Maternal Outcomes in Pregnant Females at Term Having Low Amniotic Fluid Index: Maternal Outcomes: Pregnant Females Having Low Amniotic Fluid Index

Sidra Iqbal; Umbreen Akram; Hira Shafqat; Muhammad Zeshan Ali; Muhammad Shoaib; Maria Arshad

doi:10.54393/pjhs.v7i8.3809

Authors

Sidra Iqbal Department of Obstetrics and Gynecology, Combined Military Hospital, Quetta, Pakistan
Umbreen Akram Department of Obstetrics and Gynecology, Combined Military Hospital, Quetta, Pakistan
Hira Shafqat Department of Obstetrics and Gynecology, Combined Military Hospital, Quetta, Pakistan
Muhammad Zeshan Ali Department of Radiology, Combined Military Hospital, Quetta, Pakistan
Muhammad Shoaib Department of Pediatrics, Combined Military Hospital, Quetta, Pakistan
Maria Arshad Department of Obstetrics and Gynecology, Combined Military Hospital, Quetta, Pakistan

DOI:

https://doi.org/10.54393/pjhs.v7i8.3809

Keywords:

Low Amniotic Fluid Index, Maternal Outcomes, Induction of Labor, Cesarean Section, Parity, Prolonged Labor, Postpartum Hemorrhage, Previous Cesarean Section

Abstract

Low amniotic fluid index (AFI) at term is associated with increased obstetric intervention, but its relationship with maternal outcomes remains uncertain. Objectives: To assess maternal outcomes in term pregnancies with low AFI and evaluate their association with maternal age, BMI, parity, and previous cesarean section. Methods: This analytical cross-sectional study included 137 singleton term pregnancies with low AFI (<5 cm) admitted to a tertiary care hospital in Quetta from 22-09-2025 to 30-12-2025. Sample size was estimated using n = Z²P(1-P)/d² at a 95% confidence level with P = 65% and d = 8%. Outcomes included induction of labor, mode of delivery, prolonged labor, instrumental delivery, postpartum hemorrhage, infection, and hospital stay. Chi-square or Fisher’s exact test was applied as appropriate. Results: Mean age was 28.39 ± 6.65 years, and mean BMI was 27.00 ± 4.82 kg/m². Median hospital stay was 3 days (IQR: 2–4). Labor was induced in 101 (73.7%) patients, cesarean section occurred in 94 (68.6%), prolonged labor in 32 (23.4%), instrumental delivery in 13 (9.5%), postpartum hemorrhage in 11 (8.0%), and infection in 7 (5.1%). No statistically significant association was found between maternal outcomes and age group, BMI, parity, or previous cesarean section (all p>0.050). Conclusions: In this analytical cross-sectional study, pregnancies with low AFI at term showed high rates of induction and cesarean delivery; however, maternal age, BMI, parity, and previous cesarean section were not significantly associated with adverse maternal outcomes within the study sample.

References

Multani M, Ansari S, Agarwal R, Agarwal R. A Longitudinal Observational Study on Amniotic Fluid Index and Perinatal Fetal Outcome. International Journal of Life Sciences, Biotechnology and Pharma Research. 2024 June; 13(6). doi: 10.69605/ijlbpr_13.6.2024.72.

Kharakwal S, Shobhnae HJ, Agarwal S, Mehboob Z. A Comparative Study on Maternal and Foetal Outcome Between Low and Normal Amniotic Fluid Index in Term Pregnancies. International Journal of Reproduction, Contraception, Obstetrics and Gynecology. 2023 Aug; 12(8): 2520-4. doi: 10.18203/2320-1770.ijrcog20232302.

Chaudhary R, Singh S, Dhama V, Singh M. Correlation of Reduced Amniotic Fluid Index with Maternal Outcome. Indian Journal of Obstetrics and Gynecology Research. 2017; 4(2): 141-5.

Milani F, Khosousi L, Sharami SH, Shakiba M, Rasoulian J, Attari SM et al. Evaluation of Perinatal Outcomes in Pregnant Women with Low Amniotic Fluid Index. Journal of Family and Reproductive Health. 2023 Dec; 17(4): 199. doi: 10.18502/jfrh.v17i4.14591.

Bhadana P, Swami A, Pachani S, Mittal DP, Gupta U. Reduced Amniotic Fluid Index - Does It Affect Maternal and Perinatal Outcome in Low-Risk Term Pregnancy? Scholars Journal of Applied Medical Sciences. 2017; 5(11): 4561-4565.

Sivagama Sundari S. Maternal and Fetal Outcome in Pregnancies with Borderline Amniotic Fluid Index (Doctoral dissertation, KAP Viswanatham Government Medical College, Tiruchirappalli). 2015.

Kalsoom S, Majeed NM, Riaz M, Mehdi M, Asif KU, Mushtaq I. Comparison of Maternal and Perinatal Outcome of Isolated Borderline Amniotic Fluid Index Versus Normal Amniotic Fluid in Low-Risk Pregnancies at Term. Journal of Rawalpindi Medical College. 2023 Dec; 27(4). doi: 10.37939/jrmc.v27i4.2305.

Hashimoto K, Kasdaglis T, Jain S, Turan O, Atkins K, Kopelman J et al. 391: Maternal and Fetal Doppler Pulsatility Indices Predict Adverse Pregnancy Outcome in Uncomplicated Pregnancies with Borderline-Low Amniotic Fluid Index in the Early Third Trimester. American Journal of Obstetrics and Gynecology. 2012 Jan; 206(1): S183. doi: 10.1016/j.ajog.2011.10.409.

Iqbal SA and Noreen AS. Low Amniotic Fluid Index as a Predictor of Perinatal Outcome in Low-Risk Pregnancies at Term. Pakistan Journal of Medical and Health Sciences. 2010; 4(3): 270-1.

George S. To Study the Association of Low Amniotic Fluid Index and Adverse Perinatal Outcomes in the Third Trimester of Pregnancy. Journal of South Asian Federation of Obstetrics and Gynaecology. 2023 May; 15(2): 155-60. doi: 10.5005/jp-journals-10006-2120.

Manisha A and Tembhare A. Assessment of Correlation Between Amniotic Fluid Index (AFI) and Feto-Maternal Outcomes of in-Term Pregnancies. Journal of Pharmaceutical Research International. 2021 Dec; 33(64A): 480-6. doi: 10.9734/jpri/2021/v33i64A35809.

Rehman N, Raees M, Bibi N, Shafi H. Fetomaternal Outcome in Pregnant Women at Term with Low. Biological and Clinical Sciences Research Journal. 2023: 452. doi: 10.54112/bcsrj.v2023i1.452.

Chaudhary I, Mittal R, Chauhan S. An Evaluation of Feto-Maternal Outcome in Oligohydramnios: A Prospective Study. International Journal of Reproduction, Contraception, Obstetrics and Gynecology. 2025; 14(6): 1789–1794. doi: 10.18203/2320-1770.ijrcog20251563.

Vyas A, Prasanna G, Dash S, Rath S, Vyas Jr A. Comparison of Perinatal and Maternal Outcomes in Borderline versus Normal Amniotic Fluid Index in a Tertiary Care Center in Odisha: An Observational Prospective Study. Cureus. 2021 Nov; 13(11). doi: 10.7759/cureus.19876.

Patil AB, Hurkadli K, Nagathan V. Study of Effect of Oligohydramnios on Maternal and Perinatal Outcomes in Tertiary Care Center-Hospital Based Cross-Sectional Study. International Journal of Reproduction, Contraception, Obstetrics and Gynecology. 2025; 14(5): 1458–1462. doi: 10.18203/2320-1770.ijrcog20251223.

Sawant AA, Wankhede S, Thakare S, Narayan GN, Saha I, Vernekar A et al. Maternal and Perinatal Outcomes in Oligohydramnios: A Cross-Sectional Analysis of Pregnancies Between 28 to 42 Weeks of Gestation. Cureus. 2025 Feb; 17(2). doi: 10.7759/cureus.79232.

Shiferaw MA, Solomon A, Getachew S, Gudu W. Maternal and Perinatal Outcomes of Oligohydramnios in Late Term and Post Term Pregnancies at Public Hospitals in Ethiopia: A Cross-Sectional Study. BioMed Central Women's Health. 2024 Feb; 24(1): 113. doi: 10.1186/s12905-024-02952-0.

Mathuriya G, Verma M, Rajpoot S. Comparative Study of Maternal and Fetal Outcome Between Low and Normal Amniotic Fluid Index at Term. International Journal of Reproduction, Contraception, Obstetrics and Gynecology. 2017 Feb; 6(2): 640-5. doi: 10.18203/2320-1770.ijrcog20170398.

Majumdar A, Mallick K, Majumdar R, Patel P. Amniotic Fluid Index as Indicator for Pregnancy Outcome in Late Third Trimester. International Journal of Reproduction, Contraception, Obstetrics and Gynecology. 2023; 12(10): 3109–3113. doi: 10.18203/2320-1770.ijrcog20232956.

Khan N and Iftikhar H. Success of Pregnancy in Patients with Borderline Amniotic-Fluid-Index at a Tertiary Care Hospital in Madan. Journal of Population Therapeutics and Clinical Pharmacology. 2024; 30(19): 1704-1708.