Frequency of Caesarean Section in Pregnancies with Borderline Amniotic Fluid Index at Term

Abstract

The increased risk of caesarean section after induced labour is well documented. Rate of induction of labour has doubled in the past decade from 10 to 20%. Low Amniotic Fluid Index (AFI) as an isolated finding leads to increased obstetrical interventions but without any improvement in outcome.Objectives: To determine the frequency of caesarean section due to failed induction in pregnancies at term with borderline AFI.Patients and Methods: This cross-sectional study was conducted at Department of Obstetrics and Gynaecology, Unit-III, SIMS/Services Hospital, Lahore. The duration of study was one year from January, 2015 to December, 2015. A total of 150 patients were included in this study. AFI was measured by recent obstetric ultrasound. All patients with borderline AFI (5 – 8 cm) were included in the study. They were induced by glandin E2 gel. If induction of patients failed with two doses of glandin E2 gel, given vaginally 6 hours apart, patients were considered for cesarean section. The outcome measure was rate of caesarean section due to failed induction. All data were analyzed by SPSS version 20.Results: Mean age of the patients was 30.34 ± 6.68 years. Mean gestational age was noted 38.34 ± 1.05 weeks. Out of 150 patients, 103 (68.7%) were para 1 – 3 and 47 patients (31.3%) were para 4 – 6. Caesarean section due to failed induction with borderline AFI was performed in 27 patients (18.0%). Stratification with regard to age, gestational age and parity was carried out and was found significant only for gestational age being > 39 weeks.Conclusion: It is concluded that failed induction of labour at term in women with borderline AFI is not associated with increased risk of caesarean delivery.

Comparison of Outcome of Borderline and Normal Amniotic Fluid Index in Term Pregnancy

“…11,8 Although fetal distress was most common indication, partly earlier intervention in the form of induction of labor led to failed induction and non-progression of labor as reported by the study of Bushra et al Tachycardia was seen to be more common in borderline AFI than in normal AFI group (25.9% vs 11.1%) but it was not significant statistically. 13 Meconium staining of liquor occurred more frequently in women with normal AFI (38.3% vs 33.3%). This could be because, some common causes of induction in the normal AFI group were reduced fetal movement and clinical IUGR which are independent risk factors for fetal meconium staining even when the AFI is normal.…”

Abnormal liquor volume and mode of delivery

“…Similar findings of AFI as a good predictor of maternal and perinatal outcome, with increased incidence of caesarean and instrumental deliveries in oligohydramnios has been reported. 9 Oligohydramnios as seen as an isolated finding leading to increased obstetrical interventions including caesarean. 10 Women with borderline AFI, there is no significant differences in caesarean deliveries for fetal intolerance of labour compared to cases with normal AFI.…”

“…Linear array transabdominal probe was used to measure the largest vertical pocket (cm) in perpendicular plane to the abdominal) skin in each quadrant. The AFI was obtained by adding these four measurements, 8 and categorised 9 into mild (8-9.9cm), moderate (5-7.9 cm) and severe oligohydramnios (<5 cm). In this study, based on Hospital protocol, we defined severe oligohydramnios (£5 cm AFI), moderate (5.1-8 cm) and mild (8.1-9.9 cm) respectively.…”