INTRODUCTION Oligohydramnios is a serious complication of pregnancy, that is integrated with a poor perinatal outcome. It complicates 1- 5%of term pregnancies (1). Over all incidence is 3.9% of all pregnancies. Oligohydramnios is dened as amniotic uid th index less than 5 percentile for the gestational age (Moore and cayle) or AFI less than or equal to 5cm regardless of gestational age. (Phelan) It can be classied as mild, moderate & severe Oligohyd ramnios when deepest pocket devoid of cord /fetal limbs measuring < 3, 2, or 1cm, respectively. (1) Normal amniotic uid index is between 8.1-20cm.(2) Bord erline Oligohydramnios is dened as amniotic uid index between 5.1-8cm. Manning et al dened oligohydramnios when largest pocket on ultrasound in its broadest diameter measured < 1cm. They revised the criteria to a single pocket measuring 2cm in both vertical/horizontal plane.(3) Amniotic uid is an important part of pregnancy sac and helps in fetal development(4). It surrounds the foetus and provides protective low resistance environment suitable for fetal growth and development (5). It also protects fetus from trauma, maintains body temperature and it has bacteriostatic properties. Its pressure helps in reducing the loss of lung uid and assist in pulmonary development(6). It supports development of musculoskeletal system by permitting foetal movements in addition to the growth and development of gastrointestinal system by swallowing amniotic uid(7). Oligohydramnios is found to be associated with increased frequency of maternal & fetal complications.(8) It may be associated with uteroplacental insufciency, preeclampsia, hypertension, diabetes, cardiac disease, congenital anomalies, idiopathic fetal growth restriction, fetal hypoxia etc. Oligohydramnios, in a pregnancy without fetal renal abnormality or genitourinary obstruction is thought to represent chronic in utero stress The impact of oligohy dramnios on maternal & fetal outcome can be signicant.(9) Complication of oligohydramnios a)Maternal- Prolonged labour, Malpresentation , Caesarean delivery, Instrumental delivery, Protracted labour, Premature rupture of membrane b)Fetal- Meconium aspiration syndrome, Septicaemia, Fetal Pulmonary hypoplasia, Cord compression, Deformity, Perin atal mortality, NICU admission Low APGAR, abortion By diagnosing such cases early & timely intervention can prevent most of the complications. In case of irreversible complications having occurred, termination of pregnancy can be considered. OBJECTIVE OF THE STUDY To assess the fetal and maternal outcome at term in low risk pregnancy with AFI ≤5. MATERIALS AND METHODS The prospective, case and control study conducted at Government Medical College, Nagpur, Maharashtra from Dec 2017 to Nov 2019.In study 102 pregnant women with oligohydramnios (AFI ≤5) as case group and 102 pregnant women with AFI >5 as control group. All the low risk cases that are available up to the study period is taken for the purpose of the study. Consent from the patient is taken and ethical clearance taken from the Ethical Committee. This study includes an analysis of mode of delivery, meconium passage, birth weight, Apgar score, neonatal intensive care unit admissions and neonatal deaths. INCULSION CRITERIA: 1. AFI ≤5 2. Single live intrauterine gestation with cephalic presentation 3. 37 completed weeks of gestation 4. Intact membrane. 5. Low risk pregnancy EXCLUSION CRITERIA 1. AFI more than 5 2. Gestational age <37 completed weeks 3. Post-term (more than 42weeks) 4. Associated fetal malformations 5. Ruptured membranes 6. Malpresentation and multiple gestation 7. pregnancy with maternal diseases like Hypertension in pregnancy, Diabetes, Chronic renal disease, Connective tissue disorders. 8. Any other obstetric complications. The patients is selected after detail clinical history and exami PREGNANCY OUTCOME IN AMNIOTIC FLUID INDEX LESS THAN 5 AT TERM LOW RISK PREGNANCY Original Research Paper Dr Mansi Shrigiriwar Department Of Obstetrics & Gynaecology, Government Medical College, Nagpur, Maharashtra-440009 X 29GJRA - GLOBAL JOURNAL FOR RESEARCH ANALYSIS Obstetrics & Gynaecology BACKGROUND: To study the maternal and perinatal outcome in oligohydramnios of AFI(amniotic uid index) ≤ 5 cm at term in low risk pregnancy METHODS: A Prospective case control study consists of an analysis of pregnancy outcome in 102 cases with diagnosis of oligohydramnios (≤5) after 37 to 41weeks6days completed is compared with 102 controls with pregnant women AFI>5. RESULTS: There is increased chances of oligohydramnios with primigravida. The selected outcomes showed signicant variations in both groups with increase rate of caesarean section, fetal distress, and NICU admission. CONCLUSIONS: An amniotic uid index of ≤ 5 cm detected after 37 completed weeks of gestation is an indicator of maternal and poor perinatal outcome. In method of fetal surveillance determination of AFI can be important. ABSTRACT KEYWORDS : Perinatal Outcome, Oligohydramnios, A < 5 Cm, Maternal Outcome Dr Shrikant Khandekar* Department Of Obstetrics & Gynaecology, Government Medical College, Nagpur, Maharashtra-440009 *Corresponding Author VOLUME-9, ISSUE-1, JANUARY-2020 • PRINT ISSN No. 2277 - 8160 • DOI : 10.36106/gjra 30 X GJRA - GLOBAL JOURNAL FOR RESEARCH ANALYSIS nation such as age, height, weight, BMI, weight gain, marital status, duration of amenorrhea, booked/referral ,number visits, detail obstetric history, menstrual history, regarding previous congenital abnormalities, oligohydramnios or major medical disorders complicating pregnancy like diabetes, cardiac disease, hypertensive disorders, anaemia, chronic renal diseases, etc. All patient the low risk pregnancy included having AFI≤5 on sonography and completed 37 weeks of gestation. Besides baseline characteristics, indication for induction and the method of induction is noted. METHODOLOGY FOR INDUCTION-AUGMENTATION IN OUR STUDY: Bishop score <6 PGE1 25- 50μg vaginally/orally repeated after 2-4hours if necessary (10) or Foleys induction. & Bishop score >7 -ARM(articial rupture of membrane) Titrated oxytocin infusion: dose dependant on uterine response Study conducted on women with uncomplicated oligohydramnios at term with amniotic uid index 5 cm and a low Bishop score <-6 who underwent induction of labor with prostaglandin E2. Indication for caesarean section in our study are:-Fetal distress, Failed induction, Meconium stained liquor with fetal distress, Obstetric indication (failure to progress) OBSERVATIONS This study was conducted in Department of Obstetrics & Gynaecology at tertiary care hospital from Dec 2017 to Nov 19. The observation & results of this study are shown below in form of tables and graphs. Case group - Patient with AFI ≤ 5. Control group -Patient with AFI >5. Table no 1: -Inter group comparison of mean age in case and control group Table no 2: -Age distribution of patients Table no 3-description of patient according to gravida. Table no 4-NST (Non stress test) in groups NR- NON-REACTIVE R-REACTIVE Table no 5-Mode of induction in study various methods Table no 6-Mode of delivery in study Table no7- outcome of pregnancy in case and control groups FTND-full term normal delivery, FD-fetal distress, MSL- meconium stained with liquor, VF-variable fetal heart rate, CPD-cephalopelvic disproportion, DTA-deep transverse arrest, FI-failure of induction, FP-failure to progress Table no 8-APGAR at 5min in groups of study. Table no 9-NICU Admission of neonates Table no 10-Mortality of neonates in study DISCUSSION Accurate antepartum estimation of amniotic uid volume by clinical means alone is difcult, but it is easily diagnosed by current ultrasound methods. Identication of oligohydr amnios women with sonography not difcult in modern era. This helps us to be more cautious and anticipate problems especially during labor. Reduced amniotic uid at term is generally considered to have increased risk of intrapartum complications. The risk is VOLUME-9, ISSUE-1, JANUARY-2020 • PRINT ISSN No. 2277 - 8160 • DOI : 10.36106/gjra groups N Mean Std. Deviation AGE case 102 24.96 ±4.275 control 102 25.62 ±4.450 Groups Age (years) Cases Control Total Chi square value p value of chi square test <20 4 7 11 21-25 59 48 107 26-30 23 30 53 2.904 0.407# >30 16 17 33 Total 102 102 204 Groups Cases Controls Total Chi square value p value of chi square test Gravida 1 64(62.74) 54(52.94) 118 2 33(32.35) 41(40.19 74 2.046 0.360# 3 5(4.91) 7(6.87) 12 Total 102 102 204 Groups Cases Controls Total Chi square value p value of chi square test NST NR 11(10.78%) 8(7.84%) 19 R 91(89.22%) 94(92.16%) 185 0.522 0.470# Total 102 102 204 Case Control Misoprostol 12 59 Foley's 90 74 ARM 95 85 Oxytocin 87 84 MODE OF DELIVERY NORMAL LSCS CASE 23(22.54%) 79(77.46) CONTROL 71(69.60%) 31(30.40%) Groups Cases Controls MATERNAL OUTCOME OF STUDY AND INDICATIONS OF LSCS FTND 23(22.54) 71(69.6) FD 40(39.21) 15(14.70) MSL FD 15(14.70) 7(6.86) VF 13(12.74) 3(2.94) CPD 3 2 DTA 1 1 FI 1 2 FP 6 1 Total 102 102 Groups Cases Controls Total 5'' APGAR <7 12(11.76) 6(5.88) 18 ≥7 90(88.24) 96(94.12) 176 Total 102 102 204 Case Control Mother side 90(88.24) 96(94.12) NICU admission 12(11.76) 6(5.88) Total 102 102 Case Control NO 102 102 YES 0 0 Most of patients in study is between 21 to 25 years of age group in both case (57.84%) and control (47.05%) and least number of patients were ≤20 years (i.e3.92% and 6.86%). And mean age in case group-24.96±4.275 and control group- 25.62±4.450. Among study primigravida is 62.74% in case group and rd52.94% in control group and patient with 3 gravida was less. In study booked and referral patients number was almost same. The non-reactive NST high rates in women with AFI <5 cm. The rate of non-reactive NST is 10.78% in present study and is less compared to that in similar study by Purvi p.et al ,Chandra et al. (24), Sriya and Singhai, , & Sowmya.k et al with 68% ,69.23%, 41.55% & 12% respectively. Various studies show different rate of caesarean section in pregnant women with amniotic uid index of <5 cm. The LSCS rate in case group was 77.48% and in control group 30.40% with compare to other studies casey et at, Mangal puri et al, Purvi k. Patel et al, Maha al. bayatti et al,T. minwuye. et al, P.gaikwad et al, Sowmya .k et al and ghosh et al was 32%,76%,81.25%,70%,80.3%,73.4%,68% and 49.10% respectively. In our study mode of delivery was compared between the two groups and it was found that in group with oligohydramnios normal delivery was 22.54% and with non-oligohydramnios was 69.40%. and this comparable to other studies of Mangal puri et al-24%,purvi k. Patel et al-18.25%,maha al. bayatti et al -30%,T. minwuye et al-19.7%,p. gaikwad et al-26.6% and Sowmya .k et al-32%. In this study occurrence of meconium stained liquor seen in 14.70% for that LSCS done for better outcome of newborn, and this is compare to Casey et al. 54%, Mangal puri et al. 14%, P.kaur 50%, & vibha moses 12.5% . Among patients of caesarean section most of patients indication was fetal distress .In our study 53.91% patients within case LSCS done for fetal distress of that meconium stained liquor with fetal distress was 14.70%,similarily in control 21.56% patient undergone LSCS out of which MSL FD was 6.86%.In others studies LSCS for fetal distress was casey et at 51%,sriya and singhai et al 43.05%,vibha moses et al 14%,maha al. bayatti et al 27%,T. minwuye,p. gaikwad et al 34.6% and Sowmya .k et al-50% . The 5 min Apgar score <7 is seen in 11.76% of oligohyd ramnios group and control group of 5.88 % which required NICU admission. 11.76% and 5.88% of newborns were X 31GJRA - GLOBAL JOURNAL FOR RESEARCH ANALYSIS VOLUME-9, ISSUE-1, JANUARY-2020 • PRINT ISSN No. 2277 - 8160 • DOI : 10.36106/gjra VARIABLE Casey et al 2000 (11) Sriya & Singhai 2001 (12) Mangal p. et al 2017 (13) Purvi .p et al 2014 (14) Preshit Chate et al 2012 (15) P.Kaur et al 2015 (16) Vibha Moses 2016 (17) Maya Al .bayatti 2002 (18) Tamiru Minwuye Et al 2017(19) Non- reactive Nst 41.35% 32% 65% 38% 38% Vaginal Delivery 24% 18.75% 36% 52% 58% 30% 19.7% LSCS 76% 81.25% 64% 48% 42% 70% 80.3% Fetal Distress 51% 43.05% 14% 27% MSL 54% 38.88% 14% 51.25% 46% 50% 12.5% 42% Apgar<7 @5” 58.38% 28% 20% 16% 40% 16.3% 16% 1.7% Nicu Admission 7% 88.88% 16% 20% 42% 40% 35% 11.86% Mortality 2% 8% 3.33% Birth Weigth <2.5kg 35% 58.38% 18% 62% further compounded in high risk pregnancies. However, the quantum of risk with reduced amniotic uid is less clear in low risk pregnancies. Many studies shown conict between results. Reduced AFI in low risk pregnancies that is isolated reduction in amniotic uid in the presence of intact membranes and with no other risk factors is not a common nding PARAMETER K. Jagatia et al 2011(20) R. Ghosh et al 2017(21) Sowmya. K et al 2012(22) P.Gaikwad et al 2016(23) Present study 2019 NON-REACTIVE NST 32% 12% 42.8% 10.78% VAGINAL DELIVERY 58% 50.9% 32% 26.6% 22.54% LSCS 42% 49.1% 68% 73.4% 77.4% FETAL DISTRESS 21% 50% 1% 53.91% MSL 32% 14.70% APGAR<7 @5” 15% 43.6% 14% 15% 11.76% NICU ADMISSION 22% 14% 22% 11.76% MORTALITY 2% 3% 0 2% 0% BIRTH WEIGTH <2.5KG 70.9% 70.9% 18.63% admitted in the neonatal ward for various morbidities like birth asphyxia, meconium aspiration, etc. This is consistent with studies by mangal purvi et al 28%,purvik. Patel et al 20% ,and Casey et al 7%. A study by Sriya and Singhai et and P.kaur et al showed a higher incidence of 58.38% and 40%. We studied the perinatal outcome in the two groups and compared the NICU admissions in both the groups. In our study 11.76% of neonates had NICU admissions in oligohydramnios group compared to 5.88 % in AFI >5 group and difference was not found to be statistically signicant in between the two groups. Casey et at 7%, sriya and singhai et al 88.88%, purvi k. patel et al 20%, T. minwuye-11.86%, P. gaikwad et al 28.5%,mangal puri et al 16% and Sowmya .k et al 14%. Birth weight below 2.5 kg neonates in case is 18.63% and control group is 16.66% ,comparing to other studies this less. In casey et at, sriya and singhai et al ,mangal puri et al,P. chate et al ,T. minwuye,p. gaikwad et al and Sowmya .k et al is 35%, 58.38% ,18% ,62% ,11.5% ,67.3% and 48% respectively In this study there is no mortality of neonates in both groups compare to other studies in which mortality was present like P.chate et al 2%,vibha moses et al 3.33% and P. kaur et al 8%. RESULT 1) Mean age of the women is 24.94± 4.275 years in case and 25.62± 4.45. Most of the patients is between 21 to 25 years (57.84% and 47.05%) and the least number of patients is ≤20 years (3.92% and 6.86%) in case and control groups. 2) 62.74% and 52.94% of patient are primigravida in case and control groups. So primiparity is probably more associated with oligohydramnios, though statistically not signicant. 3) Mode of induction in our institute was combined i.e misoprostol, foley's, ARM, and oxytocin. For better fetal outcome LSCS is done in study 4) Most common indication for LSCS in both groups is fetal distress i.e 53.91% (case)& 21.56% (control). 5) In case group maximum patient has LSCS as mode of delivery, while in control group mode of delivery was vaginal delivery 6) Occurrence of meconium (14.7%), failure of induction (0.98%), failure to progress (5.88%), CPD (2.94%) AND variable FHS (12.74%) is minor indication in study. 7) Variable FHS is more common in case group 12.74% than 2.94%control group. 8) NST and FHS by doppler or stethoscope are used for fetal record. Non-reactive NST is 10.78% in case and 7.84% in control. 9) From above inferences we understand that probably oligohydramnios leads to increased intrapartum fetal compromise. 10) Only % 11.76% and 5.88% neonates have APGAR <7 at 5min and all of these neonates are admitted to NICU. But there was no neonatal death in this study. 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Obstet Gynaecol Today 2000;5:478-81 VOLUME-9, ISSUE-1, JANUARY-2020 • PRINT ISSN No. 2277 - 8160 • DOI : 10.36106/gjra 32 X GJRA - GLOBAL JOURNAL FOR RESEARCH ANALYSIS