International Journal of Reproduction, Contraception, Obstetrics and Gynecology

Sreelakshmi U et al. Int J Reprod Contracept Obstet Gynecol. 2018 Aug;7(8):3205-3210

www.ijrcog.org pISSN 2320-1770 | eISSN 2320-1789

DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20183318
Original Research Article

Impact of oligohydramnios on maternal and perinatal

outcome: a comparative study
Sreelakshmi U.*, Tushara Bindu, Subhashini T.

Department of Obstetrics and Gynecology, Mallareddy Medical College for Women and Hospital, Hyderabad,
Telangana, India

Received: 24 May 2018

Accepted: 26 June 2018

*Correspondence:
Dr. Sreelakshmi U.,
E-mail: dr.sreelakshmi@yahoo.com

Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under
the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial
use, distribution, and reproduction in any medium, provided the original work is properly cited.

ABSTRACT

Background: Oligohydramnios has got significant impact on perinatal outcome and maternal morbidity. Therefore,
early detection and its management will help in reduction of perinatal morbidity and mortality, decreased operative
interventions. Hence, the present study is undertaken to study the impact of oligohydromnios on perinatal-maternal
outcome.
Methods: The present study was prospective comparative observational study conducted in the Department of
Obstetrics and Gynaecology, Mallareddy Narayana Multispecialty Hospital, reputed teaching hospital from January
2015 to August 2017. The women were divided into study and control groups based on AFI, 100 cases were selected
in each group.
Results: Out of the 200 women, included in the present study, in study group AFI <5 cm was present in 51% of
patients and AFI 5-8 cm in 49% of patients. Doppler abnormalities found in study group (n = 33). 32% of the patients
in study group had non-reactive NST while in control group 8%. Caesarean section was performed in 70% of cases in
study group as compared to 9% in control group. Foetal distress was the most common indication for LSCS. There
were no perinatal deaths in this study.
Conclusions: In this study amniotic fluid index of ≤5 cm was commonly associated with increased cesarean section
rates, intrauterine growth restriction, Non-reactive NST and abnormal umbilical artery Doppler velocimetry studies.
Hence, every case of oligohydramnios needs to be evaluated carefully, early detection and initiation of appropriate
treatment and treat the cause if possible.

Keywords: Amniotic fluid index, Non stress test, Oligohydromnios, Perinatal outcome

INTRODUCTION pregnancy complications.2 The amniotic fluid volume

estimation is the summation of influx and efflux of fluid
Successful outcome of obstetric wellbeing is assessed by within the amniotic space. Amniotic fluid volume can be
obtaining healthy mother and child in modern obstetrics.1 measured by different methods; most commonly used
Amniotic fluid provides a protective milieu for the being amniotic fluid index (AFI) evaluation using
growing foetus, cushioning it against mechanical and ultrasonography. Ultrasonography is a non-invasive test,
biological injury and allows proper growth and can be applied on a large scale and can be used frequently
development. Clinical assessment of amniotic fluid for repeated amniotic fluid volume estimation.
volume at outpatient department itself is an initial step to Quantification of amniotic fluid is an important
identify high risk pregnancy and foetal wellbeing as component of the biophysical profile in ultrasound
variation in its amount has been related to a variety of evaluation of foetal wellbeing, especially in the third

August 2018 · Volume 7 · Issue 8 Page 3205

 Sreelakshmi U et al. Int J Reprod Contracept Obstet Gynecol. 2018 Aug;7(8):3205-3210

trimester.3 Phelan et al described amniotic fluid all the subjects. Phelan method of four-quadrant
estimation by Amniotic fluid Index (AFI) through technique was used for measurement of AFI. If the
transabdominal ultrasonography using four quadrant woman did not deliver within 3 days of ultrasound, a
techniques.4 Abnormalities of the AFV have been repeat ultrasound for measuring AFI was done. Once
associated with adverse pregnancy outcomes.5,6 A drastic oligohydramnios was confirmed by measuring AFI,
reduction in its quantity may indicate underlying routine management in the form of rest in left lateral
placental insufficiency, which has definite implications position, oral and intravenous hydration was given and
on growing fetus. Phelan et al, Baron et al and Kwon et al simultaneously evaluated for underlying etiological factor
defined oligohydramnios as AFI less than or equal to 5 and corrected if identified. Ante partum foetal
cm and 5.1 to 8 as Borderline or marginal surveillance was done by USG, NST, modified
oligohydramnios.4,6,7 By quantification of amniotic fluid Biophysical profile and Umbilical Artery (UA) Doppler
volume, better identification of foetus at high risk can be studies were also done if required at the same time.
done. Oligohydramnios is caused by pregnancy induced
hypertension (PIH), congenital anomalies like renal Considering history, depending upon clinical assessment,
agenesis, idiopathic; postdate pregnancy, infections, etc. Ante partum foetal surveillance reports, investigations
Many studies have established that oligohydramnios is and other obstetric factors were deciding factors for
correlated with increased risk of congenital labour induction and elective/emergency caesarean
abnormalities, intrauterine growth retardation, meconium section. Patients with spontaneous onset of labour were
aspiration syndrome, low APGAR scores, severe birth monitored with cardiotocography in the intrapartum
asphyxia such as fetal distress and still births and period. Eventually, cases were analysed for maternal and
increased incidence of caesarean section.8-10 perinatal outcome. Maternal outcome measured in the
form of spontaneous onset /induced labour, mode of
Hence, Oligohydramnios has got significant impact on delivery, labour related events like non-reactive NST
perinatal outcome and maternal morbidity. Therefore, (abnormal fetal heart rate), and indication for emergency
early detection and its management will help in reduction LSCS were studied. Perinatal outcome in the form of
of perinatal morbidity and mortality at one end and Apgar score at 1 min and 5 min, liquor status (meconium
decreased operative interventions at another end. Hence, staining), IUGR, birth weight and NICU admission were
the present study is undertaken to study the impact of studied.
oligohydromnios on perinatal-maternal outcome.
RESULTS
METHODS
Mallareddy Narayana Multispecialty Hospital is one of
The present study was prospective comparative the few tertiary care centres in Quthbullapur
observational study conducted in the Department of municipality, semi urban area. So many cases nearby
Obstetrics and Gynaecology, Mallareddy Narayana localities were referred to this centre.
Multispecialty Hospital, reputed teaching hospital from
January 2015 to August 2017. Table 1: Demographic characteristics in study and
control groups.
Women attending the outpatient department and labour
room at or after 37 weeks of gestation with singleton Study Control
Characteristics % %
pregnancy, intact membranes, sure about gestation age group group
was calculated by LMP in patients with regular cycles or Maternal age (years)
by first trimester USG, without known uterine anomalies <20 28 28 29 29
and having AFI measurement within 3 days of delivery 20-30 70 70 68 68
included in this study. Women with congenital >30 2 2 3 3
malformation, previous caesarean section, medical Religion
disorder like cardiac disease, intrauterine death of the Hindu 88 88 90 90
foetus, multiple pregnancy, premature rupture of Muslim 12 12 10 10
membranes and post-dated pregnancy were excluded Booked 44 44 83 83
from this study. The women were divided into study and Unbooked 56 56 17 17
control groups based on AFI. For present study 100 cases Gravidity
selected in each group after fulfilling above criteria. Primigravida 73 73 68 68
Multigravida 27 27 32 32
• Study group: AFI: <8 Gestational age (weeks)
• Control group: AFI: 8-15 37-38 16 16 8 8
38-40 84 84 92 92
A written and informed consent was taken from all the AFI
study participants. A detailed history and thorough
<5 51 51 - -
clinical examination was done on admission. Base line
5-8 49 49 - -
investigations, ultrasound examination was performed on

International Journal of Reproduction, Contraception, Obstetrics and Gynecology Volume 7 · Issue 8 Page 3206
 Sreelakshmi U et al. Int J Reprod Contracept Obstet Gynecol. 2018 Aug;7(8):3205-3210

The study participants in both study and control group Table 1 was showing demographic characteristics in both
were compared in terms of age, religion, gravidity, groups. Out of the 200 women, included in the present
booking status and period of gestation. study, in study group AFI <5 cm was present in 51% of
patients and AFI 5-8 cm in 49% of patients. Table 2
Table 2: Associated obstetrics risk factors. showing associated maternal risk factors. Placental
insufficiency is the main underlying mechanism for the
Risk Study Control development of oligohydromnios in study group. Figure:
% %
factors group group 1 showing Doppler abnormalities in study group (n=33).
Isolated 32% of the patients in study group had non-reactive NST
15 15 - -
oligohydromnios while in control group 8% had non-reactive NST. Table 3
Severe anemia 18 18 10 10 showing mode of delivery in study and control groups.
Pre-eclampsia 16 16 8 8
Gestational Caesarean section was performed in 70% of cases in
2 2 - - study group as compared to 9% in control group. A chi
diabetes
Hypothyroidism 11 11 7 7 square statistic test was applied to know the significance
IUGR (Intra of correlation between mode of delivery and AFI, p value
uterine growth 17 17 8 8 was less than 0.0001; this indicated the presence of a very
restriction) strong and significant correlation between the AFI and
Placental mode of delivery.
6 6 - -
abruption
Fever Table 4: Distribution of indications for caesarean
complicating 2 2 - - section in study and control groups.
pregnancy
More than one risk factor presents in one patient. Indications for Study Control
caesarean group % group %
Table 3: Mode of delivery in study and control section n=70 n=9
groups. Foetal distress 32 45.71 8 88.89
Malpresentation
4 5.71 - -
Study Control (breech)
Mode of Failed
group % group % p-value 12 17.14 - -
delivery induction
N = 100 N = 100
Vaginal Non-progress
29 29 88 88 <0.0001 3 4.28 1 11.11
delivery of labour
Instrumental Cephalo pelvic
3 4.28 - -
vaginal 1 1 3 3 0.312 disproportion
delivery Absent diastolic
11 15.7 - -
Emergency flow
59 59 9 9 <0.0001 Reversal of
LSCS 5 7.1 - -
Elective diastolic flow
11 11 0 0 0.013
LSCS
LSCS: Lower uterine segment caesarean section Table 4 shows distribution of indications for caesarean
section in study and control groups. Foetal distress was
the most common indication for LSCS.

Table 5: Perinatal outcome.

Perinatal outcome Study group, N = 100 % Control group, N=100 % p-value

IUGR 32 32 8 8 0.0001
Apgar
<7 at 1 min 34 34 17 17 0.006
<7 at 5 min 21 21 9 9 0.017
Non-Reactive NST 32 32 8 8 <0.0001
Meconeum stained liquor
31 31 13 13 0.002
aspiration
NICU Admission 23 23 16 16 0.212
Induction of labour 32 32 8 8 <0.0001

International Journal of Reproduction, Contraception, Obstetrics and Gynecology Volume 7 · Issue 8 Page 3207
 Sreelakshmi U et al. Int J Reprod Contracept Obstet Gynecol. 2018 Aug;7(8):3205-3210

insufficiency is the main underlying mechanism, leading

to oligohydramnios. In present study pre-eclampsia was
seen in 18% cases in study group and 8% of cases in
control group. In Chate P et al study hypertensive
11 (33.3%) disorders found in 8% of oligohydromnios cases only.14
Abruptio placenta was observed in 6% of present study
17 (51.5%)
and similar incidence was reported by Chandra P et al
(7.69%).15 Hypothyroidism (14.6% versus 11%) was seen
5 (15.1%) in study group by Vidyasagar V and Chutani N and
present study.16

Increased SD ratio Reversal of diastolic flow Induction of labour was seen 32% of women with low
Absent diastolic flow AFI in study group as compared to control group 8% (chi
square test: 9.56 and p value:0.002). Similar to Singhal
SR et al study significantly higher induction of labour
Figure 1: Doppler abnormalities in study group was seen in low AFI group 72% as compared to control
(n=33). group 12%.17

Table 5 shows perinatal outcome. There were no The most common indication for LSCS was foetal
perinatal deaths in this study. Among neonatal outcomes, distress followed by failed induction and Ultrasound
induction of labour, meconeum stained liquor aspiration, Doppler abnormalities in study group. While in control
non-reactive NST and Apgar score <7 at 1 min in study group foetal distress followed by non-progress of labour.
group were statistically significant (p <0.01). In present study study group underwent LSCS in 70% of
cases, while in control group 9% undergone LSCS (chi
DISCUSSION square test: 77.85 and p value: 0.0001). Similar to
Mathuriya et al study 65% of the study cases and only
Many studies have proven that oligohydramnios is 10% of controls underwent LSCS.12 90% of the controls
correlated well with increased risk of Maternal morbidity, were delivered vaginally in both studies.
perinatal morbidity and mortality. Estimation of amniotic
fluid volume is an integral part of antenatal foetal In Ranjita G et al study caesarean section rate was 54% in
surveillance.11 Majority of study participants were in age the oligohydramnios group as compared to control group
group between 20-30 years. Demographic factors like 26%.18 Chaudhary R et al study reported 51% underwent
age, parity, religion and gestational age were comparable LSCS in cases, while 22% underwent LSCS in controls.19
in both groups. In present study 56% of cases in study
group and 27% of cases in control group were unbooked. Controversies encountered in relation to oligohydramnios
While in Mathuriya G et al study 88% in study group, and meconium-stained amniotic fluid. In present study
68% in control group were unbooked. The incidence of induction of labour, non-reactive NST, meconium stained
oligohydramnios was 73% in primigravida in present liquor aspiration, IUGR and 1 min Apgar score <7 were
study.12 Kaur P et al, found that the incidence of statistically significant difference found between study
oligohydramnios was 60% in primigravida which is and control groups.
comparable to the present study.13 Medical disorders like
pre-eclampsia, hypothyroidism were risk factors to cause
oligohydromnios in this study. Chronic placental

Table 6: Perinatal outcome in different studies.

Meconeum stained
Non-reactive NST NICU admission IUGR
Studies liquor
Study Control Study Control Study Control Study Control
Ranjita G et al 42% 15% 28% 18% 62% 25% 18% 12%
Bhagat et al 32% 9.7% 36% 24% 56% 21.7% 16% 14.9%
Bachhav AA et al 65% 24% 33% 10% 30% 11% 18% 1%
Sangeetha K 10% 0% 68% 50% - - 18% 8%
Present study 32% 8% 23% 16% 17% 8% 31% 17%

Outcomes like meconium stained liquor, 1-min Apgar statistically different in the oligohydramnos group from
score <7, IUGR and admission to NICU were not the normal group in Ranjita et al study. NICU admissions

International Journal of Reproduction, Contraception, Obstetrics and Gynecology Volume 7 · Issue 8 Page 3208
 Sreelakshmi U et al. Int J Reprod Contracept Obstet Gynecol. 2018 Aug;7(8):3205-3210

in study group were 15% in cases and 11% in controls in ACKNOWLEDGMENTS

Chaudhary R et al study.
Authors would like to thank Department of Obstetrics
In present study birth weight <2.5 kgs observed in 32% and Gynaecology and Department of Radiology,
of cases in study group compared to 8% in control group Mallareddy Medical College for Women and Hospital,
(p value = 0.0001). Bhagat et al in their study found that Suraram, Hyderabad, Telangana state, India.
56% neonate in low AFI group had birth weight less than
2.5 kg as compared to 21.7% in control group.20 In Funding: No funding sources
contrast to the present study, Sultana et al in their study Conflict of interest: None declared
observed that the difference in low birth weight was not Ethical approval: The study was approved by the
significant between the two groups of AFI (p Institutional Ethics Committee
value=0.4).21
REFERENCES
Table 7: AFI as a screening test to detect foetal
distress. 1. Manning FA. Antepartum fetal testing: a critical
appraisal. Curr Opin Obstet Gynecol.
Groups LSCS Vaginal 2009;21(4):348-52.
Study 70 (a) 30 (b) 2. Chamberlain PF, Manning FA, Morrison I. The
Control 9 (c) 91 (d) relationship of marginal and decreased amniotic fluid
Sensitivity: ×100 = ×100 = 88.60% Specificity: ×100 = ×100 = volumes to perinatal outcome. Am J Obstet Gynecol.
75.20%; Positive predictive value: ×100 = ×100 = 70%;
1984;150(3):245-9.
Negative predictive value: ×100 = ×100 = 91%
3. Bhagat M, Chawla I. correlation of amniotic fluid
index with perinatal outcome. Ind J Obstet Gynecol.
Table 7 shows AFI as a screening test to detect foetal
2014;64(1):32-5.
distress. AFI <8 cm as a screening test in predicting fetal
4. Phelan JP, Smith CV, Broussard P, Small M.
distress during labor requiring LSCS, has a sensitivity of
Amniotic fluid volume assessment with the four-
88.6%, specificity 75.2%, positive predictive value 70%
quadrant technique at 36-42 weeks gestation. J
and negative predictive value of 91%.
Reprod Med. 1987;32(7):540-2.
5. Rutherford SE, Phelan JP, Smith CV, Jacobs N. The
In Kaur P et al study AFI in study cases as a screening
four-quadrant assessment of amniotic fluid volume:
test in predicting foetal distress during labour requiring an adjunct to antepartum fetal heart rate testing.
LSCS, has a sensitivity of 68%, specificity 60%, positive Obstet Gynecol. 1987;70:353-6.
predictive value 48% and negative predictive value of
6. Baron C, Morgan MA, Garite TJ. The amniotic fluid
78%.22 A test with high sensitivity and negative volume assessed intrapartum on perinatal outcome.
predictive value makes it a good screening test. Am J Obstet Gynecol. 1995;173:167-74.
Variations in incidences of perinatal and maternal 7. Kwon JY, Kwon HS, Kim YH, Park YW. Abnormal
outcome could be because of differences in the selection Doppler velocimetry is related to adverse pregnancy
criteria, the selection of cases for the study and chosen
outcome for borderline amniotic fluid index in the
design for the sample size.
third trimester. J Obstet Gynecol Res. 2006;32:545-
9.
CONCLUSION 8. Nath J, Jain M, Najam R. A clinical study on
oligohydramnios in the third trimester of pregnancy
Amniotic fluid volume is a predictor to identify with special emphasis on the perinatal outcome. J
pregnancies at risk of poor perinatal outcomes and its Evol Med Dental Sci. 2013;2(39):7386-91.
decrease is associated with increased risk of perinatal 9. Bangal VB, Giri PA, Sali BM. Incidence of
morbidity and mortality. In this study amniotic fluid oligohydramnios during pregnancy and its effects on
index of ≤ 5 cm was commonly associated with increased maternal and perinatal outcome. JPBMS.
caesarean section rates, intrauterine growth restriction, 2011;12(5):1-4.
Non-reactive NST and abnormal umbilical artery Doppler 10. Bachhav AA, Manjushri W. Low amniotic fluid
velocimetry studies. Hence, every case of index at term as a predictor of adverse perinatal
oligohydramnios needs to be evaluated carefully, early outcome. J Obstet Gynecol India. 2014;64(2):120-3.
detection and initiation of appropriate treatment and treat 11. Ott WJ. Current perspective in antenatally
the cause if possible. Proper parental counselling and surveillance ultrasound. Rev Obst Gynaecol.
individualized decision to be taken according to the case 2003;3:1-180.
regarding timing and mode of delivery, continuous 12. Mathuriya G, Verma M, Rajpoot S. Comparative
intrapartum foetal monitoring and good neonatal care for study of maternal and fetal outcome between low and
optimum perinatal outcome. However, multicentric normal amniotic fluid index at term. Int J Reprod
randomized controlled trials are needed to define at what Contracept Obstet Gynecol. 2017;6:640-4.
threshold levels of AFI to predict adverse perinatal
outcome and guide management accordingly.

International Journal of Reproduction, Contraception, Obstetrics and Gynecology Volume 7 · Issue 8 Page 3209
 Sreelakshmi U et al. Int J Reprod Contracept Obstet Gynecol. 2018 Aug;7(8):3205-3210

13. Kaur P, Desai DA, Taraiya A. A study on the 19. Chaudhary R, Dhama V, Singh S, Singh M.
perinatal outcome in cases of oligohydramnios. Int J Correlation of reduced amniotic fluid index with
Reprod Contracept Obstet Gynecol. 2016;5:98-109. neonatal outcome. Int J Reprod Contracept Obstet
14. Chate P, Khatri M, Hariharan C. Pregnancy outcome Gynecol. 2017;6:2401-6.
after diagnosis of oligohydramnios at term. Int J 20. Bhagat M, Chawla I. correlation of amniotic fluid
Reprod Contracept Obstet Gynecol. 2013;2:23-6. index with perinatal outcome. Ind J Obstet Gynecol.
15. Chandra P, Kaur SP, Hans DK, Kapila AK. The 2014;64(1):32-5.
impact of amniotic fluid volume assessed 21. Sultana S, Khan AMN, Akhtar KKA, Aslam M. Low
intrapartum on perinatal outcome. Obstet Gynae amniotic fluid index in high-risk pregnancy and poor
Today. 2000;5(8):478-81. apgar score at birth. J Coll Physicians Surg Pak.
16. Vidyasagar V, Chutani N. Fetomaternal outcome in 2008;18:630-4.
cases of oligohydramnios after 28 weeks of 22. Kaur P, Desai DA, Taraiya A. A study on the
pregnancy. Int J Reprod Contracept Obstet Gynecol perinatal outcome in cases of oligohydramnios. Int J
2015; 4: 152-6. Reprod Contracept Obstet Gynecol. 2016;5:98-109.
17. Singhal SR, Gupta R, Sen J. Low amniotic fluid
index as a predictor of adverse perinatal outcome: an Cite this article as: Sreelakshmi U, Bindu T,
indian perspective. Clinics Mother Child Health. Subhashini T. Impact of oligohydramnios on
2015;12:201. maternal and perinatal outcome: a comparative study.
18. Ranjita G, Sandhyarani B. Correlation of Int J Reprod Contracept Obstet Gynecol
Oligohydramnios with Perinatal Outcome. J Med 2018;7:3205-10.
Res Prac. 2017;6(3):93-5.

International Journal of Reproduction, Contraception, Obstetrics and Gynecology Volume 7 · Issue 8 Page 3210