Comparison of the Effect of Injection Enoxaparin Versus Conventional Treatment on Amniotic Fluid Index in Borderline Oligohydramnios in Third Trimester of Pregnancy: A Randomized Control Trial in a Tertiary Care Hospital https://doi.org/10.60787/NMJ-64-4-319

Main Article Content

Mussarat Sultana
Asma Batool
zaiba sher
Nabila Salman
Ayesha Rafay
Ayesha Khan

Keywords

Third trimester, Oligohydramnios, Injection Enoxaparin, Conventional Treatment, Mode of Delivery, AFI., Pregnancy

Abstract

Background:  Oligohydramnios is defined as AFI less than or equal to 5 cm. A borderline AFI has been defined as an AFI of 5.1 cm to 8 cm3. The incidence of borderline AFI compared with a normal AFI (8.1 cm to 18 cm)  is 6% to 44% in different studies. A decrease in amniotic fluids leads to serious complications for the mother and fetus. The study objective was to evaluate if an injection of Enoxaparin improves the amount of liquor in oligohydramnios in the third trimester of pregnancy.


Methodology: A randomized control trial was conducted in a Tertiary care obstetrics center. Total number of participants were 130. These participants were divided into two groups, each consisting of 65 participants. Group A received conventional treatment(intravenous fluid, tablet Aspirin, and rest in lateral position), while Group B received an injection of enoxaparin in addition to conventional treatment. AFI measurements were performed in the radiology department by radiologists using standard 4 quadrant measurements, twice weekly after the initiation of the treatment. The weight of the baby was noted at birth and admission to neonatal intensive care was noted to assess the health of the neonate. Data was analyzed on SPSS (statistical package for social sciences) version 23.


Results: In group A, the AFI increased after treatment in 47(72.3%) patients, remained static in 6(9.2%)patients, and decreased in 12(18.4%) patients. Whereas in group B, AFI increased in 31(68.8%)patients and decreased in 14(31.3%)patients, p= 0.334.


Conclusion: The findings in the current study did not demonstrate any significant effect of the use of injection enoxaparin in improving borderline oligohydramnios. Further research is needed to apply this research to the general population.

Abstract 287 | PDF Downloads 85 HTML Downloads 57

References

1. Cunningham FG, Leveno KJ, Bloom SL, Spong CY, Dashe JS, Hoffman BL, et al. Amniotic fluid. Williams Obstetrics. New York: McGraw Hill Education; 2014. pp. 460–76.

2. Souza ASR, de Andrade LR, da Silva FLT, Cavalcanti AN, Guerra GV, de QL. Maternal and perinatal outcomes in women with decreased amniotic fluid. Rev Bras Ginecol Obstet. 2013;35(8):342–48.

3. Choi SR. Borderline amniotic fluid index and perinatal outcomes in the uncomplicated term pregnancy. J Matern Fetal Neonatal Med. 2016;29(3):457–60.

4. Kwon J-Y, Kwon H-S, Kim Y-H, Park Y-W. Abnormal Doppler velocimetry is related to adverse perinatal outcome for borderline amniotic fluid index during third trimester. J ObstetGynaecol Res. 2006;32(6):545–49.

5. Larsen, William J. 2001. Human embryology (3. ed.). Philadelphia, Pa.: Churchill Livingstone. p. 490.

6. Hashimoto K, Kasdaglis T, Jain S, Atkins K, Harman CR, Baschat AA, et al. Isolated low-normal amniotic fluid volume in the early third trimester: association with adverse perinatal outcomes. J Perinat Med. 2013;41(4):349–53.

7. Magann EF, Chauhan SP, Hitt WC, Dubil EA, Morrison JC. Borderline or marginal amniotic fluid index and peripartum outcomes: a review of the literature. J Ultrasound Med. 2011;30(4):523–28.

8. Calhoun S. Examining maternal hydration and amniotic fluid volume. AWHONN Lifelines. 1999 Dec-Jan;3(6):20–4.

9. Duffett L, Rodger M. LMWH to prevent placenta mediated pregnancy complications: an update. British J Haematol. 2015; 168:619–38.

10. Shahnazi M, SayyahMeli M, Hamoony F, Sadrimehr F, GhatreSamani F, Koshavar H. The effects of intravenous hydration on amniotic fluid volume and pregnancy outcomes in women with term pregnancy and oligohydramnios: a randomized clinical trial. J Caring Sci. 2012 Aug 25;1(3):123-8.

11. Azarkish, F., Janghorban, R., Bozorgzadeh, S, et al. The effect of maternal intravenous hydration on amniotic fluid index in oligohydramnios.BMC Res Notes.2022;15(95).

12. Habib N, Syed S, Khurshid N, Habib A. Efficacy of intravenous hydration versus amino acid infusion in idiopathic oligohydramnios. Ann PIMS ShaheedZulfiqar Ali Bhutto Med Univ.2021;17(1):23–7.

13. Borges VTM, Rososchansky J, Abbade JF, Dias A, Peraçoli JC, RudgeMVC.Effect of maternal hydration on the increase of amniotic fluid index.Brazilian J Med Biol Res.2011;44:263–6.

14. Zaman Z, Imran F, Iqbal MJ. Role of Enoxaparin to Improve Obstetrical Outcome in Patients with IUGR and Oligohydramnios J. Soc. Obstet. Gynaecol. Pak. 2018; Vol 8(4):232-237.

15. Akhtar N, Hameed N. Role of low molecular weight heparin in adverse obstetrical outcome in-patients due to oligohydroamnios and severe IUGR. Pak J Physiol 2015;11(1):17–9.

16. Hou L, Wang X, Hellerstein S, Zou L, Ruan Y, Zhang W.Delivery mode and perinatal outcome after diagnosis of oligohydramnios at term in China.JMatern fetal Neonatal Med.2020;33(14):2408-2414. Doi;10.1080/14767058.2018.1553944.

17. Patel PK, Pitre DS, Gupta H. Pregnancy outcome in isolated oligohydramnios at term. Ntl J of Community Med. 2015;6(2):84-8.

18. Panda S, Jayalakshmi M, ShashiKumari G, Mahalakshmi G, Srujan Y, Anusha V. Oligoamnios and Perinatal Outcome. J ObstetGynaecol India. 2017;67(2):104-108.

19. HomairaS.Fetomaternal Outcome in Term Oligohydramnios.SchInt J ObstetGynec, 2020; 3(11): 227-231.

20. Adhikari A, Gurung TK, Adhikari SP. Perinatal outcome in term pregnancy with isolated Oligohydramnios.JNGMC.2021;19.