Correlation between Amniotic Fluid Index and Perinatal Outcome in Uncomplicated Term Pregnancy
AIM: To find out the sensitivity of correlation of Amniotic fluid index to perinatal outcome and the obstetrical management and its effect on maternal health in uncomplicated term pregnancy. SETTING: The study was conducted as a prospective observational study on 300 ultrasound proven cases at PRM MEDICAL COLLEGE, Baripada, Odisha, India. METHOD OF STUDY:In our study we studied 600 cases who fulfilled our inclusion and exclusion criteria, the eligible cases were recruited from opd, ipd and labour room from our institute. For all the selected cases detailed history was taken and clinical examination was performed and gestational age assessed. For all the women, ultrasound examination was done and amniotic fluid index was calculated by four quadrant technique after informed consent was obtained. Approval from the Institutional ethics committee .Amniotic fluid index estimation was done by B-Mode real time electronic array linear scanner using four quadrant technique described by phelan et al. Women were divided into three groups based on their AFI: Normal AFI >5– 24 cm, Oligohydramnios ≤5cmPolyhydramnios ≥25 cm Maternal outcome in the form of mode of delivery, labour related events like abnormal fetal heart rate and cesarean section for fetal distress were studied. Perinatal outcome in the form of APGAR score at 1 minute and 5 minute, birth weight, meconium staining of liquor and NICU admissions were studied. Indications for NICU admission included meconium aspiration syndrome, neonatal depression, cyanosis, transient tachypnoea of newborn and jaundice. Results were tabulated and statistically analyzed. P value less than 0.05 was considered statistically significant. RESULTS: Total 600 cases were studied,of which 198 cases had AFI≤5,390 cases had AFI >5-24 and 12cases had AFI≥25. In our study 51.01% women in the oligohydramnios group was nulliparous,34.85% had parity P1,14.14% had parity P2 or more;in the group with normal AFI 52.05% were nulliparous,29.74% had parity P1,18.21% had parity P2 or more. In polyhydramnios group five cases (41.67%) were nulliparous, three (25%) were primipara, four (33.33%) had parity≥ P2. There was no statistical difference in parity among groups(p=0.32).Overall 51.5% cases were nulliparous,31.33% cases had parity of P1,17.17% cases had parity of P3 or more. In our study ,distribution of gestational age was studied and 69.7% women in the group of oligohydramnios had gestational age less than or equal to 40 weeks.30.3% women had gestational age more than 40 wks.In group of normal AFI 62.56% women below 40 weeks and 37.44% women belonged to >40wks.All polyhydramnios cases were ≤40weeks In our study,it was found that89.4% women underwent cesarean section and 10.6% women underwent normal delivery in the oligohydramnios group.In group with normal AFI 37% underwent cesarean and 63% underwent normal delivery.In polyhydramnios group 25% patients underwent cesarean delivery. In our study,indication for cesarean section was non reassuring fetal heart rate (64.01%)and CPD(30.51%) in oligohydramnios group.In normal AFI group non reassuring fetal heart rate was the cause for 59.72% cesarean section where as CPD was the cause for 36.11% of cesarean section.Failed induction was the cause for LSCS in 5% cases in oligohydramnios gr and 4% cases in normal AFI gr. We studied the perinatal outcomes and compared the NICU admission between the groups and in our study 18% of neonates had NICU admission in oligohydramnios group compared to 12.31% NICU admission in normal AFI group and there was no NICU admission in polyhydramnios groupCONCLUSION: The determination of AFI can be used as an adjunct to other fetal surveillance methods and oligohydramnios with AFI less than or equal to 5 is associated with statistically significant high cesarean rate.