.

Maternal and fetal parameters in pregnant woman undergoing tocolysis with nifedipine / Parâmetros maternos e fetais em gestante submetida a tocólise com nifedipina

Abstract Objectives: to evaluate the effects of nifedipine with tocolysis under maternal and fetal parameters. Methods: a cohort study with 40 pregnant women admitted at a high-risk pregnancy ward to inhibit premature labor between September/2010 to May/2012. Nifedipine was used as a 20mg sublingual attack dose and maintained 20mg every six and eight hours orally. The variables of the analysis were fetal heart rate (FHR), maternal heart rate (MHR), systolic blood pressure (SBP) and diastolic blood pressure (DBP), and amniotic fluid index (AFI). All the variables were evaluated prior to administrating nifedipine and approximately after 6 hours and every 24 hours, until hospital discharge. Results: there were no modification of the FHR (p=0.48) and the SBP (p=0.29). The MHR increased after 24 hours, but with no statistical difference (p=0.08), returning to similar levels as at admission within 48 hours. The DBP decreased at 6 (p=0.04) to 72 hours, being stable afterwards. The AFI decreased significantly at 24, 48 and 72 hours. Conclusions: the use of high doses of nifedipine with tocolysis causes a decrease of the maternal's diastolic blood pressure and consequently decreases the amniotic fluid index, but probably without any clinical repercussions.

Resumo Objetivos: avaliar os efeitos da nifedipina utilizada na tocólise sobre os parâmetros maternos e fetais. Métodos: estudo de coorte incluindo 40 gestantes admitidas na enfermaria de alto risco para inibição do trabalho de parto prematuro entre setembro/2010 a maio/2012. Utilizou-se a nifedipina sublingual na dose de ataque de 20mg e uma manutenção de 20mg por via oral a cada seis e oito horas. As variáveis avaliadas foram os batimentos cardio-fetais (BCF), frequência cardíaca materna (FCM), pressão arterial sistólica (PAS) e diastólica (PAD) e índice de líquido amniótico (ILA). Todas as variáveis foram avaliadas antes da administração da nifedipina e aproximadamente após 6h e cada 24h até alta hospitalar. Resultados: não houve modificação dos BCF (p=0,48) e da PAS (p=0,29). A FCM aumentou após 24h, mas sem significância estatística (p=0,08) retornando a níveis similares ao da admissão com 48h. A PAD diminuiua partir de 6h (p = 0,04)até 72h, mantendo-se constante. O ILA diminuiu significativamente em 24h, 48h e 72h. Conclusão: a utilização de altas doses de nifedipina para tocóliseocasio na diminuição dos níveis pressóricos diastólicos maternos e consequentemente diminuição do ILA, mas provavelmente sem repercussões clínicas.

Role of Cardiotocography and Amniotic Fluid Index Together in Predicting Perinatal Outcome in Low-risk Pregnancies

ntroduction: The universal aim of maternity care provision is birth of a healthy baby to a healthy mother. Various invasive andnon-invasive antepartum surveillance tests have been devised to access the fetal well-being. In developing countries like India,where workload is heavy with shortage of technical manpower and resource settings are poor, we need techniques which areadequate, simple, cost effective, easy to use, and less time consuming for better postpartum outcome.Materials and Methods: This study was conducted over a period of 1½ years in 251 primigravidae with low-risk pregnanciesat or near term who were observed with admission cardiotocography (CTG) and amniotic fluid index (AFI) and was followedduring the course of labor to access mode of delivery, Apgar score at 0, 1, and 5 min of birth, and need for neonatal intensivecare unit (NICU) admission.Results: When both AFI and CTG together were correlated with mode of delivery, it was seen that in patients with cat 1 CTGirrespective of AFI, most of the patients were delivered by NVD and in cat 3 CTG patients irrespective of AFI, most of them weredelivered by lower segment cesarean section (LSCS). In patients with cat 2 CTG, significant number of those was deliveredby LSCS who had low AFI. When AFI and CTG together were studied for Apgar score at “1-min” of birth and NICU admission,it was seen that irrespective of AFI, low Apgar, and NICU admission was mostly seen in cat 3 CTG patients, but there was noneonatal mortality in our study.Data were entered into a Microsoft Excel Spreadsheet, relationship between categorical variableswas analyzed using a Chi-square test and data were analyzed using STATA version 15.Conclusion: Therefore, admission CTG along with AFI can effectively detect fetal distress if already present at admissionand thereby avoid unnecessary delay in decision to deliver timely and improve fetal outcome. These simple, cost effective,non-invasive, and less time-consuming tests can identify those patients who need continuous fetal monitoring in low resourcesettings and fetal outcome can be improved.

Study of effects of oligohydramnios on perinatal outcome

Background: Oligohydramnios has got a noteworthy influence on perinatal outcome. Hence, early detection and its timely management will aid in curtailing of perinatal morbidity and mortality and leading to decreased operative interventions. Therefore, the present study is conducted to look for the effects of oligohydramnios.Methods: This comparative study was a prospective observational study conducted at study institution. The women were divided into study and control groups based on AFI (amniotic fluid index), 100 cases were selected in each group.Results: Out of the 200 women, included in the present study, 35% of the patients in the study group had non-reactive non-stress test (NST) while in the control group 7% had it. Caesarean section was performed in 58% of cases in the study group as compared to 30% in the control group. Amongst these, Fetal distress was the most common indication for LSCS (lower segment caesarean section). There were no perinatal deaths in this study.Conclusions: Based on this study it has been observed that, amniotic fluid index of ≤5 cm was commonly associated with increased LSCS rates, intrauterine growth restriction, non-reactive NST, and abnormal Doppler velocimetry studies. Therefore, every case of oligohydramnios requires to be assessed meticulously. Prompt detection; timely management and treating the underlying condition improve outcome.

A prospective clinical study of foetomaternal outcome in relation to oligohydramnios in pregnancies beyond 36 weeks of gestation

Background: Amniotic fluid is contributed by both mother and foetus. It plays a vital role in foetal growth. The main purpose of this study was to evaluate the foetomaternal outcome in pregnant females with oligohydramnios beyond 36 weeks of gestation.Methods: This study was conducted on 230 pregnant females beyond 36 weeks of gestation with decreased liquor clinically and confirmed sonographically. It was conducted from May 2018 to May 2019. Females with leaking per vaginum, patients who did not give consent and with intrauterine foetal death were excluded. Complete labour record was made. Assessment of maternal outcome was done in terms of mode of delivery and foetal outcome was done in terms of birth weight, Apgar score at one and five-minute, respiratory distress, meconium aspiration, seizures in first 24 hours of life, congenital malformations, neonatal intensive care unit admission and death of baby.Results: A total of 230 pregnant females met the inclusion criteria who were having AFI <5. 121 (53%) females were primigravida and 119 (52%) underwent for caesarean section. Most common indication of LSCS was foetal distress. Apgar score at 1 minute was <7 in 97 (42%) babies and after 5 minutes, it was <7 in 93 (40%) babies. Other neonatal outcome results were IUGR in 59 (26%) babies, meconium aspiration syndrome in 52 (23%) babies, respiratory distress in 92 (40%) babies, congenital malformation in 6 (3%) babies, NICU admission of 93 (40%) babies and neonatal death of 11 (5%) babies.Conclusions: Oligohydramnios increases the chances of maternal morbidity and perinatal morbidity and mortality.

A prospective clinical study of foetomaternal outcome in relation to amniotic fluid index in pregnant females beyond 36 weeks of gestation at tertiary centre

Background: Amniotic fluid plays a vital role during foetal life. The main purpose of this study was to evaluate the foetomaternal outcome in relation to amniotic fluid index in pregnant females beyond 36 weeks of gestation.Methods: This prospective type of study was conducted for one-year duration from May 2018 to May 2019 in 350 pregnant females beyond 36 weeks of gestation with clinically significant abnormal liquor volume. Clinical diagnosis was later on confirmed with ultrasonography and patients were categorized in three categories as patients with Amniotic fluid index (AFI) 5 to 24, AFI <5 and AFI > or = 25. Complete labour record was made and fetomaternal outcome was assessed.Results: In this study, incidence of oligohydramnios was found to be more than polyhydramnios at term. No significant differences were found in relation to age, parity, religion, residence and booking status in all the study groups. Mostly patients 119 (52%) delivered by caesarean section in oligohydramnios group whereas vaginal delivery was commonly seen in patients with normal AFI (80%) and polyhydramnios (55%). Growth restriction 59 (26%) and malpresentation 18 (8%) were commonly seen with oligohydramnios. In the polyhydramnios group, 14 (35%) babies had malformations whereas only 6 (3%) babies had malformations in patients with oligohydramnios. Significant differences were found in the foetal outcome between the patients with oligohydramnios and polyhydramnios in comparison to patients with normal AFI.Conclusions: In pregnant females with abnormal liquor volume increases the chances of maternal morbidity and perinatal morbidity and mortality.

Study of amniotic fluid index and its pregnancy outcome

Background: Amniotic fluid is vital to the well-being of the fetus. Severe oligohydramnios and polyhydramnios are associated with increased maternal morbidity and perinatal morbidity and mortality.Methods: This was prospective observational study conducted at tertiary teaching institute from July 2012 to July 2013. Total 200 patients were included in the study. On the basis of amniotic fluid index (AFI), patients were categorized in 3 groups, Normal AFI (8-24 cm), oligohydramnios (AFI <5cm) and polyhydramnios (AFI > = 25 cm). Results were analysed in the form of incidence, mode of delivery and perinatal outcome which includes preterm, low birth weight, still births, NICU admissions and neonatal deaths in all the 3 groups.Results: Out of 200 patients, there was 150 cases of normal AFI, 39 cases of oligohydramnios and 11 cases of polyhydramnios. Incidence of oligohydramnios was 4.1% and polyhydramnios was 1.1%. PIH was the most common etiological factor found in oligohydramnios (30.7%) and in polyhydramnios congenital anomalies (36.3%) followed by idiopathic cause (27.2%) was most common. Incidence of caesarean section was 58.9% in oligohydarmnios and 17.3% in normal AFI group. Incidence of NICU admission was 25.6% in oligohydramnios and 50% in polyhydramnios group in comparison to 9.3% in normal AFI group.Conclusions: Amniotic fluid index is an important part of antepartum fetal surveillance. Abnormalities of AFI are associated with high perinatal morbidity and mortality and maternal morbidity.

A study of fetomaternal outcome in induction of labour in third trimester oligohydramnios

Background: The Induction of labor in oligohydramnios poses a dilemma for obstetrician. Studies are limited with variable results. This study aims at finding whether isolated oligohydramnios is an indication for operative delivery or labor induction followed by vaginal delivery is possible.Methods: A prospective study carried out on females delivered in study duration in Umaid Hospital, Jodhpur, Rajasthan. Outcomes studied were gestational age at delivery, colour 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 (NICU), perinatal morbidity and perinatal mortality. Descriptive statistics were applied and data was represented on frequency tables, graphs and diagrams.Results: 40% of subjects had amniotic fluid index (AFI) <5 cm and 60% demonstrated AFI between 5-7 cm. 60% of patients induced delivered vaginally with (38.33%) having AFI <5 cm. Operative delivery was resorted to in 40% of patients. Perinatal outcomes resulted in total 97% of babies discharged in healthy condition.Conclusions: Labor induction is feasible in idiopathic oligohydramnios. Fetal distress is the most feared and predicted outcome with labor induction in oligohydramnios. This study deduced that in majority- reason for c-sections was failed labor induction due the poor Bishop's score, not fetal reasons. We hope by putting at rest apprehensions of obstetrician regarding this notion rate of c-sections could be reduced.

Obstetric outcome in pregnancies with borderline versus normal amniotic fluid index

Background: Amniotic fluid is an indicator of placental function on the fetal development. It is regulated by several systems, including transmembraneous pathway, fetal production (fetal urine and lung fluid) and uptake (fetal swallowing), and the balance of fluid movement via osmotic gradients. The amniotic fluid index is the most commonly used method of measuring amniotic fluid. An AFI between 5 to 8 cms is borderline oligohydraminos. To compare the fetal and maternal outcome in pregnancies with borderline amniotic fluid index (5 to 8 cms) and normal AFI.Methods: This prospective cohort study was carried out on 94 pregnant patients attending the antenatal clinic of MES Medical College, Perinthalmanna between January 1st and December 31st 2016. Women with a singleton pregnancy in the third trimester were enrolled into the study. Of these 47 cases were in the normal AFI group and 47 cases in the borderline group. Adequate information was obtained from the patient’s medical record and the groups were compared on maternal and fetal complications.Results: The study results showed that more cases with borderline AFI had their non stress test to be nonreactive (59.6% versus 23.4%) and was associated with more fetal heart rate abnormalities (51% versus 17%). The number of meconium stained amniotic fluid (48.9% versus 19.1%) and caesarean deliveries (51.1% versus 21.2%) were also more among the borderline group.Conclusions: Findings indicated that there are more adverse fetal and maternal outcome among the borderline AFI group.

Study of Oligohydramnios and its perinatal outcome

Background: Importance of amniotic fluid volume as an indicator of fetal status is being appreciated relatively recently. Around 3% to 8% of pregnant women are presenting with low amniotic fluid at any point of pregnancy. The present study was undertaken to study the outcome of pregnancies with Oligohydramnios [(amniotic fluid index) AFI≤5cm] at or beyond 34 weeks.Methods: This study consists of 50 cases of antenatal patients with oligohydramnios (AFI≤5) at or beyond 34 weeks of gestation compared with age and gestation matched 50 normal liquor (AFI≥5 and ≤25). The outcome measures recorded were labor, gestational age at delivery, amniotic fluid index (AFI), mode of delivery, indication for cesarean section or instrumental delivery, APGAR score and birth weight.Results: In the present study, AFI was significantly decreased in cases (3.74±1.2) compared (12.54±2.5) with controls. Variable deceleration was noted in 14 (28%) and late deceleration in 5 (10%) cases. In control group, 2 (4%) had late deceleration. In cases induced labor is in 14 (28%), spontaneous labor 36 (72%). In cases, term normal vaginal delivery was in 15 (30%), PVD in 6 (12%), LSCS in 28 (56%) and instrumental vaginal delivery in 1 (2%). In controls, full term normal vaginal delivery was in 41 (82%), PVD in 5 (10%), LSCS in 4 (8%). APGAR score <7 at 1 minute was in 19 (38%) and at 5 minutes was in 5 (10%) in cases. Birth weight is reduced in cases. IUGR was reported in 9 (18%) in cases.Conclusions: Pregnancies with Oligohydramnios (AFI≤5) is associated with increased rate of non-reactive NST. Routine induction of labor for Oligohydramnios is not recommended. It is preferable to allow patients to go into spontaneous labor with continuous FHR monitoring. Antepartum diagnosis of Oligohydramnios warrants close fetal surveillance.

Maternal and Perinatal outcomes of oligohydramnios in a tertiary care hospital in Salem, Tamil Nadu, India

Background: Oligohydramnios is the term coined for a condition where the amount of liquor amnii is less than 200 ml at term. Using an ultrasonogram, oligohydramnios can be deliberated when the vertical pocket of liquor is less than 2 cm or when amniotic fluid index (AFI) is less than 5 cm. Oligohydramnios is reported to occur in 1 to 5% of total pregnancies. It has been associated with adverse maternal and foetal outcomes.Methods: This hospital-based follow-up study was conducted among 540 pregnant women at 37 weeks attending to the Department of Obstetrics and Gynaecology for a period of 1 year from January to December 2018. All included pregnant women were subjected to routine ultrasound examination and assessment of amniotic fluid volume using Amniotic fluid index.Results: The incidence of oligohydramnios was 17.04% (n=92) among the included women and 62% (n=57) among them were primigravida. Among those women diagnosed with Oligohydramnios, the caesarean section rate was 56.5% (n=52), the common indications for LSCS being fetal distress 44. 2% (n=23) and IUGR 34.6% (n=18). The oligohydramnios pregnancies had more associated post-dated deliveries (28.3%), pregnancy induced hypertension (10.9%) and gestational diabetes (8.7%). It was also associated with higher incidence of low birth weight (27.2%), NICU admissions (32.6%), congenital anomalies (3.3%) and fetal deaths (5.4%).Conclusions: The study showed that an amniotic fluid index of less than 5 at term was associated with adverse maternal and perinatal pregnancy outcomes emphasizing the importance of amniotic fluid volume surveillance during the antenatal period.

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.

Efficacy of oral L-arginine on amniotic fluid index in pregnant women with oligohydramnios attending antenatal clinic in a tertiary care hospital in Telangana, India

Background: Oligohydramnios leads to feto-maternal morbidity and mortality. Though there is no specific treatment for oligohydramnios, use of L-arginine seems to be promising. As a nitric oxide donor, it causes vasodilatation, increases placental perfusion and finally increases amniotic fluid. However, data on the use of L-arginine for oligohydramnios is scarce. Hence, this study was aimed to evaluate the efficacy of oral L-arginine on Amniotic Fluid Index (AFI) and to document the pregnancy outcomes in women with oligohydramnios.Methods: This was a prospective observational study conducted on pregnant women attending antenatal clinic (ANC) at Mediciti Institute of Medical Sciences (MIMS), Ghanpur, Telangana, India from 1st January 2018 to 30th June 2018.Results: A total of 50 participants were enrolled and 4 participants among them were lost to follow- up. Mean age (SD) of the women enrolled was 23.3 (3.49) years. Mean gestational age (SD) at the time of diagnosis was 34.61 (1.53) weeks. Mean AFI (SD) at the time of diagnosis and after treatment with L-arginine were 6.8 (1.3) cm and 9.4 (2.82) cm respectively. After a mean treatment duration (SD) of 3.23 (1.38) weeks, a mean (SD) increase of AFI by 2.6 (1.57) cm (P <0.0001) was observed. An increase of AFI was noted in 84.78% of cases (P <0.0001). Mean (SD) Gestational age at the time of delivery was 38.25 (1.48) weeks. Only 37% of participants required operational deliveries. Mean (SD) birth weight of the new borns was 2.54 (0.47) kg. Neonatal Intensive Care Unit (NICU) admissions were required in 32.6% of new borns.Conclusions: L-arginine is efficacious in improving AFI in oligohydramnios. AFI improvement could possibly lead to better neonatal outcomes by reducing preterm deliveries and operative interventions.

A study on fetal outcome in patients with oligohydramnios

Background: There is an association between oligohydramnios and intrauterine growth restriction as well as increased perinatal mortality. Amniotic fluid provides a protected environment for the growing fetus, moderating the fetus against mechanical and biological injury. The objective of the present study was to study the fetal outcome in patients with oligohydramnios between 20 to 42 weeks of pregnancy.Methods: Prospective study of 87 pregnancies with oligohydramnios was carried in Department of Obstetrics and Gynaecology, NSCB Medical College, Jabalpur from 1st March 2016 to 31stMarch 2017. All women enrolled for the study were subjected to history taking, clinical examination and amniotic fluid index estimation.Results: Rate of caesarean section was higher in patients with oligohydramnios and higher number of neonates were admitted to the NICU amongst the patients of oligohydramnios.Conclusions: Oligohydramnios has a significant correlation with adverse perinatal outcome.

Perinatal outcome in uncomplicated pregnancies with oligohydramnios

Background: Oligohydramnios refers to amniotic fluid volume that is less than expected for gestational age. We aimed to assess the perinatal outcomes in pregnancies with oligohydramnios.Methods: The prospective study was conducted in the Department of Obstetrics and Gynecology, Pravara Medical College, Loni in which 200 consecutive singleton pregnancies delivered vaginally, with intact membranes were included. Amniotic fluid index was determined using the Phelan’s technique at the time of admission and women were diagnosed with oligohydramnios if AFI was five or less, which formed the first group and the rest of mother formed the second group. Perinatal outcomes were noted in the proforma as well.Results: Of the 200 mothers included in the study, 38 had AFI ≤ 5. Baseline characteristics was similar in both the groups. Most common antenatal risk factors studies were pregnancy induced hypertension (29% vs 12%; p value <0.05), intrauterine growth restriction (34% vs 10%; p value <0.001) and severe anemia (21% vs 9%; p value <0.05). Proportion of pregnancies needing induction of labor and birth weight less than 2.5 kgs were significantly higher among mothers with oligohydramnios.Conclusions: Authors observed that induction of labor and low birth weight were significantly associated with oligohydramnios. Prospective randomized trials are needed to establish whether early induction of labor in the presence of a oligohydramnios improves perinatal outcome.