Frequency of Caesarean Section in Pregnancies with Borderline Amniotic Fluid Index at Term

Amna Khanum,Javeria Mushtaq,Khadija Waheed,Khaula Zeeshan,Natasha Bushra,Sara Ejaz

doi:10.21649/akemu.v23i2.1559

Amna Khanum, Javeria Mushtaq + Show 4 more

Open Access

https://doi.org/10.21649/akemu.v23i2.1559

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Abstract

AbstractThe increased risk of caesarean section after induced labour is well documented. Rate of induction of labour has doubled in the past decade from 10 to 20%. Low Amniotic Fluid Index (AFI) as an isolated finding leads to increased obstetrical interventions but without any improvement in outcome.Objectives: To determine the frequency of caesarean section due to failed induction in pregnancies at term with borderline AFI.Patients and Methods: This cross-sectional study was conducted at Department of Obstetrics and Gynaecology, Unit-III, SIMS/Services Hospital, Lahore. The duration of study was one year from January, 2015 to December, 2015. A total of 150 patients were included in this study. AFI was measured by recent obstetric ultrasound. All patients with borderline AFI (5 – 8 cm) were included in the study. They were induced by glandin E2 gel. If induction of patients failed with two doses of glandin E2 gel, given vaginally 6 hours apart, patients were considered for cesarean section. The outcome measure was rate of caesarean section due to failed induction. All data were analyzed by SPSS version 20.Results: Mean age of the patients was 30.34 ± 6.68 years. Mean gestational age was noted 38.34 ± 1.05 weeks. Out of 150 patients, 103 (68.7%) were para 1 – 3 and 47 patients (31.3%) were para 4 – 6. Caesarean section due to failed induction with borderline AFI was performed in 27 patients (18.0%). Stratification with regard to age, gestational age and parity was carried out and was found significant only for gestational age being > 39 weeks.Conclusion: It is concluded that failed induction of labour at term in women with borderline AFI is not associated with increased risk of caesarean delivery.

Highlights

Amniotic fluid estimation is very important in pregnancy as increase or decrease in Amniotic Fluid Index (AFI) is indicator of some complication in pregnancy
It is concluded that failed induction of labour at term in women with borderline AFI is not associated with increased risk of caesarean delivery
In this study we found that the incidence of cesarean in patients with borderline AFI was 18%

Summary

Introduction

Amniotic fluid estimation is very important in pregnancy as increase or decrease in AFI is indicator of some complication in pregnancy. AFI between 5 – 8 cm is considered as borderline.[4] Oligohydramnios and low or borderline AFI is considered associated with raised incidence of complications in high risk pregnancies These mainly include meconium aspiration after birth, reduced fetal heart rate, low Apgar score and increased incidence of cesarean section.[4,5] AFI ≤ 5cm is associated with all these complications during pregnancy; borderline AFI has shown different and variable results in many studies. Luo et al conducted a trial and compared the outcome between patients with borderline and normal AFI. They found no significant difference in fetal distress and neonatal mortality between two groups. The incidence of cesarean rate was significantly higher in patients with borderline AFI.[6]

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