Cesarean Section For Fetal Distress Research Articles

Is ultrasound measured fetal biometry predictive of intrapartum caesarean section for failure to progress?

There are global concerns regarding excessive caesarean rates, which could be reduced by identification of risk factors leading to preventative measures such as induction of labour. This study aims to describe the association between antenatal ultrasound and emergency caesarean section for: (i) failure to progress; (ii) other indications; and (iii) any indication. Women who had an ultrasound in pregnancy between 36(+0/7) to 38(+6/7) weeks at Royal Prince Alfred Hospital from January 2005 to June 2009 were included. Ultrasound parameters were linked to clinical parameters from the maternity database. Missing clinical data were imputed and multiple logistic regression performed. Fetal biometry data were available for 2006 pregnancies. After adjusting for maternal age, height, body mass index, parity, previous caesarean section and diabetes, caesarean section for failure to progress was associated with estimated fetal weight (odds ratio (OR) 2.24 (95% CI: 1.76-2.84) per 500g increase); or biparietal diameter (OR 1.51 (1.16-1.97) per 5mm increase) and abdominal circumference (OR for the 4th quartile (>75th centile) compared with the 10-25th centile group was 2.09 (1.13-3.85)).* There were also non-linear associations between components of fetal biometry and caesarean section for fetal distress and for any indication. Components of fetal biometry in the third trimester are associated with intrapartum caesarean section for failure to progress. These parameters could be incorporated into models to predict emergency caesarean section which could lead to implementation of preventative strategies. *[Corrections added on 29 January 2018, after first online publication, '(OR for the 4th quartile (>7th centile)' has been changed to '(OR for the 4th quartile (>75th centile)'.].

Color Doppler Evaluation of Cerebral - Umbilical Pulsatility Ratio and its Usefulness in the Diagnosis of Intrauterine Growth Retardation and Prediction of Adverse Perinatal Outcome

The purpose of this study is Evaluation of cerebral umbilical pulsatility ratio by color Doppler and to estimate the value of pulsatility index ratio of cerebral umbilical vessels in the diagnosis of small-for-gestational-age (SGA) fetuses and in the prediction of adverse perinatal outcome . Validity of the test were confirmed by determining sensitivity, specificity, accuracy, positive predictive value, negative predictive value. The study population comprised 40 pregnancies of 30-41 weeks gestation that had been diagnosed clinically as intrauterine growth retardation (IUGR) over a period of 1 year. The cerebral - umbilical pulsatility ratio (C/U ratio) were calculated. The pregnancies were followed up and the final perinatal outcome of each case were noted. Various intraparum and neonatal indicators were used to assess the outcome, with an adverse outcome being defined as the presence of one or more of these indicators. The most common adverse perinatal outcome was birth asphyxia, low apgar score, stay at NICU, still birth and caesarean section for fetal distress. Of the 40 pregnancies in the study, 30 (75%) showed abnormal C/U ratio. Among these, 32 (80%) were SGA and 32 (80%) had adverse perinatal outcome. Of the 30 out of 40 pregnancies that showed abnormal C/U ratio (<1.08), all 30 (80%) were SGA and had adverse perinatal outcome. The results were correlated with parameters of fetal outcome. Inferences drawn from the study was that C/U ratio is a tools for prediction of SGA fetuses and adverse perinatal outcome.J Bangladesh Coll Phys Surg 2016; 34(3): 145-150

Intermittent auscultation (IA) of fetal heart rate in labour for fetal well-being.

Intermittent auscultation (IA) of fetal heart rate in labour for fetal well-being.

Obstetric and perinatal outcome in anti-Ro/SSA-positive pregnant women: a prospective cohort study.

•Anti-Ro/SS-A and anti-La/SS-B are clinically very relevant during pregnancy mainly because of their association to congenital heart block and neonatal lupus. •In our cohort, the prevalence of congenital heart block detected in patients taking hydroxycloroquine is much lower than in patients not taking it without distinguishing between high and low risk patients. •High umbilical artery pulsatility index in Doppler scans studies has been detected in our anti-Ro/SSA population (basely in SLE patients) demonstrated this measurement as a predictor of SGA and adverse pregnancy outcomes in general population such as cesarean section for fetal distress. The small for gestational age rate is higher probably because of SLE not because anti-Ro/SS-A •Preterm delivery happens in anti-Ro/SS-A patients at the same rate as in the general population if no complications such as congenital heart block or intrauterine growth restriction occur.

Perinatal Outcome in Patients with Isolated Oligohydramnios at Term: A Prospective Study

Objective: To evaluate the perinatal outcome in patients with isolated oligohydramnios. Design: A prospective study. Sample: 146 patients had isolated oligohydramnios. These were compared with those having AFI>5 cm (n=500). Methods: A prospective study was conducted from November 2012 to November 2014. Patients were divided into two groups (AFI>50 mm and ≤ 50 mm). The study inclusion criteria were women with singleton pregnancy at 36-42 weeks gestational age (GA) and women sure of the gestational age. Main outcome measures: Abnormal non-stress test, obstetric intervention for fetal distress, Apgar score, meconium stained liquor and NICU admission. Results: The two groups were similar with regard to maternal age, parity and mean gestational age. Isolated oligohydramnios was associated with higher rate of induction of labour (68.49% vs. 21.8%, p<0.001), nonreassuring fetal heart rate (45.20% vs. 13.2%, p<0.001), cesarean section for fetal distress (51.61% vs. 28.47%, p<0.001), meconium stained amniotic fluid (32.2% vs. 21.6%, p=0.008). However, there was no statistically significant difference between the two groups in terms of Apgar score at 1 min, NICU admissions and stillbirths. Conclusion: Isolated oligohydramnios is associated with increased risk of obstetric interventions particularly due to fetal distress. Nonetheless, fetal distress due to oligohydramnios did not lead to increased risk for low Apgar, NICU admissions, stillbirths. This may be reflective of aggressive intrapartum management that these patients received.

A case of bilateral tension pneumothorax—life saving intervention going wrong!

About 1% of newborns may develop spontaneous pneumothorax shortly after birth. However, neonatal tension pneumothorax is a rare occurrence with only few incidences reported in literature. If prolonged resuscitation of a neonate is failing, underlying tension pneumothorax may be suspected and managed early to improve survival. Here, we present a report of a newborn baby who developed a bilateral tension pneumothorax and extensive surgical emphysema after being delivered by caesarean section for fetal distress.

Choice of anaesthesia for category-1 caesarean section in women with anticipated difficult tracheal intubation: the use of decision analysis.

A predicted difficult airway is sometimes considered a contra-indication to rapid sequence induction of general anaesthesia, even in an urgent case such as a category-1 caesarean section for fetal distress. However, formally assessing the risk is difficult because of the rarity and urgency of such cases. We have used decision analysis to quantify the time taken to establish anaesthesia, and probability of failure, of three possible anaesthetic methods, based on a systematic review of the literature. We considered rapid sequence induction of general anaesthesia with videolaryngoscopy, awake fibreoptic intubation and rapid spinal anaesthesia. Our results show a shorter mean (95% CI) time to induction of 100 (87-114) s using rapid sequence induction compared with 9 (7-11) min for awake fibreoptic intubation (p<0.0001) and 6.3 (5.4-7.2) min for spinal anaesthesia (p<0.0001). We calculate the risk of ultimate failed airway control after rapid sequence induction to be 21 (0-53) per 100,000 cases, and postulate that some mothers may accept such a risk in order to reduce potential fetal harm from an extended time interval until delivery. Although rapid sequence induction may not be the anaesthetic technique of choice for all cases in the circumstance of a category-1 caesarean section for fetal distress with a predicted difficult airway, we suggest that it is an acceptable option.

Comparison of Outcome of Normal and High-Risk Pregnancies Based Upon Cerebroplacental Ratio Assessed by Doppler Studies.

To evaluate the cerebroplacental ratio which is the ratio of pulsatility index of fetal middle cerebral and umbilical arteries, in normal and high-risk pregnancies during 30-36weeks of gestation. In this study, we included 70 patients, who were scanned for Doppler parameters of Middle cerebral artery and Umbilical artery pulsatility index ratio of fetus, between 30 and 36weeks, and then were followed till delivery. Thirty-five patients with normal pregnancy and 35 patients with high-risk pregnancy were included. Perinatal outcome was evaluated in relation to indices ratio. There was cerebroplacental ratio of <1.00 in eight cases of the study group in comparison with the control group in which there is no case of <1.00 value. It was associated with poor perinatal outcome in terms of need for lower segment cesarean section for fetal distress, Apgar <8 at 5min, and admission to nursery. Cerebroplacental ratio is highly sensitive in diagnosing hemodynamically compromised fetuses and very useful for the prediction of adverse perinatal outcome in these fetuses.

Is transabdominal ultrasound measurement of single deepest vertical pocket effective for ruling out oligohydramnios and predicting complications?

EVIDENCE-BASED ANSWER Single deepest vertical pocket (SDVP) leads to fewer diagnoses of oligohydramnios than amniotic fluid index (AFI). Use of the SDVP test decreases rates of both labor induction and cesarean sections for fetal distress compared with AFI without differences in other neonatal outcomes (SOR: A, meta-analysis of RCTs and single RCT). Yet SDVP has poor sensitivity for oligohydramnios compared with the “gold standard” of dye-dilution spectrophotometry (DDS) for amniotic fluid volume assessment (SOR: C, disease-oriented evidence).

Complications of external cephalic version: a retrospective analysis of 1121 patients at a tertiary hospital in Sydney.

To report the complication rate associated with external cephalic version (ECV) at term. Single-centre retrospective study. A major tertiary hospital in Sydney, Australia. All women who underwent an ECVatRoyal Prince Alfred Hospital from 1995-2013 were included. ECV was attempted on all consenting women with a breech presentation at term in the absence of contraindications. Complications were classified as minor (transient cardiotocography abnormalities, ruptured membranes, small antepartum haemorrhage) or serious (fetal death, placental abruption, fetal distress requiring emergency caesarean section, fetal bone injury, cord prolapse). ECV success rates and rate of reversion to breech were recorded. The primary outcome was the incidence of serious complications. Secondary outcome measures were the rate of minor complications and reversion to breech. Of 1121 patients that underwent ECV, five (0.45%) experienced a serious complication. There was one placental abruption, one emergency caesarean section for fetal distress and two cord prolapses. There was one fetal death attributable to a successful ECV. Forty-eight women (4.28%) experienced a minor complication. Reversion to the breech occurred in sixteen patients (3.32%). ECV at term is associated with a low rate of serious complications. Study of 1121 consecutive ECV attempts shows low rate of complications although one fetal death reported.

Uterine artery pulsatility index at 30-34 weeks' gestation in the prediction of adverse perinatal outcome.

To investigate the potential value of uterine artery (UtA) Doppler at 30-34 weeks' gestation in the prediction of adverse perinatal outcome. This was a screening study in 30 780 singleton pregnancies at 30-34 weeks. UtA pulsatility index (UtA-PI) was measured and the values were converted to multiples of the median (MoM) after adjustment for variables relating to maternal characteristics and medical history that affect the measurements. Multivariable logistic regression analysis was used to determine if measuring UtA-PI improved the prediction of adverse perinatal outcome provided by screening with maternal characteristics, medical history and obstetric factors. The detection rate (DR) and false-positive rate (FPR) of screening by UtA-PI were estimated for stillbirth, Cesarean section for fetal distress, umbilical arterial cord blood pH ≤ 7.0 or umbilical venous cord blood pH ≤ 7.1 and 5-min Apgar score < 7. The incidence of adverse perinatal outcome was higher in small-for-gestational-age (SGA) fetuses than in non-SGA fetuses, but the majority of cases with each adverse outcome were in the non-SGA group, including about 70% of stillbirths and more than 80% with Cesarean section for fetal distress, low cord blood pH and low Apgar score. The performance of UtA-PI > 95(th) percentile in screening for each adverse outcome was poor with DR of 6-16% and a FPR of 5-6%. The DR of adverse outcome when screening by high UtA-PI was greater in pregnancies complicated by SGA than in non-SGA pregnancies; 24% vs 13% for stillbirth, 15% vs 5% for Cesarean section for fetal distress, 30% vs 9% for low cord blood pH and 20% vs 3% for low 5-min Apgar score, respectively. High UtA-PI at 30-34 weeks' gestation may be useful in the prediction of adverse perinatal outcome in pregnancies with a SGA fetus, however, in the absence of SGA, UtA-PI is a poor predictor of adverse outcome. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.

Biophysical and biochemical markers at 30-34 weeks' gestation in the prediction of adverse perinatal outcome

To investigate the potential value of biophysical and biochemical markers at 30-34 weeks' gestation in the prediction of adverse perinatal outcome. This was a screening study in 8268 singleton pregnancies at 30-34 weeks' gestation. Estimated fetal weight (EFW), uterine artery (UtA) pulsatility index (PI), umbilical artery (UA) PI, fetal middle cerebral artery (MCA) PI, mean arterial pressure (MAP), serum placental growth factor (PlGF) and soluble fms-like tyrosine kinase-1 (sFlt-1) were measured. The detection rate (DR) and false-positive rate (FPR) of screening by each biomarker were estimated for stillbirth, pre-eclampsia, delivery of small-for-gestational-age (SGA) neonate, Cesarean section for fetal distress before or during labor, umbilical arterial cord blood pH ≤7.0 or umbilical venous cord blood pH ≤7.1, 5-min Apgar score < 7 and admission to the neonatal unit (NNU). Multivariable regression analysis demonstrated that significant prediction of PE was provided by PlGF, sFlt-1, MAP and MCA-PI, with a DR of 98% for PE delivering < 37 weeks' gestation and 56% for those delivering ≥ 37 weeks, at a 10% FPR. Prediction of SGA was provided by EFW, PlGF, sFlt-1, UtA-PI, UA-PI and MCA-PI, with a DR of 88% for SGA delivering < 37 and 51% for those delivering ≥ 37 weeks' gestation, at a 10% FPR. Prediction of stillbirth was provided by EFW, UtA-PI and MCA-PI, with DR of 30% at 10% FPR. Prediction of Cesarean section for fetal distress before labor was provided by EFW, sFlt-1, UtA-PI and UA-PI, with a DR of 90% at a 10% FPR. Prediction of fetal distress in labor was provided by EFW and sFlt-1, with a DR of 16% at a 10% FPR. There were no significant differences from the normal outcome group in any of the biomarkers for low cord blood pH, low Apgar score or NNU admission for cases other than those with PE and/or SGA. At 30-34 weeks' gestation, biomarkers of impaired placentation and fetal hypoxemia provide good prediction of PE, SGA and fetal distress before labor, but poor or no prediction of stillbirth and adverse events in labor or after birth.

Biophysical and biochemical markers at 35-37 weeks' gestation in the prediction of adverse perinatal outcome.

To investigate the potential value of biophysical and biochemical markers at 35-37 weeks' gestation in the prediction of adverse perinatal outcome. This was a screening study in 3953 singleton pregnancies at 35-37 weeks' gestation. Estimated fetal weight (EFW), uterine artery pulsatility index (UtA-PI), umbilical artery (UA)-PI, fetal middle cerebral artery (MCA)-PI, mean arterial pressure (MAP), serum placental growth factor (PlGF) and soluble fms-like tyrosine kinase-1 (sFlt-1) were measured. The detection rate (DR) and false-positive rate (FPR) of screening by each biomarker were estimated for pre-eclampsia (PE), delivery of small-for-gestational-age (SGA) neonates, Cesarean section for fetal distress before or during labor, umbilical arterial cord blood pH ≤ 7.0 or umbilical venous cord blood pH ≤ 7.1, 5-min Apgar score < 7 and admission to the neonatal unit (NNU). Multivariable regression analysis demonstrated that significant prediction of PE was provided by PlGF, sFlt-1 and MAP, with a DR of 73% at a 10% FPR. Prediction of SGA was provided by EFW, PlGF and UtA-PI, with a DR of 63% at a 10% FPR. Prediction of Cesarean section for fetal distress before labor was provided by EFW and UA-PI with DR of 100% at 10% FPR. Prediction of fetal distress in labor was provided by EFW and sFlt-1, with a DR of 15% at a 10% FPR. There were no significant differences between those with a normal outcome and those with low cord blood pH, low Apgar score or NNU admission for any of the biomarkers assessed. At 35-37 weeks' gestation biomarkers of impaired placentation and fetal hypoxemia provide good prediction of PE, SGA and fetal distress before labor, but poor or no prediction of adverse events in labor or after birth.

Cervical condition and fetal cerebral Doppler as determinants of adverse perinatal outcome after labor induction for late-onset small-for-gestational-age fetuses.

To estimate the combined value of fetal cerebral Doppler examination and Bishop score for predicting perinatal outcome after labor induction for small-for-gestational-age (SGA) fetuses in the presence of normal umbilical artery Doppler recordings. We conducted a cohort study in two tertiary centers, including 164 women with normal umbilical artery Doppler recordings who underwent induction of labor because of an estimated fetal weight < 10(th) percentile. The fetal middle cerebral artery pulsatility index and cerebroplacental ratio (CPR) were obtained in all cases within 24 h before induction. Cervical condition was assessed at admission using the Bishop score. A predictive model for perinatal outcomes was constructed using a decision-tree analysis algorithm. Both a very unfavorable cervix, defined as a Bishop score < 2, (odds ratio (OR), 3.18; 95% CI, 1.28-7.86) and an abnormal CPR (OR, 2.54; 95% CI, 1.18-5.61) were associated with an increased likelihood of emergency Cesarean section for fetal distress, but only the latter was significantly associated with the need for neonatal admission (OR, 2.43; 95% CI, 1.28-4.59). In the decision-tree analysis, both criteria significantly predicted the likelihood of Cesarean section for fetal distress. Combined use of the Bishop score and CPR improves the ability to predict overall Cesarean section (for any indication), emergency Cesarean section for fetal distress, and neonatal admission after labor induction for late-onset SGA in the presence of normal umbilical artery Doppler recordings.

Relationship between Amniotic Fluid Index and Perinatal Outcome

Aims: This study was done to evaluate the predictive value of low amniotic fluid index (AFI) of &lt; 5 cm for adverse perinatal outcome in term of caesarean section for fetal distress, birth weight, meconium stained liquor and APGAR scores. Methods: This was a prospective study of 200 antenatal women booked at Nepal Medical College Teaching Hospital during the year 2013-2014 with gestational age between 34 and 41 weeks. Patients history and clinical examination were recorded and AFI was measured and the perinatal outcome was compared between two groups i.e AFI &lt;5 cm and &gt;5 cm. Results: The caesarean section (C/S) rate for fetal distress and low birth weight babies (&lt;2.5 kg) was higher in patients with low AFI (p=0.048, 0.001 respectively). There was no significant difference in meconium staining, APGAR score at 5 minutes between the two groups (p=0.881, 0.884 respectively). Conclusions: Caesarean section for fetal distress and low birth weight babies was significantly associated with low amniotic fluid index. There was no significant difference in meconium staining liquor, APGAR score at 5 minutes between the two groups.

Umbilical and fetal middle cerebral artery Doppler at 35-37 weeks' gestation in the prediction of adverse perinatal outcome.

To investigate the potential value of cerebroplacental ratio (CPR) at 36 weeks' gestation in the prediction of adverse perinatal outcome. This was a screening study in 6178 singleton pregnancies at 35-37 weeks' gestation. Umbilical artery (UA) and fetal middle cerebral artery (MCA) pulsatility index (PI) were measured and the values were converted to multiples of the median (MoM) after adjustment from variables in maternal characteristics and medical history that affect the measurements. CPR was calculated by dividing MCA-PI MoM by UA-PI MoM. Multivariable logistic regression analysis was used to determine if measuring CPR improved the prediction of adverse perinatal outcome provided by maternal characteristics, medical history and obstetric factors. The detection rate (DR) and false-positive rate (FPR) of screening by CPR were estimated for stillbirth, Cesarean section for fetal distress, umbilical arterial cord blood pH ≤ 7.0, umbilical venous cord blood pH ≤ 7.1, 5-min Apgar score < 7 and admission to the neonatal unit (NNU) and neonatal intensive care unit (NICU). There was a linear association between CPR and both birth-weight Z-score and arterial or venous umbilical cord blood pH, but the steepness of the regression lines was inversely related to the interval from assessment to delivery. The performance of low CPR < 5(th) percentile in screening for each adverse outcome was poor, with DRs of 6-15% and a FPR of about 6%. In the small subgroup of the population delivering within 2 weeks of assessment, the DRs improved to 14-50%, but with a simultaneous increase in FPR, to about 10%. The performance of CPR in routine screening for adverse perinatal outcome at 36 weeks' gestation is poor.

Valoración diagnóstica de la velocimetría Doppler de la arteria umbilical en la predicción de los resultados perinatales en el embarazo de riesgo alto

OBJETIVO: Evaluar la utilidad y capacidad predictiva de la velocimetría Doppler de arterias umbilicales con relación a resultados perinatales adversos en embarazo de alto riesgo. DISEÑO: Estudio longitudinal prospectivo observacional. MATERIAL Y MÉTODOS: Se seleccionó 72 gestantes de riesgo alto entre 28 y 41 semanas, determinándose los índices de resistencia, relación sístole-diástole y ausencia de flujo diastólico final, utilizando imágenes Doppler color pulsado de un equipo Aloka SSD 1700. Los resultados perinatales adversos fueron categorizados y relacionados con el examen Doppler umbilical. RESULTADOS: Se encontró anormalidad del flujo umbilical en 38,9% de los casos, con incremento de riesgo (p&lt;0,01) para RCIU y cesáreas por sufrimiento fetal, predicción de fetos con RCIU (70,8%), permanencia en UCI más de 8 días (66,7%) y acidemia neonatal (65,3%). La exactitud global de la relación sístole-diástole fue 66,7%. La ausencia de flujo diastólico final se asoció a muerte perinatal en 94,4%. CONCLUSIÓN: La velocimetría Doppler de arteria umbilical tiene adecuada capacidad predictiva sólo para RCIU, cesárea por sufrimiento fetal, permanencia prolongada en UCI y acidemia neonatal, siendo la ausencia de flujo diastólico final un fuerte predictor de muerte perinatal.

FLUJO VENOSO FETAL E ÍNDICE CEREBRO PLACENTARIO COMO INDICADORES DE HIPOXIA FETAL EN GESTANTES PREECLÁMPTICAS SEVERAS

Antecedentes: La velocimetría Doppler de la circulación uterina y fetoplacentaria es una herramienta importante para evaluar complicaciones asociadas a la restricción del crecimiento intrauterino y otras formas de distrés fetal debidas a hipoxemia o asfixia, como el producido por los trastornos hipertensivos del embarazo. También puede diagnosticarse anomalías cardíacas fetales, otras malformaciones y alteraciones placentarias o del cordón umbilical. Objetivos: Determinar el valor predictivo del índice cerebro placentario y del flujo anormal del ductus venoso de Aranzio, medido por velocimetría Doppler, en pacientes con preeclampsia severa, en relación a un resultado perinatal adverso. Diseño: Estudio prospectivo, no experimental, longitudinal, de tipo correlacional. Lugar: Unidad de Medicina Fetal y Diagnóstico Prenatal, Servicio de Obstetricia de Alto Riesgo, Hospital Nacional Guillermo Almenara Irigoyen, EsSalud, Lima, Perú.Participantes: Gestantes con diagnóstico de preeclampsia severa y sus fetos. Intervenciones: Se realizó los estudios ultrasonográficos Doppler en los 7 días previos al parto, en 160 pacientes con diagnóstico de preeclampsia severa. El análisis estadístico se realizó mediante la prueba de chi cuadrado (x²) y prueba exacta de Fisher, con un nivel de significancia de 0,05; confiabilidad del 95%. Principales medidas de resultados: Resultado perinatal adverso. Resultados: El 39,4% (63/160) de las pacientes tuvo un resultado de índice cerebro placentario y de flujo del ductus venoso de Aranzio anormal, lo que se asoció significativamente a restricción del crecimiento intrauterino (RCIU), oligohidramnios y cesárea por distrés fetal agudo (p&lt;0,05), y con alta sensibilidad para la ocurrencia de Ápgar &lt; 7 a los 5 minutos, pH en arteria umbilical &lt; 7,2 cesárea por distrés fetal y admisión a UCI. Conclusiones: La alteración del índice cerebro placentario y del flujo del ductus venoso de Aranzio medido por velocimetría Doppler fetal pudo detectar a más de 65% de los recién nacidos con resultado perinatal adverso por hipoxia fetal y fue prueba predictiva estadísticamente significativa de RCIU y oligohidramnios, en pacientes con preeclampsia severa.

Umbilical and fetal middle cerebral artery Doppler at 30-34 weeks' gestation in the prediction of adverse perinatal outcome.

To investigate the potential value of cerebroplacental ratio (CPR) at 30-34 weeks' gestation in the prediction of adverse perinatal outcome. This was a screening study in 30 780 singleton pregnancies at 30-34 weeks' gestation. Umbilical artery (UA) and fetal middle cerebral artery (MCA) pulsatility index (PI) were measured and the values were converted to multiples of the median (MoM) after adjustment from variables in maternal characteristics and medical history that affect the measurements. CPR was calculated by dividing MCA-PI MoM by UA-PI MoM. Multivariable logistic regression analysis was used to determine if measuring CPR improved the prediction of adverse perinatal outcome provided by screening with maternal characteristics, medical history and obstetric factors. The detection rate (DR) and false-positive rate (FPR) of screening by CPR were estimated for stillbirth, Cesarean section for fetal distress, umbilical arterial cord blood pH ≤ 7.0, umbilical venous cord blood pH ≤ 7.1, 5-min Apgar score < 7 and admission to the neonatal unit (NNU) and neonatal intensive care unit (NICU). There was a significant association between CPR and birth-weight Z-score. In addition to maternal characteristics, medical history and obstetric factors, measuring CPR provided a significant contribution to the prediction of arterial cord blood pH ≤ 7.0, venous cord blood pH ≤ 7.1 and admission to NNU. The performance of CPR in screening for each adverse outcome was poor, with DR of 5-11% and a FPR of about 5%. In the small subgroup of the population delivering within 2 weeks following assessment, the DR improved to 20-50%, but with a simultaneous increase in FPR to 10-23%. The performance of CPR in routine screening for adverse perinatal outcome at 30-34 weeks' gestation is poor.

English

Aim of the present study is to determine amniotic fluid index in labour and to assess the course of labour, mode of delivery and perinatal outcome in relation to AFI. Objective of the study is the early detection of fetal distress and prevention of neonatal morbidity and mortality. This study was conducted in Department of Obstetrics and Gynecology, Rangaraya Medical College, Kakinada from October, 2011 to October 2013, to evaluate perinatal outcome in relation to AFI with a gestational age between 37-42 weeks. AFI was measured and the perinatal outcome compared between three groups. The cesarean section rate for fetal distress and low birth weight babies, <2.5 kgs was higher in patients with oligohydroamnios. There was a significant difference in meconium staining, APGAR at 1 & 5 mins <7 at the time of birth between three groups. Oligohydroamnios has a significant correlation with cesarean section for fetal distress and low birth weight babies.