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Background: The amniotic fluid encloses and protects the fetus within the amniotic cavity in uterus. Amniotic fluid allows room for fetal growth, movement and development. The abnormal amniotic fluid either high or low volumes helps to diagnose the reduced fetal outcomes. This fluid is an important predictive tool for assessing the development of pregnancy.Methods: The present study is done to assess the effectiveness of intravenous (IV) hypotonic saline fluid maternal hydration on oligohydramnios. This study was conducted in department of obstetrics and gynecology, CHRI for 18 months. About 30 participants of third trimester with amniotic fluid index (AFI)<8 cm with the gestational age of 34-40 weeks were included. The study was done on pregnant mothers with AFI<8 cm and gestational age of 34-40 weeks. Measurement of AFI was done for all participants. The patients received 2 liters of hypotonic saline fluid over 4 hours. AFI was measured again 24 hours after baseline measurement. Treatment with IV infusion of hypotonic saline fluid is resulted in better increase in AFI in oligohydramnios.Results: After hypotonic saline infusion, the patient抯 AFI level was 7.14�31 with the p=0.000*** and it was statistically significant.Conclusions: The blood parameters and the electrolytes showed no notable changes before and after the infusion of hypotonic saline with regular antenatal visits, oligohydramnios can be detected early by clinical examination and routine ultrasonography and the proper treatment will help in preventing the complications of oligohydramnios.
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Background: Aim of the study were to evaluate the fetal outcome associated with borderline amniotic fluid index (AFI) at pregnancy 36 weeks and beyond and to study the mode of delivery among these patients.Methods: A 60 pregnant subjects who were at 36-42 weeks period of gestation and ultrasonically diagnosed to have AFI less than or equal to 8 cm were included in the study and were compared to 50 pregnant patients with normal amniotic fluid. They were monitored throughout labour and fetal outcome was studied.Results: Fetal distress was observed in 60.4% cases leading to immediate termination of pregnancy. Incidence of meconium stained liquor was found significantly high (75%). Neonatal morbidity was found to be significantly high. Low birth weight (31.6%), Apgar score less than 7 at 5 minutes (20%), NICU admission (71.6%), meconium stained liquor (23.3%) were observed.Conclusions: That there is a high risk of adverse perinatal outcome in cases of Borderline AFI at pregnancy 36 weeks and beyond. Providing intensive intrapartum monitoring and good NICU facilities for such cases is necessary to optimise the fetal outcome.
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Background:Acute undifferentiated febrile illness (AUFI / AFI) is a common cause for patients seeking hospital care in tropical countries like India. Non-specificity of symptoms and lack of appropriate diagnostics pose a challenge, especially in resource-limited settings. Investigation into the etiology and trends of AUFI provide valuable public health data to target clinical workup and guide optimal treatment.Method: A record-based descriptive study was conducted on all AFI cases presented to a Government tertiary care centre in a tribal hilly state of Northeast India in the year 2021. Result: Under five children were the most affected and respiratory infections were the most common cause of fever.Enteric fever and scrub typhus were the most common cause of undifferentiated fever.However, it was a remarkable finding that no case of malaria or dengue was reported from this region. Fevers remained undetermined in 28% of cases.Undetermined fevers and scrub typhus had higher occurrence during winters while no seasonality was observed with enteric fever. The majority of the patients recovered and were discharged. The case fatality rate was 0.35%. Conclusion:The local epidemiology of AUFI can help guide presumptive diagnosis and deliver optimal patient management in these settings.Typhoid and scrub typhus are to be considered differentials for AUFI in this region.
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Background: Amniotic fluid plays a major role in the fetal growth and development. It provides the fetus with a protective low resistance environment suitable for growth and development, a cushion against the constricting confines of the gravid uterus, allowing the fetus room for the movement and growth and protecting it from external trauma. The abnormalities of the fluid volume can interfere directly with the fetal development or may be an indirect sign of underlying disorder such as fetal hypoxia, neural tube defect or gastrointestinal obstruction. Aim of this study was to determine whether an amniotic fluid level of 5cm or less can be predictor of adverse perinatal outcome in terms of fetal distress, birth weight, APGAR score and neonatal morbidity and mortality.Methods: Amniotic fluid index (AFI) was determined with a b-mode real time scanner with linear transducer operated at 3.5 MHz. AFI estimation done by four quadrant technique in supine position. The summation of measurement from each quadrant represented the amniotic fluid index in centimeters of each patient. Fetal outcome was assessed with respect to birth weight and gestational age; Apgar score at one and five minutes; any other neonatal complications intrapartum or postpartum during stay in hospital and maturity of baby - condition at the time of discharge of mother and baby.Results: The labor was induced in 28% women with AFI <5cm, out of which 19 women delivered vaginally and 9 women underwent LSCS for failure of induction. The mean birth weight was 2.61 kg in our study. Maximum number of babies i.e. 57% were with birth weight between 2.1-2.5 kg. The APGR score at 5 min was 9 in 71% cases and 8 in 21% cases. The mean APGR score at 5 min was 8.63.Conclusions: AFI can be used as an adjunct for fetal surveillance along with other methods to identify high risks foetuses to improve the perinatal outcome.
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The occurrence of oligohydramnios complicating a pregnancy is seen in 0.8 to 5.5 % of pregnancies. Severe Oligohydramnios, though not clearly defined, but clinically with an AFI of less than 5 cm appears to be an important predictor for an abnormal fetal outcome. In general, the prognosis of mid trimester oligohydramnios is still poor. Hence we report a case with a very favourable neonatal outcome following severe oligohydramnios documented in early pregnancy. The aim of this case report is to add our experience to the currently limited literature regarding the best treatment of this unique obstetrical problem.
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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.
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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.
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Background: Decreased amniotic fluid is related to adverse maternal and perinatal outcomes. The purpose of this study was to evaluate the role of amino acid infusion in patients of oligohydromnios and compare the perinatal outcome in the two groups.Methods: This study was conducted in the Department of Obstetrics and Gynaecology, ASCOMS Hospital, Jammu for a period of one year from October 2017 to September 2018. A total of 50 women with AFI <8 cm were enrolled in the study . They were divided into two groups of 25 each. Group A were given amino acid infusion and Group B were not given any intervention. These were compared for increase in AFI and perinatal outcome.Results: In the present study, the gain in AFI in Group A was 2.32 ± 0.67 and in group B was 1.32 ± 1.03 which was statistically significant. The perinatal outcome was better Group A compared to Group B with decreased incidence of meconium stained liquor, low birth weight, low APGAR scores and NICU admissions and increase in vaginal deliveries as compared to caesarean sections.Conclusions: The present study suggests that parentral transfusion of amino acid in cases of oligohydromnios significantly increases the AFI of the patient and decreases the incidence of caesarean sections, meconium stained liquor, low APGAR scores and NICU admissions.
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Background: Fetal distress in labour is a common occurrence and is of great concern. Evaluation in early labor which could predict the risk of fetal distress could aid in the management of labour. Aim: The purpose of the study was to determine the value of routine intrapartum amniotic fluid assessment on perinatal outcome. Materials and methods: Study was done on 240 admitted patients in labou. They had an intrapartum AFI determined by four-quadrant technique subsequently these patients delivered during the same hospitalization. AFI determined was graded as Oligohydramnios was defined as AFI ≤ 5 cm (n = 48), Borderline as AFI 5.1- 8 cm (n = 50), Normal as AFI 8.1-24 cm (n = 142) and Women with AFI > 24 cm were not included in the study. The three groups were compared with regard to intrapartum and postpartum variables. Results: In present study, 20% of women were in oligohydramnios group, 21% in borderline group and 59% in normal group. Hence, the cesarean section rate for fetal distress was 54% in oligohydramnios and 28% in borderline group. The incidence of instrumental delivery for fetal distress was 12% in oligohydramnios and 14% in borderline. The incidence of APGAR score < 7 at 1 min and 5 min in oligohydramnios and borderline group were respectively 54%, 35%; and 30%, 14%. The incidence of birth weight <2500 gms in oligohydramnios group was 37% and borderline was 24%. NICU admissions in oligohydramnios group were 40% and 8% in borderline group. The percentage of neonatal deaths among oligohydramnios group was 4.2% and nil in borderline. The efficacy of intrapartum determination of oligohydramnios predicting cesarean delivery for fetal distress gave a sensitivity of 64%, specificity of 89%, positive predictive value of 53% and negative predictive value of 93%. Conclusion: Intrapartum detection of oligohydramnios is a valuable screening test for subsequent fetal distress requiring cesarean delivery
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OBJECT: The nonstress test(NST) and complete biophysical profile(BPP) were compared with the rapid biophysical profile(BPP) in order to evaluate the efficacy of the rapid BPP, namely, the combination of amniotic fluid index(AFI) and sound-provoked fetal movement(SPFM) detected by ultrasound, in predicting intrapartum fetal distress in high-risk pregnancies. STUDY DESIGN: From JAN 9th 2000, through JAN 5th 2001, the prospective study of diagnostic tests was conducted on a total of 91 high-risk singleton pregnancies, undergoing antepartum assessment both the standard NST and the new rapid BPP(including other indices of complete BPP). The diagnostic indices of the NST, rapid BPP and complete BPP were calculated in term of predicting intrapartum fetal distress. RESULT: The sensitivity, specificity, negative predictive value, and positive predictive value of NST were 50.00, 94.81, 96.05, and 42.86% respectively, and those of rapid BPP were 75.00, 98.53, 98.53, and 75.00%, and those of complete BPP were 83.33, 98.72, 98.72, and 83.33%, as well. In addition, the efficiency of NST, rapid BPP, and complete BPP were 91.57%, 97.22% and 97.62% respectively. CONCLUSIONS: The rapid BPP is an effective and reliable predictor of intrapartum fetal distress with high-risk pregnancies. Moreover, it may be inexpensive and less time-consuming method.