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Background and Objectives Evaluation of amniotic fluid is one of the main variables of examining fetal health in the second and third trimesters of pregnancy. An increase in amniotic fluid can affect the health of the fetus. The aim of this study is to compare the severity of blood flow disorder in the umbilical artery and MCA of the fetus in idiopathic polyhydramnios (IP) and diabetic polyhydramnios (DP). Subjects and MethodsIn this study, singleton pregnancies with a calendar age of 31 to 40 weeks along with DP and IP were included in the study from June 2019 to June 2019, following the inclusion and exclusion criteria. First, the patients were divided into two groups, diabetic and non-diabetic, and then each group was divided into three groups with mild, moderate, and severe polyhydramnios. In all cases, the amniotic fluid index and after fetal Doppler cytometry, pulsation index, systolic to diastolic ratio of the umbilical artery, and pulsation index, maximum systolic velocity, systolic to diastolic ratio of the middle cerebral artery were measured. Results In this study, 138 pregnant mothers with polyhydramnios in the third trimester (70 in the IP group and 68 in the DP group) were studied. Compared to the standard values, 14 (20%) of the patients in the IP group and 10 (14.7%) in the DP group had abnormal fetal Doppler indices. In the idiopathic group, Doppler indices of the umbilical artery differed significantly only in the severe subgroup compared to the other two subgroups. Doppler indices of the middle cerebral artery, except for maximum systolic velocity, differed significantly in the moderate and severe polyhydramnios subgroups compared to the other subgroups. The impairment of fetal umbilical and middle cerebral artery Doppler indices, except for the umbilical artery systolic-to-diastolic ratio, was not associated with whether the polyhydramnios was diabetic or idiopathic. There was no significant difference between the two groups for the other indices, and this impairment was only related to the severity of polyhydramnios. Conclusion Disturbance in fetal Doppler indices in mothers with polyhydramnios is related to the severity of this complication and has no relation with its cause. Therefore, maintenance treatments can be useful to reduce the relative volume of amniotic fluid in both groups. [ABSTRACT FROM AUTHOR]

The term oligohydramnios is linked to pregnancy complications. We previously presented the outcome of the low-risk population (no pregnancy complications) with term oligohydramnios. This study aims to address the high-risk group (Any maternal complication during pregnancy, such as gestational diabetes, pre-gestational diabetes, chronic hypertension, preeclampsia, anemia, asthma, obesity, and multi parity.) This retrospective cohort study of 1,114 singleton term (≥37), oligohydramnios (AFI <50 mm) pregnancies from Shamir Medical Center between 2017 and 2021. Compering the low-risk to high-risk groups with subdivision by severity of oligohydramnios. A total of 211 subjects (19 %) were high-risk cases and 903 (81 %) low-risk cases. Comparing these two groups, subjects of the high-risk group were older (31.34 ± 5.85 vs. 29.51 vs. 4.96), had earlier gestational age at delivery 39.53 ± 1.18 vs. 40, had higher mean AFI (35 ± 12.7 vs. 33 ± 14.5), were subject to more labor inductions (81 vs. 69.7 %), and CS rate (19.9 vs. 12.4 %). Logistic regression revealed a need for more cesarean sections in the high-risk group. Additionally, more labor inductions and a higher risk of negative fetal outcomes. This study highlights the importance of considering pregnancy risk factors when we are approaching oligohydramnios in high-risk pregnancies. [ABSTRACT FROM AUTHOR]

Aim and background: It is imperative to achieve precise diagnosis of prelabor rupture of membranes (PROM) and preterm prelabor rupture of membranes (PPROM) by recognizing specific amniotic fluid indicators in vaginal environment. The study included assessment of creatinine levels in vaginal fluid along with determining its cut-off value to diagnose PROM/PPROM. Methods: Sixty women with singleton pregnancy of 28 weeks or more period of gestation, were enrolled in the study to be categorized in two equal groups of 30 each. Study group comprised of patients having confirmed PROM and control group included pregnant women with intact membranes. Vaginal fluid samples were collected in a sterile syringe in study patients. In controls, 5 mL of normal (0.9%) saline was instilled into vaginal cavity, and 3 mL of vaginal fluid was collected to be sent for creatinine estimation. Results: The mean value of levels of creatinine in vaginal fluid in study groups was (1.15 ± 0.55 mg/dL) and control groups was (0.15 ± 0.16 mg/dL) showing a significant difference (p < 0.001). The value of creatinine in vaginal fluid to detect PROM/PPROM was 0.7 mg/dL, with sensitivity of 86.67% and specificity of 100%. The positive predictive value (PPV) was 100% and negative predictive value (NPV) was 88.24% with an accuracy of 93.33%. Conclusion: Creatinine estimation in vaginal fluid is an easy, reliable, as well as readily available method to diagnose PROM/PPROM. Clinical significance: Accurate diagnosis of PROM/PPROM, using an easily available and reliable method is important to guide the clinical management in high-risk pregnancy. [ABSTRACT FROM AUTHOR]

Objective: To assess the prevalence of adverse perinatal outcomes in antenatal women with low amniotic fluid index at term. Study Design: Observational Cross-sectional Analysis. Setting: Department of Gynaecology and Obstetrics Hayatabad Medical Complex, Peshawar. Period: 2nd February 2020, to 5th February 2021. Methods: The study involved a total of 165 patients, in 37 to 40-weeks of gestation period, the research included antenatal women with a low amniotic fluid index, with any parity, gravidity, and 18-35 years of age. While Excluded patients with any medical disorders during pregnancy (e.g., PIH, anemia, cardiac disease etc.), and those with gestational period <37 weeks from the study. Thorough history, clinical examination and ultrasound were carried out of all the women included in the study from OPD and emergency department, to confirm a low amniotic fluid index. Patient follow-up was extended to their arrival in the Obstetric suite during established labor, APGAR scores were calculated and recorded at birth, and at the 5-minute of birth for the neonate. Adverse Perinatal Outcome was considered positive if the APGAR Score was <7/10 at five minutes of life of neonate. Data analysis was performed using SPSS 23. Results: Out of 165 patients 57% of the patients were induced while 43% spontaneously delivered, similarly 66.7% were delivered vaginally while 33.3% were delivered via C Section. Low neonatal APGAR score was recorded in 67.9% patients which is a significant percentage, hence our study results showed positive correlation of low AFI with adverse perinatal outcome. We also observed that probability of satisfactory values of AFI is 1.5 times more in spontaneous deliveries (p=0.04, OR=1.5), however no such relation exists for period of gestation or number of parity. Similarly, there is a significant relation of mode of delivery with satisfactory values of AFI (p=0.00), however no such relation exists for period of gestation or number of parity. However, the probability of vaginal deliveries is 1.6 times more with an increased in number of para (p=0.02, OR=1.6). Conclusion: Reduced amniotic fluid index is linked with significant Unfavorable Perinatal Outcomes proved by low APGAR score (<7/10 at five minutes). [ABSTRACT FROM AUTHOR]

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Introduction: The aim of this study was to examine the efficacy of pneumatic compression of the maternal lower extremities in increasing the amniotic fluid index (AFI) in pregnancies complicated by isolated oligohydramnios. Methods: Women with isolated oligohydramnios (AFI <5 cm) at 32–41 weeks of pregnancy were connected to a sequential compression device for 60 min. Prior and after the application, AFI and the pulsatility index (PI) of a number of arteries were measured. Results: The median (interquartile range) maternal age of the 21 women included was 29 years (26.50–32.00), the median parity was 1 (1–2), and the median gestational age at intervention was 37.60 weeks (37.00–39.40). The median AFI increased after the application from 4.00 (3.62–4.50) to 6.08 cm (4.90–7.03) (p < 0.001). The median PI of the fetal renal artery decreased from 2.30 (2.01–2.88) to 2.26 (1.68–2.71) (p = 0.01). The hourly fetal urine production did not increase. Changes were not significant in the PI of the umbilical artery, the middle cerebral artery, and the bilateral uterine arteries. Conclusion: Short-term activation of pneumatic compression on maternal lower extremities could increase the AFI in women with isolated oligohydramnios. [ABSTRACT FROM AUTHOR]

Background: Preterm premature rupture of membrane (PPROM) is among the most important causes of perinatal morbidity and mortality. We sought to determine whether cervical length and amniotic fluid index, individually or in combination, can predict the pregnancy outcome in cases of PPROM. Aims and Objectives: To study the role of amniotic fluid index (AFI) and cervical length in the prediction of delivery latency period among women with premature preterm rupture of membranes. Material and Method: This was a prospective observational study performed during July 2022 to July 2023 in the Department of Obstetrics and Gynecology, NCMCH, Panipat, on 100 singleton pregnant women between 28 weeks and 34 weeks gestation with cephalic presentation and preterm premature rupture of membranes. All the women were subjected to ultrasound to determine AFI and cervical length and were followed up until delivery. Results: Out of 100 women, 86 women who underwent spontaneous labor were included in the study. 41 women delivered within 7 days of the test, and 45 delivered afterwards. Out of 41 women, 29 (67.44%) had amniotic fluid index of =5cm and 28 (65.12)% women had cervical length of = 2 cm. The sensitivity, specificity, positive and negative predictive value of AFI alone in predicting delivery within 7 days were 72.14%, 64%, 67.22%, 70.15% respectively. The sensitivity, specificity, positive and negative predictive value of cervical length alone in predicting delivery within 7 days were 68%, 73%, 76% and 69% respectively. Out of 86 women, 30 had both the characteristics, (amniotic fluid index = 5cm and cervical length = 2 cm), out of them, 22(75.86%) delivered with 7 days. The sensitivity, specificity, positive and negative predictive value of combination of both in predicting delivery within 7 days were 73%,55%,77% and 49% respectively. The PPV of cervical length = 2cm and AFI = 5cm alone in predicting delivery within 7 days were 76% and 70.15%, whereas combination of both is 77%. For AFI > 5 the total number of women who had not delivered within 7 days were 36 out of which 29 women (80.56%) had CL of > 2 cm. The NPV of AFI > 5 cm and TVCL > 2cm was 82%, means women with these two characteristics would remains undelivered within 7 days. Conclusion: This study concluded that cervical length and amniotic fluid index both independently predict the delivery latency period following preterm premature rupture of membranes and combination of both factors improves predictive ability. [ABSTRACT FROM AUTHOR]

Background: Amniotic fluid is important throughout the pregnancy for normal growth and development of fetus. Oligohydramnios is always a cause for concern in pregnant women. Aim: The aim of our study is to assess the efficacy of intravenous amino infusion in pregnant women with oligohydramnios & its effect on feto-maternal outcome. Materials and Methods: This prospective and observational study was conducted on 80 pregnant women with amniotic fluid index less than 5 cm and gestational age of 28 - 37 weeks at government hospital Gwalior from February 2021 to july 2022 as per inclusion criteria. They were administered intravenous amino-infusions. The AFI value was measured before and after the infusions in each patient. The change in AFI status and feto-maternal outcome was studied and analysed. Result: The results were tabulated with respect to age of patients, gestational age, gravida status, AFI status, maternal and perinatal outcome. Out of 80 study subjects, majority were primigravida (35%). Most common age group in our study was between 21 to 25 years with around 37.5%. Around 45% cases were in between 34 to 37 weeks of gestations. In 85% cases AFI value was increased post-infusion. Majority (65.5%) of the cases had undergone vaginal delivery post infusion. Only 25% babies were admitted in SNCU, rest babies were at mother side. No mortality was reported. Conclusion: According to the findings of study, the present study shows improvement in AFI and perinatal outcomes after intravenous aminoinfusion. [ABSTRACT FROM AUTHOR]

Aims: Fetal growth restriction (FGR) may go undetected in the antenatal period with subjective clinical evaluation, and there is a growing propensity to perform a third-trimester scan, especially in the developed countries. The literature on the importance of the same in developing countries like ours, is scant. Hence, this study was undertaken to evaluate the role of routine third-trimester ultrasonography along with Doppler in predicting adverse perinatal outcome. Methods: A prospective cohort study was conducted at a tertiary-care hospital, in which routine third-trimester ultrasonography was performed for 265 antenatal women, and included estimation of amniotic fluid index (AFI), estimated fetal-weight (EFW), and cerebroplacental ratio (CPR). Women were categorized as having normal parameters or having at least one abnormal parameter. Post-natal adverse perinatal outcomes including low birth-weight, hypoglycemia, poor Apgar scores, prolonged hospital stay, need for ventilatory support, neonatal asphyxia, neonatal sepsis and early neonatal death were recorded. Prediction analyses for sensitivity, specificity, positive and negative predictive values were done. Receiver Operating Characteristic (ROC) curves were plotted for threshold for each parameter for adverse outcome. Results: Out of 260 women that were analyzed, 47.5% had no clinically identifiable risk factors, and 52.5% had at least one abnormal parameter. Sensitivity and negative predictive value for adverse outcome were highest for composite ultrasound finding (85.4% and 90.4% respectively). Specificity, positive predictive value and diagnostic accuracy were highest for CPR (97.8%, 86.7% and 76.9% respectively). Conclusion: Routine third trimester ultrasonography, including Doppler, can help in risk-stratification of otherwise clinically low-risk pregnancies. [ABSTRACT FROM AUTHOR]

Background: Renal oligohydramnios (ROH) describes an abnormally low volume of amniotic fluid (AF) during pregnancy. ROH is mostly caused by congenital fetal kidney anomalies. The ROH diagnosis frequently implies an increased risk of peri- and postnatal fetal mortality and morbidity. The present study aimed to evaluate the impact of ROH on pre-and postnatal development in children with congenital kidney anomalies. Methods: This retrospective study included 168 fetuses with anomalies in the kidney and urinary tract. Based on the amount of AF measured by ultrasound, patients were divided into three groups: normal amniotic fluid (NAF), amniotic fluid in the lower normal range (LAF), and ROH. These groups were compared with respect to prenatal sonographic parameters, perinatal outcomes, and postnatal outcomes. Results: Among the 168 patients with congenital kidney anomalies, 26 (15%) had ROH, 132 (79%) had NAF, and 10 (6%) had LAF. Of the 26 families affected by ROH, 14 (54%) decided to terminate pregnancy. Of 10 live-born children in the ROH group, 6 (60%) survived the observation time; of these, 5/6 presented with chronic kidney disease, stages I–III, at their last examination. The main differences in postnatal development between the ROH group and the NAF and LAF groups were: restricted height and weight gain, respiratory issues, complicated feeding, and the presence of extrarenal malformations. Conclusions: ROH is not a mandatory indicator of severe postnatal kidney function impairment. However, children with ROH have complicated peri-and postnatal periods, due to the presence of concomitant malformations, which must be considered in prenatal care. [ABSTRACT FROM AUTHOR]

Objective: The objective of the study was to compare the maternal and perinatal outcomes in low-risk pregnancies having borderline Amniotic fluid index (AFI) with normal amniotic fluid index at term. Methods: This prospective observational study, included 540 low-risk pregnant women admitted at POF Hospital Wah Cantt between 1st June 2020-31st December 2022. Group A had 180 women with borderline AFI having normal umbilical artery Doppler and group B had 360 women with normal AFI between 37-40 weeks, who fulfilled the inclusion criteria. The data regarding baseline characteristics and fetomaternal outcome was collected on an already designed proforma and analysis was done by using SPSS version 23. Results: The difference in overall cesarean section rate (p=0.071) and cesarean section for fetal distress (p=0.076) was not statistically significant between the two groups. The borderline AFI did not increase the risk of meconium-stained liquor (p=0.116), 5minute APGAR score <7 (p=0.218), admission to NICU (p=0.064) and low birth weight (mean birth weights p=0.278) compared to normal AFI. Conclusion: Borderline oligohydramnios does not increase the risk of cesarean section and cesarean section for fetal distress. There is no increase in the risk of meconium-stained liquor, 5-minute APGAR score<7, admission to NICU and low birth weight. [ABSTRACT FROM AUTHOR]

Background: The health of the mother and foetus is threatened by oligohydramnios. It is a clinical condition identified by a sonographically measured amniotic fluid index (AFI) of less than 5 cm. Method & Materials: Hospital-based based prospective comparative Observational Study. This study was conducted to observe the outcome of pregnancy in oligohydramnios. Study group- 100 cases with AFI < 5 cm. Control group- 100 cases with AFI 5cm to 24 cm, admitted to Dept. of Obstetrics and Gynaecology in TMCH from 1stAugust 2021 to 31 July 2022. For all selected women, USG was done and AFI was calculated. These women were followed till day 7 of puerperium. Data were analyzed using IBM SPSS version 23. The variable was analyzed using a chi-square test p-<0.05 was considered statistically significant. Results: The results of the present study revealed that, the rate of the Caesarian section was significantly higher in the oligohydramnios group compared to the control group (70% vs. 39% respectively). There was a significantly increased in Fetal distress, meconium-stained liquor, low Apgar score at 1 and 5 min, low birth weight, admission to NICU, and early neonatal death. Conclusion: In conclusion, oligohydramnios is a high-risk pregnancy, and patients with oligohydramnios should expect proper antepartum, rigorous foetal surveillance, and intrapartum care for a better feto-maternal outcome. [ABSTRACT FROM AUTHOR]

Objective: To identify predictors of adverse perinatal outcomes in pregnancies with fetal growth restriction (FGR) using a combination of maternal clinical factors and simple ultrasound parameters and develop a risk‐scoring model for predicting adverse perinatal outcomes. Methods: A retrospective study of 370 non‐anomalous singleton pregnancies with FGR was conducted. Multivariate logistic regression analysis was used to identify factors associated with adverse perinatal outcomes; P < 0.05 was considered statistically significant. The discriminative ability was measured with the area under the receiver operating characteristic curve (AUC). A weighted score for each predictor was calculated. Results: Adverse perinatal outcomes occurred in 165/370 (44.6%) cases. There were eight predictive factors, including a history of pregnancy‐induced hypertension (PIH) (score = 1), chronic hypertension (score = 3), PIH (score = 2), maternal weight gain less than 8 kg (score = 1), early‐onset FGR (score = 1), estimated fetal weight less than 5th percentile (score = 2), amniotic fluid index less than 5 cm (score = 3), and abnormal umbilical artery Doppler (score = 2), with total scores ranging from 0 to 15. AUC for the eight‐item predictive model was 0.799 (95% confidence interval 0.753–0.845). Conclusion: A combination of maternal clinical factors and simple ultrasound parameters showed acceptable predictive performance for adverse perinatal outcomes in FGR. Synopsis: A combination of maternal clinical factors and simple ultrasound parameters has acceptable predictive performance for adverse perinatal outcomes in fetal growth restriction. [ABSTRACT FROM AUTHOR]

Aims: The study purposed to evaluate the success rate of cervical ripening using dinoprostone controlled‐release vaginal insert and reveal some factors relating to successful cervical ripening. Methods: This cross‐sectional study was conducted at Tu Du Hospital in Vietnam from December 2021 to August 2022. The study enrolled 200 pregnant women with gestational age ≥37 weeks diagnosed with oligohydramnios. These candidates underwent dinoprostone cervical ripening (DCR) according to the local protocol. The Bishop score ≥7 after 24 h was determined for the successful cervical ripening (SCR). Results: In total, the success rate of DCR achieved at 57.5% and the cesarean delivery rate was 46.5%. None of the severe side‐effects and complications was present. Using multivariable logistic regression, the study found that the body mass index ≥25 kg/m2 and oxytocin infusion drip related to SCR with adjusted odds ratio (aOR): 3.67 (95% confidence intervals [CI]: 1.78–7.57) and aOR: 4.68 (95% CI: 1.84–11.93), p < 0.001. Using the Kaplan–Meier curve, the present study revealed a significant difference between Bishop <3 and ≥3 following the duration time of cervical ripening, with hazard ratio: 1.38 (95% CI: 1.19–1.59), p < 0.001. The time duration of cervical ripening was not significantly different following amniotic fluid index from 3 to 5 cm. Conclusions: Cervical ripening using a dinoprostone vaginal insert is a potentially acceptable method in term pregnancy accompanying with oligohydramnios. The probability of SCR can be predicted on a careful assessment of relative factors by obstetricians. Further studies are required to strengthen these findings. [ABSTRACT FROM AUTHOR]

Background: Amniotic fluid index (AFI) and cervical length (CL) can be used to predict delivery latency, maternal, and neonatal outcome in cases of preterm premature rupture of membrane (PPROM). Aims and Objectives: The aims of this study were to study the AFI and CL as a predictor of pregnancy outcome in cases presenting with PPROM, to determine the AFI in cases presenting with PPROM, to determine CL ultrasonographically in cases presenting with PPROM, and to measure the efficacy of these parameters as a predictor of pregnancy outcome in cases presenting with PPROM. Materials and Methods: This was an ambispective observational study conducted from November 2019 to July 2021 in the Department of Obstetrics and Gynecology in S. N. Medical College, Agra. A total of 100 women with singleton pregnancy and vertex presentation who presented to hospital within 12 h of spontaneous rupture of membrane (PPROM) from period of gestation 28–34+6 weeks were enrolled in this study. Results: Delivery latency was inversely related to period of gestation at pprom (P2.5 cm) and AFI >5 correlated with increased delivery latency and increased risk of maternal morbidity (chorioamnionitis, abruption, and cord prolapse).

Background & Objective: Adequate amniotic fluid volume is one of the most important aspects of fetal health and Oligohydramnios refers to amniotic fluid volume that is less than expected for gestational age. The aim of this study was to compare the trend of amniotic fluid changes in the two groups of oral and injectable before and after fluid therapy. Materials & Methods: In the present study, pregnant women with oligohydramnios in the third trimester referring to Amir Al-Momenin Hospital (Zabol, 2019) were randomly divided into two groups of case. The first group received oral water and the second group was treated with serum therapy. Eventually, all patients underwent ultrasonography and their AFI was recalculated and compared. Data was analyzed using SPSS 20 statistical software. Results: The results of the study showed that there was no statistically significant difference between the amniotic fluid index before fluid therapy in the oral and injectable (serum therapy) groups (p = 0.426). After fluid therapy, the amniotic fluid index in the oral group was significantly higher than the injected group (p

Abstract Background Oligohydramnios is associated with poor maternal and perinatal outcomes. In low-resource countries, including Uganda, oligohydramnios is under-detected due to the scarcity of ultrasonographic services. We determined the prevalence and associated factors of oligohydramnios among women with pregnancies beyond 36 weeks of gestation at Mbarara Regional Referral Hospital (MRRH) in Southwestern Uganda. Methods We conducted a hospital-based cross-sectional study from November 2019 to March 2020. Included were women at gestational age > 36 weeks. Excluded were women with ruptured membranes, those in active labour, and those with multiple pregnancies. An interviewer-administered structured questionnaire was used to capture demographic, obstetric, and clinical characteristics of the study participants. We determined oligohydramnios using an amniotic fluid index (AFI) obtained using an ultrasound scan. Oligohydramnios was diagnosed in participants with AFI ≤ 5 cm. We performed multivariable logistic regression to determine factors associated with oligohydramnios. Results We enrolled 426 women with a mean age of 27 (SD ± 5.3) years. Of the 426 participants, 40 had oligohydramnios, for a prevalence of 9.4% (95%CI: 6.8–12.6%). Factors found to be significantly associated with oligohydramnios were history of malaria in pregnancy (aOR = 4.6; 95%CI: 1.5–14, P = 0.008), primegravidity (aOR = 3.7; 95%CI: 1.6–6.7, P = 0.002) and increasing gestational age; compared to women at 37–39 weeks, those at 40–41 weeks (aOR = 2.5; 95%CI: 1.1–5.6, P = 0.022), and those at > 41 weeks (aOR = 6.0; 95%CI: 2.3–16, P = 0.001) were more likely to have oligohydramnios. Conclusion Oligohydramnios was detected in approximately one out of every ten women seeking care at MRRH, and it was more common among primigravidae, those with a history of malaria in pregnancy, and those with post-term pregnancies. We recommend increased surveillance for oligohydramnios in the third trimester, especially among prime gravidas, those with history of malaria in pregnancy, and those with post-term pregnancies, in order to enable prompt detection of this complication and plan timely interventions. Future longitudinal studies are needed to assess clinical outcomes in women with oligohydramnios in our setting.

The fluid intake and hydration status during pregnancy may influence the health outcomes of both the mother and the fetus. However, there are few studies related to this. The aim of the present study was to investigate fluid intake behaviors among pregnant women in their second trimester, to evaluate their hydration status and pregnancy complications, and to further explore the association of fluid intake and the amniotic fluid index (AFI). Participants' total fluid intake (TFI) levels were determined using a 7-day 24 h fluid intake questionnaire. The levels of water intake from food were not recorded or measured. Morning urine samples were collected, and both urine osmolality levels and urine specific gravity (USG) were tested to evaluate their hydration status. Fasting blood samples were also collected and measured for osmolality and complete blood count (CBC). A total of 324 participants completed the study. They were divided into four groups based on quartiles of TFI, including participants with lower (LFI1 and LFI2) and higher (HFI1 and HFI2) fluid intake levels. The median TFI was 1485 mL, and the median values of the four groups with different TFI levels were 1348, 1449, 1530, and 1609 mL, respectively. Only 3.4% of the participants attained the recommended value following an adequate water intake (1.7 L) level for pregnant women in China. Plain water was the main TFI resource (78.8~100.00%), and differences in the plain water intake levels among the four groups were evident (χ2 = 222.027, p < 0.05). The urine osmolality decreased sequentially with increasing TFI values from the LFI1 to HFI2 group, and significant differences in the urine osmolality levels among the four groups were evident (p < 0.05). Meanwhile, the percentage of dehydrated participants decreased from 26.8% in the LFI1 group to 0.0% in the HFI2 group (χ2 = 131.241, p < 0.05). Participants with higher TFI values had higher AFI values (χ2 = 58.386, all p < 0.05), and moderate-intensity correlations were found between TFI and urine osmolality, hydration status, and AFI (all p < 0.05). A large proportion of the participants had insufficient TFIs during the second trimester of pregnancy, and a proportion of the participants were dehydrated. The preliminary analysis showed that the AFI was correlated with the TFI during the second trimester of pregnancy. A sufficient TFI is necessary for pregnant women to improve their hydration status and may have effects on their health. The results can provide appropriate scientific references for the development of beneficial recommendations concerning adequate water intake levels for pregnant women in China. [ABSTRACT FROM AUTHOR]

Introduction: Oligohydramnios is an abnormality of amniotic fluid which is one of the common complications during pregnancy and a threat to foetal development. Often it is associated with maternal risk factors like uteroplacental insufficiency, hypertension and preeclampsia which by themselves can affect perinatal outcome. Aim: To determine the perinatal outcome in isolated oligohydramnios with Amniotic Fluid Index (AFI) ≤5cm at term pregnancies. Materials and Methods: This was a hospital-based prospective case-control study done in Department of Obstetrics and Gynaecology at District Hospital Tumakuru, Karnataka, India, from January 2019 to July 2020. The study included two groups i.e, case group included 150 pregnant females with Amniotic Fluid Index (AFI) ≤5 cm and control group included 150 pregnant females with AFI range between 6-24 cm. After interview of all participants, all the information was entered in the proforma. All newborn babies birth weight, APGAR scores (Appearance, Pulse, Grimace, Activity, and Respiration) at 1st and 5th minute was recorded. Categorical outcomes were compared between the groups using Chi-square test. A p-value

Introduction: Abnormal Cerebro-Placental Ratio (CPR) is associated with a substantial risk of adverse perinatal outcomes and the test seems to be particularly useful for follow-up of foetuses with sonographically diagnosed Foetal Growth Restriction (FGR). Aim: To determine the usefulness of doppler velocimetry, especially CPR at 35 weeks of gestation or later, in predicting intrapartum foetal heart rate abnormalities and adverse neonatal outcomes in low-risk term pregnancies. Materials and Methods: The present prospective cohort study was conducted at the Department of Obstetrics and Gynaecology in Bangalore Baptist Hospital, Bangalore from September 2019 to September 2020. A total of 60 pregnant women between the ages of 18 and 35 years with low-risk pregnancies, who present for the obstetrical ultrasound at 35 weeks of gestation or later with planned delivery at the hospital were included. All low-risk pregnant women with estimated foetal weight (EFW) >10th centile and abnormal Cerebro-Placental Ratio (CPR) 10th centile. An adverse obstetric outcome, like foetal distress, meconium aspiration syndrome or respiratory distress syndrome, mode of delivery, admission to Neonatal Intensive Care Unit (NICU), and perinatal mortality was analysed in the study population using chi-square test or Fischer’s-exact test. Results: In this study, there was a significant association between foetal distress and CPR with Odds Ratio (OR) of 4.21 i.e., foetal distress was 4.21 times higher in the abnormal group compared to the normal group. Among 20 cases with abnormal CPR, 11 had foetal distress i.e., 55% and among 40 cases with normal CPR, nine had foetal distress i.e., 22.5%. Among those with abnormal CPR, 15% had Amniotic Fluid Index (AFI) 10th centile and abnormal CPR, there was a significant association with adverse obstetric outcomes, requiring vigilant intrapartum monitoring.

In recent years, scientific views on perinatal protection of fetus have shifted to earlier periods of pregnancy – to the I trimester, because from this stage the formation of the fetoplacental complex and laying of organs and tissues take place, which in most cases determines the further course of pregnancy. The objective: to clarify the role of the imbalance of angiogenic growth factors as one of the pathogenetic mechanisms in the development of placental dysfunction, and to conduct a postnatal macromorphometric study of placenta and umbilical cord in women with pathology of the fetal environment. Materials and methods. The object of the study were 80 pregnant women (the main group) with a singleton pregnancy, selected from the cohort of patients from the risk group for the development of preeclampsia and miscarriage. Among them, at 30–32 weeks of gestation oligohydramnios was diagnosed in 40 patients (the first group) and polyhydramnios – in 40 women (the second group). The control group included 30 somatically healthy pregnant women with a normal volume of amniotic fluid and a physiological course of pregnancy. The concentrations of placental growth factor (PlGF), vascular endothelial growth factor-1 (VEGF-1), and an antiangiogenic marker of neovasculogenesis, soluble fms-like tyrosine kinase (sFlt-1), were performed at 12–16 and 28–32 weeks of pregnancy by enzyme immunoassay method. The study of the structural and functional features of the placenta and umbilical cord included sonographic and organometric methods. The variational statistical method of analysis of the obtained results was carried out using the «STATISTICA for Windows®-6.0» package. Results. In the women of the main group in the I trimester the ultrasound signs of pathology of the embryo and extraembryonic structures were significantly more often observed: low placement of the fertilized egg (33.8 %), its deformation (27.5 %), and partial detachment of the chorion (28.5 %). At 12–16 weeks of pregnancy, a pronounced vascular imbalance was established with a 2.5-fold decrease in the concentration of PlGF in the case of oligohydramnios compared to control data, a 1.8-fold decrease in the level of free VEGF-1 (in the case of oligohydramnios), and an increased level of antiangiogenic growth factors (sFlt-1). The postnatal examination of the placenta and umbilical cord showed that in the pregnant women of the main group a predominance of abnormal forms of placenta (16.3 %), a predominance of eccentric and marginal types of attachment of the umbilical cord (53.8 %), main and intermediate types of vascular branching (63.7 %), changes in the diameter of the umbilical cord (17.5 %), a combination of these features in a third of cases (31.3 %) were found. In the women of the main group, there was a decrease of the placental-fetal coefficient compared to the individuals of the control group, which was especially pronounced in pregnant women with oligohydramnios (up to 0.11±0.01 units compared to control data - 0.16±0.01 units). Conclusions. In the period of 12–16 weeks of pregnancy a vascular imbalance was established at the stage of placentation in patients who were diagnosed pathology of the perinatal environment at 30–32 weeks. In particular, by oligohydramnios there is a 2.5-fold decrease in the concentration of PlGF compared to the control data, a 1.8-fold decrease in the level of VEGF-1, and an increased antiangiogenic growth factor (sFlt-1), which became a prerequisite for the development of placental dysfunction. The results of the postnatal examination of the placenta and umbilical cord became an indirect reflection of placentation conditions. They demonstrated the predominance of abnormal forms, the predominance of the eccentric and marginal type of attachment of the umbilical cord, the main and intermediate type of vascular branching, an increased rate of umbilical cord pathology (Warton’s jelly deficiency, anomalies of the umbilical cord vessels) and a decreased placental-fetal ratio in women with amniotic fluid pathology, which was it is especially pronounced with oligohydramnios. [ABSTRACT FROM AUTHOR]

Objective: To investigate whether the severity of isolated oligohydramnios at term is associated with increased rates of adverse perinatal outcome. Study design: A retrospective study conducted in a single medical center from 2017 to 2019. All low-risk pregnancies with incidental isolated oligohydramnios at term were included. The degree of oligohydramnios was arbitrarily classified into mild (AFI = 41–50 mm), moderate (AFI = 21–40 mm) and severe (AFI = 0–20 mm). Result: A total of 610 women were included: 202 with a mild (33.1%), 287 moderate (47.0%), and 121 severe oligohydramnios (19.8%). Non-reassuring monitor requiring immediate delivery and worse composite neonatal outcome were more common among severe than mild or moderate oligohydramnios (14.0% and 6.4%, 7.3% respectively; p = .039 and 19.8%, 10.9% and 11.8%, respectively; p = .048). Conclusion: Low-risk pregnancies with isolated severe oligohydramnios at term have a higher tendency toward non-reassuring fetal monitoring requiring prompt delivery and adverse neonatal outcomes, this calls for close intrapartum surveillance [ABSTRACT FROM AUTHOR]

Introduction Estimation of amniotic fluid volume (AFV) is part of routine obstetric sonography which reflects maternal–fetal circulation efficiency, fetal hemodynamic status, and a parameter for predicting adverse neonatal outcome. Fetal weight is positively correlated with AFV. Therefore, our objective is to provide a new nomogram of AFV indices and to evaluate the relation between AFV and fetal biometric parameters. Materials and methods Retrospective cohort study between 2011 and 2018, at a large tertiary medical center. Data were collected from medical charts of prenatal sonographic evaluation of normal pregnancies, including routine estimation of AFV by using amniotic fluid index (AFI). Generalized estimating equations model was used to study the association between AFI, gestational age and fetal biometric parameters. Centiles were calculated using the Generalized Additive Models for Location, Scale, and Shape model. Box-Cox-t distribution and smoothing splines were used. Results Analysis included 28,650 pregnancies. From 25 to 41 weeks gestation, the median and fifth percentile AFI gradually decreased from 174 (IQR 157–193) to 138 mm (IQR 107–173) and from 125 to 68 mm, respectively. The change in the 95th percentile was less significant, ranging around 230 mm throughout pregnancy. Multivariate regression analysis demonstrated a significant correlation between AFI and maternal body mass index (B = −0.147; CI = −0.27 to −0.02), gestational age (B = −11.8; CI = −12.5 to −11.4), estimated fetal weight (EFW) (B = 0.05; CI = 0.049–0.053) and abdominal circumference (AC) (B = 0.94; CI = 0.95–1). There was no correlation between AFI and other fetal biometric parameters. Conclusions We suggest new AFI indices of singleton pregnancies. We found a positive correlation between AFI and EFW and AC. [ABSTRACT FROM AUTHOR]

Introduction: Amniotic fluid is a clear, yellowish coloured fluid contained in amniotic sac which is in circulation around the fetus. It has numerous functions which are important for the fetus and its development in-utero. Amniotic fluid is regulated primarily by fetal swallowing and this has been observed as early in 16 weeks. The fluid gets absorbed through fetal gastrointestinal system and it either gets transferred to the maternal circulation or gets recycled back through the kidney. Aims: To study perinatal outcome in term oligohydramnios and to compare perinatal outcome in term oligohydramnios and in control groups. Materials and Methods: The present study was Prospective observational study. This Study was conducted in Nilratan Sircar Medical College and Hospital during 12 months span from January 2019 to January 2020. Result: It was found that 38.5% delivered vaginally and 59% underwent LSCS. Among the control group, 69.7% delivered vaginally and 23.8% delivered by LSCS. The p value is 0.02 and it is significant as it is less than 0.05. Conclusion: Determination of AFI is a valuable screening test for predicting fetal distress in labor requiring cesarean section. It has a sensitivity of 71% and negative predictive value of 82% specificity of 58% and positive predictive value of 43%. [ABSTRACT FROM AUTHOR]

Objective: The forebag is a pocket of amniotic fluid preceding the fetal presenting part. Herein we describe the feasibility of transvaginal measurements of the forebag and assess its correlation with the standard amniotic fluid index (AFI). Methods: A prospective study was carried out between January 2019 and July 2020. Eligible cases were women with singletons, vertex presentation, and normal AFI at term. We assessed the implementation and acceptance of a novel process in the clinical practice setting. Feasibility was assessed by using transvaginal ultrasound to measure the three orthogonal planes of the forebag. The vaginal fluid index (VFI) was defined as the volume composite of the three orthogonal planes. Correlations of the forebag measurements with both AFI and maximal vertical pocket were then calculated. Results: In total, 292 out of 305 (95.7%) women were enrolled. All participants completed both transabdominal and transvaginal ultrasound, of which the vaginal pocket was demonstrated in 266 (91.1%) cases. We found significant correlations, in both nulliparas and multiparas, between the vaginal pocket measurements and the VFI to both the AFI and maximal vertical pocket measurements (R = 0.38, P < 0.001; R = 0.3, P < 0.001, respectively). Conclusion: We introduced a new ultrasound variable, the VFI, with a high feasibility rate. This may provide invaluable information for future decision making around the time of delivery. [ABSTRACT FROM AUTHOR]

Background: Amniotic fluid index (AFI) and cervical length (CL) can be used to predict delivery latency, maternal, and neonatal outcome in cases of preterm premature rupture of membrane (PPROM). Aims and Objectives: The aims of this study were to study the AFI and CL as a predictor of pregnancy outcome in cases presenting with PPROM, to determine the AFI in cases presenting with PPROM, to determine CL ultrasonographically in cases presenting with PPROM, and to measure the efficacy of these parameters as a predictor of pregnancy outcome in cases presenting with PPROM. Materials and Methods: This was an ambispective observational study conducted from November 2019 to July 2021 in the Department of Obstetrics and Gynecology in S. N. Medical College, Agra. A total of 100 women with singleton pregnancy and vertex presentation who presented to hospital within 12 h of spontaneous rupture of membrane (PPROM) from period of gestation 28–34+6 weeks were enrolled in this study. Results: Delivery latency was inversely related to period of gestation at pprom (P<0.0001). Mean AFI in Group 1 was 5.15 cm and in Group 2 was 7.12 cm and the difference between both group was statistically significant (P<0.0001). Thus, our study shows positive correlation between AFI and delivery latency. Mean transvaginal CL (TVCL) in Group 1 was 2.47 cm and in Group 2 was 2.99 cm. Difference in terms of TVCL between both the groups was found to be statistically significant (P=0.00005). Need for neonatal intensive care unit admission was higher in Group 1 than Group 2 and this difference was statistically significant (P=0.020). Conclusion: Our study shows that there was an increase in positive predictive value when we combine AFI and TVCL in prediction of delivery latency, so women with AFI ≤5 and TVCL ≤2.5 cm had 85.6% risk of delivery within 7 days after PPROM. A long CL (TVCL >2.5 cm) and AFI >5 correlated with increased delivery latency and increased risk of maternal morbidity (chorioamnionitis, abruption, and cord prolapse). [ABSTRACT FROM AUTHOR]

Objectives: To study the influence of amniotic fluid volume at term gestation with accuracy in fetal weight estimation by ultrasound. Methods: Retrospective observational cross-sectional study was done in 358 term deliveries over a period of two years from January 2019 to December 2020 in a medical college hospital. All singleton term pregnancies that had an ultrasound estimation of fetal weight and amniotic fluid within a week of delivery were included, irrespective of parity, age and mode of delivery. Error in estimation of fetal weight was calculated with reference to actual birth weight and comparisons were made to note the degree of accuracy across varying amniotic fluid volume by applying ANOVA and Tukeys test. Results: Mean error in fetal weight estimation was not significant with respect to parity index, gestational age or fetal gender. There was a significant (p= 0.001) increasing mean birth weight with increasing amniotic fluid volume and the error in estimation of fetal weight was significant across all AFI groups (p= 0.014). Mean error in oligoamnios group was significantly lesser than normal liquor (p=0.041) and high normal (p= 0.032) at a 5% level of significance. Hence, the estimation of fetal weight in the oligoamnios group was more accurate. Conclusion: Amniotic fluid volume and ultrasound fetal weight estimation are mostly independent variables though they are factors of gestational age. Consistent errors are seen across varying AFI. The noticeable accuracy in the low liquor group is reassuring as oligoamnios is frequently associated with low birth weight.

Abstract 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

Background: Oligohydramnios is associated with poor maternal and perinatal outcomes. In low-resource countries, including Uganda, oligohydramnios is under-detected due to the scarcity of ultrasonographic services. We determined the prevalence and associated factors of oligohydramnios among women with pregnancies beyond 36 weeks of gestation at Mbarara Regional Referral Hospital (MRRH) in Southwestern Uganda.Methods: We conducted a hospital-based cross-sectional study from November 2019 to March 2020. Included were women at gestational age > 36 weeks. Excluded were women with ruptured membranes, those in active labour, and those with multiple pregnancies. An interviewer-administered structured questionnaire was used to capture demographic, obstetric, and clinical characteristics of the study participants. We determined oligohydramnios using an amniotic fluid index (AFI) obtained using an ultrasound scan. Oligohydramnios was diagnosed in participants with AFI ≤ 5 cm. We performed multivariable logistic regression to determine factors associated with oligohydramnios.Results: We enrolled 426 women with a mean age of 27 (SD ± 5.3) years. Of the 426 participants, 40 had oligohydramnios, for a prevalence of 9.4% (95%CI: 6.8-12.6%). Factors found to be significantly associated with oligohydramnios were history of malaria in pregnancy (aOR = 4.6; 95%CI: 1.5-14, P = 0.008), primegravidity (aOR = 3.7; 95%CI: 1.6-6.7, P = 0.002) and increasing gestational age; compared to women at 37-39 weeks, those at 40-41 weeks (aOR = 2.5; 95%CI: 1.1-5.6, P = 0.022), and those at > 41 weeks (aOR = 6.0; 95%CI: 2.3-16, P = 0.001) were more likely to have oligohydramnios.Conclusion: Oligohydramnios was detected in approximately one out of every ten women seeking care at MRRH, and it was more common among primigravidae, those with a history of malaria in pregnancy, and those with post-term pregnancies. We recommend increased surveillance for oligohydramnios in the third trimester, especially among prime gravidas, those with history of malaria in pregnancy, and those with post-term pregnancies, in order to enable prompt detection of this complication and plan timely interventions. Future longitudinal studies are needed to assess clinical outcomes in women with oligohydramnios in our setting. [ABSTRACT FROM AUTHOR]

Introduction: Limited evidence exists on borderline oligohydramnios. Our objective was to determine perinatal outcomes in uncomplicated term pregnancies with borderline oligohydramnios., Methods: This retrospective analysis compared adverse perinatal outcomes among pregnancies during 2018-2022, between those with borderline oligohydramnios defined as amniotic fluid index (AFI) of 5.1-8.0 cm, those with oligohydramnios (AFI ≤5 cm), and those with normal AFI (8.1-25 cm). The latter matched one-to-one to the borderline oligohydramnios group and served as the control group. The outcomes compared included birthweight, cesarean delivery due to fetal distress, the presence of meconium-stained amniotic fluid, Apgar scores, neonatal intensive care unit admission, and the occurrence of small-for-gestational-age (SGA) neonates., Results: During the study period, 140 women had borderline oligohydramnios and 345 had oligohydramnios; the control group included 140 women. Borderline oligohydramnios was associated with increased rates of delivering SGA neonates (adjusted odds ratio [aOR] = 3.6, 95% confidence interval [CI] 1.1-11.6, p = 0.034) and cesarean delivery due to fetal distress (aOR = 3.0, 95% CI 1.1-8.3, p = 0.032). Rates of composite neonatal outcome (including at least one of the following: cesarean delivery due to fetal distress, meconium-stained amniotic fluid, 5-min Apgar score &lt;7, umbilical artery pH &lt;7.15, or neonatal intensive care unit admission) were higher in both the borderline oligohydramnios (20.7%) and oligohydramnios (18.6%) groups compared to the control group (9.3%) (p = 0.019)., Conclusions: Pregnancies with borderline oligohydramnios were associated with increased risks of delivering SGA neonates and requiring cesarean delivery due to fetal distress. These findings support considering closer antepartum surveillance for these pregnancies, especially for identifying abnormal fetal growth., (© 2024 The Author(s). Published by S. Karger AG, Basel.)

Objective: The aim of the article was to investigate the changes in intra-amniotic pressure following transabdominal amnioinfusion during pregnancy. Design: This retrospective study included 19 pregnant women who underwent transabdominal amnioinfusion during pregnancy to relieve umbilical cord compression and improve the intrauterine environment or to increase the accuracy of ultrasonography. Materials and Methods: We measured and analyzed the changes in intra-amniotic pressure, single deepest pocket, and the amniotic fluid index before and after amnioinfusion. We also determined the incidence of maternal or fetal adverse events, such as preterm premature rupture of membranes, preterm delivery, fetal death within 48 h, placental abruption, infection, hemorrhage, and peripheral organ injury. Results: A total of 41 amnioinfusion procedures were performed for 19 patients. The median gestational age during the procedure was 24.3 weeks. The median volume of the injected amniotic fluid was 250 mL. The median single deepest pocket and amniotic fluid index after amnioinfusion were significantly higher than those before amnioinfusion (4.0 cm vs. 2.65 cm; p < 0.001 and 13.4 cm vs. 6.0 cm; p < 0.001). However, the median (range) intra-amniotic pressure after amnioinfusion was not significantly different compared to that before amnioinfusion (11 mm Hg vs. 11 mm Hg; p = 0.134). Maternal or fetal adverse events were not observed following amnioinfusion. Conclusion: Intra-amniotic pressure remained unchanged following amnioinfusion. The complications associated with increased intra-amniotic pressure are not likely to develop if the amniotic fluid index and/or single deepest pocket remains within the normal range after amnioinfusion. Studies of groups with and without complications are warranted to clarify the relationship between the intra-amniotic pressure and incidence of complications.

This study aimed to evaluate maternal and fetal characteristics, etiological factors and perinatal outcome in pregnancies with polyhydramnios. A total of 330 pregnancies diagnosed with polyhydramnios were included in this retrospective study conducted a tertiary center. Data on maternal age, obstetric characteristics, etiology of polyhydramnios, detailed prenatal ultrasonography findings on fetal anomaly, cesarean delivery and the adverse pregnancy outcomes were recorded. The polyhydramnios was idiopathic in 47.0% of cases, while the maternal diabetes (29.4%) and fetal conditions (23.6%) were responsible for the etiology in the remaining cases. The most common anomalies identified on prenatal ultrasonography were central nervous system anomalies (29.5%), followed by the gastrointestinal system anomalies (11.5%). Cesarean delivery occurred in 38.2% of pregnancies, while adverse pregnancy outcomes were noted in 64.5% of pregnancies and including delivery of a neonate with congenital anomaly (36.6%), macrosomia (21.1%), preterm delivery (18.3%), perinatal mortality (13.1%) and pregnancy termination (10.8%). In conclusion, our findings revealed the polyhydramnios to be idiopathic approximately in half of cases, and to be due to either maternal diabetes or fetal pathology (central nervous system and gastrointestinal anomalies) in the other half. Given the occurrence of adverse pregnancy outcomes in most of pregnancies with polyhydramnios, our findings emphasize the vital role of intensive monitoring of the maternal-fetal condition in pregnancies with polyhydramnios. Meticulous diagnostic approach seems crucial for timely recognition of fetal anomalies via detailed imaging studies as well as the early recognition and strict control of gestational diabetes via close follow up, given the likelihood of erroneously diagnosed idiopathic polyhydramnios to challenge the implementation of proper management and appropriate counselling of patients. [ABSTRACT FROM AUTHOR]

BackgroundBartter syndrome, a very rare inherited renal tubular disorder, characterized by urinary salt wastage, hypokalemia, polyuria, and metabolic alkalosis, may manifest antenatally as severe isolated polyhydramnios. Indomethacin is known to reduce salt wastage and subsequent polyhydramnios during pregnancy; however, it reduces the Ductus Arteriosus diameter among other potential complications, such as inhibition of gastrointestinal perfusion and increasing the risk of renal toxicity.CaseA 36-year-old multigravida presented with severe isolated polyhydramnios at 30 weeks of gestation. Based on a history of a previous pregnancy affected with Bartter syndrome, indomethacin was initiated. Amniotic fluid volume and Ductus Arteriosus diameter were monitored. As evidence lacks on optimal dose and duration of indomethacin, multiple-dose adjustments were made to reduce the amniotic fluid volume while maintaining normal Ductus Arteriosus diameter. Progressive polyhydramnios led to Cesarean section at 34+ weeks of gestation resulting in a healthy fetus diagnosed with Bartter syndrome in the early neonatal period.ConclusionWe share our experience in the adjustment of the dose and duration of Indomethacin therapy in the treatment of severe polyhydramnios associated with antenatal Bartter syndrome. Amniotic fluid index, Ductus Arteriosus diameter, and umbilical artery doppler work together as key indicators to guide the success and safety of the therapy.

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%)..............

The fluid intake and hydration status during pregnancy may influence the health outcomes of both the mother and the fetus. However, there are few studies related to this. The aim of the present study was to investigate fluid intake behaviors among pregnant women in their second trimester, to evaluate their hydration status and pregnancy complications, and to further explore the association of fluid intake and the amniotic fluid index (AFI). Participants’ total fluid intake (TFI) levels were determined using a 7-day 24 h fluid intake questionnaire. The levels of water intake from food were not recorded or measured. Morning urine samples were collected, and both urine osmolality levels and urine specific gravity (USG) were tested to evaluate their hydration status. Fasting blood samples were also collected and measured for osmolality and complete blood count (CBC). A total of 324 participants completed the study. They were divided into four groups based on quartiles of TFI, including participants with lower (LFI1 and LFI2) and higher (HFI1 and HFI2) fluid intake levels. The median TFI was 1485 mL, and the median values of the four groups with different TFI levels were 1348, 1449, 1530, and 1609 mL, respectively. Only 3.4% of the participants attained the recommended value following an adequate water intake (1.7 L) level for pregnant women in China. Plain water was the main TFI resource (78.8~100.00%), and differences in the plain water intake levels among the four groups were evident (χ2 = 222.027, p < 0.05). The urine osmolality decreased sequentially with increasing TFI values from the LFI1 to HFI2 group, and significant differences in the urine osmolality levels among the four groups were evident (p < 0.05). Meanwhile, the percentage of dehydrated participants decreased from 26.8% in the LFI1 group to 0.0% in the HFI2 group (χ2 = 131.241, p < 0.05). Participants with higher TFI values had higher AFI values (χ2 = 58.386, all p < 0.05), and moderate-intensity correlations were found between TFI and urine osmolality, hydration status, and AFI (all p < 0.05). A large proportion of the participants had insufficient TFIs during the second trimester of pregnancy, and a proportion of the participants were dehydrated. The preliminary analysis showed that the AFI was correlated with the TFI during the second trimester of pregnancy. A sufficient TFI is necessary for pregnant women to improve their hydration status and may have effects on their health. The results can provide appropriate scientific references for the development of beneficial recommendations concerning adequate water intake levels for pregnant women in China.

Objective: To explore the morbidity and mortality associated with preterm pre-labour rupture of membranes in the presence of amniotic fluid index (AFI) greater than or less than 5 in a tertiary care setting in Rawalpindi, Pakistan. Study Design: Cross-sectional study. Place and Duration of Study: Department of Gynaecology & Obstetrics, Pak Emirates Military Hospital, Rawalpindi Pakistan, from Mar 2019 to Aug 2020. Methodology: Data was collected from the patients presenting to the Department of Gynecology and Obstetrics at Pak emirates Military Hospital in Rawalpindi, Pakistan. Maternal and child outcomes were compared with an amniotic fluid index of less than or more than five among the patients with preterm premature rupture of membranes. Results: 1562 deliveries took place in our department, among them 73 (4.67%) cases were diagnosed as PPROM. Caesarean deliveries and the development of chorio-amnionitis were observed statistically significantly more with an amniotic fluid index <5 (p-value <0.001). Neonatal complications such as sepsis, respiratory distress syndrome, hypoglycemia, jaundice and hypothermia were also significantly observed in the group with amniotic fluid index <5 (p-value <0.05). Neonatal mortality was also significantly higher in the group with an amniotic fluid index <5 (p-value: 0.004). Conclusion: Preterm premature rupture of membranes was a relatively common finding among the patients managed at our labour unit. Such patients with an amniotic fluid index of less than five are at a high risk of maternal and fetal adverse outcomes. [ABSTRACT FROM AUTHOR]

Background: Antenatal fetal surveillance is a field of increasing importance in modern obstetrics. It is based on fetal heart rate monitoring using nonstress test and contraction stress test, ultrasound biometry and amniotic fluid assessment, Doppler blood flow studies of fetal and uteroplacental circulation, and an evaluation of biophysical fetal parameters. The combination of these methods leads to improvements in fetal morbidity and mortality. Aim: The present study aimed to assess the sensitivity, specificity, and positive and negative predictive values of umbilical artery (UA) systolic/diastolic (S/D) ratio, and amniotic fluid index (AFI) in term pregnancies for the prediction of perinatal outcome and their relation with perinatal outcome. Methods: This study was conducted at a tertiary care hospital on 100 pregnant women where all the term singleton pregnancies (37–42 weeks) admitted in maternity were subjected to color Doppler for UA S/D ratio assessment and AFI estimation. Further, management of patients was done according to color Doppler findings and their relation with perinatal outcome. Results: Out of 100 pregnant women, 68% had AFI >8 (normal), while 32% of women had AFI <8 (abnormal), with the mean AFI being 9.39 ± 2.55 cm, whereas70% had S/D ratio <3 (normal) and 30% of women had S/D ratio >3 (abnormal), with the mean S/D ratio of 2.61 ± 0.450. UA S/D ratio had better performance values (i.e., sensitivity, specificity, and positive and negative predictive value) than AFI in predicting adverse perinatal outcomes. Conclusion: AFI and UA S/D ratio are important for predicting low appearance, pulse, grimace, activity, and respiration score, meconium, respiratory complications, and perinatal mortality in high as well as low-risk pregnancy cases. However, UA S/D ratio is a better predictor of perinatal outcome in high-risk pregnancies. [ABSTRACT FROM AUTHOR]

Objective: To compare the frequency of diagnosis, induction of labour, and caesarean section in patients with isolated oligohydramnios diagnosed by amniotic fluid index versus single deepest vertical pocket. Study Design: Randomized controlled trial Place and duration of study: Department of Obstetrics and Gynecology, Holy Family Hospital, Rawalpindi from March 2020 to August 2020. Materials & Methods: A total of 110 (55 in each group), 18 to 35 years of age of parity <5 were included. Group A females were evaluated by using AFI and group B females were evaluated by using SDVP. Patients were managed according to standard protocol practiced in the department. Caesarean section was performed in case of fetal distress, in presence of meconium-stained liquor, or in case of failure to the progress of labour. Results: In my study, oligohydramnios was recorded in 19/55 (34.50%) in group A (amniotic fluid index) versus 11/55 (20.0%) in group B (single deepest vertical pocket) (p-value = 0.086). Similarly induction of labour was recorded in 19/55 (34.50%) in group A (amniotic fluid index) versus 11/55 (20.0%) in group B (single deepest vertical pocket) (p-value = 0.086) and caesarean section was recorded in 16/55 (29.09%) in group A (amniotic fluid index) versus 07/55 (12.73%) in group B (single deepest vertical pocket) (p-value = 0.035). Conclusion: This study concluded that the frequency of diagnosis, induction of labour, and caesarean section in patients with isolated oligohydramnios diagnosed by the amniotic fluid index is higher as compared to single deepest vertical pocket. [ABSTRACT FROM AUTHOR]

Objective: To compare the rate and severity of abnormal amniotic fluid volumes (oligohydramnios or polyhydramnios), as well as the distribution of amniotic fluid levels, in pregnancies with and without diabetes. Methods: We performed a retrospective cohort study of singleton nonanomalous pregnancies receiving an ultrasound examination (USE) in the third trimester. Pregnancies were categorized into those with and without diabetes and subcategorized by diabetes type. The primary outcomes were oligohydramnios or polyhydramnios. Polyhydramnios was also examined by severity. The association between maternal diabetes status and oligohydramnios or polyhydramnios was assessed using logistic regression. In addition, we computed gestational age‐specific amniotic fluid index (AFI) and deepest vertical pocket (DVP) centiles for pregnancies with and without diabetes. Results: There were 60,226 USEs from 26,651 pregnancies that met inclusion criteria. There were 3992 (15.0%) pregnancies with diabetes and 22,659 (85.0%) without diabetes. Using AFI, the rate of polyhydramnios was 10.5 versus 3.8% (odds ratio [OR] 2.95; 95% confidence interval [CI] 2.62–3.32) for pregnancies with versus without diabetes, respectively; using DVP, the rate of polyhydramnios was 13.9 versus 5.4% (OR 2.84; 95% CI 2.56–3.15). Rates of oligohydramnios were also increased in pregnancies with diabetes (3.3 versus 2.6%; OR 1.26; 95% CI 1.04–1.52). The AFI and DVP were significantly higher in the cohort with diabetes between 28 and 36 weeks. Conclusion: Within our study population, pregnancies with diabetes had increased rates of oligohydramnios and polyhydramnios as well as increased gestational age‐specific amniotic fluid volumes between 28 and 36 weeks. A higher prevalence of polyhydramnios was observed using DVP as compared to AFI; nevertheless, associations were similar using either method. [ABSTRACT FROM AUTHOR]

Background and objective: Orally disintegrating film is a solid dosage form made as an alternative for tablets for pediatric and geriatric patients who have difficulty in swallowing. These formulations are designed to dissolve in the mouth rapidly upon contact with saliva. This study aimed to prepare a thin oro-dispersible film base that can withstand handling in which a drug can be incorporated to provide a new dosage form. Methods: The solvent casting method was used to prepare the films, in which the ingredients were mixed, dissolved, and cast in a Petri dish. Then, they were left to dry in the oven overnight. Different concentrations of each of the two polymers alone and combined in different ratios were compared using different concentrations of plasticizer. Results: Successful, transparent films were prepared from gelatin and glycerin. A combination of 70% gelatin and 30% sodium carboxymethyl cellulose with glycerin formed an acceptable film having white color. The film forming capacity of sodium carboxymethyl cellulose alone was not good. All films were tearing and not well formed. All films that contain polyethylene glycol were brittle. Both superdisintegrants reduced the disintegration time for both films, but kyron was more effective than sodium starch glycolate. Conclusion: A successful oral film was prepared using different types of polymers, which is suitable for incorporating a potent drug to form a new dosage form that is easily portable and does not require water for swallowing.

Purpose: To establish a new set of reference values for third-trimester amniotic fluid index (AFI) and compare them to other previously published normograms.Methods: A retrospective cross-sectional cohort analysis of all singleton sonographic evaluations >22 gestational weeks in one university affiliated medical center between 2013 and 2017. Pregnancies complicated by rupture of membranes, major anomalies/chromosomal abnormalities were excluded. One evaluation per patient per pregnancy was randomly selected. Reference values were constructed using a best-fit regression model for estimation of mean and standard deviation at each gestational age after normalization of variables and compared with previously published norms.Results: A total of 7037 ultrasound evaluations entered the analysis. Correlation between AFI and gestational age was best represented by a first-degree polynomial equation. AFI decreased gradually from 16.4 at 22 weeks to 13.3 at 40 weeks (cm, median). The standard deviation increased with gestational age with AFI ranging from 12.9-20.2 at 22 weeks and 4.7-26.2 at 40 weeks (cm, 2.5-97.5 percentile). Compared to other curves, our reference values demonstrated a higher median AFI throughout all gestation.Conclusions: Reference values for the third trimester AFI were established. Curves should be correlated with perinatal outcome prior to wide clinical implementation. [ABSTRACT FROM AUTHOR]

Introduction: Aquaporin 1 (AQP1) plays an important role in regulation of maternal-fetal fluid exchange and amniotic fluid volume. This present study aimed to determine the relationship between amniotic fluid index and placental AQP1 levels in terms of preeclampsia, and to reveal possible pathophysiological changes of AQP1 expression under preeclamptic conditions.Methods: Placental tissues and medical records information were obtained from 389 preeclamptic and 447 uncomplicated pregnancies. Placental AQP1 levels were analyzed by molecular biological methods, DNA methylation within gene promotor was determined by targeted bisulfite sequencing assay.Results: Here, we found that preeclamptic pregnancy had a greater frequency of oligohydramnios, and higher placental AQP1 levels. There was a significantly inverse correlation between amniotic fluid index and placental AQP1 levels in preeclampsia cases. Additionally, the increased AQP1 was correlated with a decreased DNA methylation within its gene promoter.Discussion: Overall, this was the first description that a greater frequency of oligohydramnios in preeclampsia was strongly associated with reprogrammed AQP1 expression via a DNA methylation-mediated epigenetic mechanism. This study suggested AQP1 might play an important role in regulating maternal-fetal fluid balance under preeclamptic conditions, providing new information for further understanding the pathophysiological mechanism of oligohydramnios in preeclampsia. [ABSTRACT FROM AUTHOR]

Aim: To verify the role of maternal serum levels of alpha‐1‐antitrypsin (AAT), an acute‐phase inflammatory protein, as a marker for distinguishing between fetal growth restriction (FGR) and normal birth weight in pre‐eclamptic women. We correlate serum AAT levels to the essential feto‐maternal parameters for an earlier and cost–benefit diagnostic method, thus distinguishing between FGR and normal birth weight in pre‐eclamptic women. Methods: An observational study conducted at the University hospital recruited 100 pregnant women in 32/34 weeks of a singleton single tone pregnancy; all were pre‐eclampsia cases. All were tested by laboratory and ultrasound examination. Two sets of data were collected; one is maternal parameters such as blood pressure (BP), maternal serum AAT mean platelet volume (MPV), platelet distribution width (PDW), and serum uric acid levels, and the other is fetal parameters such as amniotic fluid index (AFI), fetal weight centile and estimated fetal weight. Results: A strong negative correlation proved between serum levels of AAT and all study variables except fetal weight (systolic BP, diastolic BP, MPV, PDW, serum uric acid, fetal weight percentile, and AFI) with a correlation coefficient of; −0.95, −0.95, −0.85, −0.93, −0.91, −0.94, and −0.93 respectively. The cut‐off value for AAT 0.013 mg/ml showed the highest sensitivity and specificity as a diagnostic marker for FGR. Area under the curve was 0.99. Conclusions: Negative correlations between maternal serum AAT and fetal parameters used to assess FGR were confirmed, suggesting that AAT is closely related to the pathophysiology of FGR among pre‐eclamptic patients and may serve as a helpful tool in distinguishing between FGR and normal birth weight babies, pending further validation in feto‐maternal outcomes. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Objective: To compare the utility of maximum vertical pocket versus amniotic fluid index for predicting adverse perinatal outcomes.Methods: Systematic review of randomized clinical studies comparing these two ultrasound techniques and random-effects meta-analysis to quantify a range of perinatal outcomes.Result: Six studies with 4278 women were eligible. Use of the maximum vertical pocket reduced the rate of diagnosis of oligohydramnios (pooled relative risk 0.38; 95% confidence interval 0.27, 0.53). Use of the maximum vertical pocket was associated with significantly lower rates of non-reassuring fetal heart tracing, cesarean delivery for fetal distress, and induction of labor for oligohydramnios. There were no differences in the rates of cesarean delivery, presence of meconium, umbilical artery pH <7.1, 5-minute Apgar score <7, or admission to the neonatal intensive care unit.Conclusion: The use of maximum vertical pocket is associated with a lower rate of pregnancy intervention without any worsening of adverse pregnancy outcomes. [ABSTRACT FROM AUTHOR]

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 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.

Objective: Published series regarding interventions for facilitating external cephalic version (ECV) have concluded that parenterally administered beta-stimulant tocolytics, increased ECV success rate and reduced the number of cesarean sections. However, there were insufficient data regarding calcium channel blockers to provide good evidence regarding its efficacy. Given the paucity of literature, we aimed to compare the efficacy of nifedipine to that of ritodrine on ECV success rates.Methods: This is a retrospective case control study of prospectively collected data of patients who underwent ECV between January 2012 and December 2013 at Bikur Cholim Medical Center and Hadassah-Hebrew University Medical Center in Jerusalem, Israel. Patient undergoing ECV with tocolysis by ritodrine were compared with those using nifedipine as tocolysis. Patients were matched in a one-to-one ration by parity and placental location.Results: Overall, 148 women received ritodrine and 148 women received nifedipine before ECV procedure. Overall success rate was higher among the ritodrine group (82.4 vs. 63.5%, p < .001). Among nulliparous and among parous, success rate was higher in the ritodrine group (78.9 vs. 57.9 and 88.6 vs. 73.5%, p = .001, p = .04, respectively). Vaginal delivery rate was higher among the ritodrine group (86.5 vs. 68.9%, p < .001). Cesarean delivery rate was 31.1% for the nifedipine group versus 13.5% in the ritodrine group (p < .001). Number needed to treat to benefit (NNTb) 5.7 (95% confidence interval 3.7-12.1). Overall, 216 of 296 (72.9%) of ECV were successful. Ritodrine was associated with higher success rates as compared with nifedipine (56.5 vs. 32.5%, p < .001). In a multivariate analysis, ritodrine tocolytic therapy was independently associated higher ECV success rates as compared to nifedipine (OR 4.54, 95% CI 2.38-9.09). Higher amniotic fluid index (OR 1.16, 95% CI 1.05-1.28) and nulliparity (OR 0.16, 95% CI 0.08-0.30) were additional independent predictors of ECV outcome.Conclusion: Ritodrine significantly improve the success of ECV compared with nifedipine. Both drugs are shown to be safe. [ABSTRACT FROM AUTHOR]