{¹Associate Professor, Department of Obstetrics & Gyneacology} {²Professor & HOD, Department of Anatomy} Government Medical College & General Hospital. Ongole. Andhra Pradesh, INDIA.

Email: asyspoo664@gmail.com 

Table 1: General characteristic

In present study spontaneous onset of labour was noted in 50.91% patients, while induction of labour was required in 33.64% and 15.45% patients underwent elective LSCS. In present study mode of delivery was vaginal (64.55%), LSCS (30.91%) and Instrumental delivery (4.55%)

Table 2: Mode of delivery

Fetal distress (32.35 %) was most common indication for LSCS, followed by malpresentation (17.65 %), failed induction/non-progress of labour (NPL) (14.71 %) and unfavourable cervix (14.71 %).

Table 3: Indication of LSCS

In present study 2.5-3.49 kg birthweight was most common (54.55%). 20 % babies required neonatal resuscitation. and 20.91 % babies needed NICU admission during study period. Majority of them were birthweight less than 2000 gm, meconium aspiration, cord looped around neck etc. We noted stillbirth in 1 case and early neonatal death in 3 babies. No maternal mortality was noted.

Table 4: Perinatal outcome

DISCUSSION

Oligohydramnios causes compression of the cord between the fetus and the uterine wall may occur during contractions or fetal movement, this cord compression causes severe FHR decelerations which are associated with low APGAR scores and acidosis at birth, meconium staining, caesarean section and operative vaginal delivery for fetal distress. Oligohydramnios increases the risk of operative intervention and adverse perinatal outcomes. The common clinical features of oligohydramnios are smaller symphysio fundal height, fetal malpresentation, undue prominence of the fetal parts and reduced amount of amniotic fluid. Usually, the degree of Oligohydramnios is proportional to the severity of placental hypo perfusion and intra uterine growth restriction. The most likely cause of oligohydramnios in IUGR babies is decreased urine output.⁷ In the present study most common age group was of 21- 25 years (40 %), followed by 26-30 years age group (20.91 %). Similar findings were noted by Guin G et al.⁸ and Nazlima N. et al.⁹ The mean maternal age in study by Amit S. et al.,¹⁰. was 26.07 ± 3.84 years and by Guin G et al.,⁹ was 24.71 ± 4.58 years. Similar findings were noted in the present study. In the study by Amit S. et al.,¹⁰ 59.45 % women were nulliparous. Similar findings were noted in the present study.  In the study by Amit S. et al.,¹⁰ incidence of oligohydramnios was 3.39 %. Oligohydramnios was associated with antenatal complications like PIH (20.27%), IUGR (24.32%), prolonged pregnancy (10.81%), post term pregnancy (2.70%) and fetal anomalies (6.75%). The rate of LSCS in the oligohydramnios was 55.40%. Oligohydramnios was found to increase the incidence of low-birth-weight babies, low Apgar score at 1,5 min, admission to NICU and Perinatal mortality. In study by Bansal D,¹¹ incidence of oligohydramnios was 3% and 78.5% cases had associated obstetrical complications; acting singly or in combination for causing oligohydramnios. The LSCS was done in 47% in present study. 17.5% babies had low Apgar score (less than 7 at 5 min), 36% of neonates were admitted in NICU and perinatal mortality was 15%. Ashish P et al.,¹² studied 168 parturient women (84 study group and 84 control group) and noted that the rate of Caesarian section was significantly higher in oligohydramnios group compared to the control group (44.0% vs. 30.0% respectively). There was significant increasing in FHR decelerations, low Apgar score at 5 min, low birth weight, admission to NICU. Anisodowleh N¹³ conducted a case control study of 255 pregnant women (85 cases of oligohydramnios and 170 cases in control group). Rate of caesarean was significantly higher in oligohydramnios group compared to the control group (75.3% vs. 36.5% respectively). There was statistically significant increasing in meconium passage in control group compared to oligohydramnios group (17.1% vs. 5.9% respectively). Mean of first minute and five-minute APGAR score, mean of birth weight, fetal sex and need to admission to NICU were not statistically different between two group of study. They concluded that amniotic fluid index of ≤ 5 cm detected after 37 completed weeks of gestation is not an indicator of poor perinatal outcome, but it is associated with increasing rate of caesarean delivery. In study by Sowmya K et al.,¹⁴ low birth weight was seen in 48%, Apgar score <7 seen in 14% and 14% were admitted in NICU. Another study by Madhavi K et al.,¹⁵ found the incidence of meconium-stained liquor in 36%, 20% had Apgar score less than 7 at 5 minutes, incidence of NICU admission in 34%, incidence of meconium aspiration syndrome (MAS) in 6%. Similar findings were noted in the present study Early detection of oligohydramnios and its management may aid in decreased perinatal morbidity and mortality on one side and reduce caesarean deliveries on the other side. 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.

CONCLUSION

In pregnant women with oligohydramnios, high incidence of meconium-stained liquor, fetal distress, need of LSCS, low Apgar score, low birth weight, perinatal morbidity and mortality noted. Evaluation of AFI should be used as an adjunct to other fetal surveillance methods to identify infants at risk of poor perinatal outcome.

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