Obstetric outcome study of oligohydramnios beyond 34 completed weeks of gestation
Keywords:AFI, Fetal anomalies, Ultrasound GE Voulson S8-PRO
Background: Perinatal morbidity and mortality are significantly increased when oligohydramnios is present. As the amniotic fluid volume decreases, the perinatal mortality rate increases. The incidence of major congenital anomalies with IUGR also increases as the amniotic fluid volume declines. There is a close association between declining placental function in the latter part of the third trimester and amniotic fluid volume1. Thus, post term patients are at a greater risk for development of oligohydramnios. Fetal anomalies that results in oligohydramnios classically involve the urinary tract. The most frequently mentioned renal anomalies include bilateral renal agenesis, multicystic dysplastic kidneys, bladder outlet obstruction and infantile polycystic kidneys.
Methods: All antenatal patients seen in the Department of Obstetrics and Gynecology at Sri Siddhartha Medical College and Research Centre between January 2015 to January 2017, who were willing to participate in the trial study were enrolled. Ultrasound GE Voulson S8-PRO equipped with 3.5 MHz transducer was used to measure the amniotic fluid index. The AFI in each group was noted and the pregnancy outcome in each group was determined. At the time of delivery following data variables were collected and compiled.
Results: There were 105 women, who were divided into three groups of 35 each. Those women with AFI<5 had more chances of emergency caesarian section, the causes were fetal distress with variable and late fetal heart decelerations. The incidence of meconium stained liquor and NICU admission were more.
Conclusions: The women with AFI<5 had more chances of emergency caesarian section, the causes were fetal distress with variable and late fetal heart decelerations. Amniotic Fluid Index is a valuable screening test for detecting fetuses that may have poor perinatal outcome.
Crowley P, O'Herlihy CO, Boylan P. The value of ultrasound measurement of amniotic fluid ume in the management of prolonged pregnancies. BJOG: An Int J Obstet Gynaecol. 1984 May;91(5):444-8.
Chamberlain MB, Manning FA, Morisson 1. Ultrasound evaluation of amniotic fluid index, the relationship of marginal and decreased amniotic fluid volume to perinatal outcome. Am J Obstet Gynecol. 1984;150:245-9.
Brace RA. Physiology of amniotic fluid volume regulation. Clin Obstet Gynecol. 1997;40:280.
Wallenburg HCS. The amniotic fluid: I. water and electrolyte homeostatis. J Perinat Med. 1977;5:193.
Phelan JP, Smith CV, Broussard P, Small M. Amniotic fluid volume assessment with the four-quadrant technique at 36-42 weeks' gestation. J Reprod Med. 1987 Jul;32(7):540-2.
Marks AD, Divon MY. Longitudinal study of the amniotic fluid index in post-dates pregnancy. Obstet Gynecol. 1992 Feb;79(2):229-33.
Sherer DM, Cullen JB, Thompson HO, Woods JR. Transient oligohydramnios in a severely hypovolemic gravid woman at 35 weeks' gestation, with fluid reaccumulating immediately after intravenous maternal hydration. Am J Obstet Gynecol. 1990 Mar 1;162(3):770-1.
Kirshon B, Mari G, Moise JK. Indomethacin therapy in the treatment of symptomatic polyhydramnios. Obstet Gynecol. 1990 Feb;75(2):202-5.
O'brien JM, Mercer BM, Friedman SA, Sibai BM. Amniotic fluid index in hospitalized hypertensive patients managed expectantly. Obstet Gynecol. 1993 Aug;82(2):247-50.
Bronshtein M, Blumenfeld Z. First‐and early second‐trimester oligohydramnios—a predictor of poor fetal outcome except in iatrogenic oligohydramnios post chorionic villus biopsy. Ultrasound Obstet Gynecol. 1991 Jul 1;1(4):245-9.
Lagrew DC, Pircon RA, Nageotte M, Freeman RK, Dorchester W. How frequently should the amniotic fluid index be repeated?. Am J Obstet Gynecol. 1992 Oct 1;167(4):1129-33.
Deutinger J, Bartl W, Pfersmann C, Neumark J, Bernaschek G. Fetal kidney volume and urine production in cases of fetal growth retardation. J Perinatal Med-Official J WAPM. 1987;15(3):307-15.
Chauhan SP, Sanderson M, Hendrix NW, Magann EF, Devoe LD. Perinatal outcome and amniotic fluid index in the antepartum and intrapartum periods: a meta-analysis. Am J Obstet Gynecol. 1999 Dec 1;181(6):1473-8.
Redźko S, Przepieść J, Urban J, Jóźwik M, Skotnicki MZ, Urban R. Antepartum amniotic fluid index and pregnancy outcome. Ginekologia Polska. 1998 Apr;69(4):163-7.
Baron C, Morgan MA, Garite TJ. The impact of amniotic fluid volume assessed intrapartum on perinatal outcome. Am J Obstet Gynecol. 1995 Jul 1;173(1):167-74.
Locatelli A, Vergani P, Toso L, Verderio M, Pezzullo JC, Ghidini A. Perinatal outcome associated with oligohydramnios in uncomplicated term pregnancies. Arch Gynecol Obstet. 2004 Jan 1;269(2):130-3.
Casey BM, McIntire DD, Bloom SL, Lucas MJ, Santos R, Twickler DM, et al. Pregnancy outcomes after antepartum diagnosis of oligohydramnios at or beyond 34 weeks’ gestation. Am J Obstet Gynecol. 2000 Apr 1;182(4):909-12.