FETOMATERNAL OUTCOME IN PATIENTS WITH LOW AMNIOTIC FLUID INDEX IN PREGNANCY
DOI:
https://doi.org/10.71000/5sw0y444Keywords:
Amniotic Fluid Index, Cesarean Section, Fetal Growth Retardation, Neonatal Mortality, Oligohydramnios, , Pregnancy Outcomes, UltrasonographyAbstract
Background: Amniotic fluid plays a critical role in fetal development, serving as a protective medium and a marker of placental function. The amniotic fluid index (AFI), measured via ultrasound, is a widely accepted tool for assessing fluid volume. Oligohydramnios, defined as an AFI ≤5 cm, has been linked to several adverse perinatal outcomes, including intrauterine growth restriction (IUGR), low birth weight, and neonatal morbidity. Early identification through routine antenatal screening is essential for timely intervention and improved maternal and fetal outcomes.
Objective: To determine the frequency of low amniotic fluid index (AFI) in women presenting for routine antenatal checkups and to compare fetomaternal outcomes between patients with low AFI and those with normal AFI levels.
Methods: This descriptive case series was conducted at the Department of Obstetrics and Gynaecology, Ch. Muhammad Akram Teaching and Research Hospital, Lahore, from December 2024 to February 2025. A total of 205 pregnant women meeting the inclusion criteria were enrolled using non-probability consecutive sampling. The AFI was assessed by ultrasound, with ≤5 cm defined as low. Patients were monitored throughout pregnancy and childbirth. Data were collected using a structured proforma and analyzed using SPSS version 26. Chi-square test was applied, and a p-value ≤0.05 was considered statistically significant.
Results: The mean maternal age was 30.40 ± 5.76 years. The average gestational age was 36.33 ± 1.72 weeks, and the mean birth weight was 3.01 ± 0.42 kg. Low AFI was observed in 14 patients (6.83%). Among these, 9 (27.3%) neonates had low birth weight compared to 5 (2.9%) in the normal AFI group (p < 0.001). Significant associations were also found between low AFI and meconium staining (50.0% vs 4.1%, p < 0.001), IUGR (50.0% vs 4.1%, p < 0.001), neonatal ICU admissions (42.9% vs 5.6%, p = 0.008), low APGAR scores (42.9% vs 2.7%, p < 0.001), cesarean delivery (13.1% vs 2.5%, p = 0.003), and neonatal death (66.7% vs 5.9%, p = 0.013).
Conclusion: Low amniotic fluid was identified in a notable proportion of patients and was significantly associated with adverse fetomaternal outcomes. Routine AFI monitoring during antenatal visits is crucial for identifying high-risk pregnancies and initiating timely interventions.
References
Figueroa L, McClure EM, Swanson J, Nathan R, Garces AL, Moore JL, et al. Oligohydramnios: a prospective study of fetal, neonatal and maternal outcomes in low-middle income countries. Reproductive health. 2020; 17:1-7.
Twesigomwe G, Migisha R, Agaba DC, Owaraganise A, Aheisibwe H, Tibaijuka L, et al. Prevalence and associated factors of oligohydramnios in pregnancies beyond 36 weeks of gestation at a tertiary hospital in southwestern Uganda. BMC Pregnancy and Childbirth. 2022;22(1):610.
Whittington JR, Ghahremani T, Friski A, Hamilton A, Magann EF. Window to the womb: Amniotic fluid and postnatal outcomes. International Journal of Women's Health. 2023:117-24.
Arif N, Zafar B, Arif A, Ahmed RQ, Shehzad F. The impact of isolated oligohydramnias at term on perinatal outcome: A comparative study. Pakistan Armed Forces Medical Journal. 2021(4):1274.
Bohiltea R-E, Mihai BM, Ducu I, Cioca A-M, Bohiltea A-T, Iordache A-M, et al. Current Innovative Methods of Fetal pH Monitoring—A Brief Review. Diagnostics. 2022;12(11):2675.
Sekhon S, Rosenbloom JI, Doering M, Conner SN, Macones GA, Colditz GA, et al. Diagnostic utility of maximum vertical pocket versus amniotic fluid index in assessing amniotic fluid volume for the prediction of adverse maternal and fetal outcomes: a systematic review and meta-analysis. The Journal of Maternal-Fetal & Neonatal Medicine. 2021;34(22):3730-9.
Vasanthamani DP, Meenakshi DS, Ponnuraja DC, Padmanaban S. A study on perinatal outcome in oligohydramnios. International Journal of Clinical Obstetrics and Gynaecology. 2020;4(1):39-41
Vyas A, Prasanna G, Dash S, Rath S. Comparison of Perinatal and Maternal Outcomes in Borderline Versus Normal Amniotic Fluid Index in a Tertiary Care Center in Odisha: An Observational Prospective Study. Cureus. 2021 Nov;13(11): e19876.
Milani F, Khosousi L, Sharami SH, Shakiba M, Rasoulian J, Attari SM, et al. Evaluation of Perinatal Outcomes in Pregnant Women with Low Amniotic Fluid Index. J Family Reprod Health. 2023 Dec;17(4):199-204.
Aramabi E, Ebeigbe P, Ogbeide A, Onyemesili C. Borderline amniotic fluid index in nigerian pregnant women is associated with worse fetal outcomes: Results of a prospective cohort study. Nigerian Journal of Clinical Practice. 2022;25(6):938-43.
Mashkaria AM, Patel BS, Shah AC, Jani SK, Patel VB, Patel AB, et al. Study of effects of oligohydramnios on perinatal outcome. International Journal of Reproduction, Contraception, Obstetrics and Gynecology. 2020;9(6):2525.
Lajber F, Habib H, Khaliq S. Role of Low Amniotic Fluid Index (AFI) on Perinatal Outcome in Women with Term Pregnancy. Pakistan journal of medical and health sciences. 2020;14(3):1498-500.
Masood A, Ujala S, Anwar S. Mode of delivery and perinatal outcomes of oligohydramnios: a study at a tertiary care hospital in Bahawalpur, Pakistan. Rawal Medical Journal. 2021;46(3):632-.
Saxena R, Patel B, Verma A. Oligohydramnios and its perinatal outcome. Int J Reprod Contracept Obstet Gynecol. 2020;9(12):4965-70.
Simmons PM, Whittington JR, Estrada SM, Ounpraseuth ST, Shnaekel KL, Slaton KB, et al. What is the impact of abnormal amniotic fluid volumes on perinatal outcomes in normal compared with at-risk pregnancies? International Journal of Women's Health. 2020:805-12.
Schreiber H, Cohen G, Zahavi M, Wiener I, Biron-Shental T, Chowers M, et al. Adverse obstetric outcomes in cases of meconium-stained amniotic fluid complicated with intrapartum fever. Arch Gynecol Obstet. 2024;310(4):1951-7.
Bakhsh H, Alenizy H, Alenazi S, Alnasser S, Alanazi N, Alsowinea M, et al. Amniotic fluid disorders and the effects on prenatal outcome: a retrospective cohort study. BMC Pregnancy Childbirth. 2021;21(1):75.
Buyuk GN, Oskovi-Kaplan ZA, Kahyaoglu S, Engin-Ustun Y. Echogenic particles in the amniotic fluid of term low-risk pregnant women: does it have a clinical significance? J Obstet Gynaecol. 2021;41(7):1048-52.
Azarkish F, Janghorban R, Bozorgzadeh S, Arzani A, Balouchi R, Didehvar M. The effect of maternal intravenous hydration on amniotic fluid index in oligohydramnios. BMC Res Notes. 2022;15(1):95.
Itzhaki-Bachar L, Meyer R, Levin G, Weissmann-Brenner A. Incidental finding of meconium-stained amniotic fluid in elective cesarean deliveries: Features and perils. Int J Gynaecol Obstet. 2022;158(2):418-23.
Teka H, Gidey H, Gebrehiwot TG, Yemane A, Abraha HE, Ebrahim MM, et al. Perinatal outcome of oligohydramnios in academic hospitals in a low resource setting. Afr J Reprod Health. 2023;27(4):54-64.
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