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Category: Volume 06 Issue 05 May 2018
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Title: Antepartum Oligohydramnios and Perinatal Outcome: A Reevaluation

Authors: Dr Sabahat Rasool MS, MRCOG (UK), DNB, MNAMS, FMAS, Dr Tamkin Rabbani (MD, DNB, MNAMS, MICOG), Dr Omar S Akhtar (MS, DNB (Surgery), MRCS (Edin), DNB (Urology), FMAS), Prof Nazoora Khan (MD), Prof Ibne Ahmad (MD), Dr Nishat Afroz (MD)

 DOI:  https://dx.doi.org/10.18535/jmscr/v6i5.175

Abstract

Objective: The study was undertaken to re-evaluate the impact of isolated oligohydramnios on pregnancy and perinatal outcome.

Study Design: The study was a case-control study of 100 antenatal subjects in the Department of Obstetrics and Gynaecology in collaboration with Departments of Pathology and Radio-diagnosis, Jawaharlal Nehru Medical College, AMU, Aligarh, India over a period of two years (2012-2015). Two groups, study and control, based on their latest amniotic fluid assessment, were evaluated to determine the relationship between amniotic fluid index (AFI) and gestational age at delivery, induction of labour, meconium-stained liquor, cesarean delivery, birth weight, congenital anomalies, Apgar Score at 5 minutes and neonatal complications. Statistical evaluation was done using z-test. Subjects and controls were matched for age, social status and gravidity.

Results: AFI determinations in 100 pregnant females beyond 34 weeks gestation were used to allocate the patients to the study (AFI < 5cm, oligohydramnios) and the control (AFI 5-25cm) groups.

The mean gestational age at delivery was significantly lower in the study group. Labour was induced in a significantly higher number of patients in the study group compared to the control group. The incidence of cesarean delivery and congenital anomalies was significantly higher in the study group. There was no statistically significant difference in meconium-staining of liquor, birth weights, low 5-minute Apgar Score and neonatal complications between the two groups.

Conclusion: Oligohydramnios has been classically considered an indicator of fetal compromise and compromised utero-placental circulation but recent studies have called this into question. The present study suggests that the benefits of AFI in ante-partum surveillance need to be re-determined in a large, multi-center, randomised study.

References

  1. American College of Obstetricians and Gynecologists. Antepartum fetal surveil-lance. Practice Bulletin No. 9 : Antepartum fetal surveillance. October 1999.
  2. Peipert JF, Donnenfeld AE. Oligohydr-amnios: A Review. Obstet Gynecol Surv. 1999;46:325.
  3. Rutherford SE, Phelan JP, Smith DV, Jacobs N. The four quadrant assessment of AFV; an adjunct to fetal heart rate testing. Obstet gynecol. 1987;70:353.
  4. Garmel SH, Chelmow D, Sha SJ, Roan JT, D’Alton ME. Oligohydramnios and appropriately grown fetus. Am J Perinat 1997;14:359-63.
  5. Kreiser D, EI-Sayed YY, Sorem KA, Chitkara U, Holbrook RH, Druzin ML. Decreased amniotic fluid in low risk pregnancy. J Reprod Med 2001;46:743-6.
  6. Magann EF, Chauhan SP, Doherty DA, Barrilleuax PS, Martin JN, Morrison JC. Predictability of intrapartum and neonatal outcomes with the amniotic fluid volume distribution: a reassessment using the amniotic fluid index, single deepest pocket, and a dye-determined amniotic fluid volume. Am J Obstet Gynecol 2003;188:1523-8.
  7. Magann EF, Kinsella MJ, Chauhan SP, McNamara MF, Gehring BW, Morrison JC. Does an amniotic fluid index of less than 5cm necessitate delivery in high-risk pregnancies? A case-control study. Am J ObstetGynecol1999;180:1354-9.
  8. Shipp TD, Bromley B, Panker S. Outcome of singleton pregnancies with severe oligohydramnios in second and third trimesters. Ultrasound Obstet Gynecol 1996;7:108.
  9. Bastide A, Manning F, Harman C. Ultrasound evaluation of amniotic fluid: outcome of pregnancies with severe oligohydramnios. Am J Obstet Gynecol 1986;154:895.
  10. Locatelli A, Vergani P, Toso L, Verderio M, Pezzullo JC, Ghidini A. Perinatal outcome associated with oligohydramnios in uncomplicated term pregnancies. Arch GynecolObstet 2004; 269:130-33.
  11. Chauhan SP, Sanderson M, Hendrix NW, Magann EF, Devoe LD. Perinatal outcome and amniotic fluid index in antepartum and intrapartum periods: a meta-analysis. Am J ObstetGynecol1999;181:1473-8.
  12. Alchalabi HA, Obeidat BR, Jallad MF, Khader YS. Induction of labor and perinatal outcome: the impact of AFI. Eur J Obstet Gynecol Reprod Biol 2005.
  13. Casey BM, McIntire DD, Bloom SL, Lucas MJ, Santos R, Twickler DM, Ramus RM, Leveno KJ. Pregnancy outcomes after antepartum diagnosis of oligohydramnios at or beyond 34 weeks gestation. Am J ObstetGynecol2000;182:909-12.
  14. Ott WJ. Reevaluation of the relationship between amniotic fluid volume and perinatal outcome. Am J Obstet Gynecol 2005;192:1803-9.
  15. Magann EF, Chauhan SP, Kinsella MJ, McNamara MF, Whitworth NS, Morrison JC. Antenatal testing among 1001 high-risk patients: the role of ultrasonographic estimation of amniotic fluid volume. Am J ObstetGynecol1999;180:1330-6.

Corresponding Author

Sabahat Rasool

Fertility Consultant & Reproductive Medicine Specialist, Gynaecworld, Mumbai, India

Email: This email address is being protected from spambots. You need JavaScript enabled to view it., Mob: 08879337870