NST, AMNIOTIC FLUID INDEX [AFI] AND COLOR OF LIQUOR IN TERM PREGNANCIES IN ACTIVE LABOUR AND THEIR ASSOCIATION WITH LABOUR AND PERINATAL OUTCOME

NST, AMNIOTIC FLUID INDEX [AFI] AND COLOR OF LIQUOR IN TERM PREGNANCIES IN ACTIVE LABOUR AND THEIR ASSOCIATION WITH LABOUR AND PERINATAL OUTCOME | Authorea try { document.documentElement.classList.add('js'); } catch (e) { } var _gaq = _gaq || []; _gaq.push(['_setAccount', 'G-8VDV14Y67G']); _gaq.push(['_trackPageview']); (function() { var ga = document.createElement('script'); ga.type = 'text/javascript'; ga.async = true; ga.src = ('https:' == document.location.protocol ? 'https://ssl' : 'http://www') + '.google-analytics.com/ga.js'; var s = document.getElementsByTagName('script')[0]; s.parentNode.insertBefore(ga, s); })(); Skip to main content Preprints Collections Wiley Open Research IET Open Research Ecological Society of Japan All Collections About About Authorea FAQs Contact Us Quick Search anywhere Search for preprint articles, keywords, etc. Search Search ADVANCED SEARCH SCROLL This is a preprint and has not been peer reviewed. Data may be preliminary. 5 May 2025 V1 Latest version Share on NST, AMNIOTIC FLUID INDEX [AFI] AND COLOR OF LIQUOR IN TERM PREGNANCIES IN ACTIVE LABOUR AND THEIR ASSOCIATION WITH LABOUR AND PERINATAL OUTCOME Authors : Divya George [email protected] , Shiny Daniel , and Anoop Krishnan Authors Info & Affiliations https://doi.org/10.22541/au.174642675.57988784/v1 357 views 107 downloads Contents Abstract Supplementary Material Information & Authors Metrics & Citations View Options References Figures Tables Media Share Abstract Background : Amniotic fluid volume and color are crucial for fetal health assessment and postnatal prediction. Oligohydramnios and meconium-stained amniotic fluid increase the likelihood of poor neonatal outcomes Method : A comparative prospective cross-sectional study was conducted at the Obstetrics and Gynaecology Department of teaching hospitals affiliated with J.J.M. Medical College, Davangere, from March 2021 to August 2022. 100 term pregnant women in active labor were enrolled in the study. Clinical and ultrasonographic assessments were performed to evaluate the Amniotic Fluid Index (AFI), non-stress test (NST) reactivity, properties of the amniotic fluid, and neonatal outcomes were recorded. Results : Maternal age exhibited a significant correlation with meconium-stained liquid (p=0.026). The non-reactivity of NST was significantly higher in the meconium-stained liquor groups (thin: 50%, thick: 33%) compared to clear liquor (16%) (p=0.011). A low AFI of <8 cm was observed more frequently in the thin meconium-stained liquid (75%) than in the clear (54.67%) and thick meconium-stained groups (22.2%). Thick meconium staining demonstrated significantly lower mean APGAR scores at 1 minute (5.89±0.98) compared to the thin (6.47±2.05) and clear liquor (6.87±1.21) (p=0.007). NST, AFI, and liquor color showed significant correlations with cesarean delivery, NICU hospitalization, and infant morbidity. The predictive sensitivity for neonatal problems was 77.78% for liquor volume, 80% for liquor hue, and 81.82% for NST. Conclusion NST, AFI, and amniotic fluid color affect fetal health. Oligohydramnios, abnormal NST, and meconium-stained amniotic fluid increase the risk of surgical delivery and lower APGAR scores. NST, AMNIOTIC FLUID INDEX [AFI] AND COLOR OF LIQUOR IN TERM PREGNANCIES IN ACTIVE LABOUR AND THEIR ASSOCIATION WITH LABOUR AND PERINATAL OUTCOME Authos: Divya George, Dr. Shiny Daniel, Dr Anoop Krishnan Affiliation: Department of Obstetrics and Gynaecology, J.J.M. Medical College, Davangere, India Abstract Background : Amniotic fluid volume and color are crucial for fetal health assessment and postnatal prediction. Oligohydramnios and meconium-stained amniotic fluid increase the likelihood of poor neonatal outcomes Method : A comparative prospective cross-sectional study was conducted at the Obstetrics and Gynaecology Department of teaching hospitals affiliated with J.J.M. Medical College, Davangere, from March 2021 to August 2022. 100 term pregnant women in active labor were enrolled in the study. Clinical and ultrasonographic assessments were performed to evaluate the Amniotic Fluid Index (AFI), non-stress test (NST) reactivity, properties of the amniotic fluid, and neonatal outcomes were recorded. Results : Maternal age exhibited a significant correlation with meconium-stained liquid (p=0.026). The non-reactivity of NST was significantly higher in the meconium-stained liquor groups (thin: 50%, thick: 33%) compared to clear liquor (16%) (p=0.011). A low AFI of <8 cm was observed more frequently in the thin meconium-stained liquid (75%) than in the clear (54.67%) and thick meconium-stained groups (22.2%). Thick meconium staining demonstrated significantly lower mean APGAR scores at 1 minute (5.89±0.98) compared to the thin (6.47±2.05) and clear liquor (6.87±1.21) (p=0.007). NST, AFI, and liquor color showed significant correlations with cesarean delivery, NICU hospitalization, and infant morbidity. The predictive sensitivity for neonatal problems was 77.78% for liquor volume, 80% for liquor hue, and 81.82% for NST. Untitled Document Generated on Sun May 4 03:58:08 2025 by LaTeXML Funding: No funding has been received for this research. Untitled Document Generated on Sun May 4 03:58:08 2025 by LaTeXML METHODOLOGY This study was a comparative prospective cross-sectional study conducted in the Department of Obstetrics and Gynaecology at the teaching hospitals attached to J.J.M. Medical College, Davangere. The study was carried out from March 2021 to August 2022 across three hospitals: Bapuji Hospital, Chigateri District General Hospital, and Women and Child Hospital, Davangere. Study Population and Sampling A total of 100 term pregnant women in active labor were recruited for the study. Patients who met the inclusion criteria were randomly selected. The inclusion criteria comprised term gestation pregnancies in active labor, whereas the exclusion criteria included multiple gestations, non-cephalic presentations, and previous lower segment cesarean section (LSCS). Data Collection Procedure After obtaining ethical clearance from the J.J.M Medical College, informed written consent was taken from each participant before study initiation. Patients were informed about the study, including its benefits, cost, and voluntary nature, ensuring that their decision did not affect their treatment. A detailed history was recorded, which included demographic details such as age, educational level, socioeconomic status, marital status, parity, gestational age, serology, and comorbidities. General clinical examinations were performed, including pulse rate, blood pressure, temperature, symphysiofundal height measurement, fetal presentation, and assessment of amniotic fluid adequacy. Table 1: Assessment Parameters Non-Stress Test (NST) - Reactive - Non-reactive Amniotic Fluid Index (AFI) - Less than 8 cm - More than 8 cm Color of Amniotic Fluid - Clear liquor - Thin meconium-stained liquor - Thick meconium-stained liquor Mode of Delivery - Normal vaginal delivery - Instrumental delivery - Cesarean section APGAR Score at 1 minute - Less than 5 - 5 or more APGAR Score at 5 minutes - Less than 7 - 7 or more Birth Weight - Less than 2.5 kg - 2.5 kg or more NICU Stay Duration - Less than 5 days - 5 days or more Ultrasonographic and Clinical Examination An ultrasound examination was performed using a curvilinear transducer, following the method described by Phelan et al. The uterus was divided into four quadrants using maternal sagittal and transverse reference lines. The transducer was positioned parallel to the maternal sagittal plane and perpendicular to the coronal plane to measure the AFI. Follow-Up and Data Analysis Patients were followed throughout labor and delivery, and their mode of delivery and fetal condition were recorded. In cases where cesarean sections were performed, the indications for surgery were documented. Neonatal outcomes were assessed based on birth weight, APGAR scores, color of liquor, and NICU stay duration. The collected data were stored in MS Excel and analyzed using SPSS software. Statistical tests were applied to determine the sensitivity of NST, AFI, and liquor color in predicting fetal distress. Categorical data was given in frequency and percentage form, and the Chi square test was used to analyze variable associations. The quantitative data were represented using mean and standard deviation. ANOVA and unpaired t-tests were performed to determine correlation (p < 0.05 was deemed significant). IBM SPSS version 22.0 was used for data analysis. Sample Size Estimation Considering the prevalence of term pregnancies in India (66%) and assuming a 10% margin of error, a minimum of 86 cases was required. However, to enhance the reliability of the study, 100 term pregnant women were recruited. RESULTS A total of 100 term pregnant ladies were enrolled in the current study. Participants were further categorized into three groups based on their liquor color which included (clear liquid, thin meconium-stained liquor, and thick meconium-stained liquor. Regarding parity, 73% of the participants were multigravida, with no significant difference between groups (p=0.14). Maternal age distribution showed that the majority (78%) were between 21-30 years, with a significant difference among groups (p=0.026), as represented in Table 2. Untitled Document Generated on Sun May 4 03:58:08 2025 by LaTeXML Untitled Document Generated on Sun May 4 03:58:08 2025 by LaTeXML Gestational age analysis revealed that 63% of cases were between 37-40 weeks, with no significant variation among groups (p=0.14). Neonatal gender distribution indicated that 40% of newborns were male, with no significant differences observed between the groups (p=0.568). Birth weight analysis showed that 74% of neonates had a birth weight below 2.5 kg, with no statistically significant difference between groups (p=0.137). Regarding educational levels, most mothers had at least a graduate-level education, and no significant difference was found among the groups (p=0.250). Socioeconomic status assessment indicated that the majority of participants belonged to SES III-IV categories, with no significant difference between groups (p=0.271). Additionally, BMI evaluation revealed that 95% of mothers had a BMI above 25 kg/m², with no significant association observed (p=0.436). Overall, apart from maternal age, no other factors showed statistically significant differences among the study groups. In the clear liquor group, all participants (100%) were non-reactive. Among those in the thin meconium-stained liquor group, 93.75% were non-reactive, while 6.25% were reactive. In the thick meconium-stained liquor group, 77.78% were non-reactive, whereas 22.22% were reactive. The difference between the groups was statistically significant, with a p-value of 0.007. [Table 3] Untitled Document Generated on Sun May 4 03:58:08 2025 by LaTeXML Clear Liquor 75 0 75 100.00% 0.00% 100.00% Thin Meconium-Stained Liquor 15 1 16 93.75% 6.25% 100.00% Thick Meconium-Stained Liquor 7 2 9 77.78% 22.22% 100.00% Total 97 3 100 97.00% 3.00% 100.00% p-value 0.007 (Significant) There were no significant changes in IUGR, gestational diabetes, or gestational hypertension between the clear, thin, and thick meconium-stained liquor groups (p > 0.009, 0.964, and 0.164, respectively). The mean GCT and hemoglobin levels were likewise similar across groups (p = 0.32 and 0.495). Similarly, there were no significant variations in method of birth, including vaginal, lower segment cesarean, and instrumental deliveries (p = 0.344). NST were substantially greater in the thin (50.00%) and thick (33.34%) meconium-stained liquor groups than in the clear liquor group (16.00%) (p = 0.011). A low AFI was found in 45.33% of the clear liquor group, 75.0% of the thin meconium-stained liquor group, and 22.2% of the thick meconium-stained liquor group. The thick meconium-stained liquor group had substantially lower APGAR scores at 1 minute (mean 5.89, SD 0.98) than the thin (mean 6.47, SD 2.05) and clear liquor groups (mean 6.87, SD 1.21) (p = 0.007). [Table 4.] At 5 minutes post-delivery, the average APGAR score was 8.79 (SD ±1.21) for the clear liquor group, 8.35 (SD ±2.05) for the thin meconium-stained group, and 8.22 (SD ±0.98) for the thick meconium-stained group. The differences were not statistically significant (p = 0.5). Table 4: Clinical correlation of NST, AFI, and APGAR score (at 1 minute) NST Reactive 63 (84.00%) 8 (50.00%) 6 (66.67%) 77 (77.00%) Non-Reactive 12 (16.00%) 8 (50.00%) 3 (33.33%) 23 (23.00%) Total 75 (100.00%) 16 (100.00%) 9 (100.00%) 100 (100.00%) p-value 0.011 (Significant) AFI < 8 41 (54.67%) 4 (25.00%) 7 (77.78%) 52 (52.00%) ≥ 8 34 (45.33%) 12 (75.00%) 2 (22.22%) 48 (48.00%) Total 75 (100.00%) 16 (100.00%) 9 (100.00%) 100 (100.00%) APGAR Score at 1 Min Mean 6.87 6.47 5.89 SD 1.21 2.05 0.98 p-value 0.007 (Significant) A significant difference was observed between the groups (p = 0.08), with 9.33% in the clear liquor group, 31.25% in the thin meconium-stained liquor group, and 22.22% in the thick meconium-stained liquor group. A significant association between the AFI and several parameters. Specifically, HIV positivity (p = 0.004), antenatal complications (p = 0.008), IUGR (p = 0.035), mode of delivery (LSCS) (p = 0.020), non-reactive NST (p = 0.03), NICU stay (p = 0.05), and IUGR (p = 0.035) were all significantly associated with AFI levels. However, there was no significant relationship between AFI and other parameters such as primipara, multipara, gender, birth weight, GDM, GHTN, or liquor status. Similarly, NST demonstrated significant associations with several parameters. A notable association was found between non-reactive NST and low birth weight (p = 0.002), with a higher incidence of low birth weight in non-reactive cases. Additionally, non-reactive NST was significantly linked to IUGR, with a p value of 0.025, indicating that non-reactive NST was more prevalent in cases of IUGR. The mode of delivery also showed a significant relationship with NST, as non-reactive NST was associated with a higher rate of LSCS (p = 0.020). Moreover, a significant correlation was observed between non-reactive NST and the need for NICU stay, with a p value of 0.045, highlighting the increased likelihood of NICU admission for non-reactive NST cases. Diagnostic performance The diagnostic performance for predicting neonatal complications was evaluated using three parameters. The amount of liquor showed a sensitivity of 77.78% (95% CI: 39.99–97.19%), specificity of 50.00% (95% CI: 6.76–93.24%), positive predictive value (PPV) of 77.78%, negative predictive value (NPV) of 50.00%, and an overall accuracy of 69.23%. Similarly, the color of liquor demonstrated a sensitivity of 80.00% (95% CI: 44.39–97.48%) and the same specificity of 50.00%, with a PPV of 80.00%, NPV of 50.00%, and a slightly higher accuracy of 71.43%. In contrast, the non-stress test (NST) exhibited the highest sensitivity at 81.82% (95% CI: 48.22–97.72%) but a lower specificity of 33.33% (95% CI: 4.33–77.72%), resulting in an accuracy of 64.71% and a PPV of 69.23% with an NPV of 50.00%. The disease prevalence across these measures ranged from 64.71% to 71.43%. DISCUSSION Antepartum oligohydramnios is associated with intrauterine growth limitation, post-term pregnancy, and irregular fetal heart rate patterns before delivery. Given that amniotic fluid volume normally decreases with advancing gestational age, evaluating it during the early stages of labor seems to be a rational approach for forecasting fetal morbidity. Moreover, meconium-stained amniotic fluid has been acknowledged as a sign of possible difficulties impacting fetal health during and after childbirth. Historically, the presence of meconium in the amniotic fluid of cephalic presentations posed a considerable worry for midwives and obstetricians alike. The present research concentrated on a low-risk cohort of parturient individuals. This cross-sectional research examined the relationship between amniotic fluid parameters and diverse maternal and newborn outcomes in 100 term pregnant women in active labor. In general, the majority of maternal variables, such as parity, gestational age, neonatal gender, birth weight, educational attainment, socioeconomic position, and BMI, exhibited no significant variations between the groups; nevertheless, maternal age shown a significant difference (p = 0.026). Ravikant R. Patel [14] reported that 65.71% of the women were primigravida, and Charu Jandial et al [15] found a primigravida rate of 60.0%, which stands in stark contrast to the current study, where only 27% of the participants were primigravida. Significant disparities were seen in the evaluation of fetal well-being. NST were more prevalent in the meconium-stained groups, exhibiting 50.00% non-reactivity in the thin meconium-stained liquor group and 33.33% in the thick meconium-stained liquor group, in contrast to only 16.00% in the clear liquor group (p = 0.011). The AFI was substantially correlated with negative perinatal outcomes. In a prospective case-control research, Kaushik Das et al. [16] documented a 38.0% incidence of non-reactive NST, observing that cesarean sections were more prevalent in the presence of oligohydramnios with a non-reactive NST. Hoskins IA noted that 75.0% of instances with a non-reactive NST resulted in a cesarean birth. [17] A low AFI (< 8 cm) was more common in the group with thin meconium staining (75.00%),Maiti GD et al. reported in their study that the occurrence of meconium-stained liquor in cases where the amniotic fluid index (AFI) was ≤5 was 74.4%. [18] Similarly Rutherford et al, [19] reported AFI ≤5 in 54% and Sriya R et al reported 38.88%. [20] This parameter significantly correlated with elevated rates of HIV positivity (p = 0.004), antenatal complications (p = 0.008), IUGR (p = 0.035), and a higher incidence of LSCS (p = 0.020). Maiti GD et al. [18] reported that the incidence of cesarean delivery in the severe oligohydramnios group (AFI ≤ 5) was 79%. This rate is notably higher than the findings of Sriya R et al. [20] (43.05%), Guin et al. [21] (42.8%), and Casey et al. [22] (51%), but closely aligns with the study by Visvalingam G et al. [23] (75.6%). The elevated cesarean rate in this study may be attributed to the overall rising trend in operative deliveries and increased patient preference for cesarean sections. Furthermore, non-reactive NST was substantially associated with low birth weight (p = 0.002), IUGR (p = 0.025), and heightened NICU hospitalizations (p = 0.045), highlighting its predictive value for fetal distress. The APGAR score at 1 minute was much lower in the thick meconium-stained group (mean 5.89, SD 0.98) compared to the other groups (p = 0.007), perhaps indicating poor newborn health immediately post-delivery. Maiti GD et al. revealed that the incidence of an Apgar score below 7 at 1 minute and 5 minutes in cases with AFI <5 was 79.1% and 39.5%, respectively. [18] These findings are notably higher compared to other studies including Sriya R et al, Umber A et al, [25] and Chandra P et al [24] . The diagnostic performance for predicting neonatal complications was evaluated across three parameters. The amount of liquor demonstrated a sensitivity of 77.78% (95% CI: 39.99%–97.19%), specificity of 50.00% (95% CI: 6.76%–93.24%), a PPV of 77.78%, a NPV of 50.00%, and an overall accuracy of 69.23%. Similarly, the color of liquor showed a sensitivity of 80.00% (95% CI: 44.39%–97.48%) with the same specificity of 50.00%, PPV of 80.00%, NPV of 50.00%, and a slightly higher accuracy of 71.43%. In contrast, the NST exhibited the highest sensitivity at 81.82% (95% CI: 48.22%–97.72%) but a lower specificity of 33.33% (95% CI: 4.33%–77.72%), resulting in a PPV of 69.23%, NPV of 50.00%, and an overall accuracy of 64.71%. Anand RS et al. reported in their study that in the oligohydramnios group (AFI NST at admission, meconium-stained liquor during labor, cesarean delivery for fetal distress, low Apgar score (<7) at 1 minute, NICU admission, and neonatal mortality, with a highly significant p-value (<0.00001). In addition, the study revealed that NST, AFI, and the color of amniotic fluid serve as reliable predictors of fetal well-being in pregnancies between 37 and 41.6 weeks. Their study highlighted that the likelihood of adverse outcomes, including operative delivery and low Apgar scores, increases in cases of oligohydramnios, pathological NST, and meconium-stained liquor. [26] Clinical Implications: The findings of this study underscore the clinical importance of detailed antepartum and intrapartum fetal surveillance using NST, AFI measurement, and liquor color assessment. The significant associations between non-reactive NST, low AFI, and adverse neonatal outcomes such as low birth weight, IUGR, and low APGAR scores emphasize the need for close monitoring and timely intervention in pregnancies with abnormal liquor characteristics. This comprehensive evaluation can aid in stratifying risk and guiding decisions regarding the mode of delivery and neonatal care, potentially improving perinatal outcomes in high-risk pregnancies. Limitations: While the study provides valuable insights, several limitations should be acknowledged. The sample size, although adequate per the initial calculation, was relatively small and derived from a single geographical area, which may limit the generalizability of the findings. Furthermore, the study design was cross-sectional, precluding any causal inferences. Variability in ultrasound measurements and subjective interpretation of liquor color could also introduce bias. Future studies with larger, multicentric cohorts and standardized assessment protocols are warranted to validate these findings. Untitled Document Generated on Sun May 4 03:58:08 2025 by LaTeXML Acknowledgements The authors declare that this study was conducted independently, without external sponsorship, support, or assistance. No individuals or organizations contributed to the research design, data collection, analysis, or manuscript preparation. We affirm that the work presented here is solely the result of our own efforts. Disclosure of interest The author has nothing to disclose. 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NST, AMNIOTIC FLUID INDEX [AFI] AND COLOR OF LIQUOR IN TERM PREGNANCIES IN ACTIVE LABOUR AND THEIR ASSOCIATION WITH LABOUR AND PERINATAL OUTCOME. Authorea . 05 May 2025. DOI: https://doi.org/10.22541/au.174642675.57988784/v1 If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. Simply select your manager software from the list below and click Download. For more information or tips please see 'Downloading to a citation manager' in the Help menu . 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