The impact of intrapartum amniotic fluid index on perinatal outcome

ABSTRACT

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