¹Assistant Professor, Assistant Professor, Department of Obstetrics & Gynecology, Swami Ramanad Teerth Government Medical College, Ambajogai, Beed, Maharashtra, INDIA.

²Professor, ³Professor & HOD, Department of Obstetrics & Gynecology, MIMSR Medical College, Latur, Maharashtra, INDIA.

Email: jyotidawle@gmail.com

Table 3: Distribution according to neonatal outcome and non-stress test results

All 6 neonatal deaths were in women who had undergone LSCS (100%) as against 80 women who underwent LSCS and babies were alive. This difference in incidence of death of newborn was not significant (p>0.05)

Table 4: Distribution according to neonatal outcome and mode of delivery

All 6 neonates admitted in NICU were died (100%) incidence. Out 94 who survived, NICU admission was required in only 17% (16) newborns. This difference was highly significant.

Table 5: Distribution according to neonatal outcome and NICU admission required

NICU admission required in 59.1% cases with AFI 0-2 as against 36.4% in AFI 2-4 and 4.5% with AFI >4. The difference in proportion was significant (<0.05) and there is association between NICU admission and AFI grades

Table 6: Distribution according to AFI grades and NICU admissions

Neonatal death occurred in 83.3% cases with AFI 0-2 as against 16.7% in AFI 2-4. The difference in proportion was significant (<0.05) and there is association between NICU admission and AFI grades

Table 7: Distribution according to AFI grades and neonatal deaths

LSCS took place in 39.5% cases with AFI 0-2 as against 47.7% in AFI 2-4 and 12.8% with AFI > 4.The difference in proportion was significant (<0.05) and there is association between NICU admission and AFI grades

Table 8: Distribution according to AFI grades and mode of delivery

DISCUSSION

Oligohydramnios is an important sign of placental insufficiency which affects perinatal outcome. An amniotic fluid index of ≤ 5 cm detected after 37 completed weeks of gestation is an indicator of poor perinatal outcome. Morbidity is seen in pregnancies with oligohydramnios due to various complications like Fetal pulmonary hypoplasia, cord compression and subsequent distress, deformity due to intra-amniotic adhesions, decreased fetal weight, fetal hypoxia. It is a significant health problem as its rate has increased despite advances in perinatal care. For prevention of development of oligohydramnios proper care regarding maternal nutrition and hydration and regular sonographic study of amount of liquor is necessary along with tests for fetal well-being.⁵ Mean maternal age (in years) of study group in present study was 23.80 compared to 27.04, 22.88 and 23.9 in study by Bhagat M⁶, Bangal VB et al.⁷ and Casey BM et al.⁸ respectively. In a study by Jandial C et al.,⁹ 48% women belonged to 21-25 years of age group. Mean maternal age (in years) in a study by Melamed Net. et al.¹⁰ was 28.2 in active delivery group and 28.1 in expectant management group. In our study group primigravida accounted for 41% compared to 60% in the study by Jandial. C et al.⁹ In present study mean gestational age at delivery was 38.38±0.90 weeks compared to 38 ± 2 weeks in study by Casey BM et al.⁸ In study by Bhagat M⁶, 56% of women were <37 weeks of gestational age at delivery. In study by Melamed N et al.¹⁰, gestational age at delivery was 36.7 + 1. 1 weeks in active delivery group and 38.9 ± 1.7 weeks in expectant. In our study group 72% women were nullipara compared to 68%, 40% and 60.3 % in study by Bhagat M⁶, Casey BM et al.⁸. and Melamed N. et al.¹⁰ respectively. In our control group 68 % women were nullipara compared to 58.9 %, 37%₀and 57.4 % in study by Bhagat⁶, Casey BM et al.⁸. and Melamed N et al.¹⁰. respectively. NST was non-reactive in 40% women of our study group compared to 32% and 38% in a study by Bhagat M⁶ and Jandial C et al.⁹. respectively. Occurrence of meconium-stained liquor was 14% in our study as compared to 16%, 48%, 6% and 6.7% in study by Bhagat M⁶, Jandial C et al.⁹., Casey BM. et al.⁸ and Melamed N et al.¹⁰. respectively. In present study group, 44% of women were induced (induction of labour) compared to 72%o, 58% and 42% in study by Bhagat M⁶, Jandial C et al.⁹. and Casey BM et al.⁸. respectively. Caesarean delivery (LSCS) for fetal distress was done in 73.3% women of our study group compared to 57.1 %, 42% in study by Bhagat M⁶, Jandial C. et al.⁹ respectively. In study by Melamed N et al.¹⁰., 59%> women in active delivery group and 16.7% in expectant management group underwent caesarean delivery for fetal. Apgar score was <7 at 1 minute in 54% neonates in present study group compared to 36%o and 10% in study by Bhagat M⁶ and Bangal VB et al.⁷ respectively. Apgar score was <7 at 5 minutes in 3% neonates in present study group compared to 4%, 16%o and 12% in study by Bhagat M⁶, Bangal VB et al.⁷ and Jandial C et al.⁹ respectively. In present study group 84% neonates birth weight was less than 2.5 kg, compared to 56%, 58% and 35% in study by Bhagat M⁶. Jandial C. et at.⁹ and Casey BM. et al.⁸ respectively as shown in Table 38. Birth weight of neonates in oligohydramnios group was less, due to chronic uteroplacental insufficiency. In present study group 22% of neonates were admitted to NICU compared to 92%, 16% and 7% in study by Bhagat M⁶, Jandial C et al.⁹. and Casey BM et al.⁸.respectively. In a study by Melamed N. et al.¹⁰ 12.8% neonates in active delivery group and 6.6% in expectant management group were admitted to NICU. Early neonatal deaths accounted for 6% in present study group compared to 16%, 6% and 5% in study by Bangal VB. et al.⁷, Jandial C. et al.⁹ and Casey BM et al.³³ respectively. A study conducted by Baron et al.¹¹ showed that meconium-stained amniotic fluid occurred significantly less often in the oligohydramnios group as compared to the normal AFI group. A study by Voxman et al.¹² concluded that there was no difference between the groups with regard to meconium-stained liquor. Chauhan. et al.¹³ In their meta-analysis found that intrapartum AFI ≤ 5 was associated with increased risk of cesarean section for fetal distress (pooled RR=1.7), which was similar to our study. Rutherford. et al.¹⁴ found an inverse relationship between amniotic fluid index and cesarean section for fetal distress. Thus oligohydramnios causes increased occurrence of non-reactive NST, meconium stained liquor, induction of labour, development of fetal distress, rate of LSCS, low Apgar score, low birth weight neonates, NICU admissions and early neonatal deaths. Identification of oligohydramnios and performing fetal surveillance tests will help us to manage patients in a better way and will definitely improve clinical outcome.

Limitations of present study were, diagnosis of fetal distress was made depending on the NST. However, the fetal acidosis was not proved by fetal scalp blood sampling or other methods. Neonatal follow up after 7 days was not done.

CONCLUSION

In oligohydramnios, the occurrence of non-reactive NST, meconium-stained liquor, development of fetal distress, the rate of LSCS, low 1- and 5-minute Apgar score, low birth weight, NICU admission, perinatal morbidity and mortality are more.

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