REFERENCE ID:
TITLE: A cross sectional study on the mode of delivery and perinatal
outcomes in Oligohydramnios cases.
INTRODUCTION:
Amniotic fluid plays a vital role in fetal development, acting as a
protective cushion and facilitating musculoskeletal and pulmonary
maturation.
Normal amniotic fluid levels ensure fetal well-being and prevent
complications associated with cord compression and placental
insufficiency.
Oligohydramnios is diagnosed when the amniotic fluid index (AFI)
measures <5 cm or when the single deepest vertical pocket is <2 cm, as
assessed by ultrasonography .
The condition occurs in 1-2% of pregnancies, increasing in post-term
pregnancies, and is associated with an increased risk of intrauterine
growth restriction (IUGR), umbilical cord compression, meconium
aspiration, and non-reassuring fetal heart rate patterns .
Perinatal outcomes in oligohydramnios cases have been widely studied,
with evidence suggesting increased neonatal complications, including
low birth weight, preterm labor, and neonatal intensive care unit (NICU)
admissions .
Oligohydramnios is also associated with higher cesarean section rates
due to fetal distress, impacting maternal health outcomes .
Despite extensive research, controversy remains regarding the optimal
management approach for oligohydramnios.
Some studies advocate for expectant management with close fetal
surveillance, while others recommend timely induction of labor to
prevent adverse perinatal outcomes .
This study aims to analyze maternal morbidity and perinatal outcomes in
pregnancies between 28 and 42 weeks complicated by oligohydramnios.
This research will provide valuable insights into risk stratification,
management strategies, and potential interventions to improve outcomes
in affected pregnancies.
Aims and objectives:
To evaluate the mode of delivery and associated perinatal outcomes in
pregnancies complicated by oligohydramnios.
1. To determine the incidence of different modes of delivery (vaginal
delivery , instrumental delivery , caesarean section) in pregnancies
with oligohydramnios.
2. To compare the indications for caesarean section in women with
oligohydramnios.
3. To assess and compare immediate perinatal outcomes (e.g., Apgar
scores at 1 and 5 minutes, need for resuscitation, NICU admission,
birth weight, presence of meconium-stained liquor, fetal distress,
perinatal mortality) in neonates born to mothers with
oligohydramnios based on the mode of delivery.
4. To identify maternal and fetal risk factors associated with adverse
perinatal outcomes in oligohydramnios
Methodology:
STUDY DESIGN: CROSS SECTIONAL OBSERVATIONAL
STUDY .
STUDY SETTING : DEPARTMENT OF OBSTETRICS &
GYNAECOLOGY , APOLLO INSTITUTE OF MEDICAL
SCIENCES AND RESEARCH,CHITTOOR .
STUDY PERIOD : 24 MONTHS
Data Collection -18 month
Data Analysis- 6 months
STUDY POPULATION : PREGNANT WOMEN DIAGNOSED
WITH OLIGOHYDRAMNIOS PRESENTING TO THE
ANTENATAL CLINIC OR ADMITTED TO THE LABOR WARD
OF DEPARTMENT OF OBSTETRICS & GYNAECOLOGY
SAMPLE SIZE:
Formula : n = ( Zα2)P(1-P) / d 2
Where
Zα Standard normal Variant -1.96
P = prevalence in previous studies = 29.7
D=absolute precision =9
Sample size : 100
DATA COLLECTION PROCEDURE:
A pre-tested semi-structured proforma is used to collect demographic
and clinical data, including maternal age, parity, and comorbidities,
obstetric history and gestational age at diagnosis, AFI measurement
and Doppler findings, mode of delivery (vaginal vs. Cesarean), fetal
distress and meconium-stained amniotic fluid, neonatal outcomes
(Apgar scores, NICU admissions, birth weight, and perinatal
mortality).
Data analysis will involve:
• Descriptive statistics for demographics and findings.
Chi-square or Fisher’s test for categorical variables.
Sensitivity, specificity, PPV, NPV for diagnostic value.
Correlation analysis (e.g., Pearson/Spearman) between
ultrasound and biochemical parameters.
INCLUSION CRITERIA:
Consenting pregnant women aged 18-40 years with singleton
pregnancies with gestational age ≥ 28 weeks of gestation .
Diagnosed oligohydramnios (AFI <5) with intact membranes,
and in cephalic presentation .
EXCLUSION CRITERIA:
Exclusion criteria encompassed pregnancies with multiple
gestations , fetal congenital anomalies , pregnancies
complicated by polyhydramnios or pre-existing maternal renal
disease , previous history of scarred uterus , and patients having
concomitant antepartum haemorrhage or malpresentations .
PARAMETERS ASSESSED:
ULTRASOUND AND FETAL SURVEILLANCE
Amniotic fluid is assessed ultrasonographically using the four-
quadrant AFI method, which is widely accepted for diagnosing
oligohydramnios .
Fetal well-being is monitored using non-stress tests (NST),
Doppler velocimetry, and biophysical profiles. Expectant
management involved hydration therapy and frequent monitoring,
while cases with severe oligohydramnios necessitated expedited
delivery
OUTCOME MEASURES
After birth, neonatal Apgar scores were recorded at one and five
minutes.
Newborns with poor Apgar scores or requiring resuscitation were
admitted to the neonatal intensive care unit (NICU) or ward, and
the reasons for admission were documented.
Maternal outcomes were assessed based on the mode of delivery
and the need for labor induction.
Perinatal outcomes were evaluated in terms of perinatal mortality
(stillbirths and early neonatal deaths) and neonatal morbidity,
including NICU admissions due to fetal distress, intrauterine
growth retardation, or low Apgar scores.
The incidence of congenital malformations is also noted.
The data collected were entered in Microsoft Excel and
systematically analyzed using appropriate statistical methods to
draw meaningful conclusions regarding the maternal and perinatal
outcomes associated with oligohydramnios.
Statistical analysis is performed using chi-square and t-tests to
compare outcomes between oligohydramnios cases and
normohydramnios controls.
A p-value <0.05 is considered statistically significant.
SAFETY ASSESSMENT:
Adverse effects such as post op nausea vomiting, retching ,
hallucinations will be documented after each session. All patients will
be monitored for adverse reactions.
STATISTICAL ANALYSIS:
Categorical variables will be presented as percentages, and
continuous variables as mean ± SD.
Comparisons between the two groups will be made using the
Wilcoxon–Mann–Whitney test for ANASI scores at different time
points.
The Friedman test will be used to analyze changes in ANASI scores
over time within each group.
A p-value <0.05 will be considered statistically significant.
Data will be entered into an MS Excel spreadsheet, and analysis will
be performed using SPSS version 26.0.
ETHICAL CONSIDERATIONS:
The study will be conducted in accordance with the Declaration of
Helsinki.
Ethical approval obtained from the Institutional Ethical Committee.
Written informed consent will be obtained from all participants.
Participants' confidentiality will be maintained, and data will be
stored securely.
IMPLICATIONS:
This study helps doctors decide whether to go for normal delivery or cesarean in cases of
oligohydramnios.
2. It helps identify which pregnancies are high-risk, so care can be better planned.
3. Unnecessary cesarean deliveries may be avoided if it's shown that normal delivery is safe in
some cases.
4. The findings will help prepare for possible problems in newborns, like breathing issues or
NICU needs.
5. It can guide hospitals and doctors to make better treatment plans based on actual evidence.
6. The results may also help improve policies and care for pregnant women with low amniotic
fluid.
REFERENCES:
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3. . Casey BM, McIntire DD, Bloom SL, et al.: Pregnancy
outcomes after antepartum diagnosis of oligohydramnios at or
beyond 34 weeks’ gestation. Am J Obstet Gynecol. 2000,
182:909-12. 10.1016/s0002- 9378(00)70345-0
4. Locatelli A, Vergani P, Toso L, Verderio M, Pezzullo JC,
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5. 5.Chauhan SP, Sanderson M, Hendrix NW, et al.: Perinatal
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