Normal Amniotic Fluid Index Research Articles

Fetal Outcome Evaluation in High-risk Term Pregnancy Using Biophysical Profile at a Tertiary Hospital in Anambra State, Nigeria

Introduction: A high-risk pregnancy is defined as a pregnancy in which there is a significant probability of an adverse maternal or fetal outcome that is more than the incidence of that outcome in the general population. Aim: To determine the usefulness of biophysical profile evaluation in women with high-risk term pregnancies. Methods: Biophysical profile (BPP) parameters were used to evaluate 160 high-risk women with term pregnancies. Results: All the participants had normal amniotic fluid index values [AFI] of 8.1-24.0cm. Most of the participants 115 (71.9%) showed good BPP scores. Outcome at delivery was as follows; fetal distress [presence 8.9%, absence 91.1%], stillbirth = none, admission into the intensive care unit (ICU) [Yes 2.0%, No 88%], meconium staining [Yes 8.2%, Clear 91.8%], birth weight [< 2.5kg = 5.7%, > 2.5kg = 94.3%]. APGAR score at 1 minute [<7 = 5.1%, >7 = 94.9%] while at 5 minutes [<7 = 3.2%, > 7= 96.8%]. The commonest mode of delivery was vaginal 84 (52.8%). The association between gross body movement, fetal breathing movement, and fetal outcome was not statistically significant p > 0.05. Conclusion: BPP parameters were found to be associated with fetal outcomes.

Perinatal Outcomes of Pregnancies with Borderline Oligohydramnios at Term

Introduction: Limited evidence exists on borderline oligohydramnios. Our objective was to determine perinatal outcomes in uncomplicated term pregnancies with borderline oligohydramnios. Methods: This retrospective analysis compared adverse perinatal outcomes among pregnancies during 2018–2022, between those with borderline oligohydramnios defined as amniotic fluid index (AFI) of 5.1–8.0 cm, those with oligohydramnios (AFI ≤5 cm), and those with normal AFI (8.1–25 cm). The latter matched one-to-one to the borderline oligohydramnios group and served as the control group. The outcomes compared included birthweight, cesarean delivery due to fetal distress, the presence of meconium-stained amniotic fluid, Apgar scores, neonatal intensive care unit admission, and the occurrence of small-for-gestational-age (SGA) neonates. Results: During the study period, 140 women had borderline oligohydramnios and 345 had oligohydramnios; the control group included 140 women. Borderline oligohydramnios was associated with increased rates of delivering SGA neonates (adjusted odds ratio [aOR] = 3.6, 95% confidence interval [CI] 1.1–11.6, p = 0.034) and cesarean delivery due to fetal distress (aOR = 3.0, 95% CI 1.1–8.3, p = 0.032). Rates of composite neonatal outcome (including at least one of the following: cesarean delivery due to fetal distress, meconium-stained amniotic fluid, 5-min Apgar score <7, umbilical artery pH <7.15, or neonatal intensive care unit admission) were higher in both the borderline oligohydramnios (20.7%) and oligohydramnios (18.6%) groups compared to the control group (9.3%) (p = 0.019). Conclusions: Pregnancies with borderline oligohydramnios were associated with increased risks of delivering SGA neonates and requiring cesarean delivery due to fetal distress. These findings support considering closer antepartum surveillance for these pregnancies, especially for identifying abnormal fetal growth.

EVALUATION OF MATERNAL AND PERINATAL OUTCOME IN WOMEN WITH BORDERLINE AFI AND OLIGOHYDRAMNIOS IN THIRD TRIMESTER: A TERTIARY CARE HOSPITAL-BASED STUDY

Objectives: Objectives of our study were (1) to study and compare obstetric outcome in women with oligohydramnios, borderline amniotic fluid index (AFI), and normal AFI in terms of (a) type of labor (spontaneous/induced) and (b) mode of delivery-C-section or vaginal delivery and (2) to study and compare perinatal outcome in women with oligohydramnios, borderline AFI, and normal AFI in terms of (a) prematurity, (b) APGAR score at 1 and 5 min, (c) fetal distress, (d) low birth weight, (e) weight for gestational age, (f) neonatal intensive care unit (NICU) admission, (g) cause of NICU admission, and (h) neonatal deaths. Methods: This prospective and comparative study was conducted in Rajindra Hospital Patiala, over a period of 1 year. Women with ≥34 weeks POG were subjected to ultrasonography. They were then divided into following three groups of 50 women each depending upon AFI: Group A – oligohydramnios (AFI &lt;5 cm), Group B – borderline AFI (AFI 5–8 cm), and Group C – normal AFI (AFI &gt;8–25 cm). Patients were followed up to 40 weeks POG or till delivery occurred or decision for C-section was taken. Results: Perinatal outcome was adversely affected by decrease in AFI in terms of increase in rate of preterm delivery, small for gestational age babies, low birth weight babies, and neonatal deaths. Conclusion: Measurement of AFI is an important tool for prediction of adverse neonatal outcome

AUTOSOMAL RECESSIVE POLYCYSTIC KIDNEY DISEASE ABOUT A NEW CASE REPORT

We present the case of a 25-year-old woman gravida 2, para 01 who presented for childbirth at 40 weeks of gestation. Which Fetal Anatomy Ultrasound showed enlarged, hyperechoic fetal kidneys and a normal amniotic fluid index. Karyotyping was done on umbilical cord blood to look for mutations in the PKHD1 gene for the presumptive diagnosis of autosomal recessive polycystic kidney disease (ARPKD). In our patient, a previously reported pathogenic missense mutation in the PKHD1 gene, c.10444C&gt;T, was found to be maternally inherited. A second previously unknown de novo mutation, c.5909-2delA, was discovered. This mutation is likely pathogenic because it affects the canonical splice site. Our case emphasizes PKHD1 allelic heterogeneity and the importance of prenatal genetic testing in a setting where many other genetic etiologies can phenocopy ARPKD.

The role of the cerebroplacental ratio in predicting pregnancy outcomes at 40-42 gestational weeks: a prospective observational trial.

The cerebroplacental ratio is a sonographic tool used to predict poor pregnancy outcomes. Data are insufficient regarding its use in postdate pregnancy. We evaluated the cerebroplacental ratio's prediction of unfavorable pregnancy outcomes in women at 40-42 weeks gestation with normal amniotic fluid index. This prospective observational study included 101 women with low-risk singleton pregnancy and gestational age > 40 weeks who delivered in a university affiliated hospital during 2020-2021. The middle cerebral artery pulsatility index, the umbilical artery pulsatility index, and the cerebroplacental ratio, which is their quotient, were compared between women with favorable and unfavorable pregnancy outcomes. The latter included: meconium-stained amniotic fluid, cesarean or vacuum-assisted delivery due to pathological cardiotocography (category 2 or 3), 5-min Apgar score < 7, umbilical cord pH < 7.1, neonatal intensive care unit admission, and neonatal death. Fetal Doppler, performed at a median gestational age of 40.3 (40.0-41.6), did not differ between 75 (74.3%) women with favorable obstetrical outcomes and 26 (25.7%) with unfavorable outcomes. In multivariate analysis, advanced maternal age and a history of a cesarean section were correlated with unfavorable outcomes, while Doppler indices were not found to be predictive. Among women at 41-42 weeks' gestation, for those with intrapartum fetal monitor category 2-3 vs. category 1, the mean umbilical artery pulsatility index was higher: 0.92±0.34 vs. 0.71±0.11 (p = 0.044). According to the study results, fetal Doppler indices, including the cerebroplacental ratio, are not predictive of unfavorable outcome in women with pregnancies exceeding 40 weeks. Larger prospective studies are needed.

Correlation between oligohydramnios and anaemia in the third trimester of pregnancy: A study in a tertiary care hospital in Pakistan.

Maintaining normal amniotic fluid index and normal hemoglobin level is crucial for normal fetal development. Their reduction can lead to maternal and fetal morbidity in the form of operative delivery and poor perinatal outcome such as, low birth weight. There is an association between oligohydramnios and anaemia, although there is scarcity on this correlation in literature. Early detection of oligohydramnios can improve maternal and perinatal outcome. This study aimed to investigate the association between oligohydramnios and anaemia during the third trimester of pregnancy. This retrospective cohort study was conducted at NESCOM Hospital, Pakistan. The study spanned from August 1, 2021, to July 31, 2022. The study included 109 pregnant individuals with oligohydramnios, resulting in an incidence of 22% among the total of 551 deliveries during the study period. The average age of participants was 29.75 years. The average gestational age was 33.52 weeks, with a range of 28 to 38 weeks. The analysis indicated that 44.03% of cases with oligohydramnios were associated with anaemia, followed by idiopathic causes (41.28%). Pearson's correlation revealed a significant association between oligohydramnios and anaemia (r = 0.307, p = 0.001), supporting the hypothesis of a potential interconnection between these two conditions. Regarding delivery outcomes, 81.6% underwent cesarean section, emphasizing the need for careful management in cases of oligohydramnios and anaemia. Neonatal outcomes indicated that 1.8% and 44.5% of neonates were extremely low birth weight and low birth weight, respectively. This study provides empirical evidence supporting a significant association between oligohydramnios and anaemia in the third trimester.

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

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. 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. 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. 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 &lt;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&lt;7, admission to NICU and low birth weight. Keywords: Amniotic fluid index, borderline oligohydramnios, cesarean section, fetal distress, meconium-stained liquor.

Comparison of Maternal and Foetal Outcome between Normal and Abnormal Amniotic Fluid Index in the Third Trimester of Pregnancy - A Longitudinal Analytical Study in A Tertiary Level Medical College of Suburban West Bengal, India

Background: Amniotic fluid (AF) is the protective liquid present in the amniotic sac of a gravid uterus. Amniotic fluid has nutritive, protective and diagnostic functions. Amniotic Fluid Index (AFI) is most popular and reliable method for quantifying amniotic fluid, till date. AFI is one of the major parameters of foetal biophysical profile (BPP) that can predict perinatal and maternal outcomes. Periodical scanning of foetus is utmost essential during antenatal visits, especially in high-risk pregnancies, but there is no definite standard protocol regarding its frequency.Methods: This study was conducted in the department of Obstetrics &amp; Gynaecology, College of Medicine &amp; JNM Hospital, Kalyani, Nadia, India. This longitudinal analytical study included 356 patients, among whom 151 (42.4%) were in oligohydramnios group, 174 (48.9%) in normal group and 31 (8.7%) in polyhydramnios group.Results: The data revealed oligohydramnios was strongly associated with caesarean section (p = 0.0010). In oligohydramnios group, IUGR was found in 37 (24.5%) patients (p = 0.0297). Meconium-stained liquor was almost similar in all three categories i.e. 15 (10.0%) in oligohydramnios group, 18 (10.3%) in normal group and 5 (16.1%) in polyhydramnios group, respectively. There was higher SNCU admission among babies delivered by mothers with oligohydramnios (p = 0.0369). There was no statistically significant difference in 1 and 5 minutes APGAR scores among normal and abnormal AFI groups. Conclusions: It was inferred that LSCS, IUGR baby and SNCU admission rates were more in oligohydramnios group compared to other categories. The perinatal death was 3.3% with oligohydramnios compared to 1.7% with normal liqour. The results from this study emphasize on the importance of AFI among the various means of antepartum surveillance and predictors of foetal outcome. Keywords: Oligohydramnios, Polyhydramnios, Foetal Outcome, IUGR, AFI

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.&#x0D; 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 &lt; AFI &lt; 8 cm and 8.1 &lt; AFI &lt; 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.&#x0D; 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)&#x0D; Conclusion: Our study indicates that borderline oligohydramnios does not have an adverse effect on perinatal or early postnatal outcomes in term pregnancy.

Association of Adverse Perinatal Outcome with Oligohydramnios during Third Trimester of Pregnancy

Background: For the growth and development of the unborn child, amniotic fluid is absolutely necessary. Strong interactions between the fetus, placenta, and parts of the mother are given their volume1. Oligohydramnios is defined as having an amniotic fluid index (AFI) &lt;5th percentile or AFI 5 cm during pregnancy and no water at a depth of 23 cm before the cornea. This is a common problem that occurs in 35% of pregnancies during childbirth2. Aim: To determining the correlation between oligohydramnios in pregnant women who are late in pregnancy (3rd trimester) and adverse birth outcomes such as partial surgery, decreased Apgar score, and lower birth weight. Study design: Cohort study Study set up: Obstetrics and Gynecology Department, Fatima Memorial Hospital Lahore. Study period: six months starting15-01-2022 to 14-07-2022 Methods: 242 females were enrolled. Two groups of participants were created: group II had normal AFI and group I had oligohydramnios. Females given intra venous fluids to group I after ruling out any contra indication. The perinatal result was then documented. SPSS version 20 was used to enter and evaluate all of the gathered data. Results: In exposed group the mean age was 27.79±6.72 years, whereas in unexposed group the mean age was 28.25±6.77 years. The C-section was done in 124(51.2%) females. RR = 0.693 [1.25-3.49] While the Low Birth Weight and poor APGAR score has shown protective effect. Practical implication: Oligohydramniosmeans decreased amniotic fluid around the fetus. There is deficiency of amniotic fluid &lt; 200 ml at a time. Approximately 8-10% of pregnant ladies may have decreased level of amniotic fluid but 5% have been confirmed diagnosis of oligohydramnios. Conclusion: So complications of surgery are directly related to the severity of oligohydramnios in pregnant women while low birth weight and poor APGAR scores has shown protective effect in women presented in last trimester of pregnancy. Keywords: Oligohydramnios, Low Birth Weight, Perinatal Outcome, APGAR SCORES, Pregnancy

Comparison of the Effect of Injection Enoxaparin Versus Conventional Treatment on Amniotic Fluid Index in Borderline Oligohydramnios in Third Trimester of Pregnancy: A Randomized Control Trial in a Tertiary Care Hospital.

Oligohydramnios is defined as amniotic fluid index (AFI) less than or equal to 5cm. A borderline AFI has been defined as an AFI of 5.1cm to 8cm. The incidence of borderline AFI compared with a normal AFI (8.1cm to 18cm) is 6% to 44% in different studies. A decrease in amniotic fluid leads to serious complications for the mother and fetus. The study objective was to evaluate if an injection of Enoxaparin improves the amount of liquor in oligohydramnios in the third trimester of pregnancy. A randomized controlled trial was conducted at a tertiary care obstetric center, involving a total of 130 participants. Inclusion criteria include participant in 3rd trimester of pregnancy, singleton pregnancy, intact amniotic membranes, and no known medical disorder. Patients with multiple pregnancies, ruptured amniotic membranes, anomalous fetuses, and known medical disorders were excluded. These participants were divided into two groups, each consisting of 65 participants. Group A received conventional treatment (intravenous fluid, tablet Aspirin, and rest in lateral position), while Group B received an injection of enoxaparin in addition to conventional treatment. AFI measurements were performed in the radiology department by radiologists using standard 4 quadrant measurements, twice weekly after the initiation of the treatment. The weight of the baby noted at birth and admission to neonatal intensive care was noted to assess the health of the neonate. Data was analyzed on SPSS (statistical package for social sciences) version 23. In group A, the AFI increased after treatment in 47(72.3%) patients, remained static in 6(9.2%) patients, and decreased in 12(18.4%) patients. Whereas in group B, AFI increased in 31(68.8%) patients and decreased in 14(31.3%) patients, p= 0.334. The findings in the current study did not demonstrate any significant effect of the use of injection enoxaparin in improving borderline oligohydramnios. Further research is needed to apply this research to the general population.

Term Idiopathic Polyhydramnios, and Labor Complications.

Background and Aim: Polyhydramnios is associated with an increased risk of various adverse pregnancy outcomes, yet complications during labor have not been sufficiently studied. We assessed the labor and perinatal outcomes of idiopathic polyhydramnios during term labor. Methods: Retrospective cohort study at a tertiary medical center between 2010 and 2014. Women with idiopathic polyhydramnios defined as an amniotic fluid index (AFI) greater than 24 cm or a deep vertical pocket (DVP) > 8 cm (cases) were compared with women with a normal AFI (5-24 cm) (controls). Statistics: Descriptive, means ± SDs, medians + IQR. Comparisons: chi-square, Fisher's exact test, Mann-Whitney Test, multivariate logistic models. Results: During the study period 11,065 women had ultrasound evaluation completed by a sonographer within two weeks of delivery. After excluding pregnancies complicated by diabetes (pre-gestational or gestational), fetal anomalies, IUFD, multifetal pregnancies, elective cesarean deliveries (CD) or missing data, we included 750 cases and 7000 controls. The degree of polyhydramnios was mild in 559 (75.0%) cases (AFI 24-30 cm or DVP 8-12 cm), moderate in 137 (18.0%) cases (30-35 cm or DVP 12-15 cm) and severe in 54 (7.0%) cases (AFI >35 cm or DVP > 15 cm). Idiopathic polyhydramnios was associated with a higher rate of CD 9.3% vs. 6.2%, p = 0.004; a higher rate of macrosomia 22.8% vs. 7.0%, p < 0.0001; and a higher rate of neonatal respiratory complications 2.0% vs. 0.8%, p = 0.0001. A multivariate regression analysis demonstrated an independent relation between polyhydramnios and higher rates of CD, aOR 1.62 (CI 1.20-2.19 p = 0.002) and composite adverse neonatal outcome aOR 1.28 (CI 1.01-1.63 p = 0.043). Severity of polyhydramnios was significantly associated with higher rates of macrosomia and CD (p for trend <0.01 in both). Conclusions: The term idiopathic polyhydramnios is independently associated with macrosomia, CD and neonatal complications. The severity of polyhydramnios is also associated with macrosomia and CD.

Obstetric ultrasonography as a screening tool for the diagnosis of GDM: Detection of raised AFI and large for gestational age fetus

Objective: To establish the role of determining increased amniotic fluid index (AFI) and large for gestational age (LGA) fetus on ultrasound for the screening of gestational diabetes mellitus (GDM). Study Design: Descriptive Observational study. Place and Duration: Department of Gynaecology and Obstetrics, Pakistan Railway Hospital, Rawalpindi from 1st September 2021 till 28th February 2022. Methodology: The pregnant women, between 20-30 weeks of gestation, suspected of having excessive AFI or LGA fetuses on routine clinical examination, were advised to have an obstetric ultrasound scan. AFI &gt; 20 cm or LGA on ultrasound (&gt;90th percentile for that gestation) were considered abnormal. These participants were then subjected to 75-gram Oral Glucose Tolerance test (OGTT). Based on OGTT, the sample population was divided into two groups at the post-stratification stage: with and without Gestational Diabetes Mellitus (GDM). Chi-square test was applied to compare the frequency of increased AFI and LGA between patients having GDM or not having GDM. Results: The study population (n=75) showed the frequency of LGA as 37.3 % and increased AFI as 65.3%. Women with increased AFI were at a significantly greater risk of GDM (65%), as compared to those with normal AFI (27%) with p-value of 0.002. Also, patients having LGA fetuses (60.7%) were at a greater risk of having GDM, as compared to those with normal weight fetuses (34%) with p-value of 0.024. Conclusion: Women with Increased AFI and LGA fetuses between 20-30 weeks of gestation are at a greater risk to develop GDM. Hence these ultrasound parameters can be used as reliable screening tools for the detection of GDM. Keywords: Adverse pregnancy outcome, Fetal macrosomia, Gestational diabetes mellitus, Increased Fetal weight, Polyhydramnios

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.

Vaginal fluid index - The fifth amniotic pocket.

The forebag is a pocket of amniotic fluid preceding the fetal presenting part. Herein we describe the feasibility of transvaginal measurements of the forebag and assess its correlation with the standard amniotic fluid index (AFI). A prospective study was carried out between January 2019 and July 2020. Eligible cases were women with singletons, vertex presentation, and normal AFI at term. We assessed the implementation and acceptance of a novel process in the clinical practice setting. Feasibility was assessed by using transvaginal ultrasound to measure the three orthogonal planes of the forebag. The vaginal fluid index (VFI) was defined as the volume composite of the three orthogonal planes. Correlations of the forebag measurements with both AFI and maximal vertical pocket were then calculated. In total, 292 out of 305 (95.7%) women were enrolled. All participants completed both transabdominal and transvaginal ultrasound, of which the vaginal pocket was demonstrated in 266 (91.1%) cases. We found significant correlations, in both nulliparas and multiparas, between the vaginal pocket measurements and the VFI to both the AFI and maximal vertical pocket measurements (R= 0.38, P< 0.001; R= 0.3, P< 0.001, respectively). We introduced a new ultrasound variable, the VFI, with a high feasibility rate. This may provide invaluable information for future decision making around the time of delivery.

The role of oligohydramnios and fetal growth restriction in adverse pregnancy outcomes in preeclamptic patients.

We aimed to compare perinatal outcomes of oligohydramnios or fetal growth restriction with normal amniotic fluid index and fetal growth in preeclampsia and to compare the outcomes of only oligohydramnios, only fetal growth restriction and oligohydramnios with fetal growth restriction preeclamptic groups. A total of 743 preeclamptic patients were evaluated between June 2016 and 2020. Patients were divided into two groups: preeclampsia with oligohydramnios or fetal growth restriction (n = 237) and preeclampsia with normal amniotic fluid index and fetal growth (n = 506). Then, the first group was divided subgroups as only oligohydramnios (n = 55), only fetal growth restriction (n = 125) and oligohydramnios with fetal growth restriction (n = 57). Demographic characteristics and perinatal outcomes were recorded. Gestational age at delivery (p < 0.001), birth weight (p < 0.001), Apgar scores (p < 0.001) and eclampsia (p < 0.001) were lower whereas impaired doppler findings (p < 0.001), cesarean rates (p < 0.001), preterm delivery (p < 0.001), abruptio placenta (p < 0.001), acute fetal distress (p < 0.001), RDS (p < 0.001), NICU requirement (p < 0.001) and neonatal death (p < 0.001) were higher in oligohydramnios or fetal growth restriction preeclamptic group. In subgroup analysis, there were differences between three groups according to the gestational age (p < 0.001), cesarean rates (p = 0.002), preterm delivery (p < 0.001), intensive care unit requirement (p = 0.039), birth weight (p < 0.001), Apgar scores (p < 0.001), RDS (p < 0.001) and NICU requirement (p < 0.001). In pairwise comparison, there was significant difference between only oligohydramnios and only fetal growth restriction group and between only oligohydramnios and oligohydramnios with fetal growth restriction group according to birth weight, Apgar scores, preterm delivery and cesarean rates, presence of RDS, maternal and neonatal intensive care unit requirement. No significant difference was detected between only fetal growth restriction group and oligohydramnios with fetal growth restriction group in terms of all parameters. We suggest that patients with only oligohydramniosis have more favorable pregnancy outcomes than pregnants with only fetal growth restriction and coexistence of two conditions in preeclamptic patients. We claim that it could be appropriate to recommend close monitorization in preeclamptic patients with only fetal growth restriction and oligohydramniosis and fetal growth restriction.

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.

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.

OEIS Syndrome: Omphalocele, Exstrophy of the Cloaca, Imperforate Anus, and Spinal Defects

OEIS Syndrome: Omphalocele, Exstrophy of the Cloaca, Imperforate Anus, and Spinal Defects