Nature has made floating bed in form of amniotic fluid cavity filled with liquor amnii for the requirement of fetus, for its existence and growth in sterile environment, regulation of temperature, avoidance of external injury and reduction of impact of uterine contractions. Decrease in amniotic fluid volume or Oligohydramnios[1] has been correlated intrauterine with increased risk of growth retardation, meconium aspiration syndrome, severe birth asphyxia, low APGAR scores and congenital abnormities.[2] Oligohydramnios is also associated with maternal morbidity in form of increased rates of induction and/ or operative interference.[3] With the help of method of amniotic fluid estimation by Amniotic fluid Index (AFI) using four quadrant technique during transabdominal USG, as per described by Phelan et al[4] in 1997, better identification of fetus at high risk can be done, which was otherwise difficult in past by clinical estimation of amniotic fluid done. Increased induction of labour and elective caesarean deliveries are currently practiced for better perinatal outcome. Early detection of oligohydramnios and its management may help in reduction of perinatal morbidity and mortality one side and decreased caesarean deliveries on the other side. Since Oligo hydramnios has got significant impact on neonatal outcome and material morbidity, it prompted us to study the condition.

Present study was done over a period from May 2024 to November 2024. 100 patients in third trimester of pregnancy with Oligohydramnios selected randomly after satisfying inclusion and exclusion criteria.

Inclusion Criteria: Antenatal patients in their third trimester with intact membranes.

Exclusion Criteria: Antenatal patients having heart diseases, Polyhydramnios, premature rupture of membranes, twins and multiple pregnancies.

Study was conducted to observe outcome of labour in form of perinatal morbidity and maternal outcome in form of induction and deliveries:

• To study affects Oligohydramnios on fetal outcome in form of – (a) Fetal distress, (b) Growth retardation, (c) NICU admission;
• To study APGAR scores of newborn babies in relation to Oligohydramnios;
• To study incidence of congenital malformation;
• To study early neonatal morbidity and mortality;
• To study maternal morbidity in form of operative delivery and induced

A detailed history and examination were done. All required investigation done. Oligohydramnios confirmed by measuring AFI. Routine management in form of rest, left lateral position, oral and intravenous hydration and control of etiological factor was done if present. Fetal surveillance was done by USG, modified Biophysical profile and Doppler. Decision of delivery by either induction or elective or emergency LSCS was done as per required. Some.

patients were already in labour and other allows going in spontaneous labour. Cases were than studied for maternal and perinatal outcome.

67% of patients were in 20-25 years age group and 23% patients were in 26-30 years age group. Thus, maximum patients were in 20-30 years age group. Rate of caesarean was highest in 26-30 years and lowest in patients of >39 years of age. Mean maternal age was 23.66 years (Table 1). Incidence of oligohydramnios was more in primipara (52%) in our study. And operative morbidity was also more in primipara (57.7%, 55.78 ± 1.92) (Table 2). Most common cause of Oligohydramnios is idiopathic (52%). Second commonest cause is PIH (25%). Operative morbidity is highest in PIH (60%) (Table 3).

Operative morbidity was significantly higher in NST non-reactive (78.12%, 3.12 ± 0.75) group than NST reactive (26.47%) group (Table 4). All patients were undergone Doppler study. 7% were found with fetoplacental insufficiency. In present study, 25 patients had induction of labour. It showed 64% vaginal delivery and 36% caesarean section (Table 5). Most common reason to perform caesarean was fetal distress which was either due to cord compression or IUGR (Table 6). Oligohydramnios was related to higher rate of growth retardation and NICU admission (Table 7). In NST Reactive group, 1 baby expired due to septicaemia and another expired due to HMD and LBW. In NST Non-Reactive group, both babies expired due to meconium aspiration syndrome + acute respiratory distress syndrome (Table 8).

Table-1: Age and Maternal Outcome of Labour

Table-2: Parity and Maternal Outcome of Labour

Table-3: Associated Condition and Maternal Outcome of Labour

Table-4: Non-Stress Test (NST)

Table-5: Doppler

Table-6: Indication of Caesarean Section

Table-7: Outcome of Baby

Table-8: Attributes Related to Domestic Violence [Frequency of Violence]

In Casey et al[5], the mean maternal age was 23.9 years which is comparable to the present study. In Donald D et al[6], the incidence of oligohydramnios was 60% in primigravida which is comparable to present study as it was 52%. Sir Gangaram Hospital study[7] shows 68% vaginal deliveries in induced patients of Oligohydramnios and 32% by caesarean section which is comparable to our study. Manzanares S et al[8] shows 84% vaginal deliveries in induced patients of Oligohydramnios and 16% by caesarean section. In this study, in spite of non- reactive NST 25% patients delivered vaginally. The caesarean section was done more commonly in 755 patients with non-reactive NST as seen in Jandial study.[9] As these patients had oligohydramnios, a non-reactive NST + AFI < 5 indicated fetal jeopardy as per revised Biophysical profile scoring by Clerk et. al.[10] The fetal jeopardy was reflected as increase operative interference in this study.

The operative morbidity is significantly higher in patients with altered Doppler study. In Weiss et al[11] and Yound HK et al[12], it was 71% and 69.7%

respectively which was comparable to this study. The two patients were given amnioinfusion antenatally. Both showed improvement in AFI and pregnancy was prolonged. Both babies were low birth weight but healthy and did not required NICU admission. It was comparable to Gramellini D et al[13] where amnioinfusion was significantly gestation and reduced neonatal mortality. In present study, 36% babies had weight < 2.5 kg. Mean birth weight was 2.33 kg which is similar to the study conducted by William Ott et al[14] with the mean birth weight was 2.4 kg. The incidence of low birth weight babies is higher in Oligohydramnios except in post maturity where the babies may have average birth weight. In Julie Johnson et al[15], 92.6% babies were AGA and 7% were SGA. In Brain M Casey et al[16] 75.5% AGA and 24% SGA. In Philipson EH et. al[17] 60% AGA and 40% SGA. In Manning et al[18] 64% AGA and 36% SGA. In Raj Sariya et al[19] 83.4% AGA and 16.6% SGA. This high percentage of SGA babies suggesting correlation of IUGR with Oligo hydramnios. In Manning et al[18] 15% babies had APGAR score < 7. In Raj Sariya et al[19], it was 38%. In Julie M Jhonson et al[15] 20% babies had NICU admission. In Manning et al[18] and Raj Sariya et al[19], 43% and 88.88% respectively. Golan et al[20] show 6.3% neonatal death in deliveries of Oligohydramnios patients which is observed our study.

Oligohydramnios is frequent occurrence and demands intensive fetal surveillance and proper antepartum and intrapartum care. Oligohydramnios is a frequent finding in pregnancy involving IUGR, PIH, and pregnancy beyond 40 weeks of gestation. Amniotic fluid volume is a predictor of fetal tolerance in labour and its decrease is associated with increased risk of abnormal heart rate and meconium stained fluid. Due to intrapartum complication and high rate of perinatal morbidity and mortality, rates of caesarean section are rising, but decision between vaginal delivery and caesarean section should be well balanced so that unnecessary maternal morbidity prevented and other side timely intervention can reduce perinatal morbidity and mortality.

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21. Hitschold T, Weiss E, Berle P, Muntefering H. Histologic placenta findings in prolonged pregnancy: correlation of placental retarded maturation, fetal outcome and Doppler sonographic findings in the umbilical artery. Z Geburtshilfe Perinatol 1989;193(1):42–6
22. Kwon JY, Kwon HS, Kim YH, Park YW. Abnormal Doppler Velocimetry is related to adverse perinatal outcome for borderline amniotic fluid index during third trimester. J Obstet Gynecol Res 2006:32(6):545 49.
23. Volante E, Gramellini D, Moretti S, Kaihura C, Bevilacqua G. Alteration of the amniotic fluid and neonatal outcome. Acta Biomed 2004;75 (Suppl 1):71-5.
24. Ott WJ. Reevaluation of the relationship between amniotic fluid volume and perinatal outcome. Am J Obstet Gynecol 2005;192(6):1803-9.
25. Johnson JM, Chauhan SP, Ennen CS, Niederhauser A, Magann EF. A comparison of 3 criteria of oligohydramnios in identifying peripartumcomplications: a secondary analysis. Am J Obstet Gynecol 2007;197(2):207.e1- 7.
26. Casey BM, McIntire DD, Bloom SL, Lucas MJ, Santos R, Twickler DM, et al. Pregnancy outcomes after antepartum diagnosis of oligohydramnios at or beyond 34 weeks’ of gestation. Am J Obstet Gynecol 2000;182(4):909-12.
27. Philipson EH, Sokol RJ, Williams T. Oligohydramnios: Clinical Associations and Predictive Value for Intrauterine Growth Retardation. Am J Obstet Gynecol 1983;146(3):271-278.
28. Manning FA, Hill LM, Platt LD. Qualitative amniotic fluid volume determination by ultrasound : Antepartum detection of intrauterine growth retardation. Am J Obstet Gynecol 1981;139(3):254 58.
29. Sriya R, Singhai S. Perinatal outcome in patients with amniotic fluid index < 5cm. J Obstet Gynaecol India 2001;51:98-100.
30. Golan A, Lin G, Evron S, Arieli S, Niv D, David MP. Oligohydramnios: maternal complications and fetal outcome in 145 cases. Gynecol Obstet Invest 1994;37(2):91-5.