Role of Amniotic Fluid Optical Density (AFOD) and Low dose Isoxsuprine Hcl rapid infusion tocolysis for the management of PTL

Abstract

Background:S.Ramet.al reported: Onset of spontaneous labor occurs at completion of fetal functional maturity at AFOD value of 0.98±0.27 (at 650nm). All these events together occurring at any time from 35+wks to 42+wks indicateindividual term for each fetus .Preterm labors with AFOD 0.98±0.27 are mature and cannot be stopped by any means, as labor cascades are already established. Babies born with AFOD <0.40 arefunctionally premature , and we expected thesepremature laborswouldrespond well for tocolysis and other methods for continuation of pregnancies as labor cascades are not fully established. Methods:In thiscase series study, 22 singleton pregnant women who were inpreterm labor (PTL),and who underwent CRL gestational age estimations, 5 of them PTL with membrane rupture and17 without membrane rupture were included. USG guided amniocentesis was performed as per the ACOG guidelines, and AFOD estimations were done for fresh uncentrifuzed samples. Antenatal corticosteroids, low dose Isoxsuprine Hcl rapid infusion tocolysis, and weekly 17-alphahydroxy progesterone caproate were given. After successful tocolysis and continuation of pregnancies, AFOD estimations were repeated when women presented with labor pains again before 37w+6days. Women were allowed to deliver if mature or near mature AFOD values were observed. AFOD estimations were also done at spontaneous labor or at caesarean sections after 38wks. Babies were observed for functional maturity in terms of color of skin, adherence of vernix, and development of RDS. Results were presented in two tables and analyzed. Results:In non-membrane rupture group (N=17), pregnancies could be continued for 1 to 7 wks. In membrane rupture group, in N=2/5 women leak could be stopped and pregnancies could be continued for 3 to 6 wks. Except one, in both groups all babies could attain mature or near mature AFOD values irrespective of GA and birth weight,noRDS was observed, and all babies survived. Conclusion:WithAFOD guided PTL management coupled with low dose Isoxsuprine Hcl rapid infusion tocolysis, pregnancies could be continued to completion of fetal functional maturity in 21/22 women with good neonatal outcome.