Oligohydramnios is a clinical condition characterized by amniotic fluid index (AFI) of 5cm or less [1]. Its incidence is 3-5 % and is usually associated with a high rate of pregnancy complications and increased perinatal morbidity and mortality [2]. It often increases the risk of small for gestational age (SGA) and also the incidence of cesarean section, meconium stained, low Apgar score and Neonatal intensive care (NICU) admission [3]. Thus, amniotic fluid index (AFI) assessed antepartum or intrapartum would help to identify women who need increased antepartum surveillance for pregnancy complications. During antenatal fetal surveillance, amniotic fluid assessment is a crucial barometer to know the fetal status. [4] Quantification of amniotic fluid is an important component of the biophysical profile in USG evaluation of fetal well-being at term. Keeping in mind the above knowledge [5], the present study was carried out to find whether oligohydramnios can be used as a predictor of adverse perinatal outcome in non-complicated pregnancies at term.

Aim: To determine the maternal and perinatal outcome of term pregnancy with oligohydramnios during third trimester of pregnancy.

Objectives

• To study the maternal outcome i.e. mode of delivery.
• To evaluate the perinatal outcome in third trimester oligohydramnios, NICU admission, meconium-stained liquor and Apgar score.

MATERIAL & METHODS

• Study Design -     Retrospective Hospital based Study.
• Study Centre -     Department of Obstetrics & Gynecology, Index Medical 

                                          College Hospital & Research Centre, Indore

• Duration of Study -      18 months after approval from ethic committee
• Sample Size -     100 patients

Inclusion criteria

• Antenatal Women > 37 weeks of gestational age (third trimester)
• Intrauterine singleton live pregnancy without rupture of membranes
• USG confirmed cases of oligohydramnios with amniotic fluid index <5 cms.

Exclusion criteria

• Multifoetal gestation
• Pregnancy <37 completed weeks
• With premature rupture of membrane
• Major cardiac/respiratory illness
• Previous history of caesarean section

100 Antenatal women admitted in the hospital in third trimester with gestational age ≥37 weeks diagnosed with oligohydramnios (AFI <5 cms) with intact membranes satisfying the inclusion criteria were selected. Amniotic fluid index (AFI) was determined by the Phelans technique using transabdominal sonography. AFI was measured by dividing the uterus into four quadrants. The enrolled patient was followed until their delivery. Detailed history like age, parity, and co morbid condition was been entered.

General examination including haemoglobin level, nutritional status, BMI, and blood pressure was noted. Parameters noted were MSAF, the mode of delivery, birth weight, Apgar score at 1 and 5 minutes.

Statistical analysis: Statistical analysis was done using SPSS 25.0 Version Software package. Complete data of relevance was collected from all the patients and statistical analysis using Chi square test was done. P value <0.05 was considered statistically significant.

It was observed that 70 (70%) women with oligohydramnios were in age group of 20-25 years, most of them were farmer (54%) and majority of them belong to lower-middle socio-economic class (80%). 

Table 1: Socio-demographic profile of the study subjects

Majority of the patients (45%) had gestation age at delivery were 39 weeks. Among clinical complaint 59% had reduced fetal movement, 25% had lower abdominal pain, 3% had bleeding PV and 12% had no clinical complaint

Table 2: Clinical features of the study subjects

Most of the oligohydromnios women (65%) were multiparous.

Graph 1: Distribution according to parity

Majority of them (65%) had Spontaneous labour, 60% delivered by Normal Vaginal delivery,30% had meconium stained liquor and  half of them were duration of hospital stay was 48-72 hours.

Table 3: Details related to delivery/labour of the study subjects

Most of the neonates (81%) were birth weight less than 2kg, 12 had required NICU admission and 33% had APGAR score <7 at 1 min.

Table 4: Details related to perinatal outcome

Most of them (32%) had AFI was 4 and 39% had abnormal CTG.

Graph 3: Distribution according to AFI on admission

Graph 4: Distribution according to CTG on admission

Socio-economic class, Mode of delivery, Duration of hospital stay, Malpresentations, Neonatal LBW, NICU admission and duration of admission were significantly associated with the AFI in oligohydromnios women.

Table 5: Association of AFI with different variables among oligohydramnios subjects

Amniotic fluid serves as an indicator of foetal wellbeing. Decreased amniotic fluid volume in pregnancies without premature rupture of membranes reflects a foetus in chronic stress with shunting of blood to brain, adrenal glands and heart and away from other organs including kidneys. Decreased renal perfusion results in decreased urinary output and oligohydramnios. Thus assessment of amniotic fluid volume in antenatal period is a helpful tool in determining the women who are at risk for potentially adverse outcomes.

The results of our study reported that Antepartum measurement of AFI can help to identify women who need increased antepartum surveillance for pregnancy complications. Caesarean section is mostly required for the cases with anhydramnios and intrapartum fetal heart rate abnormalities. Babies are relatively more prone for certain complications like intrapartum fetal distress, MSAF and birth asphyxia.

In this study maximum number of oligohydromnios women was in age group of 20-25 years. These findings are comparable with the study done by Biradar et al [6], but contrast result was found in study done by Vidyasagar et al [7].

Most of the participants were primigravida in this study. Results were similar to the study done by Jagatia K et al [8].

Present study found that AFI <5 cm was associated with an increased incidence of caesarean section for fetal distress, in agreement with the results of Umber A, et al [9] and Jandial et al [10] which showed significantly increased incidence of Caesarean section and non-reassuring fetal heart rate in women with low AFI.

Lower AFI were significantly associated with the Malpresentations, lower birth weight, requiring NICU admission, and prolonged NICU stay in current study, our results correlates with the

Kumsa H,et al [11] and Zhang J et al [12].

The perinatal morbidity and mortality are due to foetal distress, low APGAR scores and meconium aspiration syndrome in the foetus due to umbilical cord compression and potential uteroplacental insufficiency more in oligohydromnios women [13].

Another study assessed the optimal definition of Oligohydramnios associated with adverse neonatal outcomes and concluded that AFI < 5th percentile better predicts foetuses at risk for adverse perinatal outcomes compared to an AFI < 5 cm [14].

Oligohydramnios in obstetrics is a frequent occurrence and is associated with high rate of pregnancy complication, increased perinatal morbidity and mortality. Due to high perinatal morbidity and mortality, an increase in incidence of LSCS, abnormal fetal growth and IUGR is seen. Every case of oligohydramnios needs careful antenatal evaluation, parental counseling, individualized decision regarding timing and mode of delivery. Adverse perinatal outcome can be avoided by careful intrapartum fetal heart rate monitoring and good neonatal care. So timely intervention by an obstetrician will be help in improving the perinatal outcome.

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