Vol. 3, Issue 4 (2017)
Maternal and fetal factors in pregnancy with oligohydramnios and maternal and perinatal outcome
Author(s): Dr. Yashodhara Gaur, Dr. Hemlata Parashar, Dr. Deepika Dhurve
Abstract: Background: For maternal and fetal health, oligohydramnios has become a threatening condition. Oligohydramnios is the clinical condition in which amniotic fluid index (AFI) ≤ 5 cm is quantified using ultrasonographic techniques. Aims and objectives: To evaluate amniotic fluid volume using AFI and to assess the maternal and fetal factors and perinatal outcome in cases with oligohydramnios. Materials and Methods: Present study was performed at KRH and GR Medical College, Gwalior between September 2011 to September 2012. The study included 100 clinically suspected cases of oligohydramnios in third trimester. Detailed history along with ultrasonographic examination was performed for number of fetus, gestational age and placental localization. Amniotic fluid volume was measured using amniotic fluid index (AFI) as normal (8.1 to 18 cm), low (5.1-8 cm) and very low (≤ 5cm). Congenital anomalies of head spine abdomen and limbs were also observed. Apgar score at 1 min and 5 min, weight, sex, maturity, congenital anomalies, perinatal mortality if present was also noted. Results: Out of 5789 admission, 100 (1.7%) were the suspected cases of oligohydramnios. Out of 100 suspected cases, 74 were confirmed using ultrasonography. Incidence rate of oligohydramnios as calculated out of total admissions (N=5789) and conformed cases during the study period was 1.2%. Out of 100 oligohydramnios cases, 38% were confirmed as having very low AFI, 36% had low and 26% cases had normal AFI. Most of the women who had very low AFI belong to age group of 21-25 years (57.89%) and were nulliparous (63.15%). Most common maternal factors associated with oligohydramnios were anemia and PIH. In women with very low AFI, vaginal delivery was possible in 36.8% compared to CS (50%). Variable fetal heart rate deceleration (10.52%) was mostly observed. Higher incidence of low Apgar score <7 at 1 min and 5 min and meconium stained liquor was observed among cases with very low AFI [6 (15.2%) and 5 (13.15%) respectively] and low AFI (22.2%) respectively. Higher incidence of IUGR was observed in very low AFI [16 (42.10%)]. Gross and corrected perinatal mortality rate was increased as the AFI decreased. Corrected still birth rate was increased as the AFI decreased in present study. Conclusion: In very low AFI group, risk of intervention for fetal distress, meconium passage and low Apgar score at 1 and 5 min was significantly higher. Such patients should be monitored carefully during labor and active intervention for a very low AFI, probably allows margin of safety before a major risk of perinatal complication is incurred.