IS THERE A DIFFERENCE BETWEEN PREGNANCY OUTCOMES IN PREGNANT NIGERIAN WOMEN WITH BORDERLINE AND NORMAL AMNIOTIC FLUID INDICES AT TERM? A PROSPECTIVE COHORT STUDY

Abstract

Background: Ultrasound assessment of amniotic fluid volume has important implications in
obstetric care. While the observation of diminished amniotic fluid volume has long been
recognized as a predictor of adverse perinatal outcome, there is a paucity of information on
the clinical significance and pregnancy outcomes associated with borderline amniotic fluid
index.
Aims: The aim of this study was to compare pregnancy outcomes of antenatal patients at
term with borderline and normal amniotic fluid index at DELSUTH, Oghara and Central
Hospital Warri.
Objectives: The objectives of this study were to determine the pregnancy outcomes of
women with normal Amniotic Fluid Index at term, the pregnancy outcomes of women with
borderline Amniotic Fluid Index at term, any significant difference in the proportions of the
outcome measures in women with normal amniotic fluid index and borderline AFI and based
on the findings, make recommendations on the management of women with borderline AFI at
term.
Methodology: This study was a prospective cohort study conducted at Delta State University
Teaching Hospital, Oghara and Central Hospital, Warri. A total of 114 pregnant women
attending the antenatal clinics with singleton pregnancies at gestational age between 37
weeks and 41 weeks and 6 days were recruited. Fifty seven subjects with borderline amniotic
fluid index making up the exposed group were matched with fifty seven unexposed subjects
with normal amniotic fluid index for gestational age, age of the parturient and parity.
Maternal outcome measures included induction of labour, spontaneous labour, assisted
vaginal delivery, antepartum and intrapartum Caesarean Section. Fetal outcome measures
assessed in this study were Apgar score <7 in 5th minute, meconium stained liquor,
intrapartum fetal distress, intrapartum fetal death, early neonatal death, birth weight < 2.5kg
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and admission to neonatal intensive care unit. These outcome measures were analyzed using
Statistical Package for the Social Sciences version 22. Statistical tests of significance between
the differences in proportions of outcome measures between the exposed and unexposed
groups was done using the Chi square with Yates’ correction where appropriate.
Results: The study population consisted of 114 consecutive booked patients with singleton
pregnancies between the gestational age of 37 weeks and 41+6 weeks. There was no
statistically significant difference between maternal age, parity, gestational age at study entry
and delivery with amniotic fluid index. With regard to mode of delivery, spontaneous labour,
induction of labour, assisted vaginal delivery, antepartum and intrapartum caesarean section
were statistically significantly associated with borderline AFI (p = 0.007, 0.009, 0.006, 0.001
and 0.008 respectively). Intrapartum fetal distress, Apgar score <7 in 5minutes and
birthweight <2.5kg were the only perinatal outcome measures that were statistically
significantly associated with borderline AFI in this study (p = 0.036, 0.011, and 0.036
respectively).
Conclusion: The findings of the study suggest that borderline amniotic fluid index is
associated with adverse pregnancy outcomes.

IS THERE A DIFFERENCE BETWEEN PREGNANCY OUTCOMES IN PREGNANT NIGERIAN WOMEN WITH BORDERLINE AND NORMAL AMNIOTIC FLUID INDICES AT TERM? A PROSPECTIVE COHORT STUDY