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Amniotic fluid optical density at spontaneous onset of labour and it’s correlation with gestational age, birth weight and functional maturity of newborn

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Background: Respiratory distress is the common cause of neonatal morbidity and mortality. Babies born even at 40 weeks of gestation developed respiratory distress. The maturity of newborn is independent of gestational age and birth weight of newborn. In this study amniotic fluid optical density (AFOD) is correlated with the functional maturity of newborn.Methods: In this study, hundred singleton pregnant women who underwent first trimester scan and crown rump length estimation, and who were on spontaneous labor were selected for this observational study. Under aseptic precautions AF samples were collected while doing amniotomy with 2 ml disposable syringe, also collected during caesarean section after careful hysterotomy from the bulging membranes. Amniotic fluid optical density studied with spectrometer at 650 nm. Birth weights were recorded for all the babies. Babies are also looked for the respiratory distress, NICU admission.Results: In this study, respiratory distress was reported in 28% of newborns whereas 72% of newborns did not have distress. In the present study, 27% of newborns were admitted in NICU where as 73% of the newborns were on mother’s side following delivery. Babies with AFOD 0.98±0.27 were functionally mature, skin was pleased brown in colour with little vernix, none of them had respiratory distress. Amniotic fluid optical density <0.4 developed respiratory distress.Conclusions: Amniotic fluid optical density is a simple method to assess the functional maturity of newborn.
December 2020 · Volume 9 · Issue 12 Page 5060
International Journal of Reproduction, Contraception, Obstetrics and Gynecology
Sengodan SS et al. Int J Reprod Contracept Obstet Gynecol. 2020 Dec;9(12):5060-5064
www.ijrcog.org
pISSN 2320-1770 | eISSN 2320-1789
Original Research Article
Amniotic fluid optical density at spontaneous onset of labour and
it’s correlation with gestational age, birth weight and
functional maturity of newborn
Subha S. Sengodan*, Santhya Velumani
INTRODUCTION
Respiratory distress syndrome remains a common cause
of neonatal morbidity and mortality. The pulmonary
system is among the last of the fetal organ system to
mature both functionally and structurally.
Pulmonary surfactant increases the lung compliance and
prevents the collapse of alveoli during expiration.
Biochemical analysis of LS ratio of 2:1 and phosphatidyl
glycerol indicates pulmonary maturity.1,2 Among the
biophysical methods, bubble formation tests, optical
density at 650 nm, flourescense polarisation lamellar
body concentration helps in determining the fetal lung
maturity.2-6
Gestational age at delivery is unique to fetomaternal
unit.7 One of the most important preventive measures in
obstetrics is the individual evaluation of most appropriate
time to terminate the pregnancy.8 It is a conventional
degree that babies born between 37-40 weeks are
completely mature. Even after 40 weeks full term, an
evidence of 0.25% RDS has been recorded. About 0.05%
who were delivered electively between 37-40 weeks
ABSTRACT
Background: Respiratory distress is the common cause of neonatal morbidity and mortality. Babies born even at 40
weeks of gestation developed respiratory distress. The maturity of newborn is independent of gestational age and birth
weight of newborn. In this study amniotic fluid optical density (AFOD) is correlated with the functional maturity of
newborn.
Methods: In this study, hundred singleton pregnant women who underwent first trimester scan and crown rump
length estimation, and who were on spontaneous labor were selected for this observational study. Under aseptic
precautions AF samples were collected while doing amniotomy with 2 ml disposable syringe, also collected during
caesarean section after careful hysterotomy from the bulging membranes. Amniotic fluid optical density studied with
spectrometer at 650 nm. Birth weights were recorded for all the babies. Babies are also looked for the respiratory
distress, NICU admission.
Results: In this study, respiratory distress was reported in 28% of newborns whereas 72% of newborns did not have
distress. In the present study, 27% of newborns were admitted in NICU where as 73% of the newborns were on
mother’s side following delivery. Babies with AFOD 0.98±0.27 were functionally mature, skin was pleased brown in
colour with little vernix, none of them had respiratory distress. Amniotic fluid optical density <0.4 developed
respiratory distress.
Conclusions: Amniotic fluid optical density is a simple method to assess the functional maturity of newborn.
Keywords: AFOD, Functional maturity, Respiratory distress
Department of Obstetrics and Gynecology, Government Kumarmangalam, Medical College Hospital, Salem, Tamil
Nadu, India
Received: 29 September 2020
Revised: 05 November 2020
Accepted: 06 November 2020
*Correspondence:
Dr. Subha S. Sengodan,
E-mail: drppsamysubha@gmail.com
Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under
the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial
use, distribution, and reproduction in any medium, provided the original work is properly cited.
DOI: https://dx.doi.org/10.18203/2320-1770.ijrcog20205247
Sengodan SS et al. Int J Reprod Contracept Obstet Gynecol. 2020 Dec;9(12):5060-5064
International Journal of Reproduction, Contraception, Obstetrics and Gynecology Volume 9 · Issue 12 Page 5061
required mechanical ventilation.9 The lung skin
interaction by the surfactant causes vernix detachment,
increases amniotic fluid turbidity.10,11
Though there are several techniques practiced in recent
times to assess the maturity of fetus, role of amniotic
fluid optical density (AFOD) in assessing the gestational
age and functional maturity of newborn has been reported
in several researches.12-14 Amniotic fluid absorbance at
650 nm is considered as a standard investigation for lung
maturity evaluation.15 Even the low birth weight babies if
functionally mature can be managed at home.16 In our
study we confirm this phenomenon in terms of AFOD
which measures lung maturity, skin maturity as well as
biological age. Hence this study was conducted to
correlate the AFOD at spontaneous onset of labour with
gestational age, birth weight and functional maturity of
newborn.
Aims and objectives
To establish the correlation between amniotic fluid
optical density (AFOD) with gestational age, birth weight
and functional maturity of newborns and to study the
functional maturity of the newborns, especially in terms
of lung maturity by means of presence or absence of
respiratory distress in babies born out of spontaneous
labour.
METHODS
A prospective study conducted on hundred antenatal
women, admitted for delivery in GMKMCH, Salem.
Duration of study:
July 2019 to December 2019.
Ethical committee approval
Ethical committee approval was obtained for this study to
find the correlation between amniotic fluid optical
density with gestational age, birth weight and functional
maturity of the new born among antenatal mothers
attending inpatient department of Obstetrical and
Gynecology, from the ethics committee.
Inclusion criteria
Women who underwent first trimester scan and crown
rump length estimation and women with regular
menstrual cycles who underwent USG at less than 20
weeks gestation which is in agreement with the gestation
age calculated from the last menstrual period.
Exclusion criteria
Blood stained and meconium stained amniotic fluid
samples, intrauterine growth restriction, premature
rupture of membranes, multiple pregnancies.
Under aseptic precautions, amniotic fluid samples were
collected while doing amniotomy with a sterile syringe.
Amniotic fluid samples were also collected at cesarean
section, after careful incision in the uterus from the
bulging membranes. Minimum 2 ml of amniotic fluid
transferred to the plain test tube. Amniotic fluid optical
density (AFOD) was measured using spectrometer. The
wavelength was set at 650 nm, first the control test tube
with water was read by the spectrometer followed by the
amniotic fluid sample. The amniotic fluid optical density
(AFOD) was shown immediately as digital number in the
spectrometer.
Figure 1: Spectrometer with test tube containing
amniotic fluid.
Figure 2: AFOD levels and fetal maturity.
Birth weights were recorded for all the babies by
electronic weighing machine. APGAR scores at one
minute and 5 minute were obtained. Babies were
observed for clinical signs of respiratory distress. Clinical
signs of respiratory distress (RR>60, grunting, retraction
of ribs/sternum, low SPO2 requiring O2 for more than 2
hours (to exclude transient tachypnea of newborn), chest
x-ray findings after 24 hours were suggestive of RDS.
Factors like sepsis, gestational diabetes mellitus,
pneumonia, meconium aspiration, congenital anomalies
were excluded.
Sengodan SS et al. Int J Reprod Contracept Obstet Gynecol. 2020 Dec;9(12):5060-5064
International Journal of Reproduction, Contraception, Obstetrics and Gynecology Volume 9 · Issue 12 Page 5062
Data analysis
The data was entered in excel sheet and analyzed using
statistical package for social sciences (SPSS- version 17).
Descriptive statistics with mean, standard deviation (SD)
and proportions (%) were calculated for continuous
variables. To test the hypothesis chi Square test,
independent sample t test and ANOVA were used
appropriately. P value <0.05 was considered as
statistically significant.
RESULTS
In this study, there were hundred participants included.
Among them majority (47%) of them were in the age
group of 21-25 years followed by 26-30 years (33%), less
than or equal to 20 years (15%) and 31-35 years (5%).
Table 1: Proportion of participants in different
gestational age.
Gestational age
Percentage
33-33 weeks + 6 days
5.0
34-34 weeks + 6 days
11.0
35-35 weeks + 6 days
5.0
36-36 weeks + 6 days
26.0
37-37 weeks + 6 days
20.0
38-38 weeks + 6 days
23.0
39-39 weeks + 6 days
5.0
40-40 weeks + 6 days
5.0
Spontaneous labour occurred most commonly in the
gestational age group 36-36 weeks + 6 days of gestation
(26%) followed by 38-38 weeks + 6 days of gestation
(23%), 37-37 weeks + 6 days of gestation (20%) and 34-
34 weeks + 6 days of gestation (11%). Also 5% of cases
had spontaneous labour in the gestational age group 33-
33 weeks + 6 days, 35-35 weeks + 6 days, 39-39 weeks +
6 days of gestation and 40-40 weeks + 6 days of
gestational age. In this study, respiratory distress was
reported in 28% of newborns whereas 72% of newborns
did not have distress.
Table 2: Association between gestational age and
respiratory distress.
Respiratory distress
P value
Present
Absent
5
0
0.000*
6
5
3
2
3
23
2
18
7
16
0
5
2
3
28
72
Table 3: Difference in mean AFOD with respect to
respiratory distress.
Variable
Respiratory
distress
Mean±SD
P value
Amniotic fluid
optical density
Present
0.4±0.1
0.000*
Absent
1.2±0.1
*Significant
Mean difference in AFOD among the cases with and
without respiratory distress was found to be 0.4±0.1 and
1.2±0.1, respectively. The difference in AFOD with
respect to respiratory distress was found to be statistically
significant in this study with a p value of 0.000.
Figure 3: Correlation between gestational age
and AFOD.
DISCUSSION
Gestational age by itself does not always exclude the
possibility of respiratory distress syndrome because
literature has reported prevalence of RDS after 40 weeks
of gestation as 0.25%.17,18 Though the percentage is
small, the number increases to significant proportions
when extrapolated to larger populations which are
avoidable. American College of Obstetricians and
Gynecologists guidelines recommend the obstetricians to
confirm fetal pulmonary maturity prior to elective
delivery less than 39 weeks gestation.19 ACOG
recommends the AFOD value >0.15 of a centrifuged
amniotic fluid sample to confirm lung maturity. The
onset of spontaneous labour takes place at AFOD value
around 0.98.21
In this study, we observed that newborns with AFOD
value <0.40 developed RDS. The findings are in
accordance with the previous studies, AFOD represents
indirectly the amount of surfactant.21,22 Hence severity
depends on the how low the AFOD value is or in other
words how low the surfactant phospholipids are and not
always how low the chronological age is. There could be
other factors accounting for less severity of RDS like trial
of labour or unknown constitutional factors at advanced
gestational age despite low surfactant levels as revealed
by low AFOD values.23 However the severity could be
Sengodan SS et al. Int J Reprod Contracept Obstet Gynecol. 2020 Dec;9(12):5060-5064
International Journal of Reproduction, Contraception, Obstetrics and Gynecology Volume 9 · Issue 12 Page 5063
more than expected on rare occasions.24-26 Exact
measurements of AFOD is possible in AFI value of 9-
16.27 Ram et al reported mean optical density of
1.03±0.31 in babies devoid of RDS.28,29 Babies With
AFOD 0.98±0.27 are functionally mature, skin was
pleased brown in colour with little vernix, none of them
had respiratory distress.30 Amniotic fluid optical density
<0.4 developed respiratory distress.31,32
In our study, mean difference in AFOD among the cases
with and without respiratory distress was found to be
0.4±0.1 and 1.2±0.1, respectively. The difference in
AFOD with respect to respiratory distress was found to
be statistically significant in this study. In this study, it
was found that amniotic fluid optical density levels were
high among the newborns with better APGAR score at
five minutes. Thus shows a significant positive
correlation between APGAR at five minutes and amniotic
fluid optical density.
The onset of labour is more closely related to fetal
functional maturity than either gestational age or birth
weight.33 The gestational age at delivery is unique to each
feto-maternal unit . The understanding of AFOD prevents
iatrogenic prematurity and complications of postmaturity
thereby optimizing labour.
Limitation of this study is only 100 amniotic fluid
samples are studied, further studies are needed.
CONCLUSION
In this study we conclude that each fetus has got its own
maturity potential amniotic fluid optical density (AFOD)
was found to be significantly associated with functional
maturity of newborn. It was found that AFOD increases
with gestational age.
AFOD is higher among the newborns with better APGAR
score. In our study babies with AFOD <0.40 developed
respiratory distress irrespective of gestational age and
birth weight of newborn. Babies with AFOD 1.2±0.1 are
functionally mature and did not develop respiratory
distress irrespective of gestational age and birth weight of
newborn, which is found to be statistically significant.
Induction of labour needs to be reviewed in lights of
AFOD which determines the preparedness of labour and
hence the biological gestational age that is more relevant
than the estimated date of confinement (EDC).
Funding: No funding sources
Conflict of interest: None declared
Ethical approval: The study was approved by the
Institutional Ethics Committee
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Cite this article as: Sengodan SS, Velumani S.
Amniotic fluid optical density at spontaneous onset
of labour and it’s correlation with gestational age,
birth weight and functional maturity of newborn. Int
J Reprod Contracept Obstet Gynecol 2020;9:5060-4.
Article
Full-text available
Objective: To assess the trend of rise in Amniotic Fluid Optical Density (AFOD) with the onset of spontaneous term labor. Methods: Amniotic Fluid (AF) samples collected by amniocentesis for lung maturity assessment in 12 preterm labor subjects were utilized for AFOD estimation. After successful tocolysis and continuation of pregnancies, AFOD estimations were repeated when women presented with labor pains again before 37w+6days. AF samples were also collected while doing amniotomy at spontaneous labor in all subjects. Un-centrifuged fresh AF samples were used for AFOD estimations with colorimeter at 650nm. Babies were evaluated for functional maturity in terms of RDS, color of the skin, and adherence of vernix caseosa to skin surface at birth. Results: Among these 12 subjects the CRL gestational age at delivery ranged from 35w+3days to 42w+0days. The AFOD values at amniotomy ranged from 0.74 to 1.54. In 11 subjects who underwent repeat amniocentesis we could observe a slow and prolonged rise in AFOD till a value around 0.40 was reached. After this value, the AFOD rose rapidly like a surge, which coincided with the onset of spontaneous labor. All babies born were functionally fully mature irrespective of gestational age and birth weight. In 6 subjects the duration of surge was observed to range from 6 to 10 days. Conclusion: There was a definite surge of AFOD which coincided with completion of fetal functional maturity and onset of spontaneous labor. All these factors occurring at different gestational ages with different fetuses indicate individualized term gestation for each fetus.
Article
Full-text available
Background: Onset of spontaneous labor occurs on completion of fetal functional maturity at amniotic fluid optical density (AFOD) value 0.98 ± 0.27 (Mean ± SD). All three events occurring together at any time from 35 to 42 weeks indicate individual term for each fetus. Babies born with AFOD ≤0.40 are functionally premature and develop varying degrees of respiratory distress syndrome (RDS). In this study, we tested the hypothesis, labors with AFOD 0.98 ± 0.27 are functionally mature with well-established labor cascades and may respond well t o induction. On the other hand, labors with AFOD ≤0.40 are functionally premature with poorly established labor cascades and may not respond well t o induction. Methods: In this gestational age and parity-matched case control study, cases consisted of 36 uncomplicated singleton laboring women who delivered normally with premature (≤0.40) AFOD values. Controls consisted of 36 similar laboring women who delivered normally with mature AFOD (0.98 ± 0.27) values. Uncentrifuged fresh AF samples collected at amniotomy were used for OD measurement with colorimeter at 650 nm. Women were assigned to groups based on AFOD values. In both groups, labor was induced with vaginal T. Misoprostol 25 mcg 6 hourly up to 4 doses. Labor outcome measures; Bishop score at induction, induction- delivery intervals (IDI), induction failures, number of T. Misoprostol required, presence of fetal distress, RDS, and NICU admission days were recorded in both groups and compared. Results: Median Bishop scores at induction in cases and controls were 5.0 (IQR 4.25--6), 7.0 (IQR 6--8), respectively. Median IDI in cases and controls were 18 h (IQR 12.25--21.5 h) and 7.0 h (IQR 5--9.5 h), respectively. Number of induction failures in cases and controls were 8 and 0, respectively. Outcomes of Induction of labor with…. Statistically significant differences observed in all these outcomes between groups (P = 0.00) favoring inductions with mature AFOD. Conclusion: Labor induction with mature AFOD value was successful in all women with shorter IDI and with better perinatal outcomes.
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Low birth weight neonates with 2000g or less birth weight constitute about 10% of live births with perinatal mortality as high as 32.4%. Perinatal morbidity is 19.3% with asphyxia neonatorum and neonatal jaundice heading the list. Epidemiological maternal factors include extremes of age and parity, lack of antenatal care, low socioeconomic status, illiteracy and underweight short women. Etiologic factors are obstetric complications, hypertensive disorders, systemic diseases or idiopathic. The scope of preventive measures include improvement of economic status and education about health and safe pregnancy. Proper antenatal care for early detection of high risk cases, adequate and timely management of complications and adequate facilities for neonatal care can reduce the perinatal morbidity and mortality.
Article
Objective: To establish whether the timing of delivery between 37 and 42 weeks gestation influences neonatal respiratory outcome and thus provide information which can be used to aid planning of elective delivery at term. Design: All cases of respiratory distress syndrome or transient tachypnoea at term requiring admission to the neonatal intensive care unit were recorded prospectively for nine years. Setting: Rosie Maternity Hospital, Cambridge Subjects: During this time 33,289 deliveries occurred at or after 37 weeks of gestation. Main outcome measures: This information enabled calculation of the relative risk of respiratory morbidity for respiratory distress syndrome or transient tachypnoea in relation to mode of delivery and onset of parturition for each week of gestation at term. Results: The incidence of respiratory distress syndrome at term was 2.2/1000 deliveries (95 % CI; 1.7-2.7). The incidence of transient tachypnoea was 5.7/1000 deliveries (95 % CI; 4.9-6.5). The incidence of respiratory morbidity was significantly higher for the group delivered by caesarean section before the onset of labour (35.5/1000) compared with caesarean section during labour (12.2/1000) (odds ratio, 2.9; 95% CI 1.9-4.4; P < 0.001), and compared with vaginal delivery (5.3/1000) (odds ratio, 6.8; 95 % CI 5.2-8.9; P < 0.001). The relative risk of neonatal respiratory morbidity for delivery by caesarean section before the onset of labour during the week 37+0 to 37+6 compared with the week 38+0 to 38+6 was 1.74 (95 % CI 1.1-2.8; P < 0.02) and during the week 38+0 to 38+6 compared with the week 39+0 to 39+6 was 2.4 (95 % CI 1.2-4.8; P < 0.02). Conclusions: A significant reduction in neonatal respiratory morbidity would be obtained if elective caesarean section was performed in the week 39+0 to 39+6 of pregnancy.