Borderline amniotic fluid index as a predictor of adverse perinatal outcomes

J A J N Jayasinghe,W Gunawardana,W Fernandupulle

doi:10.4038/sljog.v41i3.7894

Abstract

Objectives: To determine whether the borderline amniotic fluid index (bAFI) at term in low risk pregnancies is associated with adverse perinatal outcome Method: A retrospective cohort study carried out over a period of 3 months. 303 uncomplicated pregnant women who delivered at term and who had amniotic fluid assessment in 4 days of delivery were recruited. An AFI of 5-10 cm was defined as borderline and an AFI of 10 cm- 24 cm normal. Intrapartum pathological cardiotocograph (CTG), meconium stained amniotic fluid (MSAF) at amniotomy or spontaneous rupture of membranes (SROM), instrumental vaginal delivery (IVD) or emergency caesarean delivery (CD) due to fetal distress, 5 min APGAR less than 7 and admission to the neonatal unit (NNU) were considered as the measures of adverse perinatal outcomes. Results: Eighty three (27.0%) of the 303 subjects had borderline AFI. Statistically significant differences were observed between the proportions of patients in the two groups with regard to MSAF at amniotomy, (18.1% vs. 17.7%, RR 1.02, 95% CI 1.23 to 1.76, p= 0.01) or SROM (48.2% Vs 60%, RR 0.80, 95% CI 1.2 to 2.1), AVD or emergency LSCS due to fetal distress (P= Conclusions: Women with borderline AFV have a higher chance of their babies getting admission to the NNU immediately after delivery. Meconium stained amniotic fluid, non-reassuring CTG changes and interventions due to fetal distress, which were statistically significant, may contribute to above observation.

Highlights

Antenatal and intrapartum fetal surveillance is a fast evolving field aiming to reduce the adverse perinatal outcomes (APO)[1]
Significant differences were observed between the proportions of patients in the two groups with regard to meconium stained amniotic fluid (MSAF) at amniotomy, (18.1% vs. 17.7%, RR 1.02, 95% CI 1.23 to 1.76, p= 0.01) or spontaneous rupture of membranes (SROM) (48.2% Vs 60%, RR 0.80, 95% CI 1.2 to 2.1), AVD or emergency LSCS due to fetal distress (P=
Intra partum pathological CTG (4.8% vs. 1.4%RR 3.42, 95% CI 0.56 to 2.67, P= 0.10), and less than 7 APGAR at 5 minute after delivery (2.4% vs. 0.5%, RR 4.8, 95% CI 0.67to 2.83, p= 0.05),) were not statistically significant

Summary

Introduction

Antenatal and intrapartum fetal surveillance is a fast evolving field aiming to reduce the adverse perinatal outcomes (APO)[1]. As the intra partum fetal monitoring and timely intervention reduces the incidence of neonatal morbidity and mortality abundant techniques for assessing fetal wellbeing have evolved significantly over the last few decades[1]. Accepted interventions compose are fetal heart rate monitoring (Auscultation and Cardiotocography), real time ultrasound guided fetal biometry, amniotic fluid volume, and Doppler blood floor assessment, biophysical profile and evaluation of fetal ECG with ST analysis and fetal scalp blood sampling[1,2]. Out of the above parameters real time clinical sonography plays a major role in assessing fetal wellbeing, to estimate fetal weight, Biophysical profile, and Amniotic fluid volume and Doppler studies[1,3]. Amniotic fluid volume is considered as an indirect, yet a dynamic parameter of feto-placental function mainly in the latter part of pregnancy[4]. The Dye-Dilution technique accurately measures the AFV, it is time consuming, invasive and depend on skilled personnel and laboratory facilities which persuade obstetrician to welcome indirect measures, generally clinical sonography[1,5]

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