Comparison of Perinatal and Maternal Outcomes in Borderline Versus Normal Amniotic Fluid Index in a Tertiary Care Center in Odisha: An Observational Prospective Study

Abstract

BackgroundAmniotic fluid is a protective fluid in the amniotic sac of a gravid uterus that serves many crucial functions by becoming part of an indicator of a functioning fetoplacental unit during the intrauterine life of a fetus. The most commonly used method for measuring amniotic fluid is the amniotic fluid index (AFI). In this study, we aimed to investigate the perinatal and maternal outcomes in borderline AFI versus normal AFI. MethodologyThis observational prospective study included 200 pregnant women who were admitted to Pradyumna Bal Memorial Hospital, Bhubaneswar from September 2019 to February 2021. Women with singleton pregnancy in their third trimester were enrolled in this study after applying inclusion and exclusion criteria. Of the included women, 100 were cases with borderline AFI, and 100 were control with normal AFI. Fetal and maternal outcomes were compared between the two groups. Data analysis was done using SPSS version 23 (IBM Corp., Armonk, NY, USA). ResultsMaternal outcomes such as preterm delivery, meconium-stained liquor, and lower segment cesarean section in women with borderline AFI were significantly higher (p ≤ 0.001). The borderline AFI group had a higher rate of perinatal complications such as Apgar score of <7 (p = 0.001), respiratory distress syndrome (p = 0.001), neonatal intensive care unit admission (p <0.001), intrauterine growth restriction (p < 0.001), and low birth weight (p < 0.001). ConclusionsThe borderline AFI group was associated with adverse perinatal and maternal outcomes which were significantly higher in this group compared to the control group. Therefore, patients with borderline AFI should be monitored carefully during the antepartum and intrapartum period.

Comparison Of Maternal And Perinatal Outcome Of Isolated Borderline Amniotic Fluid Index Versus Normal Amniotic Fluid In Low-Risk Pregnancies At Term

“…Vyas A in his study of 200 pregnant women calculated a mean age of 28.5 years, a finding similar to our study. 14 The mean age was 25.17 years in the study by Sadia S which was less than the mean age of our patients. 15 The majority of women in our study were multigravida (76.5% versus 23.5%).…”

“…21 Vyas A also observed a very high cesarean section rate (59% versus 35%) in the borderline AFI group which might be because cases of IUGR and abnormal Doppler studies were not excluded. 14 Meconium staining of amniotic fluid was observed in 10.5% (19/180) and 6.6% (24/360) cases of borderline and normal AFI respectively in our study(p=0.116). There is an increased risk of meconium staining of liquor in postdate pregnancy, pre-eclampsia, prolonged labour, prelabour rupture of membranes, fetal distress, and intrauterine growth restriction.…”

“…20,21 Vyas A noted a higher rate of passage of meconium in cases of borderline AFI ( 27% versus 11%, p=0.006). 14 The reason may be that he did not exclude women with pre-eclampsia and IUGR which increase the risk of meconium-stained liquor. More cases of meconium-stained liquor (18% versus &7%) were observed in the study by Desia DV which did not exclude high-risk pregnancies.…”

“…In studies by Vyas A and Vennila M more newborns in the borderline AFI group had APGAR score <7 at 5 minutes and required admission in NICU. 14,19 The reason might be that they have not excluded women with medical and other risk factors. There was no significant increase in cases of meconium-stained liquor and NICU admission in a study by Arambi EO, which excluded women with medical comorbidities.…”

Fetomaternal Outcome in Pregnant Women at Term With Low Amniotic Liquid

“…A study conducted in India to assess the fetomaternal outcome in borderline AFI vs normal AFI reported that the number of caesarean sections was significantly higher in the borderline AFI group, which supports our findings. They also reported that the incidence of low APGAR score at 5 minutes, low birth weight, and NICU admission were significantly higher in the borderline AFI group than the controls (Vyas et al, 2021).…”