ASSOCIATION OF ABNORMAL AMNIOTIC FLUID VOLUME WITH ADVERSE NEONATAL OUTCOMES IN HIGH-RISK PREGNANCIES: A PROSPECTIVE COHORT STUDY

Abstract

Background: Amniotic fluid volume (AFV) abnormalities, including oligohydramnios and polyhydramnios, are associated with adverse perinatal outcomes. However, their predictive value in high-risk pregnancies, particularly in South Asian populations, remains inadequately characterized. This study aimed to determine the association between abnormal AFV and neonatal outcomes in high-risk pregnancies.

Methods: This prospective cohort study enrolled 81 high-risk pregnant women at ≥28 weeks gestation from a tertiary care hospital in Islamabad, Pakistan. AFV was assessed using Amniotic Fluid Index (AFI) and classified as normal (AFI 5-25 cm), oligohydramnios (AFI <5 cm), or polyhydramnios (AFI >25 cm). Maternal high-risk factors were documented, and neonatal outcomes including birth weight, Apgar scores, NICU admission, and mode of delivery were recorded. Statistical analysis was performed using Python 3.10 with chi-square tests, ANOVA, and binary logistic regression.

Results: Among 81 participants, 49 (60.5%) had normal AFV, 16 (19.75%) had oligohydramnios, and 16 (19.75%) had polyhydramnios. Oligohydramnios was associated with significantly lower mean birth weight (2.5±0.3 kg vs. 3.1±0.4 kg in normal AFV; p<0.001), lower 1-minute Apgar scores (6.4±1.1 vs. 8.2±0.6; p<0.001), and higher NICU admission rates (43.7% vs. 12.2%; p<0.01). Polyhydramnios demonstrated similarly elevated NICU admissions (37.5%) and lower Apgar scores (6.8±0.9). Composite adverse outcome rates were 14.3% in normal AFV, 62.5% in oligohydramnios (OR 3.8, p<0.01), and 56.2% in polyhydramnios (OR 2.9, p<0.05). Cesarean delivery rates were elevated in both abnormal AFV groups (50.0% in oligohydramnios, 31.2% in polyhydramnios).

Conclusion: Abnormal AFV, particularly oligohydramnios, is a strong independent predictor of adverse neonatal outcomes in high-risk pregnancies. Routine AFV assessment should be integrated into antenatal surveillance protocols, with abnormal findings prompting enhanced fetal monitoring and timely obstetric intervention.