RELATIONSHIP OF AMNIOTIC FLUID INDEX AND CERVICAL LENGTH WITH DELIVERY LATENCY IN PATIENTS WITH PRETERM PREMATURE RUPTURE OF MEMBRANES IN OUR SETTINGS

Abstract

Abstract

Introduction:- Several research have shown that a cervical length of < 2 cm and low amniotic fluid index (AFI) of less than 5 cm may be associated with a shorter latency to delivery and a higher rate of delivery within 7 days. However, it is unclear how these two clinical variables can be used, either independently or in combination, to help predict spontaneous preterm delivery in Preterm Premature Rupture Of Membranes. The aim of this study was to assess the role of  sonographic measurement of cervical length and amniotic fluid index in women with PPROM between 28 to 34 weeks in predicting the delivery latency period.

Materials and Methods

This study, conducted over a 1.5-year period, included 312 patients diagnosed with PPROM in a tertiary care hospital. The diagnosis was based on amniotic fluid leakage or sterile speculum examination. Patients were managed according to hospital protocol, with daily follow-up examinations for labor, infection, and wellbeing. The time of delivery was determined by individual circumstances, with induction of labor initiated or cesarean delivery performed when signs of infection or fetal distress were observed. The data was analyzed using SPSS Version 20.0.

Results:- Out of 312 patients 169 patients had latency period of less than 7 days and 143 patients had latency period of more or equal to 7 days.  Most of patients with AFI <5 and/or CL <2 delivered within 7 days and most of patients with AFI ≥5 and/or CL ≥2 were having delivery latency ≥7 days. So delivery latency was directly related to amount of AFI and cervical length. Most of patients with POG <34 weeks delivered with delivery latency ≥7 days and most of patients with POG ≥34 weeks delivered with delivery latency <7 days. Amongst the babies who developed complications most of them babies were extreme preterm a. The complications seen in preterm infants in our setting were Respiratory distress syndrome, hypothermia, hypoglycemia, intra cranial hemorrhage, Apnea of prematurity, Necrotizing enterocolitis, sepsis and death. The survival and salvageblity of these preterm babies were dependent on their gestational age, birth weight and apgar score. Babies with late preterm gestation were having good birth weight and good apgar score were found less prone to these complications and vice versa.

Conclusion:- A shorter TVCL and lesser AFI independently predict delivery within 7 days in women presenting with PPROM. The combination of an AFI ≥5 cm and TVCL ≥2 cm greatly improved the potential to remain undelivered after 7 days and vice versa.