Borderline Amniotic Fluid Index Research Articles

Clinical and Sonological Evaluation of Borderline Amniotic Fluid Index and Oligohydramnios-Its Correlation with Perinatal Outcomes

Objective: To evaluate the correlation of low borderline amniotic fluid index and oligohydramnios with perinatal outcomes among pregnant females presenting at the tertiary care hospital of Karachi. Study Design: Cross-sectional study.Place and Duration of Study: The study was conducted at the Department of Obstetrics and Gynecology, Hamdard University, Karachi, Pakistan, from March 2021 to March 2022.Methods: Females aged 18-45 years, with a gestational age of 20-42 weeks assessed on the last menstrual period and a single fetus on ultrasound were enrolled. The final sample size for the study was determined to be 260 with 130 participants in each group, i.e., the females with Amniotic Fluid Value (AFI) value of ≤5 cm considered as oligohydramnios (group-1) and AFI value of 5.1 to 8 cm considered as borderline AFI (group-2)The amniotic fluid index value was determined in all the females using ultrasonographic reports by the consultant physicians. Females were classified as having oligohydramnios if their amniotic fluid index value was less than 5 cm and borderline amniotic fluid index between 5.1 and 8 cm. To evaluate the maternal and perinatal outcomes, all females were monitored up to birth. Data was analyzed using SPSS version 23.Results: The mean maternal age was 29.85±5.45 years, and the mean BMI was 29.78±5.62 kg/m . Most of the females had gravida ≥1. Females with oligohydramnios had higher rates of low birth weight (84.6% vs. 51.5%, p=0.001), IUGR (68.5% vs. 22.3%, p=0.001), meconium staining (42.3% vs 7.7%, p=0.001), low APGAR score (50.8% vs. 13.8%, p=0.001), respiratory distress syndrome (72.3% vs 27.7%, p=0.001), birth asphyxia (65.4% vs 23.1%, p=0.001), NICU admission (73.8% vs. 43.1%, p=0.001), and neonatal death (21.5% vs. 5.4%, p=0.001) than women with borderline amniotic fluid index.Conclusion: This observational study demonstrates a significant correlation between oligohydramnios and adverse perinatal outcomes, emphasizing the importance of vigilant monitoring and intervention in pregnancies with low amniotic fluid. How to cite this: Jamsheed S, Abid K. Clinical and Sonological Evaluation of Borderline Amniotic Fluid Index and Oligohydramnios-Its Correlation with Perinatal Outcomes. Life and Science. 2024; 5(1): 16-21. doi: http://doi.org/10.37185/LnS.1.1.378

Evaluation of Perinatal Outcomes in Pregnant Women With Low Amniotic Fluid Index

Objective: The outcomes and management of low amniotic fluid index (AFI) in pregnancy are controversial. The purpose of this study was to determine the relationship between low AFI and perinatal outcomes.
 Materials and methods: This prospective study was conducted on 420 uncomplicated singleton pregnant women with a gestational age of over 28 weeks who referred to Al-Zahra Hospital in Rasht (Iran) for routine perinatal care. Pregnant women were divided into 3 groups of 140 patients based on the AFI and were followed up until delivery. Three groups included normal (8<AFI≤25 cm(, borderline )5<AFI≤8 cm( and oligohydramnios (AFI≤5cm( AFI.
 Results: The three adverse outcomes of respiratory distress, hospitalization in NICU, and length of hospitalization were statistically significantly different between the two groups with normal and borderline AFI and in the borderline group was more than the normal group. Adverse outcomes including; low birth weight (LBW), small for gestational age (SGA), respiratory distress, 1- min APGAR scores<7, hospitalization in NICU and its duration were statistically significantly different between the two groups with normal AFI and oligohydramnios, and it was more in the oligohydramnios group than the normal group. The three adverse outcomes of LBW, SGA and1- min APGAR scores<7 in the two borderline and oligohydramnios groups had statistically significant differences and were more in the oligohydramnios group than the borderline group.
 Conclusion: Consideration to the AFI in perinatal care to predict adverse perinatal outcomes and perform necessary interventions to improve these outcomes is necessary.

Comparison Of Maternal And Perinatal Outcome Of Isolated Borderline Amniotic Fluid Index Versus Normal Amniotic Fluid In Low-Risk Pregnancies At Term

Objective: The objective of the study was to compare the maternal and perinatal outcomes in low-risk pregnancies having borderline Amniotic fluid index with normal amniotic fluid index at term. Methods: This prospective observational study, included 540 low-risk pregnant women admitted at POF Hospital Wah Cantt between 1st June 2020-31st Dec 2022. Group A had 180 women with borderline AFI having normal umbilical artery Doppler and group B had 360 women with normal AFI between 37-40 weeks, who fulfilled the inclusion criteria. The data regarding baseline characteristics and fetomaternal outcome was collected on an already designed proforma and analysis was done by using SPSS version 23. Results: The difference in overall cesarean section rate (p=0.071) and cesarean section for fetal distress (p=0.076) was not statistically significant between the two groups. The borderline AFI did not increase the risk of meconium-stained liquor (p=0.116), 5minute APGAR score <7 (p=0.218), admission to NICU (p=0.064) and low birth weight (mean birth weights p=0.278) compared to normal AFI. Conclusion: Borderline oligohydramnios does not increase the risk of cesarean section and cesarean section for fetal distress. There is no increase in the risk of meconium-stained liquor, 5-minute APGAR score<7, admission to NICU and low birth weight. Keywords: Amniotic fluid index, borderline oligohydramnios, cesarean section, fetal distress, meconium-stained liquor.

Evaluation of Pregnancy Outcomes of Women with Borderline Amniotic Fluid Index Measured in the Second Trimester

Objective: The aim of this study is to evaluate the pregnancy outcomes of pregnant women who were found to have borderline amniotic fluid index (AFI) in second trimester. Materials and Methods: 71 patients who underwent second trimester ultrasound scan (18-24 weeks) between 1 February and 1 August 2021 at our clinic were investigated retrospectively. Patients with borderline AFI (5-8 cm) and who gave birth in the same center were selected. Pregnancy outcomes such as mode of delivery, gestational age at birth, 1st minute APGAR score and birth weights were examined. All data were obtained from the hospital database.  Results: In the study sample, the mean age was 28.2±6.7, the mean gravida was 2±1.4 and the mean week of gestation in which AFI was measured was 22±2.5. 38.1% of the pregnancies (27 patients) resulted in cesarean section. 18.3% of births (13 patients) occurred at preterm. 16.9% of pregnancies (12 patients) resulted in low birth weight. APGAR score at 1-minute was 8 and above in all term newborns. Conclusions: Borderline AFI detected in the second trimester is a challenging issue for the obstetricians in terms of clinical management. There is insufficient evidence in the literature regarding the effect of borderline AFI on pregnancy outcomes, and previous studies have reported controversial results. Compared to the findings of previous studies, our results support the studies reporting adverse effects of borderline AFI on pregnancy outcomes.

Is borderline oligohydramnios a problem at term pregnancy? a prospective study of a tertiary hospital

Aims: The objective of this study is to conduct a comparative analysis and ascertain the perinatal and early postnatal outcomes in term pregnant women who have a borderline amniotic fluid index (AFI) in comparison to those with a normal AFI.
 Methods: This prospective study was conducted on 376 pregnant women of 37-42 weeks gestational age. Ultrasound evaluation was performed, and the AFI was calculated. Borderline and normal AFI were defined as 5.1 < AFI < 8 cm and 8.1 < AFI < 24 cm, respectively. Age, body mass index, gestational age at delivery, gravida, and parity were compared between the borderline and normal AFI groups, patient demographics, obstetric data, and information on delivery complications data were recorded. Newly born babies received a thorough physical evaluation and were followed up for two months by a neonatologist. Umbilical artery pH, birth weight, admission to neonatal intensive care unit (NICU), neonatal complications were also reported.
 Results: There were 202 patients in the borderline AFI group and 174 patients in the normal AFI group. There was no statistically significant difference between groups in terms of normal delivery, operative vaginal delivery, elective cesarean delivery, or emergency cesarean delivery (p=0.088). Apgar score at 5 minutes, umbilical artery pH value, birth weight, admission to the NICU, small for gestational age, and cesarean delivery for non-reassuring fetal heart rate testing were not statistically different between the groups (p=0.139, p=0.644, p=0.790, p=0.317, and p=0.16, respectively)
 Conclusion: Our study indicates that borderline oligohydramnios does not have an adverse effect on perinatal or early postnatal outcomes in term pregnancy.

Assessment of Perinatal Outcomes in Pregnant Women with Borderline Amniotic Fluid Index

Assessment of Perinatal Outcomes in Pregnant Women with Borderline Amniotic Fluid Index

Study of Doppler Velocimetry abnormalities in term low risk pregnancies with borderline amniotic fluid index

Study of Doppler Velocimetry abnormalities in term low risk pregnancies with borderline amniotic fluid index

Perinatal Outcome in Patients with Borderline AFI

Background: During pregnancy, amniotic fluid indicates the normal placental function. It is the most essential element for surveillance of fetal growth and health. Amniotic fluid index (AFI) is the most ideal way to determine the level of amniotic fluid during pregnancy. However, the single deepest pocket is applied to determine the changes in AFI level in pregnancies suspected to oligohydramnios. Borderline AFI is defined as AFI levels > 5 to < 10cm; it is a challenging task in obstetrics to associate it with adverse pregnancy outcomes. Objective: To assess the perinatal outcomes in patients with borderline AFI. Study Design: Cross-sectional. Setting: Department of Obstetrics & Gynaecology, Sharif Medical City Hospital, Lahore. Study Duration: Study was carried out over a period of six months from 10-11-2020 to 11-05-2021. Subjects And Methods: A total of 160 patients having borderline AFI (more than 5 and less than 10cm) were included in the study. Perinatal outcomes were assessed at the time of delivery in the hospital. Data Analysis Method: Stratification of data was carried out with regard to age, gestational age, parity and area of residence. Results: Mean age of the patients was 25.17±4.90 years. Mean gestational age was observed to be 38.44±1.54 weeks. Majority of the patients were between Para 0 to 3. There was no smoker in preset study. Most of the patients belonged to rural area. Perinatal outcomes were as follows: Intrapartum fetal distress was observed in 64 (40%), meconium staining in 56 (35%), Apgar score < 10 at 5 minutes in 37 patients (23.1%) and NICU admission in 38 (23.8%). Conclusion: In conclusion, borderline AFI during pregnancy can lead to severe hazardous consequences. Therefore, pregnancy complicated with borderline AFI must be observed carefully in order to improve the outcome of pregnancy and avoid adverse perinatal outcomes. Keywords: Borderline AFI, Apgar Score, NICU Admission, Intrapartum Fetal Distress, Meconium Staining.

Borderline amniotic fluid index in nigerian pregnant women is associated with worse fetal outcomes: Results of a prospective cohort study.

The amniotic fluid index (AFI) is one of the parameters used to assess fetal well-being and predict perinatal outcomes. There is, however, a dearth of studies on the pregnancy outcomes of women with borderline AFI in Nigerian and African women. To compare the pregnancy outcomes of Nigerian women with borderline and normal amniotic fluid index. This was a prospective cohort study conducted at two health facilities in Delta State, Southern Nigeria. A total of 114 pregnant women attending the antenatal clinics with singleton pregnancies at gestational age 37 to 41 + 6 weeks were recruited over a 5-month period. Fifty-seven subjects with borderline amniotic fluid index were matched with an equal number of subjects with the normal amniotic fluid index for gestational age, age of the parturient, and parity. These women were followed up till delivery, and pregnancy outcomes were determined. The data were analyzed using the Statistical Package for the Social Sciences (SPSS) version 22 software. The results showed that borderline amniotic fluid index was associated with increased risk of adverse pregnancy outcomes including intrapartum fetal distress, Appearance, Pulse, Grimace, Activity, and Respiration (Apgar) score <7 in 5 min, and birthweight <2.5 kg, and these were statistically significant (P = 0.04, 0.01, and 0.04, respectively). Borderline AFI is associated with an increased risk of adverse pregnancy outcomes in low-risk Nigerian women.

Assessment of Correlation between Amniotic Fluid Index (AFI) and Feto-maternal Outcomes of In-term Pregnancies

Background: Amniotic fluid plays a crucial role in providing basic life support to the fetus. This clear, slightly yellowish liquid that surrounds the fetus is helpful in the development of fetal systems by providing thermally controlled and a non-restricted sterile environment for fetal growth. During labour, amniotic fluid helps in providing an adequate cushion for umbilical cord. It is this mechanical function of the cushion which aids in preventing compression of cord in-between fetus and uterine wall during uterine contractions and fetal movements. Therefore, helps to prevent fetal distress. It protects fetus from any kind of injury and helps in preventing infection by its bacteriostatic properties. This study aims to estimate the effect of decreased amniotic fluid index (AFI) on maternal and fetal outcomes in term pregnancy.&#x0D; Materials and Methods: This will be a Prospective cross sectional observational study conducted in OBGY dept. of AVBRH, Wardha. Pregnant women will be enrolled and divided into 3 groups as per Amniotic Fluid Index. Group A with low amniotic fluid index (AFI&lt; 5 cm) Group B with borderline amniotic fluid index (AFI&gt;5cm and &lt;8cm)and Group C with normal amniotic fluid index (AFI 8cm-24cm). Data will be collected, analysed and compared between the groups in terms of the ultrasonographic findings and feto-maternal outcomes of in term pregnancy.&#x0D; Expected Results: Significant correlation is expected between AFI and feto-maternal outcomes.&#x0D; Conclusion: Unexpected adverse outcomes can be minimized by estimation of AFI and timely antepartum treatment in mothers with decreased AFI.

Borderline Amniotic Fluid Index, Fetal Doppler Indices and Non-Stress Test as Predictors of Poor Perinatal Outcomes

Borderline Amniotic Fluid Index, Fetal Doppler Indices and Non-Stress Test as Predictors of Poor Perinatal Outcomes

Comparison of Perinatal and Maternal Outcomes in Borderline Versus Normal Amniotic Fluid Index in a Tertiary Care Center in Odisha: An Observational Prospective Study.

BackgroundAmniotic fluid is a protective fluid in the amniotic sac of a gravid uterus that serves many crucial functions by becoming part of an indicator of a functioning fetoplacental unit during the intrauterine life of a fetus. The most commonly used method for measuring amniotic fluid is the amniotic fluid index (AFI). In this study, we aimed to investigate the perinatal and maternal outcomes in borderline AFI versus normal AFI.MethodologyThis observational prospective study included 200 pregnant women who were admitted to Pradyumna Bal Memorial Hospital, Bhubaneswar from September 2019 to February 2021. Women with singleton pregnancy in their third trimester were enrolled in this study after applying inclusion and exclusion criteria. Of the included women, 100 were cases with borderline AFI, and 100 were control with normal AFI. Fetal and maternal outcomes were compared between the two groups. Data analysis was done using SPSS version 23 (IBM Corp., Armonk, NY, USA).ResultsMaternal outcomes such as preterm delivery, meconium-stained liquor, and lower segment cesarean section in women with borderline AFI were significantly higher (p ≤ 0.001). The borderline AFI group had a higher rate of perinatal complications such as Apgar score of <7 (p = 0.001), respiratory distress syndrome (p = 0.001), neonatal intensive care unit admission (p <0.001), intrauterine growth restriction (p < 0.001), and low birth weight (p < 0.001).ConclusionsThe borderline AFI group was associated with adverse perinatal and maternal outcomes which were significantly higher in this group compared to the control group. Therefore, patients with borderline AFI should be monitored carefully during the antepartum and intrapartum period.

Mild Fetal Tricuspid Regurgitation in the First Trimester as a Predictor of Perinatal Outcomes.

sBackground and Objectives: This study aimed to investigate whether mild fetal tricuspid regurgitation (TR) at 11+ 0 to 13+ 6 weeks of gestation affects perinatal outcomes. Since fetal right ventricular load is associated with placental resistance, we hypothesized that fetal mild TR would be associated with perinatal outcomes as a consequence of abnormal placentation. Materials and Methods: We retrospectively evaluated 435 women with first-trimester scan data. Blood flow across the tricuspid valve was examined in singleton pregnancies between 11+ 0 and 13+ 6 weeks of gestation. Women were categorized according to the presence or absence of fetal mild TR, and the maternal and pregnancy characteristics and perinatal outcomes were compared. Multiple linear and logistic regression analyses were conducted to identify independent predictors of perinatal outcome. Results: In the group with mild TR, there were more cases of borderline amniotic fluid index, including oligohydramnios (p = 0.031), and gestational age- and sex-specific birth weights were lower (p = 0.012). There were no significant differences in other perinatal outcomes, including preeclampsia, gestational hypertension and small for gestational age. Gestational diabetes (adjusted odds ratio (OR) 0.514, 95% confidence interval (CI) 0.312–0.947) and fetal mild TR (adjusted OR 1.602, 95% CI 1.080–2.384) were identified as factors associated with below borderline amniotic fluid index before birth. The factors that affected gestational age and sex-specific birth weight were also gestational diabetes (adjusted beta coefficient 9.673, p = 0.008) and the presence of fetal mild TR (adjusted beta coefficient −6.593, p = 0.007). Conclusions: Mild fetal TR observed in the first trimester is negatively associated with fetal growth and the amniotic fluid index at term but not with other adverse pregnancy or perinatal outcomes due to abnormal placentation.

Comparison of Outcome of Borderline and Normal Amniotic Fluid Index in Term Pregnancy

Background Determination of Amniotic Fluid Index (AFI) is an important component of antepartum assessment of all normal pregnancies.&#x0D; Objective To compare the obstetric interventions and neonatal outcomes in term pregnancies with borderline Amniotic Fluid Index versus normal Amniotic Fluid Index.&#x0D; Method This hospital based prospective study was conducted at Tribhuwan University Teaching Hospital over 1 year between 2017 and 2018 in 128 women having uncomplicated term pregnancy admitted in labor ward. Of the 128 women, 64 women had borderline Amniotic Fluid Index (5.1-8 cm) and 64 normal AFI (8.1 - 24 cm). Parameters studied were induction of labor, cesarean section, instrumental delivery, intrapartum abnormal fetal heart rate, meconium staining of liquor, APGAR score at 5 and 7 minutes, birth weight, neonatal intensive care unit (NICU) admission and neonatal death. Data was analyzed using software OpenEpi.&#x0D; Result Statistically significant difference in result was obtained in the two groups in terms of rate of induction of labor (73.4% vs 35.9%, p = 0.0001, OR = 4.9), rate of cesarean section (42.1% vs 28 .1%, p = 0.04, OR = 1.8), tachypnea (50% vs 11.1%, p = 0.01) and low birth weight (9.1% vs 4.5%, p = 0.04). No statistical significance was found in meconium staining of liquor (33% vs 38.3%, p = 0.3) and APGAR score of &lt;7 at 5 minutes (3.1% vs 1.5%, p = 0.06). There were no neonatal intensive care unit admissions and neonatal mortality in any of the babies.&#x0D; Conclusion Detection of amniotic fluid volume at term is important for timely maternal interventions to improve the overall fetal outcome.  

Borderline amniotic fluid index as a predictor of adverse perinatal outcomes

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.

Perinatal outcomes following labor induction with dinoprostone in pregnancies with borderline amniotic fluid index at term: A clinical observation study.

To compare perinatal outcomes of dinoprostone for induced labor in pregnancies with a borderline versus normal amniotic fluid index (AFI) at term, and to investigate the related factors affecting outcomes of cesarean section. The retrospective study was carried out in Hubei Maternal and Child Health Hospital with singleton pregnancies of 37-42 weeks' gestation from January to August 2016. A total of 992 subjects were divided into two groups: borderline AFI group (n =125) with 5 < AFI ≤ 8 and normal AFI group (n = 867) with 8 < AFI ≤ 24. Time to delivery (P =0.004) and use of oxytocin augmentation (P = 0.011) were significantly lower in pregnancies with borderline AFI. There were no significant differences between the two groups in terms of delivery mode, time to onset of labor, fetal distress, Apgar scores, meconium-stained amniotic fluid, birth weight, or incidences of admission to neonatal intensive care unit (NICU). Gestational hypertension and birth weight were the major factors affecting outcomes of cesarean section in the borderline group (odds ratio [OR] = 13.61, 95% confidence interval [CI] 1.96-94.49, P =0.008 and OR = 1.003, 95% CI 1.001-1.005, P =0.001, respectively). Maternal age (OR = 1.12, 95% CI 1.06-1.19, P < 0.001), parity (OR = 7.57, 95% CI 3.05-18.76, P < 0.001), biparietal diameter (OR = 0.55, 95% CI 0.33-0.91, P = 0.021), and meconium-stained amniotic fluid (OR = 1.56, 95% CI 1.12-2.17, P = 0.009) were related factors in the normal group. The perinatal outcomes of dinoprostone for induced labor are comparable between the two groups. Gestational hypertension and birth weight are factors related to outcomes of cesarean section in the borderline group.

Effect of vaginal trial production on pregnancy outcome in pregnant women with limited amniotic fluid

Objective To analyze the effect of vaginal trial production on pregnancy outcome in pregnant women with limited amniotic fluid. Methods 88 cases with normal amniotic fluid index(AFI) were selected as control group.88 cases with a borderline AFI were selected as observation group.AFI was used to assess maternal amniotic fluid, and all women without other risk factors.The maternal pregnancy outcome was compared between the two groups. Results The amniotic fluid volume, midwifery time, natural delivery rate and cesarean section rate of the observation group were (308.63±148.69)mL, (25.98±7.62)h, 40.91%(36/88), 52.27%(46/88), respectively, which of the control group were (628.51±120.34)mL, (17.63±5.84)h, 60.23%(53/88), 30.68%(27/88), respectively, there were statistically significant differences between the two groups (t=14.43, 8.16, χ2=6.57, 8.45, all P 0.05). Conclusion Ultrasound diagnosis of amniotic fluid less than full-term maternal, after careful clinical monitoring can be vaginal trial production. Key words: Oligohydramnios; Pregnancy trimester, third; Pregnancy outcome

Perinatal outcomes in uncomplicated late preterm pregnancies with borderline oligohydramnios

Purpose: The purpose of this study is to determine the adverse perinatal outcomes in uncomplicated late preterm pregnancies with borderline oligohydramnios.Methods: A total of 430 pregnant women with an uncomplicated singleton pregnancy at a gestational age of 34 + 0–36 + 6 weeks were included. Borderline oligohydramnios was defined as an amniotic fluid index (AFI) of 5.1–8 cm, which was measured using the four-quadrant technique. Adverse perinatal outcomes were compared between the borderline and normal AFI groups.Results: Approximately 107 of the 430 pregnant women were borderline AFI, and 323 were normal AFI. The demographic and obstetric characteristics were similar in both groups. Delivery <37 weeks, cesarean delivery for non-reassuring fetal heart-rate testing, meconium-stained amniotic fluid, Apgar 5 min <7, transient tachypnea of the newborn, respiratory distress syndrome, neonatal intensive care unit, and hyperbilirubinemia were not statistically different between the groups (p = .054, p = .134, p = .749, p = 0.858, p = .703, p = .320, p = .185, and p = .996, respectively). Although gestational age was full-term, induction of labor rates were significantly higher in the borderline AFI group (p = .040). In addition, fetal renal artery pulsatility index pulsatility index (PI) was significantly lower in the borderline AFI group than in the normal AFI group (p = .014).Conclusion: Our results indicated that borderline AFI was not a risk for adverse perinatal outcomes in uncomplicated, late preterm pregnancies.

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

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 &gt; 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.

Adverse perinatal outcomes in borderline amniotic fluid index

Normal amniotic fluid predicts normal placental function, fetal growth and fetal well-being. To determine adverse pregnancy outcomes in borderline amniotic fluid index (AFI). Pregnant women (37-40 wks) with diagnosis of borderline AFI between December 2012 and August 2014 were identified. Antepartum, intrapartum and neonatal data were collected and compared with those of pregnant women with normal AFI. An AFI less than 8 and more than 5 cm was defined for borderline AFI. Pregnancy outcomes included Cesarean section for non-reassuring fetal heart rate, meconium stained amniotic fluid, 5-min Apgar score <7, low birth weight, umbilical cord blood pH at term and NICU admission. Gestational age at delivery in pregnancies with borderline AFI was significantly lower than normal AFI. Cesarean section rate for non-reassuring fetal heart rate in women of borderline AFI was significantly higher and there was an increased incidence of birth weight less than 10th percentile for gestation age in borderline AFI group. Incidence of low Apgar score and low umbilical artery pH in pregnancies with borderline AFI was significantly higher than women with normal AFI. There were no significant difference in the rate of NICU admission and meconium staining in both groups. There are significant differences for adverse pregnancy outcomes , such as Cesarean section due to non-reassuring fetal heart rate, birth weight less than 10th percentile for gestation age, low 5 min Apgar score and low umbilical artery pH between pregnancies with borderline and normal AFI.