Intrapartum Amniotic Fluid Index as a Predictor of Perinatal Outcome: A Prospective Observational Study

Abstract

Objective: To evaluate the relationship between intrapartum Amniotic Fluid Index
(AFI) and perinatal outcomes, assessing its predictive value for adverse events such
as fetal distress, cesarean delivery, low APGAR scores, and neonatal intensive care
unit (NICU) admission.
Methods: This prospective observational study included 200 singleton pregnant
women at ≥37 weeks gestation admitted in labor at Government Victoria Hospital,
Visakhapatnam, from November 2022 to April 2024. AFI was measured using the
four-quadrant technique and categorized as low (<5 cm), borderline (5–8 cm),
normal (8–25 cm), or polyhydramnios (>25 cm). Outcomes assessed included nonstress test (NST) reactivity, labor onset, mode of delivery, liquor color, APGAR
scores, and NICU admission. Statistical significance was determined using Chisquare tests (p<0.05).
Results: Of 200 participants, 16% had low AFI, 27% borderline, 54% normal, and
3% polyhydramnios. Low AFI was significantly associated with non-reactive NST
(59.4%, p<0.001), cesarean delivery (65.6%, p<0.001), meconium-stained liquor
(37.5%, p=0.0016), low 1-minute APGAR scores (18.8%, p=0.0127), and NICU
admission (56.3%, p<0.001). Borderline AFI showed similar trends, while
polyhydramnios had higher cesarean rates (66.7%) but limited sample size precluded
generalization. Normal AFI correlated with favorable outcomes.
Conclusion: Low and borderline AFI are reliable predictors of adverse perinatal
outcomes, necessitating heightened intrapartum surveillance. Polyhydramnios
findings require further investigation due to low incidence.