The association between isolated oligohydramnios at term and pregnancy outcome and perinatal outcome in case of isolated oligohydramnosis: a retrospective analysis

Background: Current study was carried out to assess the impact of isolated oligohydramnios on perinatal outcomes and mode of delivery.Methods: A retrospective observational cohort study was conducted at term pregnancy with sonographic finding of isolated oligohydramnios (AFI <5 cm) were recruited for the study. Uterine anomaly and high risk pregnancies were excluded from the study. The mode of delivery and perinatal outcome were compared with control group of pregnancy with normal amniotic fluid (AFI >5-25 cm).Results: When compared to the normal AFI, women with oligohydramnios had significantly lower birth weight babies and were delivered at a significantly earlier gestational age. However there was no difference in the APGAR scores at birth and NICU admissions between the two groups. Reactive NST had more chances of good APGAR score at 1 and 5 minute and that lower the AFI more the probability of nonreactive NST and abnormal Doppler. The number of inductions and caesareans done for foetal reasons were significantly higher in the exposed group.Conclusions: Obstetric and perinatal outcome remains similar in both isolated oligohydramnios with reactive NST as well as in patients with normal amniotic fluid index. Isolated oligohydramnios is not associated with adverse perinatal outcomes. However, it increases the risk for labour induction and caesarean section.

Relation between Fetal Renal Artery Doppler ‎Indices and Non-PROM Oligohydramnios in ‎Third Trimester of Pregnancy

Background: Amniotic fluid is the liquid which surround the fetus after the first few weeks of gestation. Amniotic fluid is derived mostly from the fetus and has many functions that are essential for normal growth and development. The aim of this work is to study the relation between fetal renal artery flow velocity waveforms and amniotic fluid volume in normal pregnancies and those complicated by oligohydramnios. Methods: This prospective observational study was carried out on 40pregnant women (10) of them were with normal amount of amniotic fluid (group I), while (30) of them suffered from oligohydramnios (group II).By using color doppler ultrasound imaging, the fetal renal circulation can be assessed. Intermittent assessment of renal artery flow velocity waveforms during the early stages of pregnancy may help in predicting changes in amniotic fluid dynamics. Results: There was a non-significant difference between cases with normal amount of amniotic fluid and cases with oligohydramnios in Gestational age, Maternal age, fetal femur length, bi parietal diameter, abdominal circumference and Fetal weight. There were increased values of fetal renal artery Resistance index (RI) and Pulsatility index (PI) in cases of oligohydramnios than cases with normal amount of amniotic fluid. There was no correlation between Peak systolic velocity (PSV) and Amniotic fluid index (AFI). There was a significant difference in End diastolic velocity (EDV) between cases with normal amount of amniotic fluid and cases with oligohydramnios. Also, there was a significant difference in Systolic diastolic ratio (S/D) and Amniotic fluid index (AFI) between cases with normal amount of amniotic fluid and cases with oligohydramnios. Conclusions: There is a relation between renal artery flow velocity waveforms and oligohydramnios using Pulsed wave Doppler Ultrasonography. There are higher values of renal artery Resistance index and Pulsatility index in cases of oligohydramnios more than cases with normal amount of amniotic fluid.

Fetal monitoring from 39 weeks’ gestation to identify South Asian-born women at risk of perinatal compromise: a retrospective cohort study

To investigate whether earlier “post-term” monitoring of South Asian (SA) pregnancies from 39 weeks’ gestation with amniotic fluid index (AFI) and cardiotocography (CTG) detected suspected fetal compromise. Retrospective cohort study of all SA-born women at an Australian health service with uncomplicated, singleton pregnancies following the introduction of twice-weekly AFI and CTG monitoring from 39 weeks. Monitoring results, and their association with a perinatal compromise composite (including assisted delivery for fetal compromise, stillbirth, and NICU admission) were determined. 771 SA-born women had earlier monitoring, triggering delivery in 82 (10.6%). 31 (4%) had a non-reassuring antepartum CTG (abnormal fetal heart rate or variability, or decelerations) and 21 (2.7%) had an abnormal AFI (≤ 5 cm). Women with abnormal monitoring were 53% (95% CI 1.2–1.9) more likely to experience perinatal compromise and 83% (95% CI 1.2–2.9) more likely to experience intrapartum compromise than women with normal monitoring. Monitoring from 39 weeks identified possible fetal compromise earlier than it otherwise would have been, and triggered intervention in 10% of women. Without robust evidence to guide timing of birth in SA-born women to reduce rates of stillbirth, earlier monitoring provides an alternative to routine induction of labour.

The impact of height on the spread of spinal anesthesia and stress response in parturients undergoing caesarean section: a prospective observational study

Background The spread of spinal anesthesia was influenced by many factors, and the effect of body height on spinal anesthesia is still arguable. This study aimed to explore the impact of height on the spread of spinal anesthesia and the stress response in parturients. Methods A total of ninety-seven parturients were allocated into two groups according to their height: the shorter group (body height was shorter than 158 cm) and taller group (body height was taller than 165 cm). Spinal anesthesia was performed with the same amount of 12 mg plain ropivacaine in mothers of different heights. The primary outcome of the study was the success or failure of the spinal anesthesia. The secondary outcomes of the study were stress response, time to T6 sensory level, the incidence of hypotension, the satisfaction of abdominal muscle relaxation and patient VAS scores. Results The rate of successful spinal anesthesia in the shorter group was significantly higher than that in the taller group (p = 0.02). The increase of maternal cortisol level in the shorter group was lower than that in the taller group at skin closure (p = 0.001). The incidence of hypotension (p = 0.013), time to T6 sensory block (p = 0.005), the quality of abdominal muscle relaxation (p < 0.001), and VAS values in stretching abdominal muscles and uterine exteriorization (p < 0.001) in the shorter group were significantly different from those in the taller group. Multivariate analysis showed that vertebral column length (p < 0.001), abdominal girth (p = 0.022), amniotic fluid index (p = 0.022) were significantly associated with successful spinal anesthesia. Conclusions It’s difficult to use a single factor to predict the spread of spinal anesthesia. Patient’s vertebral column length, amniotic fluid index and abdominal girth were the high determinant factors for predicting the spread of spinal anesthesia. Trials registration ChiCTR-ROC-17012030 (Chictr.org.cn), registered on 18/07/2017.

Perinatal Outcome in Term Pregnancies with Isolated Oligohydroamnios

Objective: To evaluate the frequency of adversative perinatal outcome in pregnancies with oligohydramnios isolation at term. Study Design: Case series Place and Duration of Study: Department of Obstetrics & Gynecology, Sadiq Abbasi Hospital Bahawalpur from 1st January 2021 to 30th June 2021. Methodology: Two hundred women with term pregnancy 37+0 to 41+6 weeks, pregnancy with isolated oligohydramnios, active phase of labour were included. CTG and obstetrical ultrasound for biophysical profile were done. Patient’s labour was monitored closely and followed till delivery. Results: Majority of the patients 87 (43.5%) were between 20-25 years with mean age was 28.43±4.27 years. Seventy six (38%) were between para 1-2, 83 (41.5%) were para 3-4, while 41 (20.5%) were para >4. Perinatal outcome reveals that APGAR score <6 at 1 minute was calculated in 21 (10.5%) and <7 at 5 minutes in 17 (8.5%) which is not very significant. Conclusion: Oligohydramnios Isolation was not related with adversative perinatal consequences. Keywords: Isolated oligohydramnios, Perinatal outcome, Amniotic fluid index, Term pregnancy, APGAR score

A case report on placental chorioangioma

Chorioangioma is the term used to describe an abnormal proliferation of vessels arising from chorionic tissue, which is most commonly observed in the third, and less frequently in the second trimester of pregnancy as a solitary nodule or, less commonly, as multiple nodules. We here report a case of placental chorioangioma which presented as a case of preterm labour. 21 year old primigravida presented to us at 26 weeks of gestation with history of PV leak and pain in abdomen. Ultrasound showed a single live foetus corresponding to 24-26 weeks of gestation with amniotic fluid index (AFI): 5 cm (oligohydramnios) there was evidence of 58×42 mm heterogeneously hypoechoic lesion noted over placenta likely s/o chorioangioma. Patient went into spontaneous preterm labour on day 5 and delivered vaginally. Placenta weighted 700 gm. A globular mass of size 6×7 cm was attached to foetal surface of placenta with a pedicle with confirmed the finding of ultrasonography. Placental chorioangioma is associated with high rates of perinatal complications. Most complications may appear early and delivery is problematic due to prematurity. Thus better prenatal investigations and regular follow up is required for early diagnosis and treatment.

Study of mode of delivery and fetal outcome in pregnancies with oligohydramnios

Background: The significance of amniotic fluid volume as a marker of fetal status is an ongoing turn of events. Oligohydramnios causes adverse fetal outcomes like meconium-stained liquor, meconium aspiration syndrome, fetal heart rate abnormalities, poor APGAR scores, fetal growth restriction and fetal prematurity. It is associated with maternal hypertension, infections, and placental insufficiency. It causes maternal complication because of increased incidence of induction of labour and operative intervention.Methods: Hundred cases of oligohydramnios were included in our study conducted at the Navodaya medical research, hospital and research centre, during a period of two years after obtaining the informed consent of patients and institutional ethical clearance. All gravidas were included with a gestational age greater than 28 weeks with singleton pregnancies with oligohydramnios. Associated fetal and maternal risk factors were observed. The amniotic fluid index (AFI) was measured by ultrasound. The nonstress test, the fetal biophysical profile and the Doppler study were carried out to evaluate the fetal condition. Then we have observed for delivery and fetal outcome.Results: Incidence of oligohydramnios was 2.85% in our study. The 53% of cases had LSCS while 47% had normal delivery. Fetal distress was the commonest indication for LSCS. Poor neonatal APGAR score was 16.9% in LSCS while 36% in vaginal delivery.Conclusions: From the above study, the caesarean delivery seems to be a safer mode of delivery than vaginal delivery because it is associated with a good perinatal outcome.