PREDICTIVE VALUE OF ULTRASONOGRAPHIC AMNIOTIC FLUID VOLUME ASSESSMENT FOR ADVERSE BIRTH OUTCOMES IN HIGH-RISK PREGNANCIES

Abstract

Background: Abnormal amniotic fluid volume (AFV) is frequently encountered in high-risk obstetric practice and may reflect placental insufficiency, maternal disease, fetal growth disturbance, or congenital pathology. Amniotic Fluid Index (AFI) and Single Deepest Pocket (SDP) are the most widely used semiquantitative ultrasound methods, but their comparative prognostic value remains debated.

Objective: To evaluate the relationship between ultrasonographically assessed AFV and adverse birth outcomes in high-risk pregnancies and to compare the clinical contribution of AFI and SDP.

Methods: This prospective observational cohort included 81 high-risk pregnant women evaluated at HBS Hospital, Islamabad. AFV was classified as normal (AFI 5-25 cm or SDP 2-8 cm), oligohydramnios (AFI <5 cm or SDP <2 cm), or polyhydramnios (AFI >25 cm or SDP >8 cm). Maternal risk factors, birth weight, Apgar scores, delivery mode, neonatal intensive care unit (NICU) admission, and composite adverse perinatal outcomes were assessed. Statistical analyses described in the thesis included categorical and continuous-variable comparisons, correlation analysis, and binary logistic regression.

Results: Forty-nine participants (60.5%) had normal AFV, whereas 16 (19.8%) had oligohydramnios and 16 (19.8%) had polyhydramnios. The thesis reports lower mean 1-minute Apgar scores in oligohydramnios (6.4 ± 1.1) and polyhydramnios (6.8 ± 0.9) than in normal AFV (8.2 ± 0.6). Based on the tabulated outcome counts, NICU admission occurred in 5/49 normal-AFV pregnancies, 9/16 oligohydramnios pregnancies, and 3/16 polyhydramnios pregnancies. Composite adverse outcome rates were reported as 14.3%, 62.5%, and 56.2%, respectively. In the reported regression analysis, oligohydramnios (OR 3.8, p<0.01), polyhydramnios (OR 2.9, p<0.05), maternal hypertension (OR 4.2, p<0.01), and maternal diabetes (OR 3.5, p<0.05) were associated with adverse neonatal outcomes. AFI was described as the more stable prognostic marker, while SDP added diagnostic value in borderline low-fluid states.

Conclusion: Abnormal AFV identified a substantially higher burden of adverse perinatal outcomes in this high-risk cohort. AFI and SDP should be interpreted as complementary ultrasound measures, with maternal comorbidity and the underlying etiology of fluid abnormality incorporated into clinical risk stratification.