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Objective: To assess the frequency of IUDs and their possible causes since the Covid-19 pandemic. Material and Methods:. Study design: Cross-sectional study. Setting: Department of Obstetrics and Gynaecology, Shalamar Hospital, Medical and Dental College, Lahore, Pakistan. Duration of study: 15/03/2020 to 15/06/2020 This is a cross-sectional single-center study. The relevant details about IUDs like age, parity, social status, booked status, comorbidities, and social status were entered into a Performa and the data analyzed. Results: The Intrauterine death rate from the study was 41.99 fetal deaths per 1000 live births (Total births: 643, IUDs: 27) while the mean age of the mothers was 29.67 with a minimum age of 22 years and a maximum of 37 years. According to the risk factors associated with the IUD, 11.1% had Pregnancy Induced hypertension, 11.1% had Pre-Eclampsia, 22.2% had Gestational Diabetes Mellitus and 22.2% Pregnancy Induced Hypertension and Gestational Diabetes Mellitus and 33.3% had no comorbidities. Amongst all the patients 33.3% of cases were unbooked. Conclusion: We conclude that in the last one year the fetal deaths per 1000 at Shalamar Hospital were around 28.57 per 1000 live births, during the last 3 months they gone up to 41.99 fetal deaths per 1000 live births. The leading cause(s) for IUDs in Pregnancy during the Covid-19 were pandemic Induced Hypertension and Gestational Diabetes Mellitus, which cumulatively account for 44.4% cases but 33.3% cases had no co-morbidities and still ended up in an Intra-Uterine death, which may or may not have been influenced by a Covid-19 infection. From the looks of it, Non-clinical reasons seem to have a higher probability of increasing the IUD rate but clinical effects of the Covid-19 infection can also not be ruled out completely, further studies are required into the pathogenesis and the effect of Covid-19 on pregnancy. [ABSTRACT FROM AUTHOR]

AbstractsBackground and Objectives: This study aimed to investigate whether mild fetal tricuspid regurgitation (TR) at 11+ 0 to 13+ 6 weeks of gestation affects perinatal outcomes. Since fetal right ventricular load is associated with placental resistance, we hypothesized that fetal mild TR would be associated with perinatal outcomes as a consequence of abnormal placentation. Materials and Methods: We retrospectively evaluated 435 women with first-trimester scan data. Blood flow across the tricuspid valve was examined in singleton pregnancies between 11+ 0 and 13+ 6 weeks of gestation. Women were categorized according to the presence or absence of fetal mild TR, and the maternal and pregnancy characteristics and perinatal outcomes were compared. Multiple linear and logistic regression analyses were conducted to identify independent predictors of perinatal outcome. Results: In the group with mild TR, there were more cases of borderline amniotic fluid index, including oligohydramnios (p = 0.031), and gestational age- and sex-specific birth weights were lower (p = 0.012). There were no significant differences in other perinatal outcomes, including preeclampsia, gestational hypertension and small for gestational age. Gestational diabetes (adjusted odds ratio (OR) 0.514, 95% confidence interval (CI) 0.312–0.947) and fetal mild TR (adjusted OR 1.602, 95% CI 1.080–2.384) were identified as factors associated with below borderline amniotic fluid index before birth. The factors that affected gestational age and sex-specific birth weight were also gestational diabetes (adjusted beta coefficient 9.673, p = 0.008) and the presence of fetal mild TR (adjusted beta coefficient -6.593, p = 0.007). Conclusions: Mild fetal TR observed in the first trimester is negatively associated with fetal growth and the amniotic fluid index at term but not with other adverse pregnancy or perinatal outcomes due to abnormal placentation. [ABSTRACT FROM AUTHOR]

Background: Amniotic fluid index is one of the most commonly used methods of amniotic fluid volume assessment and is a predictor of adverse maternal and perinatal outcome. Objectives: To compare the maternal and perinatal outcome in women with singleton term pregnancies having amniotic fluid index (AFI) ≤5 cm to those having AFI ≥5 to 20 cm. Methods: This is a prospective, case-control study which was conducted at Gandaki Medical College Teaching Hospital over a period of one year from July 2017 to July 2018. It included 60 pregnant women at term pregnancy with amniotic fluid index ≤5 cm. The control group included 60 pregnant women at term pregnancy with amniotic fluid index ≥5 cm. The two groups were compared. Statistical analysis was done using the Chi-square test to calculate the P- value. Results: There was a significantly higher incidence of overall cesarean rates due to fetal distress, low birth weight babies and adverse neonatal outcome like 5 minute Apgar score ≤7, neonatal intensive care unit (NICU) admission rates, and meconium aspiration syndrome in the group with oligohydramnios as compared to the group with normal liquor volume. Conclusion: Oligohydramnios adversely affects the perinatal outcome. However a favorable outcome can be expected by good antenatal and intrapartum surveillance and neonatal care.

Aim: To assess and compare the perinatal outcome among mothers with normal and abnormal amniotic fluid volume. Methodology: A prospective comparative study was conducted for a period of one year from January 2016 to December 2016. Group I consist of 50 patients with normal amniotic fluid and group II consists of 50 patients with either oligohydramnios or polyhydramnios. Amniotic fluid index (AFI) was calculated using Phalen’s four quadrant technique using ultrasound. The perinatal outcome was judged by assessing the fetal distress predicted by abnormal fetal heart rate (FHR) or meconium stained liquor, one minute and 5 minute Apgar score, frequency of admission to neonatal intensive care unit (NICU), baby weight of less than 10th percentile for gestation age and perinatal mortality. Results: Induction of labour, caesarean section and meconium stained liquor was found to be most common among the patients in group II (abnormal AFI) in comparison with normal AFI subjects and similarly the perinatal outcome measures like low birth weight, increased frequency of admission to NICU due to respiratory distress and a low APGAR score was more commonly found in abnormal AFI group and the difference was found to be statistically significant. Conclusion: AFI measurement in antepartum or intrapartum period can help to identify women who need increased antepartum surveillance for pregnancy complications and such women should be managed in a special unit to combat the complications effectively.

Objective: To determine the normal value of amniotic fluid (AF) volume among pregnant women in a Northern Nigerian population and to determine if there is a relationship between AF index (AFI) and single deepest pocket (SDP) with anthropometric variables. Materials and Methods: A prospective cross-sectional study was conducted among singleton pregnant women at late second and third trimester attending the antenatal clinic in Abubakar Tafawa Balewa Teaching Hospital, Bauchi, from December 2016 to April 2017. The mean AFI and SDP were measured by sonography. Ethical approval was obtained from the institution and informed consent was sought for from all the participants. Descriptive statistics, i.e. mean, standard deviation, and correlation coefficient, were used for the analysis. Results: A total of 206 women, aged between 18 and 40 years, with fetal gestational ages between 22 and 39 weeks were included in the study. The values for AFI in the study ranged from 12 to 28.7 cm, with a mean value of 19.84 ± 3.64 cm, and SDP ranged from 3.7 to 9.1 cm with a mean value of 6.04 ± 1.12 cm. This study found a weak relationship between the anthropometric variables and AFI and SDP and a strong relationship between AFI and SDP with a correlation coefficient of R = 0.901 and P = 0.014. Conclusion: This study found the mean values for AF volume using AFI and SDP in the studied population to be 19.84 ± 3.64 cm and 6.04 ± 1.12 cm, respectively; a strong positive relationship between AFI and SDP; and a negative relationship between body mass index with AFI and SDP.

Objectives: To ascertain the normal values of amniotic fluid index in third trimester among Nigerian women with uncomplicated singleton pregnancies in Jos, Nigeria.Materials and Methods: This was a prospective cross-sectional study among 500 healthy pregnant women. Fifty women each were recruited at two-weekly interval from 28-36 weeks’ gestation and then weekly up to 41 weeks’ gestation. The uterine cavity was divided into four quadrants and using real-time ultrasonography, the vertical diameter of the largest pool of amniotic fluid was measured and summation of the values gave the amniotic fluid index (AFI). Mean, ranges, 5th, 10th, 50th, 90th and 95th percentiles for each gestational age were calculated using SPSS version 20 (IBM, Armonk, NY, USA).Results: Mean AFI among the entire study population was 18.1±3.1 cm (range of 10.4-26.8 cm) while the mean AFI for preterm and term pregnancies were 18.5±2.6 cm and 17.8±3.5 cm respectively. The AFI reference range for the study population was 13.6-24.6 cm. Amniotic fluid volume was highest at 28 weeks, stabilized and plateau between 37-39 weeks and declined after 40 weeks’ gestation. Using 5th and 95th percentile as lower and upper limits of normal, reference ranges for each gestational age was ascertained.Conclusion: Third trimester reference ranges of AFI is established and this can be used as a guide for evaluation of amniotic fluid volume in this obstetric population.

Objective: To assess the effects of oral fluids and intravenous fluids in terms of frequency of improving Amniotic Fluid Index during third trimester of pregnancy having oligohydramnios. Study Design: Comparative prospective survey. Place and Duration of Study: Obstetrics and Gynaecological Department of Fauji Foundation Hospital Rawalpindi, from Apr 2018 to Oct 2018. Methodology: A total of 100 patients with singleton pregnancy (50 in each group) at gestational age of 28-37 weeks and AFI of 5cm or less than 5cm were included. Non probability consecutive sampling technique was used. Ethics approval from hospital ethical committee and research board was taken. Patients were randomized into 2 groups (50 patients each) by lottery method. Group A was instructed to drink 2 liters of water per day for a time period of seven days and patients in group B was given 2 liters of 5% D/W which was in addition to their normal fluids intake. Amniotic fluid index was measured pre hydration and post hydration in both groups. Data was analyzed using SPSS-21. Results: Mean age of the patients was 33.62 ± 5.45 years and 34.70 ± 4.76 years for groups A and B respectively. In group A and group B mean gestational age was 34.28 ± 1.85 weeks vs 34.32 ± 1.82 weeks. In group A, 44 (88%) while in group B, 37 (74.0%) patients were of para 0-3 while para 4-7 were 6 (12.0%) in group A and 13 (26%) in group B. In group A 36 (72%) patients although in group B, 34 (68%) were of gravida 1-4. In group A and group B, 14 (28%) vs 16 (32%) were of gravida 5-8. Improvement was observed in 39 (78%) patients of group A while 22 (44%) patients of group B (p<0.001). In group A pre-hydration, mean amniotic fluid index level was 4.79 ± 0.53 and in group B 4.87 ± 0.36 (p=0.383). Post-hydration mean amniotic fluid index level was 6.79 ± 1.22 and 5.97 ± 1.37 in group A and B, respectively (p=0.002). Conclusion: Oral hydration of gestational women is more effective as compare to intravenous hydration in terms of frequency of improving Amniotic Fluid level during third trimester of pregnancy having oligohydramnios. [ABSTRACT FROM AUTHOR]

Purpose To evaluate modified myocardial performance index (MPI), or Tei index, in fetuses of pregnancies with idiopathic mildly increased amniotic fluid index (AFI). Methods: We studied 25 cases (24‐40 weeks) with idiopathic mildly increased AFI, and 25 gestational age‐ and fetal gender‐matched healthy controls. Fetal echocardiographic variables and Doppler‐derived indices were recorded, including left and right MPI, left isovolumetric contraction time (IVCT), left ejection time (ET), left isovolumetric relaxation time (IVRT), aortic and pulmonary arterial peak systolic velocity (PSV), left and right E/A ratios, middle cerebral artery (MCA) pulsatility index (PI), and umbilical artery (UA) PI. Results: The mean left MPI (0.52 vs 0.41, P <.0001) and right MPI (0.50 vs 0.42, P <.001) were higher, and mean IVCT (37.7 vs 25.9, P <.0001) was longer in cases than in controls. However, there were no significant differences between the two groups in IVRT (45.2 vs 43.2, P =.381), ET (160.2 vs 170.0, P =.079), aortic PSV (P =.073), left E/A (P =.080), pulmonary artery PSV (P =.061), right E/A (P =.054), MCA PI (P =.259), UA PI (P =.685), and cerebroplacental ratio (P =.645). Conclusion: Pregnancies with idiopathic mildly increased AFI were associated with a significant increase in the fetal MPI of both left and right ventricles. [ABSTRACT FROM AUTHOR]

Background and objective: Placental insufficiency is the primary cause of intrauterine growth restriction in normally formed fetuses and can be identified using middle cerebral artery to umbilical artery ratio Doppler velocimetry, and provide an estimate of downstream placental vascular resistance and placental blood flow. There is a strong association between reduced end-diastolic umbilical artery blood flow velocity and increased vascular resistance in umbilical placental microcirculation. Doppler ultrasound can assess the uteroplacental blood flow just before labor. This study aimed to investigate the use of the fetal cerebroumbilical ratio to predict the intrapartum fetal compromise in appropriately grown fetuses. Methods: A comparative cross-sectional study set at Sulaimania Maternity Teaching Hospital, Sulaimania, Iraq, from January to June 2015. The study recruited 121 cases, fetal biometry and Doppler indices were measured before established labor. The intrapartum and neonatal outcome details recorded. Results: Infants delivered by cesarean section for fetal compromise had significantly lower cerebroumbilical ratio than those born by spontaneous normal (none assisted) vaginal delivery and by cesarean section for other intrapartum causes. Infants with cerebroumbilical ratio 10th percentile. A cerebroumbilical ratio >90th percentile appears protective against cesarean section for fetal compromise. Amniotic fluid index of < 5 was associated with an increased cesarean section for fetal indication. Conclusion The cerebroumbilical ratio can identify fetuses at high risk of intrapartum fetal compromise. As a confounding variable, the amniotic fluid index was a useful tool for surveillance in prolonged pregnancy.

Objective: Prediction of delivery latency complicated with preterm premature rupture of membrane (PPROM) is crucial for reducing maternal and neonatal complications. Therefore, we investigated the correlations between latency period and cut-off values of ultrasonographic parameters, ultimately predicting delivery latency. Materials and methods: The retrospective study was performed on 121 PPROM patients enrolled between March 2010 and July 2015. Parameters including amniotic fluid index (AFI), single deepest pocket (SDP) and transvaginal cervical length (TVCL) were measured in 99 singleton pregnancies with PPROM. Latency was defined as the period from sonographic measurements to delivery day. The parameters were analyzed independently by Wilcoxon rank sum test and Fisher's exact test. Cut-off values were determined using a receiver operating characteristic (ROC) curve. Results: In delivery latency within 3 days, AFI and SDP were decreased with significantly shorter TVCL. AFI and SDP had the highest sensitivity (82.2%) and SDP combined with TVCL showed the highest specificity (75.9%) in area under curve (AUC) value. The predicted median latency period was less than 2 days within the cutoff value of parameter (AFI ≤ 7.72, SDP ≤ 3.2 and TVCL ≤ 1.69). Conclusion: AFI and SDP combined with TVCL could be useful predictive parameters of the latency interval from PPROM to delivery.

Objectives: To compare the grade of hydronephrosis between the antenatal and first postnatal ultrasound (US) and their clinical outcomes. Methods: This retrospective study included all cases of isolated hydronephrosis detected by antenatal US from August 2005 to February 2011. Hydronephrosis was classified based on the standard criteria into mild, moderate, or severe. Cases associated with other major congenital anomalies were excluded. All patients were followed-up postnatally and outcomes available were analyzed at one year of age. Results: A total of 105 cases were included out of which 83 (79.0%) were males and 22 (20.9%) were females with a median gestational age of 38 weeks. First postnatal US of 105 cases showed that 20 (19.0%) were free of hydronephrosis, 39 (37.1%) had mild, 29 (27.6%) moderate, and 17 (16.1%) had severe hydronephrosis. Half (50.4%) of hydronephrosis cases improved in their clinical presentation while 13.3% showed deterioration and 36.3% remained the same. Almost half of all cases (52 cases) were diagnosed by US at the end of first year without any effect on renal function. Conclusions: Antenatal and postnatal US are sensitive tools for detecting hydronephrosis as well as for postnatal counseling. Fetal anatomy US is usually done at 18 weeks gestation and if this reveals any evidence of hydronephrosis, the patient is followed according to the severity. Postnatal US is not done routinely for cases where hydronephrosis resolves completely during pregnancy. Although newborns with antenatal hydronephrosis due to secondary causes are at greater risk for renal impairment, surgical intervention reserves renal function.

Background: Oligohydramnios is defined as an Amniotic Fluid Index (AFI) of less than normal for that gestational age. It is mainly associated with increased perinatal morbidity and mortality due to cord compression, fetal distress, pulmonary hypoplasia. So, an effective medical therapy is very important to prevent the complications. Aim and Objectives: To compare efficacy of maternal hydration with oral water, 1Lof Ringer Lactate (RL) + 1Lof 5% Dextrose (5% D) and 2L of 0.45% Normal saline (0.45% NS) in increasing AFI in patients with oligohydramnios. Material and Methods: Patients who had been diagnosed as oligohydramnios (with AFI

Objective: To compare fetomaternal outcomes using amniotic fluid index and single deep vertical pocket for estimating amniotic fluid volume among pregnant women. Study Design: Comparative prospective study. Place and Duration of Study: Department of Obstetrics and Gynaecology, Pak Emirates Military Hospital, Rawalpindi, from Aug 2019 to Feb 2020. Methodology: Sample of 110 pregnant women was calculated with WHO calculator. We used non probability consecutive sampling as effective sampling technique. Research approval and patient consent were taken before initiation of study. Patients were randomly divided into two groups; group A underwent amniotic fluid index measurement while group B underwent single deep vertical pocket measurement. Feto maternal outcomes were measured in both groups. Results: Total 110 pregnant women were included in our study (55 women in each group). Mean age of women was 26.9 ± 4.6 SD. In Amniotic fluid index group, preeclampsia 14 (12.7%) vs 5 (4.5%) respectively, p=0.04, rupture of membrane 12 (10.9%) vs 4 (3.6%) respectively, p=0.05 was significantly higher as compared to single deep vertical pocket group. Patients with oligohydroamnios were significantly higher in amniotic fluid index group as compared to single deep vertical pocket 15 (13.6%) vs 3 (2.7%), respectively, p=0.04. Conclusion: Amniotic fluid volume assessment could be done with both amniotic fluid index and single deep vertical pocket method. Single deep vertical pocket is safe, effective and better diagnostic choice for amniotic fluid assessment as it is associated with avoidance of unnecessary interventions without affecting peripartum outcomes. [ABSTRACT FROM AUTHOR]

Objective: Prediction of success of trial of labor after cesarean delivery (TOLAC) is of major importance. We investigated the impact of polyhydramnios on the success rate of TOLAC.Study Design: A retrospective cohort study of all women with singleton pregnancies ≥ 34th weeks of gestation who underwent TOLAC after one previous cesarean delivery, between 2011 and 2016 in a single tertiary care center. Polyhydramnios was defined as amniotic fluid index ≥ 240 mm. Primary outcome was defined as the rate of successful TOLAC.Results: 31,245 women gave birth during the study period, of them 1637 (5.3 %) women underwent TOLAC and met inclusion criteria. 39 (2.4 %) women with polyhydramnios were compared to a control group of 1598 (97.6 %) women with amniotic fluid index < 240 mm. Polyhydramnios significantly reduced the rate of successful TOLAC: 69.2 % (27/39) in the study group compared to 85.8 % (1371/1598) in the control group (P = 0.009). In a subgroup analysis based on amniotic fluid index, women with AFI > 270 mm had substantially lower TOLAC success rate [9/19 (47.4 %) vs 18/20 (90 %); P = 0.006]. There was no difference in the rate of uterine rupture between the groups (0/39 (o%) vs 9/1598 (0.56 %); P = 0.64). Logistic regression analysis revealed that polyhydramnios remained significantly associated with higher rates of cesarean delivery [OR 3.09 (95 % CI, 1.37-6.98)] after adjustment for confounding factors.Conclusion: Polyhydramnios was associated with significantly reduced TOLAC success rate with no statistical difference in the rate of uterine rupture. This information should be considered in physician counseling. [ABSTRACT FROM AUTHOR]

Nowadays, prediction of abnormality plays a vital role in healthcare applications for deciding the treatment and guiding for proper treatment on time. The amniotic fluid is the water of the womb, and it is a strong indicator of congenital fetal anomaly. The automatic calculation of amniotic fluid index (AFI) and shape features of varying gestational periods will be useful to predict the perinatal outcome of high risk in maternity patients. Some perinatal outcomes are expected fetal weight, head circumferences and need of new-born ICU which decide the mode of delivery. These perinatal outcomes will be helpful in increasing the live birth and reducing the risk of premature delivery. The aim of this work is to identify the abnormal AFI of expectant mothers to alert the clinicians. Computer-aided diagnosis supports the clinicians in decision-making process. In the proposed work, using the training set of ultrasound images, the shape templates are developed by using deformable methods. Contour points in the edges will be helpful to find the AFI. After that, features are extracted and fuzzy logic algorithm is used to classify the given image into one of the four categories such as oligohydramnios, borderline, normal and hydramnios state for expectant mothers and their impact on fetal growth. The outcome of the proposed approach is measured in two different ways. The first outcome is that calculated AFI will be compared with the value calculated by the radiologist/clinicians, and the second outcome is that along with AFI, shape feature with contour points and gestational age are used for making decision/classification such as normal, borderline, oligohydramnios and hydramnios, and the classified results will also be compared with the expert's opinion. The outcomes are represented quantitatively. The results proved that AFI calculated by the proposed work was matching 94% with the expert opinion and classification of test image into any one of the categories such as normal, borderline, oligohydramnios and hydramnios fetched average accuracy of prediction up to 92.5%. [ABSTRACT FROM AUTHOR]

Objectives: To investigate association of amniotic fluid index (AFI) with perinatal fetal and maternal outcomes in pregnancies complicated by preterm premature rupture of membranes (PPROM) Material and methods: A total of 70 singleton pregnancies complicated by PPROM at 23--33 weeks' gestation were enrolled in this prospective observational study. Data on maternal clinical and obstetric characteristics [maternal age, gravidity, parity, PPROM time, and AFI (cm), latency period, treatments, type of delivery, length of hospital stay (LOS, day)], fetal characteristics (gestational age at delivery, birth weight (g), gender) and maternal and fetal complications were recorded and compared in AFI < 5 cm (n = 27) and AFI ≥ 5 cm (n = 21) groups. Results: Overall AFI was ≤ 5 cm in 27 (56.3%) patients and > 5 cm in 21 (43.7%) patients. No significant difference was noted in maternal clinical and obstetric characteristics, gestational age at delivery and gender of the newborn as well as in maternal and fetal complications rates with respect to AFI groups. AFI was correlated positively with latency period (r = 0.399, p = 0.018) and negatively with postpartum LOS (r = --0.314, p = 0.030). Conclusions: In conclusion, our findings seems to indicate increased likelihood of shorter latency to delivery and longer postpartum LOS with decrease in AFI after PPROM between 23--33 weeks' gestation, whereas no impact of AFI on mode of delivery and fetal or maternal complications. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study is to assess the incidence of oligohydramnios at term and evaluate whether the mode of delivery in patients with oligohydramnios influences perinatal outcomes in China.Methods: A cross-sectional survey of all deliveries in 39 hospitals in China from 1 January 2011-31 December 2011 was evaluated for the mode of delivery and perinatal outcomes in women with oligohydramnios compared to those without known oligohydramnios after excluding preterm births, polyhydramnios, and oligohydramnios secondary to premature rupture of membranes.Results: Oligohydramnios complicated 3954 (4.4%) of the 89,050 pregnancies, analyzed. Pregnancy cases with oligohydramnios compared those without known oligohydramnios had a significantly higher incidence of preexisting or gestational diabetes mellitus, fetal growth restriction, nonreassuring fetal heart tracings, obesity and malpresentation (p<.001). The cesarean delivery (CD) rate was significantly higher in pregnancies with identified oligohydramnios compared to those without (84.4 versus 54.7%; p<.001). Furthermore, in 2/3 of these CD in pregnancies with oligohydramnios, the identification of oligohydramnios was the only indication for the CD. In pregnancies with oligohydramnios, vaginal delivery did not significantly increase the risks of adverse outcomes compared to vaginal delivery without oligohydramnios, except postpartum complication.Conclusion: CD is not indicated in term pregnancies with isolated oligohydramnios. Vaginal delivery of oligohydramnios is not associated with increased perinatal mortality. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the utility of ultrasound markers in the management of pregnancies complicated by preterm prelabor rupture of membranes (PPROM) between 23 + 0 and 33 + 6 weeks' gestation, and to assess the ability of ultrasound markers to predict adverse neonatal outcomes.Methods: This was a retrospective cohort study of all patients with PPROM between 23 + 0 and 33 + 6 weeks' gestation and latency period (PPROM to delivery) > 48 h, who delivered before 34 weeks' gestation at a tertiary referral center between 2005 and 2017. All patients underwent a non-stress test daily and an ultrasound scan twice a week for assessment of amniotic fluid volume, biophysical profile (BPP) and umbilical artery (UA) pulsatility index (PI). In patients with suspected fetal growth restriction, fetal middle cerebral artery (MCA)-PI was also assessed and the cerebroplacental ratio (CPR) calculated. The last ultrasound examination performed prior to delivery was analyzed. We compared the characteristics and outcomes between women who were delivered owing to clinical suspicion of chorioamnionitis and those who were not delivered for this indication. The primary objective was to evaluate the utility of ultrasound in the management of patients with PPROM. The secondary objective was to assess the diagnostic performance of ultrasound markers (BPP score < 6, oligohydramnios, UA-PI > 95th percentile, MCA-PI < 5th percentile, CPR < 5th percentile) for the prediction of composite adverse neonatal outcome, which was defined as the presence of one or more of: perinatal death, respiratory distress syndrome, periventricular leukomalacia, intraventricular hemorrhage Grade 3 or 4, necrotizing enterocolitis, hypoxic ischemic encephalopathy, neonatal sepsis or neonatal seizures.Results: A total of 504 women were included in the study, comprising 120 with suspected chorioamnionitis and 384 without. Women with suspected chorioamnionitis, compared with those without, were less likely to be nulliparous (34.2% vs 45.3%; P = 0.03) and more likely to have fever (50.8% vs 2.6%; P < 0.001) and be delivered by Cesarean section (69.2% vs 42.4%; P < 0.001), mainly owing to a history of previous Cesarean section (18.3% vs 9.1%; P = 0.005) and to having non-reassuring fetal heart rate tracings (32.5% vs 14.6%; P < 0.001). No significant differences were found between the two groups with regard to the median amniotic fluid volume, overall BPP score, BPP score < 6, MCA-PI or CPR. Median UA-PI was slightly higher in the suspected-chorioamnionitis group, yet the incidence of UA-PI > 95th percentile was similar between the two groups. There was a higher incidence of composite adverse neonatal outcome in the group with suspected chorioamnionitis than in the group without (78.3% vs 64.3%, respectively; P = 0.004). However, on logistic regression analysis, none of the ultrasound markers evaluated was found to be associated with chorioamnionitis or composite adverse neonatal outcome, and they all had a poor diagnostic performance for the prediction of chorioamnionitis and composite adverse neonatal outcome.Conclusions: Commonly used ultrasound markers in pregnancies complicated by PPROM were similar between women delivered for suspected chorioamnionitis and those delivered for other indications, and performed poorly in predicting composite adverse neonatal outcome. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd. [ABSTRACT FROM AUTHOR]

Objective: To compare the labor characteristics and neonatal outcome of dinoprostone vaginal insert and double balloon catheter in pregnancies with isolated oligohydramnios at term. Methods: All pregnant women with isolated oligohydramnios and immature cervix at term that underwent labor induction with either the dinoprostone vaginal insert or double balloon catheter between 08 September 2016 and 08 September 2017 at a tertiary centre were included in the study. Data regarding the characteristics of parturition, including the period of time from insertion of the ripening agent to vaginal delivery, caesarean section rate, distribution of caesarean indications, need for augmentation, change in haemoglobin, newborn birth weight, meconium-stained amniotic fluid, 5-minute Apgar score and neonatal intensive care unit admission, were extracted from medical records. Results: The cesarean section rates were 29% versus 48.8% in the dinoprostone and balloon catheter groups, respectively (p = 0.03). The other intrapartum, postpartum characteristics and neonatal outcome were comparable between groups. Conclusion: Dinoprostone vaginal insert is a more efficient way of cervical ripening compared to the double balloon catheter in patients with isolated oligohydramnios. Both agents are comparable for neonatal outcome. [ABSTRACT FROM AUTHOR]

Objective: Coffee is frequently (one or two cups/day) consumed throughout pregnancy. Although there are a few studies evaluating caffeine effects on pregnancy; however, a diuretic effect of caffeine on fetal kidneys has not been reported. Therefore, after drinking coffee whether changing of amniotic fluid index (AFI) and fetal renal artery blood flow (FRABF, RI, Resistive index; PI, Pulsatility index) were evaluated in this study. Methods: This clinical study was performed with two groups. For the study group, 63 participants with isolated borderline oligohydramnios who agreed to drink one cup of instant coffee were included in this study while 63 participants with isolated borderline oligohydramnios who did not drink one cup of instant coffee formed the control group. AFI, RI and PI were evaluated both before and after coffee intake. Results: Maternal characteristics of all study population were homogenous. FRABF indices were similar in both before and after coffee consumption. AFI was increased significantly six hours after drinking coffee (p<0.001). Conclusions: The coffee consumption increased the amniotic fluid volume. However it does not seem to affect on FRABF. According to our study findings, coffee consumption may offer a new opportunity to improve amniotic fluid volume for pregnant women with oligohydramnios. [ABSTRACT FROM AUTHOR]

Objectives: to evaluate the effects of nifedipine with tocolysis under maternal and fetal parameters. Methods: a cohort study with 40 pregnant women admitted at a high-risk pregnancy ward to inhibit premature labor between September/2010 to May/2012. Nifedipine was used as a 20mg sublingual attack dose and maintained 20mg every six and eight hours orally. The variables of the analysis were fetal heart rate (FHR), maternal heart rate (MHR), systolic blood pressure (SBP) and diastolic blood pressure (DBP), and amniotic fluid index (AFI). All the variables were evaluated prior to administrating nifedipine and approximately after 6 hours and every 24 hours, until hospital discharge. Results: there were no modification of the FHR (p=0.48) and the SBP (p=0.29). The MHR increased after 24 hours, but with no statistical difference (p=0.08), returning to similar levels as at admission within 48 hours. The DBP decreased at 6 (p=0.04) to 72 hours, being stable afterwards. The AFI decreased significantly at 24, 48 and 72 hours. Conclusions: the use of high doses of nifedipine with tocolysis causes a decrease of the maternal's diastolic blood pressure and consequently decreases the amniotic fluid index, but probably without any clinical repercussions. [ABSTRACT FROM AUTHOR]

Objectives: To identify abnormal amniotic fluid volumes (AFVs), normal volumes must be determined. Multiple statistical methods are used to define normal amniotic fluid curves; however, quantile regression (QR) is gaining favor. We reanalyzed ultrasound estimates in identifying oligohydramnios, normal fluid, and polyhydramnios using normal volumes calculated by QR. Methods: Data from 506 dye‐determined or directly measured AFVs along with ultrasound estimates were analyzed. Each was classified as low, normal, or high for both the single deepest pocket (SDP) and amniotic fluid index (AFI). A weighted κ statistic was used to assess the level of agreement between the AFI and SDP compared to actual AFVs by QR. Results: The overall level of agreement for the AFI was fair (κ = 0.26), and that for the SDP was slight (κ = 0.19). Although not statistically significant (P =.792), the positive predictive value to classify a low volume using the AFI was lower compared to the SDP (35% vs 43%). The positive predictive value for a high volume was higher using the AFI compared to the SDP (55% versus 31%) but not statistically significant. The missed‐call rate for high‐volume identification by the SDP versus AFI was statistically significant (odds ratio, 5.5; 95% confidence interval, 2.04–14.97). The missed‐call rate for low‐volume identification by the AFI versus SDP was not statistically significant (odds ratio, 3.3; 95% confidence interval, 0.96–11.53). Conclusions: Both the AFI and SDP identify actual normal AFVs by QR, with sensitivity higher than 90%. The SDP is superior for identification of oligohydramnios, and the AFI superior for identification of polyhydramnios. [ABSTRACT FROM AUTHOR]

The present study aims to evaluate the adverse pregnancy outcome in low-risk pregnancy term have low amniotic fluid index [AFI]. A case-control study included pregnancy outcome for 300 pregnant cases diagnosis by ultrasound of oligohydramnios (Low AFI) at 37 gestation weeks with detection Apgar score, Oligohydramnios (oligo) and Non Stress test (NST). The results show elevated chances of lowering fetal heart rate, dens meconium, the Apgar score was low at 5 min, birth weight was about <2.5 kg the incidence of labor induction was raised and the cesarean section for fetal distress significant increased also. it can be concluded that the AFI estimation is useful for predicting fetal distress in labor needing cesarean section used as an adjuvant to other fetal surveillance methods. it's an indicator for poor pregnancy outcome. [ABSTRACT FROM AUTHOR]

Background: The two most commonly used nomograms for amniotic fluid index (AFI) were developed by Moore and Cayle and Magann et al. However, there are several inconsistencies between the two methods.Objective: The aim of the study was to determine whether these differences carry clinical significance.Methods: A retrospective cohort of women with singleton pregnancies evaluated for AFI during pregnancy at a tertiary medical center in 2007-2014 were divided into five groups: group A, definite oligohydramnios-AFI below the fifth percentile according to the nomograms of both Moore and Cayle and Magann et al.; group B, intermediate oligohydramnios-AFI below the fifth percentile according to only one nomogram (Moore and Cayle); group C, euhydramnios-normal AFI according to both nomograms; group D, intermediate polyhydramnios-AFI above the 95th percentile according to one nomogram (Magann et al.); group E, definite polyhydramnios-above the 95th percentile according to both nomograms. The association of group by maternal and perinatal outcomes was analyzed.Results: A total of 6987 women were included: group A, 996 (14%); group B, 1344 (19%); group C, 2561 (37%); group D, 1051 (15%); group E, 1034 (15%). Group B (intermediate oligohydramnios) was characterized by significantly lower rates of adverse perinatal outcomes than group A (definite oligohydramnios): small for gestational age neonate (12.3 versus 15.2%, p = .05), neonatal intensive care unit admission (11.1 versus 21.5%; p < .001), composite respiratory outcome (4.8 versus 9.8%; p < .001), and neonatal sepsis (6.4 versus 10.8%; p < .001). No such differences were found between groups B and C. Group D (intermediate polyhydramnios) differed from group E (definite polyhydramnios) by lower rates of 5 minutes Apgar score <7 (1.3 versus 3.2%; p = .003), neonatal intensive care unit admission (10.9 versus 14.4%; p = .02), and major congenital anomalies (1.7 versus 5.6%; p = .02). There was no difference in these parameters between groups D and C.Conclusion: This study suggests that intermediate oligohydramnios and intermediate polyhydramnios are not associated with adverse perinatal outcomes. Outcome in these pregnancies is similar to pregnancies with euhydramnios. Commonly used AFI nomograms should be updated. [ABSTRACT FROM AUTHOR]

Background of the Study: Amniotic fluid or liquor, the fluid around the developing fetus serves various functions. A balance of formation and reabsorption of this fluid has to be maintained. The amniotic fluid volume (AFV) undergoes changes during pregnancy. Oligohydramnios is a condition in which the AFV decreases and is associated with conditions like renal agenesis, placental dysfunction, congenital anomalies, anemia, PIH, hypoxia. Its effects depend on the duration of pregnancy. But when AFV decreases terminally, the chances of having a normal baby are more. Aims and Objective: This study was aimed to find the perinatal outcome in terms of LSCS and instrumental deliveries, needs for induction, neonatal mortality, low apgars, meconium staining, NICU admissions in women with oligohydramnios occurring after 34 weeks of pregnancy. Materials and Methods: A prospective observational study included women with singleton pregnancy admitted with intact membranes after 34 weeks. AFV was calculated by USG. Results: Less number of women had AF Index less than 5 cm but as AFV decreases risk of LSCS increases and spontaneous onset of labor ends mostly with vaginal deliveries. Amniotic fluid Index less than 5 cm increases the risk of low Apgar, septicaemia and neonatal mortality. Although Apgar was low at 1 min, it improved at 5 min suggesting a good adaption outside utero. Conclusion: Low AF Index (as determined by USG)in last trimester was associated with increased risk of adverse perinatal outcome like operative delivery, fetal distress, NICU, low apgar, septicemia, neonatal mortality. Here, Doppler can relieve obstetrician stress in decision making and amnioinfusion in selected cases can reduce operative morbidity. Parameters like risk of septicemia and effects in extremes of maternal age need to be evaluated further in a larger number of cases.

Objectives: To compare oral maternal hydration and intravenous infusion in women with third trimester isolated oligohydramnios in terms of mean change in amniotic fluid. Study Design: This is a Comparative Study. Setting: The study was conducted in Department of Gynecology, Pakistan Institute of Medical Sciences, Islamabad. Period: Between 1st May, 2015 to 31st July, 2016. Material & Methods: One hundred and fourteen pregnant females with singleton pregnancy, beyond 28 weeks gestation and AFI < 5cm were included. Placental insufficiency was ruled out on Doppler ultrasound of umbilical artery. Basal AFI and routine intake of fluid of all patients was noted. Patients were randomized either to receive oral maternal hydration or intravenous infusion. AFI measurement was repeated at 6th day after hydration therapy. Data was stratified for mean difference in improvement in amniotic fluid index. Results: One hundred and fourteen patients with mean age of 27.33 ± 3.87 years were included. 52 patients (45.6%) were primigravida and remaining 62 patients (54.4%) were multipara. Mean AFI value before treatment in sampled population was 3.35 ± 0.744 in oral hydration and 3.33 ± 0.787 in intravenous hydration (p=0.903). Mean AFI value after treatment was 5.53 ± 0.966 in oral hydration and 5.68 ± 1.490 in intravenous hydration, independent sample test showed non-significant (p=0.903) difference. Mean increase in AFI before and after treatment was cross tabulated and resultant difference was significant (p value=0.001). There is no effect of age, gestational age, history of oligohydramnios on improvement in amniotic fluid index. Conclusion: Both treatment modalities i.e. oral maternal hydration and intravenous infusion are effective in terms of improvement of amniotic fluid index but there is no difference in both treatments in pregnant females with isolated oligohydramnios in 3rd trimester at current sample size. [ABSTRACT FROM AUTHOR]

Background: External cephalic version (ECV) should be offered for patients presenting with a noncephalic pregnancy that are willing to deliver vaginally. Various reports have evaluated predictors for successful ECV. Yet, none have reported a single‐operator large cohort experience. We aim to analyze the outcome of referrals for ECV. Methods: We conducted a retrospective cohort study of prospectively collected data. We performed a multivariate analysis of data with respect to ECV procedures performed by a single operator in a 6‐year period. Maternal and fetal characteristics were compared between ECV success and failure groups. Results: Six hundred and two women underwent ECV. Of them, ECV was successful in 432 (71.7%). A multivariate binary logistic regression model demonstrated that high liquor volume was a predictor of ECV success (Adj OR 1.17 [95% CI 1.09‐1.26]). Failure of ECV was correlated with anterior placenta (0.44 [0.56‐0.76]) and nulliparity (0.21 [0.11‐0.36]). Adverse events were rare and mostly minor, occurring in 1% of procedures. Conclusions: ECV has a high success rate and a low complication rate, enabling vaginal birth and avoiding cesarean. The role of manipulation of modifiable determinants such as liquor volume should be further assessed in future studies. [ABSTRACT FROM AUTHOR]

The present study aims to find an alternative solution to continuous monitoring with Cardiotocography (CTG) during intrapartum management process of pregnant women with no previous antenatal follow-up, and to diagnose low-risk pregnancies and avoid the financial burden and discomfort to the pregnant woman resulting from continuous monitoring. Randomly selected 114 term pregnant women with expected vaginal delivery, singleton pregnancies and no major fetal abnormalities were included in the study. Routine obstetric ultrasonography (USG) and uterine artery (UA) doppler measurements were administered. The pregnant women included in the study had an average gestation period of 38.3 ± 1.3, average age of 26.1 ± 5.3, average parity of 2.1 ± 1.5 and average infant birth weight of 3280 ± 442 g. 13 pregnant women were considered to have fetal distress following continuous monitoring with cardiotocography. Furthermore, decreased amniotic fluid index was detected in 9 of them. 10 cases were assessed to be pathological as a result of Uterine Artery Doppler examination. In two cases deemed pathological, fetal distress developed and found to be statistically insignificant. No statistically significant difference was found between decreased amniotic fluid index cases and non-decreased amniotic fluid index cases in terms of C-section application due to fetal distress. In our study, Cardiotocography + Amniotic Fluid Index measurement was determined to be the most valuable combination as the delivery room admission test.

Aim of the study: To evaluate the effect of L-arginine in the treatment of oligohydramnios. This prospective cohort study included 90 pregnant ladies who were diagnosed according to clinical and ultrasound findings as having oligohydramnios. The study was carried out in Al-Diwaniyah maternity and child hospital during the period from June 2017 through December 2018. Maternal and gestational age were obtained for all participants and the amniotic fluid index (AFI) was assessed by ultrasound. Women were all informed about the aim and the procedure of the study and verbal consent was obtained from all of them, in addition, the study was approved by the institutional approval committee. Women were given L-arginine treatment for a duration ranging from 8 to 28 days. The change in AFI following treatment was highly significant (P <0.01) and the mean change was 2.19 ±0.36 cm. Mean duration of treatment with L-arginine was 20.70 ±5.47 days and it ranged from 8 to 28 days. The change in AFI was higher with increasing duration of treatment in women within approximately the same weeks of gestation; the change in AFI among all women with respect to duration of treatment was highly significant (P < 0.001). [ABSTRACT FROM AUTHOR]

Objective: To determine the normal value of amniotic fluid (AF) volume among pregnant women in a Northern Nigerian population and to determine if there is a relationship between AF index (AFI) and single deepest pocket (SDP) with anthropometric variables. Materials and Methods: A prospective cross-sectional study was conducted among singleton pregnant women at late second and third trimester attending the antenatal clinic in Abubakar Tafawa Balewa Teaching Hospital, Bauchi, from December 2016 to April 2017. The mean AFI and SDP were measured by sonography. Ethical approval was obtained from the institution and informed consent was sought for from all the participants. Descriptive statistics, i.e. mean, standard deviation, and correlation coefficient, were used for the analysis. Results: A total of 206 women, aged between 18 and 40 years, with fetal gestational ages between 22 and 39 weeks were included in the study. The values for AFI in the study ranged from 12 to 28.7 cm, with a mean value of 19.84 ± 3.64 cm, and SDP ranged from 3.7 to 9.1 cm with a mean value of 6.04 ± 1.12 cm. This study found a weak relationship between the anthropometric variables and AFI and SDP and a strong relationship between AFI and SDP with a correlation coefficient of R = 0.901 and P = 0.014. Conclusion: This study found the mean values for AF volume using AFI and SDP in the studied population to be 19.84 ± 3.64 cm and 6.04 ± 1.12 cm, respectively; a strong positive relationship between AFI and SDP; and a negative relationship between body mass index with AFI and SDP. [ABSTRACT FROM AUTHOR]

Objective: Premature rupture of the membranes (PROM) remains a leading cause of neonatal morbidity. The objectives of the present study were to analyze the outcomes of pregnancies complicated by PROM between 22 and 27+6 weeks of gestation (WG) and to study antepartum risk factors that might predict neonatal death. Patients and methods: One hundred and seven pregnancies were analyzed over a 3-year period in a tertiary maternity hospital. The collected maternal and neonatal data were used to model and predict the outcome of PROM. Results: Prevalence of PROM (for live births) was 1.08%, and the overall survival rate was 59.8%. From preselected candidate variables, gestational age (GA) at PROM (p = .0002), a positive vaginal culture for pathogenic bacteria (p = .01), primiparity (p = .02), and the quantity of amniotic fluid (p = .03) were included in a multivariable logistic regression analysis. The corresponding adjusted odds ratios [95% confidence interval] were, respectively, 0.91 [0.87-0.96], 11.08 [1.65-74.42], 0.55 [0.33-0.91], and 0.97 [0.95-0.99]. These parameters were used to build a predictive score for neonatal death. Conclusions: The survival rate after PROM at 22-27+6 weeks of gestation was 59.8%. Our predictive model (built using multivariable logistic regression) may be of value for obstetricians and neonatologists counseling couples after PROM. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the effect of vaginal isosorbide mononitrate (IMN) plus oral hydration compared with oral hydration alone in improving the amniotic fluid index (AFI) and obstetric and perinatal outcomes in pregnancies complicated by isolated oligohydramnios (IO). Design: A randomized controlled trial. Setting: Obstetrics and Gynecology Department, Benha University Hospital. Materials and methods: The study included 210 singleton pregnancies (>28 gestational weeks) complicated by IO. Participants were scheduled into two equal groups. The study group received vaginal isosorbide mononitrate plus oral hydration and the control group received oral hydration plusplacebo vaginal tablet. The amniotic fluid index was assessed at randomization, 24 h after treatment then weekly till delivery. Results: One-hundred participants completed the study in each group. A significant increase of AFI was detected 24 h after treatment in both groups. This effect did not continue for more than one week unless IMN was added. The mean AFI was significantly higher in IMN group at the final assessment. The IMN group had significantly higher gestational age on the time of delivery, prolonged randomization delivery interval, a lower cesarean delivery rate, and their neonates were less likely to have low birth weight, low Apgar score, and admission to the neonatal intensive care unit. Neonatal deaths were reported in one case of the study group and 5 in the control group, and the difference was not significant. Conclusion: Nitric oxide donors may offer a promising choice in improving amniotic fluid volume and pregnancy outcomes in cases of isolated oligohydramnios. [ABSTRACT FROM AUTHOR]

Objective  The objective of this study was to determine the effect, if any, of maternal body mass index (BMI) and amniotic fluid index (AFI) on the accuracy of sonographic estimated fetal weight (EFW) at 40 to 42 weeks' gestation. Methods  This was a retrospective cohort study of singleton gestations with ultrasound performed at 40 to 42 weeks from 2010 to 2013. In this study, patients with documented BMI and sonographic EFW and AFI, concurrently, within 7 days of delivery were included. Chronic medical conditions and fetal anomalies were excluded from this study. The primary variable of interest was the rate of substantial error in EFW, defined as absolute percentage error (APE) >10%. Results  A total of 1,000 pregnancies were included. Overall, the APE was 6.0 ± 4.5% and the rate of substantial error was 17.4% (n  = 174). There was no significant difference in APE or rate of substantial error between BMI groups. In the final multivariable logistic regression model, the rate of substantial error was increased in women with oligohydramnios (OR 1.79; 95% CI: 1.10–2.92). Furthermore, oligohydramnios was significantly more likely to overestimate EFW while polyhydramnios was more likely to underestimate EFW. Maternal BMI did not affect the accuracy of sonographic EFW. Conclusion  Sonographic EFW may be affected by extremes of AFI in the postdates period. Maternal BMI does not affect EFW accuracy at 40 to 42 weeks. [ABSTRACT FROM AUTHOR]

Objective: Numerous studies have evaluated the factors associated with ECV success. Yet, bladder volume has never been examined. We hypothesize that maternal bladder volume may affect ECV success rate. We aim to evaluate the role of maternal bladder volume during external cephalic version (ECV) on the procedure success rates.Study Design: We reviewed prospective collected data of all patients who underwent ECV at our center during 2001-2012. The study group included 100 patients that underwent ECV with bladder volume below 400 ml. These patients were matched to 400 patients that underwent ECV with bladder volume equal or above 400 ml which composed the control group. Maternal and fetal characteristics and outcomes were compared.Results: ECV was successfully performed in 80/100 (80.0%) of patients in the study group as compared to 257/400 (64.3%) in the control group (P = 0.002). Factors associated with ECV success were older age (P = 0.003), having prior delivery (P < 0.0001), higher amniotic fluid index (AFI) (P = 0.001) and placenta located in the posterior wall (P = 0.001). In a logistic regression analysis, bladder volume was found to be an independent predictor of ECV success Odds radio (OR) for ECV success 2.5 (CI 1.42-4.34). Posterior placenta and higher AFI were found to be an independent predictors of ECV success as well; OR 2.7 (CI 1.74-4.34) and OR 1.07 (CI 1.02-1.13) respectively.Conclusion: ECV is more successful in patient with bladder volume below 400 ml. Amniotic fluid volume and placental location were found as independent predictors of ECV outcome as well. [ABSTRACT FROM AUTHOR]

Background and aims: Preterm delivery is associated with significant perinatal morbidity and mortality. This study aimed to determine the effects of intravenous (IV) hydration on time interval from rupture of membranes to delivery (latency period) in pregnant women with Preterm premature rupture of fetal membranes. Methods: 24 pregnant women during their 28 to 34 weeks of gestational age with singleton live pregnancy whose baseline amniotic fluid index (AFI) was ≥ 5 cm were randomized into 2 case and control groups. The study group (Amniotic Fluid Index) received one liter intravenous fluid bolus of isotonic Ringer serum during 30-minute period. The control group received expectant management. The time interval from rupture of membranes to delivery was studied. Independent t-test and paired t-test were used to compare 2 groups and mean latency period before and after hydration, respectively. Results: The results of this study demonstrated that AFI decreased significantly at 90 minutes in both control and study groups. The mean between time intervals and delivery was 196.41 h and 140.58 h in the study and control groups, respectively, But this differences were not statistically significant (95%: 75.9-316/9 CI 95% :10.2-270.9) (P=490). Conclusion: This study did not show any significant impact of hydration on AFI and consequently latency period as a prophylactic method. So, further studies with a larger sample size and at different time intervals seem to be needed to clarify the effect of hydration on latency period in PPROM.

Background: Amniotic fluid volume may reflect a problem with fluid production or circulation due to fetal, placental, and maternal pathology. Some authors have shown that amniotic fluid index (AFI) is a poor predictor of adverse pregnancy outcome, but others have not confirmed the association of adverse perinatal outcome with oligohydramnios. Objectives: To compare the mode of delivery and neonatal outcome in patients with oligohydramnios (AFI

ABSTRACT: Polyhydramnios refers to the excessive accumulation of liquor amnii more than 2 liter, which is likely to influence the course of pregnancy and labour. The maintenance of amniotic fluid volume within normal limits is an important indicator of fetal well-being, so when polyhydramnios is detected during pregnancy, it should be investigated thoroughly because of its association with several maternal and fetal complications. Although, 60% of cases are idiopathic. The most common causes are fetal anomalies maternal diabetes and twin pregnancy. The aim of the study is to find out the frequency of an adverse perinatal outcome. The adverse perinatal outcome was determined by the presence of congenital anomalies and other neonatal adverse parameters which are solely caused by polyhydramnios. OBJECTIVE: To determine the frequency of an adverse perinatal outcome in women with Polyhydramnios. STUDY DESIGN: Descriptive-Cross sectional. SETTING: The study was conducted at the Department of Gynecology and Obstetrics, Unit-I Liaquat University of Medical and Health Sciences, Hyderabad / Jamshoro (LUMHS). DURATION OF STUDY: This study was carried out for the period of 6 months, i.e. from 25th Dec 2009 to 25th June 2010. RESULTS: Study outcome was measured by immediate neonatal assessment after birth. Out of 79 patients, 19(24.05%) women delivered with congenitally malformed babies. Among that CNS system involvement was more frequent, i.e. anencephalus 6(7.59%) and Hydrocephalus 8(10.13%). GIT anomalies were 5(6.33%). 13(16.46%) babies were born with low Apgar score, 4(5.06%) had low birth weight and most of the babies were preterm i.e. 50 (63.29%). The categorical data is presented via different tables and pie charts and the possible confounding variable i.e. age, gestational age, and parity, that could affect the outcome were analyzed. CONCLUSION: It is concluded that polyhydramnios carries a higher incidence of adverse perinatal outcomes like congenital anomalies, low birth weight, low Apgar score and preterm gestation. It is imperative to make efforts to antenatally detect as many cases as possible to provide proper perinatal care. So these women should have early antenatal booking visits and should be fully investigated for the cause of polyhydramnios and need to be encouraged to take folic acid supplementation.