Impact of abnormal amniotic fluid index on maternal and perinatal outcomes in term pregnancies

Abstract

Amniotic fluid, the protective medium within the amniotic sac, plays a vital role in fetal development and maternal well-being during pregnancy. Abnormal amniotic fluid index (AFI), including oligohydramnios (AFI ≤ 2 cm) and polyhydramnios (AFI ≥ 8 cm), is associated with various maternal and fetal complications such as preeclampsia (6.6%), antepartum hemorrhage (3.1%), gestational diabetes (3.5%), prematurity, and intrauterine growth restriction. The objective of this study was to evaluate fetomaternal outcomes in full-term pregnancies with abnormal AFI, with the aim of informing delivery timing and improving both maternal and neonatal outcomes. Furthermore, the study explores the utility of ultrasonography and Doppler imaging in identifying and managing high-risk cases.

A prospective observational study was conducted on 60 term pregnancies meeting the inclusion criteria after obtaining informed consent. The incidence of oligohydramnios was 5.33%, and polyhydramnios was 2%. Most cases were observed in women aged 20 to 24 years, with a higher prevalence among primigravida. Oligohydramnios was frequently associated with postdated pregnancy, whereas polyhydramnios was predominantly linked to maternal diabetes. Both conditions were significantly associated with increased rates of cesarean delivery, fetal distress, and neonatal intensive care unit admissions.

The findings emphasize the clinical significance of regular AFI monitoring, particularly beyond 37 weeks of gestation. Ultrasonography, coupled with Doppler studies, proved valuable in early detection and informed decision-making, ultimately contributing to better perinatal outcomes. Early identification and timely intervention in pregnancies complicated by abnormal AFI can reduce adverse fetomaternal outcomes and guide clinicians in optimizing delivery management strategies.

1. Introduction

Amniotic fluid (AF) is the protective liquid contained within the amniotic sac of the pregnant uterus. It begins to form as a fluid-filled extracoelomic cavity even before the embryo is recognized.^[1] In the first trimester, human AF is isotonic with maternal or fetal plasma and contains minimal protein.^[2] It exhibits low oxygen tension and elevated concentrations of sugar alcohols, reflecting anaerobic metabolism.^[3] The fluid originates from transudation of plasma across the nonkeratinized fetal skin, maternal decidua, and placental surface.^[4]

As gestation advances, the composition of AF diverges from plasma. AF osmolality and sodium levels decrease due to the production of dilute fetal urine. AF osmolality decreases by 20 to 30 mOsm/kg, reaching 85% to 90% of maternal serum levels. During the second half of pregnancy, concentrations of urea, creatinine, and uric acid in AF increase, often exceeding fetal plasma levels by 2 to 3 times.^[5] AF provides essential protection against trauma, cord compression, and infection. It is also critical for fetal musculoskeletal, pulmonary, and gastrointestinal development.^[6] Normal AF volume increases from approximately 30 mL at 10 weeks to 200 mL at 16 weeks, peaking between 400 and 1200 mL at 34 to 38 weeks. After 38 weeks, the volume declines by about 125 mL/wk, averaging 800 mL at 40 weeks.^[7]

The most common method for calculating the amniotic fluid index (AFI) is ultrasonographic assessment of the largest vertical pocket in each of the 4 uterine quadrants.^[8] A single vertical pocket of 2 to 8 cm is considered normal. An AFI ≥ 8 cm is defined as polyhydramnios, while an AFI ≤ 2 cm is defined as oligohydramnios. Polyhydramnios occurs in 0.4% to 1.2% of pregnancies and is associated with increased perinatal mortality due to fetal malformations, immaturity, diabetes, and potentially preeclampsia. Maternal complications include preeclampsia (6.6%), antepartum hemorrhage (3.1%), gestational diabetes (3.5%) with preexisting diabetes (0.3%), abruptio placentae (2.2%), anemia (1.2%), urinary tract infection (UTI), rhesus isoimmunization, intrauterine infection, and acute renal failure. Fetal complications include preterm delivery (<37 weeks) in 28.6% of cases and congenital anomalies in 18% of polyhydramnios-affected deliveries. Common malformations involve the central nervous system (CNS; 31%), musculoskeletal (12%), gastrointestinal (10%), cardiovascular (9%), hydrops fetalis (6.5%), cleft lip and palate (5%), urinary (3.9%), respiratory (3.2%), and other systems (0.5%).^[9]

Oligohydramnios is seen in 1% to 5% of pregnancies, particularly between 34 and 42 weeks of gestation.^[10] Causes vary by trimester. In the first trimester, these include congenital heart anomalies, chromosomal aneuploidy, fetal demise, membrane rupture, or iatrogenic factors (e.g., post-chorionic villous sampling), or may remain idiopathic.^[11,12] Second trimester causes include congenital urinary tract obstruction (51%), preterm premature rupture of membranes (PROM; 34%), placental abruption, amniochorionic separation (7%), early/severe intrauterine growth restriction (IUGR; 5%), and unknown causes (3%).^[12,13] In the third trimester, oligohydramnios may result from PROM, IUGR, placental abruption, fetal anomalies, medications (e.g., ACE inhibitors or prostaglandin synthase inhibitors), or be idiopathic.^[13,14] Complications include cord compression, musculoskeletal deformities (e.g., facial distortion, clubfoot), pulmonary hypoplasia, and IUGR. Amnion nodosum is frequently observed. It is associated with abnormal fetal heart rate, fetal distress, fetal asphyxia, and often necessitates lower segment cesarean section (LSCS), contributing to increased perinatal morbidity and mortality.^[15]

Doppler waveforms of the umbilical artery offer an indirect assessment of uteroplacental insufficiency^[16] and play a critical role in evaluating high-risk pregnancies.^[17] Common Doppler indices include the systolic/diastolic (S/D) ratio,^[18] resistance index,^[19] and pulsatility index.^[20] These reflect downstream vascular resistance. Normally, the umbilical artery maintains diastolic flow, and the placental bed demonstrates low resistance and high perfusion. The S/D ratio decreases from 4.0 at 20 weeks to 2.0 at 40 weeks, typically remaining below 3.0 after 30 weeks. Elevated S/D ratios indicate conditions such as maternal hypertension, poorly controlled diabetes, IUGR, and placental insufficiency.^[18] Resistance index typically ranges from 0.6 at 20 weeks to 0.5 at 40 weeks,^[21] and pulsatility index ranges from 2.0 to 1.5 in the second trimester to 1.5 to 1.0 in the third trimester.^[22] Abnormalities progress from reduced to absent and eventually reversed end-diastolic flow.^[23] Identifying fetuses at risk due to increased placental resistance is essential to prevent complications. Fetuses with abnormal Doppler findings are at higher risk for oligohydramnios, preterm delivery, low birth weight, low appearance, pulse, grimace, activity, respiration (APGAR) scores, and neonatal intensive care unit (NICU) admissions.^[24]

Management of high-risk pregnancies using Doppler indices improves perinatal outcomes by reducing the need for labor induction, increasing the use of cesarean section where indicated, shortening hospital stays, and lowering perinatal mortality. Absent or reversed end-diastolic flow is strongly associated with adverse outcomes such as preterm delivery, stillbirth, and long-term neurodevelopmental impairment.^[25]

Therefore, this study aims to evaluate fetomaternal outcomes in full-term pregnancies with abnormal AFI, facilitating appropriate timing of delivery and improving both maternal and neonatal outcomes. Additionally, it highlights the role of ultrasonography and Doppler in identifying high-risk pregnancies, allowing timely interventions and reducing morbidity, and mortality.

2. Methodology

2.1. Study design and setting

This hospital-based, cross-sectional study was conducted over a period of 6 months at a tertiary maternity healthcare center. The primary objective was to evaluate fetomaternal outcomes in full-term pregnancies complicated by abnormal AFI, specifically focusing on cases of oligohydramnios and polyhydramnios.

2.2. Sampling method and sample size

Participants were selected using a convenience sampling method. All women with singleton term pregnancies presenting to the antenatal outpatient department, emergency services, or admitted to the inpatient obstetric ward, who met the inclusion criteria, were recruited. Approximately 110 women presented with abnormal AF levels during the study period, of which around 30 had polyhydramnios and 80 had oligohydramnios. A target sample size of 60 was determined for the study. In light of the lower incidence of polyhydramnios compared to oligohydramnios, a sampling ratio of 5:1 was maintained, including 5 cases of oligohydramnios for every case of polyhydramnios.

2.3. Inclusion and exclusion criteria

Pregnant women with singleton term pregnancies whose ultrasonographic scans demonstrated an AFI of ≤8 cm (oligohydramnios) or ≥25 cm (polyhydramnios) were included in the study. Women were excluded if they had intrauterine fetal demise or if their AFI fell within the normal range, defined as >8 cm and <25 cm.

2.4. Data collection

Patient data were collected from medical records. A detailed history was obtained, including age, parity, residence, occupation, menstrual and contraceptive history, and a full obstetric history encompassing antenatal visits, previous medical or surgical conditions, and past pregnancy outcomes. Each patient underwent a general physical and abdominal examination to ensure they met the study criteria. Gestational age was confirmed using the last menstrual period, ultrasound scan, and clinical examination. All cases underwent ultrasonographic assessment, and Doppler velocimetry was performed in cases of severe oligohydramnios. The S/D ratio of the umbilical artery was assessed, and any absence or reversal of end-diastolic flow was noted. The pregnancy outcome, including mode of delivery, delivery findings, fetal outcome and complications, and maternal condition and complications, was documented in detail.

2.5. Data analysis

Data were entered and analyzed using SPSS software version 16 (IBM Corp., Armonk). Continuous variables were presented as mean ± standard deviation, while categorical variables were expressed as frequencies and percentages. Findings were displayed in the form of tables, charts, and diagrams as appropriate. Pearson’s correlation coefficient was applied for statistical analysis, and a P-value of <.05 was considered statistically significant.

3. Results

A total of 60 women with abnormal AFI were included in the study, comprising 16 cases of polyhydramnios and 44 cases of oligohydramnios. All participants provided written informed consent prior to inclusion. Each patient underwent a detailed clinical evaluation including history-taking, physical examination, ultrasonographic assessment, and Doppler velocimetry when indicated. Delivery decisions were made based on clinical condition, investigative findings, and obstetric judgment. Maternal and perinatal outcomes were documented and analyzed comprehensively.

The distribution of maternal age showed that the highest proportion of cases in both the polyhydramnios and oligohydramnios groups fell within the 20 to 24 years age bracket. Specifically, 50% (n = 8) of women with polyhydramnios and 50% (n = 22) of those with oligohydramnios belonged to this age group. The mean maternal age in both groups was 22 years, with the age range extending from 19 to 40 years (Fig. 1).

Figure 1.

Distribution of polyhydramnios and oligohydramnios according to age.

Regarding parity, a majority of the women in both groups were primigravida. Among the polyhydramnios group, 69% were primigravida, followed by 18.75% who were gravida 2, and 12.5% who were gravida 3. Similarly, in the oligohydramnios group, 59.1% were primigravida, 22.72% were gravida 2, 13.64% were gravida 3, and 4.54% were gravida 4 (Fig. 2).

Figure 2.

Distribution of polyhydramnios and oligohydramnios according to parity.

In the oligohydramnios group, postdated pregnancy was the most commonly associated maternal condition, present in 36.36% of cases. PROM was observed in 13.63% of cases, while pregnancy-induced hypertension (PIH) was reported in 6.81%. Anaemia was also noted as a frequent comorbidity (Table 1). Fetal anomalies accounted for 6.81% of oligohydramnios cases, including 1 case each of gastrointestinal, CNS, and cardiovascular malformations (Table 2).

Table 1.

Maternal factors associated with oligohydraminos.

Factors	AFI (cm)		Total number
	<5 cm	5–8 cm
PIH	0	3	3 (6.81%)
PROM	1	5	6 (13.63%)
Chronic abruption	0	0	0
Postdated pregnancy (40–42 wk)	1	15	16 (36.36%)
Post term pregnancy (>42 wk)	0	0	0

AFI = amniotic fluid index, PIH = pregnancy-induced hypertension, PROM = premature rupture of membranes.

Table 2.

Fetal factors associated with oligohydraminos.

Factors	AFI (cm)		Total number
	<5 cm	5–8 cm
GIT abnormalities	0	1	1 (2.27%)
CNS abnormalities	1	0	1 (2.27%)
CVS abnormality	1	0	1 (2.27%)
Congenital infections	0	0	0

AFI = amniotic fluid index, CNS = central nervous system, CVS = cardiovascular system, GIT = gastrointestinal tract.

Among the polyhydramnios group, maternal DM was identified in 25% (n = 4) of cases, while PIH was reported in 12.5% (n = 2; Table 3). A single fetal anomaly involving the CNS was observed in this group, constituting 6.25% of polyhydramnios cases (Table 4).

Table 3.

Maternal factors associated with polyhydramnios.

Factors	AFI (cm)			Total number
	25–30 cm	30–35 cm	>35 cm
Diabetes mellitus	4	0	0	4 (25%)
PIH	2	0	0	2 (12.5)
Rh isoimmunization	0	0	0	0
Rh incompatibility	0	0	0	0
Cardiac abnormality	0	0	0	0

AFI = amniotic fluid index, PIH = pregnancy-induced hypertension.

Table 4.

Fetal factors associated with polyhydramnios.

Factors	AFI (cm)			Total number
	25–30 cm	30–35 cm	>35 cm
CNS defects	0	1	0	1 (6.25%)
GIT abnormalities	0	0	0	0
Skelatal malformation	0	0	0	0
Fetal tumor	0	0	0	0
CVS abnormality	0	0	0	0
Intrauterine infections	0	0	0	0

AFI = amniotic fluid index, CNS = central nervous system, CVS = cardiovascular system, GIT = gastrointestinal tract.

Maternal complications in the oligohydramnios group included preeclampsia (PE)/PIH in 4 women (9.09%), and single cases (2.27% each) of postpartum hemorrhage (PPH), anemia, and UTI. In the polyhydramnios group, PPH was noted in 2 cases (12.5%), while 1 case each of gestational DM, renal complications, and maternal fever with dyspnea was recorded (Fig. 3).

Figure 3.

Maternal outcome. DVT = deep vein thrombosis, GDM = gestational diabetes mellitus, PE = preeclampsia, PPH = postpartum hemorrhage, UTI = urinary tract infection.

In terms of neonatal outcomes, 6 newborns (13.63%) in the oligohydramnios group had low APGAR scores (<5 at 1 minute, <7 at 5 minutes). Five infants (11.36%) weighed <2.5 kg, and 6 (13.63%) required admission to the NICU/special care baby unit (SCBU). One case (2.27%) was associated with a congenital anomaly and neonatal death. In contrast, within the polyhydramnios group, 2 neonates (12.5%) required NICU/SCBU admission, and 1 (6.25%) presented with a congenital anomaly and low APGAR scores (Fig. 4).

Figure 4.

Fetal outcome. APGAR = appearance, pulse, grimace, activity, respiration, NICU = neonatal intensive care unit, NND = neonatal death, SB = stillbirth, SCBU = special care baby unit.

With respect to mode of delivery, 26 women (70.46%) with oligohydramnios underwent LSCS, while 12 (27.27%) had vaginal deliveries and 1 (2.27%) required instrumental delivery. In the polyhydramnios group, vaginal delivery occurred in 9 women (56.25%) and LSCS in 7 cases (43.75%; Fig. 5).

Figure 5.

Mode of delivery. LSCS = lower segment cesarean section.

4. Discussion

Polyhydramnios is a relatively less common complication in pregnancy compared to oligohydramnios in clinical practice. Out of a total of 60 cases in our study, 44 cases of oligohydramnios were identified. The incidence of polyhydramnios was 2%, which is comparable and similar to the findings of Bundgaard et al,^[26] while the incidence was slightly lower in the study by Rajgire et al,^[27] reporting 1.5% cases of polyhydramnios, and slightly higher in the study by Pri-Paz et al,^[28] with an incidence of 2.3%.

Oligohydramnios is a relatively common complication during pregnancy and is frequently encountered in clinical practice. A total of 44 cases of oligohydramnios were recorded in the present study, yielding an incidence of 5.35%, which is comparable to the findings of Mishra et al,^[29] who reported an incidence of 0.5% to 5%. Shivalingaiah et al^[30] and Gaikwad et al^[31] reported slightly higher incidences of 3% to 7% and 3% to 8%, respectively. Tajinder et al^[32] and Goyal et al^[33] reported higher incidences of 10% and 15%, respectively, compared to our study.

In this study, among the 16 cases of polyhydramnios, the mean maternal age was 22 years, with a maximum age of 33 years and a minimum age of 19 years. A study conducted by Magann et al^[34] reported a mean maternal age of 23 years, ranging between 21 and 28 years, which is similar to our findings. In contrast, Tajinder et al^[32] reported an age group of 27 to 35 years with a mean age of 31 years.

For oligohydramnios, among 44 cases, the mean maternal age was also 22 years, with a maximum age of 38 years and a minimum age of 20 years. Studies by Tajinder et al^[32] and Dhakal et al^[35] showed that the majority of cases occurred in the age group of 21 to 25 years, similar to our study. Gaikwad et al^[31] reported a mean age of 25.31 years, while Mathur et al^[36] found that 54.6% of patients were between 37 and 40 years of age. Comparatively, in our study and several others, the majority of cases occurred in women under 30 years of age, which is within the reproductive age group.

Regarding parity, in cases of oligohydramnios, approximately 60% were primigravida, followed by 22.72% gravida 2, 13.64% gravida 3, and 4.54% gravida 4, which is similar to findings by Chauhan et al^[37] Gaikwad et al^[31] reported 31 cases of primigravida and 18 multigravida, while Mathur et al^[36] conducted a comparative analytical study on 150 pregnant women beyond 34 weeks of gestation with oligohydramnios (AFI < 5 cm), observing that the majority of cases were primigravida across all age groups.

In polyhydramnios cases, about 68% were primigravida, followed by 18.75% gravida 2 and 12.5% gravida 3, similar to Tajinder et al,^[32] who found 60% of polyhydramnios patients were nullipara. Raghuwanshi et al^[38] observed 50% nulliparous women. Rajgire et al^[27] reported 40% primigravida, 33.3% gravida 2, and 26.6% gravida >2, with primigravida being the largest group – though lower than in our study.

The most common maternal condition associated with oligohydramnios was postdated pregnancy (36.36%), followed by PROM (13.63%) and PIH (6.81%), findings similar to those of Raghuwanshi et al,^[38] who reported postmaturity >42 weeks (35.7%), PE (10.7%), eclampsia (3.5%), and PROM (21%). Similarly, Guin et al^[39] noted postmaturity (38.5%) and PROM (30%) as common maternal factors. Raghuwanshi et al^[38] reported 50% postmaturity, 30% PIH, and 30% PROM, which are higher compared to our findings.

In polyhydramnios cases, among 16 patients, 6 had maternal factors, including 4 cases (25%) of diabetes mellitus (DM) and 2 cases (12.5%) of PIH. These results are consistent with Guin et al,^[39] who found 20% DM and 17% PIH. Tajinder et al^[32] reported 14.3% each of DM, PIH, and Rh incompatibility.

Regarding fetal risk factors in oligohydramnios, 1 case each of gastrointestinal tract, CNS, and cardiovascular system abnormalities were recorded, accounting for 2.27% each, with an overall anomaly rate of 7%. This is similar to Tajinder et al,^[32] who reported renal anomalies (6.4%) and spina bifida (1.6%), with an overall abnormality rate of 8%. The variation in maternal and fetal risk factors across studies may be due to differences in geographical location, lifestyle, literacy rates, and socioeconomic status.

Among the 44 women diagnosed with oligohydramnios, 4 women (9.09%) had PE/PIH, and 1 woman (2.27%) each had PPH, anemia, and UTI. In cases of polyhydramnios, 2 women (12.5%) had PPH, and 1 case (6.25%) each had gestational diabetes mellitus, renal complications, and maternal fever with dyspnea. Guin et al^[39] reported 5% diabetes and 20% PPH in polyhydramnios. Sonak et al^[40] identified preterm labor (46%) as the most common maternal complication, followed by malpresentation (11%), atonic PPH (10%), PROM (9%), eclampsia (7%), abruption placenta (6%), and dyspnea (4%), which were slightly higher than in our study. Guin et al^[39] also reported 21% fetal congenital anomalies in oligohydramnios.

In terms of fetal outcomes, among the 44 oligohydramnios cases, 6 newborns (13.63%) had low APGAR scores (<5 at 1 minute, <7 at 5 minutes), 5 newborns (11.36%) had birth weights <2.5 kg, and 6 babies (13.63%) required NICU/SCBU admission. There was 1 case (2.27%) each of congenital anomaly and neonatal death. In the 16 cases of polyhydramnios, 2 newborns (12.5%) were admitted to NICU/SCBU, and 1 baby (6.25%) had a congenital anomaly and low APGAR score, findings similar to those of Chidanandaiah et al,^[41] who reported thick meconium (46%), low APGAR score at 5 minutes (16%), birth weight <2.5 kg (12%), NICU admission (4%), and congenital anomalies/neonatal mortality (2%). Tajinder et al^[32] also reported high rates of low APGAR scores (<7 at 1 minute) in both oligohydramnios and polyhydramnios groups. The incidence of intrauterine death and macrosomia was significantly higher in the polyhydramnios group. Radhamani et al^[42] observed APGAR <7 at 5 minutes, 17.7% with birth weight <2.5 kg, and 6.9% requiring NICU admission.

Regarding mode of delivery, among 44 cases of oligohydramnios, 26 (70.46%) underwent LSCS, 12 (27.27%) had vaginal delivery, and 1 (2.27%) had an instrumental delivery. Among 16 polyhydramnios cases, 9 (56.25%) had vaginal deliveries, and 7 (43.75%) underwent LSCS, consistent with the findings of Varghese et al,^[43] who reported 8% labor induction, 16% vaginal delivery, and 84% LSCS in group 1; 24% labor induction, 29% vaginal delivery, and 71% LSCS in group 2; and 50% each for labor induction, vaginal delivery, and LSCS in group 3. Sonak et al^[40] reported 62% LSCS and 38% vaginal deliveries in polyhydramnios, while 57% of controls with normal AF volume delivered vaginally and 43% by cesarean section, which is slightly higher than our study. Radhamani et al^[42] and Tajinder et al^[32] found that in isolated oligohydramnios cases, 55.4% and 52.4% had vaginal delivery, while 44.6% and 38.1% underwent LSCS, respectively. In polyhydramnios groups, the rates of cesarean, instrumental, and normal deliveries were 28.6%, which is lower than in our study.

This study has several limitations that should be considered when interpreting the findings. First, the study was conducted at a single tertiary care center with a relatively small sample size, which may limit the generalizability of the results to the broader population. Second, a convenience sampling method was used, introducing potential selection bias. Third, the lower incidence of polyhydramnios compared to oligohydramnios led to an unequal sampling ratio, which may affect the comparability of outcomes between groups. Additionally, while ultrasonography and Doppler assessments were performed, inter-observer variability was not formally assessed, which may impact the reproducibility of findings. Finally, certain maternal and fetal outcomes could have been influenced by confounding factors such as underlying medical conditions or variations in obstetric management, which were not fully controlled for in this study. Future multicenter studies with larger, more balanced cohorts and standardized protocols are recommended to validate and expand upon these results.

5. Conclusion

Thus, oligohydramnios is a more prevalent AF abnormality compared to polyhydramnios, with the majority of affected women being young primigravidas within the reproductive age group. Postdated pregnancy emerged as the most common maternal factor associated with oligohydramnios, whereas DM and PIH were predominant in polyhydramnios cases. Both conditions were linked to adverse perinatal outcomes, including low APGAR scores, increased NICU admissions, and congenital anomalies. Cesarean delivery was more frequently required in oligohydramnios, reflecting the heightened obstetric risk. These findings underscore the importance of vigilant antenatal monitoring and timely intervention to improve maternal and fetal outcomes in pregnancies complicated by abnormal AF volumes.

Acknowledgments

Authors are thankful to the department of obstetrics and gynecology for providing the needful information and guidance for the study. We extend our gratitude to all the study participants for their cooperation and support.

Author contributions

Conceptualization: Dinesh Kumar Meet.

Data curation: Dinesh Kumar Meet, Birendra Kumar Yadav, Sanjay Karki.

Formal analysis: Birendra Kumar Yadav, Bibisa Bhandari, Sanjay Karki.

Investigation: Birendra Kumar Yadav.

Methodology: Prajwol Thapa.

Resources: Prajwol Thapa.

Software: Prajwol Thapa.

Supervision: Sajjad Ahmed Khan, Tarun Pradhan, Anisha Uprety.

Validation: Anisha Uprety.

Visualization: Anisha Uprety.

Writing – original draft: Dinesh Kumar Meet, Sajjad Ahmed Khan, Bibisa Bhandari.

Writing – review & editing: Sajjad Ahmed Khan, Tarun Pradhan.