CONTENTS
SECTION-I
Page No.
Supervisor’s certificate……………………………………………………………i
Dedication………………………………………………………………………...ii
Acknowledgements………………………………………………………………iii
List of Tables……………………………………………………………………..iv
List of Figures…………………………………………………………………….v
List of Abbreviations……………………………………………………………..vi
SECTION-II
1. Abstract…………………………………………………………………………..1
2. Introduction ……………………………………………………………………...3
3. Review of Literature
Amniotic fluid volume: physiology and assessment ……………………..6
o Amniotic fluid dynamics………………………………………….8
o Polyhydramnios………………………………………………….13
o Oligohydramnios…………………………………………………22
Pathophysiology………………………………………….22
Epidemiology…………………………………………….23
Presentation………………………………………………24
Causes……………………………………………………26
Workup…………………………………………………..26
Treatment………………………………………………...44
4. Objectives ……………………………………………………………………….50
5. Materials and Methods ………………………………………………………….52
6. Results…………………………………………………………………………...55
7. Discussion ……………………………………………………………………….75
8. Conclusion ……………………………………………………………………....80
9. References……………………………………………………………………….81
SUPERVISOR’S CERTIFICATE
I certify that DR. AYESHA QASIM
CPSP Registration Number: OBG-2017-037-8514
Has been working under my direct supervision with effect from 1 st July 2017 to date in
the Department of Obstetrics & Gynecology, Independent Uniersity Hospital,
Faisalabad.
The enclosed dissertation titled:
“PERINATAL OUTCOME IN PREGNANT FEMALES AT TERM HAVING LOW
AMNIOTIC FLUID INDEX (AFI)”
Was prepared according to CPSP Guidelines, and under my direct supervision, I have
read the Dissertation and have found it satisfactory for FCPS Part-II examination in the
subject of Obstetrics & Gynecology..
Signature of Supervisor with Official Stamp
Dedication
Dedicated to:
My Parents and my
respected teachers
ii
ACKNOWLEDGEMENT
Prior to acknowledgement, I glorify, Almighty Allah, The Most Merciful, The Most
Gracious Who gave me the power, health, strength and means to complete my research.
It gives me a lot of pleasure to acknowledge the proper guidance, rewardless suggestions
and motherly affection of Dr. Maahnaz Roohi, Professor of Department of Obstetrics &
Gynecology, Independent University Hospital, Faisalabad during the preparation of my
dissertation and training in Obstetrics & Gynecology. She is a source of inspiration for
the postgraduate students.
I am also thankful to my family and colleague medical officers without their help it was
not possible to prepare this dissertation.
Dr. Ayesha Qasim
iii
LIST OF TABLES
Table No. Title Page No
I Risk factors for hydramnios 14
II Amniotic fluid index values in normal pregnancy 34
III Age distribution of patients 56
IV Distribution of patients according to gestational 57
age
V Distribution of patients according to parity 58
VI Frequency of perinatal outcome in pregnant 59
females at term having low amniotic fluid index
VII Stratification of the cesarean section with respect 60
to age
VIII Stratification of the low birth weight with respect 61
to age
IX Stratification of the apgar score <7 at 5 min with 62
respect to age
X Stratification of the meconium stained liquor with 63
respect to age
XI Stratification of the NICU admission with respect 64
to age
XII Stratification of the cesarean section with respect 65
to gestational age
XIII Stratification of the low birth weight with respect 66
to gestational age
XIV Stratification of the apgar score <7 at 5 min with 67
respect to gestational age
XV Stratification of the meconium stained liquor with 68
respect to gestational age
XVI Stratification of the NICU admission with respect 69
to gestational age
XVII Stratification of the cesarean section with respect 70
to parity
XVIII Stratification of the low birth weight with respect 71
to parity
XIX Stratification of the apgar score <7 at 5 min with 72
respect to parity
XX Stratification of the meconium stained liquor with 73
respect to parity
XXI Stratification of the NICU admission with respect 74
to parity
iv
LIST OF FIGURES
Figure No. Title Page No
I Amniotic fluid dynamics 7
II Amniotic fluid volumes as a function of gestational 12
age
III Sonogram obtained before second-trimester 28
amnioinfusion
IV Sonogram obtained after second-trimester 29
amnioinfusion
V Amniotic fluid index (AFI) measurement technique 40
LIST OF ABBREVIATIONS
Abbreviations Description
AFI Amniotic fluid index
IUGR intrauterine growth-restricted
AA Amino acid
AFV amniotic fluid volume
TIUV total intrauterine volume
PMR perinatal mortality rate
PROM premature rupture of the membranes
BPD bronchopulmonary dysplasia
PIH Pregnancy induced hypertension
LS lecithin-sphingomyelin
PG phosphatidylglycerol
vi
