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Aminotic Fluid Index and its Correlation with Fetal Growth and Perinatal Outcome

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Abstract

The present study aimed to measure amniotic fluid index (AFI) in high-risk pregnancies at ≥30 weeks of gestation and its correlation with fetal growth and perinatal outcome. The Study was carried out in the Department of Obstetrics and Gynecology Hindu Rao Hospital, Delhi. Ultrasound examination was done on women with high-risk pregnancy (pregnancy-induced hypertension, intrauterine growth restriction, diabetes, and postdated pregnancy etc.) attending the antenatal OPD and maternity ward at ≥30 weeks of gestation. AFI was measured by the four quadrant technique. The study included 48 (48 %) primigravida and 52 (52 %) multigravida. Sixteen patients with a history of previous abortion had mean AFI of 9.97 cm which was lower than patients with no history of previous abortion i.e., 11.87 cm (P ≥ 0.1 insignificant). The mean AFI was maximum between 34–36 weeks, i.e., 13.1 cm, after which, it gradually decreased to 9.08 cm beyond 40 weeks. Mean AFI of patients with <40 weeks of gestation gradually decreased from 12.2 cm to 8.0 cm after 42 weeks (P value <0.05). Patients with IUGR had low mean AFI i.e., 9.8 cm whereas mean AFI in patients without IUGR was 12.1 cm (P value <0.01). Congenital anomalies were found in 4 % patients in the present study. Out of seven cases of perinatal mortality encountered, four (57 %) had abnormal AFI values, of which, two had low AFI (i.e., <8 cm) and two had abnormally-high AFI values i.e., >18 cm. Serious congenital malformations were present in three neonates, which resulted in early neonatal death. Out of these three, one patient had low AFI i.e., <8 cm and one had abnormally-high AFI value i.e., >24 cm. The study supports the view that AFI is a quick, noninvasive, and good indicator of fetal outcome in high-risk pregnancy.
ORIGINAL ARTICLE
Aminotic Fluid Index and its Correlation with Fetal Growth
and Perinatal Outcome
Sonia Madaan
1
Suman Lata Mendiratta
1
Pawan Kumar Jain
2
Meenakshi Mittal
1
Received: 25 March 2015 / Accepted: 29 July 2015 / Published online: 28 August 2015
ÓSociety of Fetal Medicine 2015
Abstract The present study aimed to measure amniotic
fluid index (AFI) in high-risk pregnancies at C30 weeks of
gestation and its correlation with fetal growth and perinatal
outcome. The Study was carried out in the Department of
Obstetrics and Gynecology Hindu Rao Hospital, Delhi.
Ultrasound examination was done on women with high-
risk pregnancy (pregnancy-induced hypertension,
intrauterine growth restriction, diabetes, and postdated
pregnancy etc.) attending the antenatal OPD and maternity
ward at C30 weeks of gestation. AFI was measured by the
four quadrant technique. The study included 48 (48 %)
primigravida and 52 (52 %) multigravida. Sixteen patients
with a history of previous abortion had mean AFI of
9.97 cm which was lower than patients with no history of
previous abortion i.e., 11.87 cm (P C0.1 insignificant).
The mean AFI was maximum between 34–36 weeks, i.e.,
13.1 cm, after which, it gradually decreased to 9.08 cm
beyond 40 weeks. Mean AFI of patients with \40 weeks
of gestation gradually decreased from 12.2 cm to 8.0 cm
after 42 weeks (P value \0.05). Patients with IUGR had
low mean AFI i.e., 9.8 cm whereas mean AFI in patients
without IUGR was 12.1 cm (P value \0.01). Congenital
anomalies were found in 4 % patients in the present study.
Out of seven cases of perinatal mortality encountered, four
(57 %) had abnormal AFI values, of which, two had low
AFI (i.e., \8 cm) and two had abnormally-high AFI values
i.e., [18 cm. Serious congenital malformations were pre-
sent in three neonates, which resulted in early neonatal
death. Out of these three, one patient had low AFI
i.e., \8 cm and one had abnormally-high AFI value
i.e., [24 cm. The study supports the view that AFI is a
quick, noninvasive, and good indicator of fetal outcome in
high-risk pregnancy.
Keywords Amniotic fluid index (AFI)
Oligohdramnios Polyhdramnios IUGR Perinatal
outcome High-risk pregnancy
Introduction
Amniotic fluid acts as a protective layer which exerts a
cushion-like effect for the growing fetus against mechani-
cal and biological injury. Amniotic fluid may be regarded
as the largest part of the fetal extracellular space, and it
provides a more accessible means than fetal blood for
investigation of the fetus and its environment. Amniotic
fluid assessment is an integral part of the antenatal evalu-
ation of pregnancies at risk for an adverse pregnancy out-
come especially in the third trimester [1,2]. Detecting the
fetus at risk for in utero damage or death, quantifying, and
balancing the fetal risk against the risk of neonatal com-
plications from immaturity, and determining the optimal
time and mode of intervention are the cornerstone of
modern day obstetrics care and perinatal medicine [3].
Reduced amniotic fluid volume (AFV) is associated
with adverse effects such as meconium staining, congenital
anomalies, growth retardation, dysmaturity, and fetal
asphyxia [46]. Polyhydramnios is sometimes associated
with major fetal anomalies [5], aneuploidy, macrosomia,
and stillbirth [6]. Decreased AFV in those pregnancies
&Suman Lata Mendiratta
sumanmendi@yahoo.co.in
1
Obstetrics & Gynaecology Department, North DMC Medical
College & Hindu Rao Hospital, A-3/224, Janakpuri,
New Delhi 110058, India
2
Radiology Department, North DMC Medical College &
Hindu Rao Hospital, New Delhi, India
123
J. Fetal Med. (June 2015) 2:61–67
DOI 10.1007/s40556-015-0049-8
Article published online: 2023-05-08
without premature rupture of the membranes can reflect a
fetus in chronic stress, shunting of blood to its brain,
adrenal and heart and away from other organs, which
include the kidney, and results in decreased fetal renal
perfusion and urinary output. Phelan et al. [7] have rec-
ommended that labor induction be considered in patients
with oligohydramnios (AFI \5 cm) to reduce the
increased risk of fetal death and morbidity. An antepartum
amniotic fluid index (AFI) of 5 cm or less is a predictor of
adverse perinatal outcome in terms of meconium staining,
cesarean section for fetal distress, birth weight, low Apgar
scores and cord pH [8]. AFI of [18 cm is taken as cut-off
point for normal limit of AFI. Pregnancy complicated with
polyhydramnios is also classified as high risk. AFV can be
measured by dye-dilution techniques and by direct quan-
tification at the time of cesarean delivery, but both methods
are invasive, require laboratory support, and when mea-
sured at the time of operative abdominal delivery, cannot
be used serially to evaluate high-risk pregnancies [1]. The
limitation of the direct AFV measurement led to the use of
ultrasonic AFV estimation. Ultrasonography is noninvasive
and can clinically quantitate the AFV. There are various
reported ultrasonographic modalities to assess AFV like (1)
single deepest pocket (2) 2-diameter pocket, and (3) AFI by
4-quadrant method. Since the introduction of AFI by
Phelan et al. [7], a rapid semi-quantitative assessment of
AFV can be performed quickly, is easily taught, and is
reproducible.
AFI also facilitated the diagnosis of a congenital
anomaly not detected in referring clinics. The antepartum
information regarding malformation was valuable for the
patients and their health-care providers in deciding on the
timing and mode of delivery, determining an etiology of
intrauterine or postnatal death, and counseling of future
pregnancies. The present study was aimed to measure AFI
in high-risk pregnancies C30 weeks of gestation and its
correlation with fetal outcome.
Materials and Methods
This was a one year prospective study undertaken in the
department of Obstetrics and Gynecology, Hindu Rao
Hospital, Delhi a period of one year, after obtaining
ethical clearance from institutional committee. Ultra-
sound examination was done on women with high-risk
pregnancy (pregnancy-induced hypertension, intrauterine
growth restriction, diabetes, and postdated pregnancy
etc.) attending the antenatal OPD and maternity ward
at C30 weeks of gestation. Only patients who were sure
of dates were included in the study. Patients with pre-
mature rupture of membranes and twin pregnancy were
excluded from the study.
A detailed history was taken and a general physical and
obstetrics examination were done. The patient was then
subjected to ultrasonographic examination. Routine scan
for fetal well being was done and AFI was measured by the
4-quadrant technique [7]. The vertical diameter of the
maximum pocket was measured in centimeters in each of
the four quadrants and measurement obtained from each
quadrants were summed to form the AFI in centime-
ters.Follow-up of these patients was done till delivery and
their neonatal outcome was noted in terms of fetal distress
in labor, birth weight, Apgar at five minutes, congenital
anomalies, and perinatal mortality. The results were com-
piled and analyzed.
Results
The present study was conducted on 100 antenatal patients
over a period of one year. All the 100 patients included in
the study had attended antenatal OPD/maternity ward at
Hindu Rao Hospital and delivered at the Labor Room in
Hindu Rao Hospital and the results were analyzed as
follows.
The majority of cases i.e., 62 (62 %) were in the age
group of 21–25 years, followed by 27 (27 %) in the age
group 26–30 years, and the least were among the age
group [31 years (2 %). The mean age for the entire study
population was 24.31 years. The mean AFI for all age
groups was 11.567 ±5.364 cm. Present study included 48
(48 %) primigravida and 52 (52 %) multigravida.
The maximum cases i.e., 36 (36 %) had a gestational
age between 36 to 38 weeks at the time of enrollment. The
mean AFI was maximum, between 34–36 weeks i.e.,
13.1 cm, after which, it gradually decreased to 9.08 cm
beyond 40 weeks (Table 1). Mean AFI of patients
with \40 weeks of gestation gradually decreased from
12.2 cm to 8.0 cm after 42 weeks (P value \0.05) implies
significant relationship between post-term pregnancy and
AFI.
Antenatal complications in the present study group show
that anemia (Hb \10 g %) was the commonest compli-
cation found in 27 % cases, followed by IUGR (24 %),
PIH (20 %), previous abortions (16 %) cases, previous
lower segment cesarean section (11 %), oligohydramnios
(8 %), post-term pregnancy (6 %), and polyhydramnios
(5 %) being the next common complications (Table 2).
Mean AFI of patients with IUGR was 9.8 cm whereas
that in patients without IUGR was 12.1 cm, implies a
highly-significant relationship between IUGR and AFI. It
was found that out of 20 patients who were hypertensive, 8
(40 %) had low AFI i.e., \8 cm. The mean AFI of
hypertensive patients was 10.7 cm which was not signifi-
cantly different, statistically, from mean AFI of
62 J. Fetal Med. (June 2015) 2:61–67
123
normotensive patients i.e., 11.7 cm. The mean AFI in
patients with anemia was 11.63 cm which was not signif-
icantly different from patients without anemia i.e.,
11.54 cm. There was no disparity between AFI in preg-
nancies with previous LSCS and non-LSCS group, mean
AFI being 11.864 and 11.530 in cases and controls,
respectively. Mean AFI of patients \40 weeks gradually
decreased from 12.2 cm to 9.085 cm at [40 weeks and
8.0 cm after 42 weeks. There is no significant relation
between diabetes mellitus and AFI, though mean AFI in
pregnancies with diabetes (12.3 cm) was found to be more
than those without diabetes (11.5 cm). Mean AFI in Rh-
negative pregnancies was 12.8 cm which was slightly
higher than rest of the cases i.e., 11.5 cm. The mean AFI of
16 patients with a history of previous abortion was 9.97 cm
which was lower than those with no history of previous
abortions i.e., 11.87 cm.
Table 3depicts the relation of clinical assessment of
liquor to the AFI obtained ultrasonographically. Mean AFI
of 65 patients with clinically-normal liquor was 11.9 cm;
mean AFI of 27 patients with clinically-less liquor was
6.7 cm and mean AFI of eight cases with clinically-more
liquor was 24.3 cm. Statistical tests were applied and it was
found that clinical estimation of liquor has a sensitivity of
74.35 % and a specificity of 90.16 %, the accuracy being
84 %. Table 4depicts AFI in relation to delivery outcomes.
Discussion
The present study was undertaken to measure AFI in high-
risk pregnancies and to correlate it with fetal outcome. The
mean maternal age in this study was 24.31 ±3.19 years.
Magann et al. [9,10] in 1999 and 1997 reported the mean
Table 1 Distribution of
patients according to gestation
age at enrollment
POG at enrollment (weeks) No. of patients Mean AFI (cm) SD
30–32 1 4.000
32–34 4 9.200 1.860
34–36 15 13.133 7.067
36–38 36 12.908 5.602
38–40 24 11.354 4.977
[40 20 9.085 2.948
Total 100 11.567 5.364
AFI amniotic fluid index, POG period of gestation, SD standard deviation
Table 2 AFI in various high-risk pregnancy groups (some cases had more than one high-risk factor)
High-risk pregnancy factor No. of cases (out of 100) Mean AFI (cm) in cases Mean AFI (cm) in controls SD
IUGR 24 9.821 12.118 5.650
Hypertension 20 10.740 11.774 4.859
Anemia 27 11.637 11.541 2.690
Previous LSCS 11 11.864 11.530 6.581
Post-term [40 wks 20 9.085 12.188 2.948
Diabetes 5 12.300 11.528 5.709
Rh-negative 5 12.840 11.500 2.806
Previous abortions 16 9.97 11.870 2.617
AFI amniotic fluid index, IUGR intrauterine growth restriction, LCSC lower segment cesarean section, SD standard deviation
Table 3 Comparison of AFI
and clinical assessment of liquor
(by palpation)
Clinical assessment of liquor No. of cases % Mean AFI SD
Normal 65 65 11.975 3.417
Less 27 27 6.785 1.789
More 8 8 24.388 3.272
Total 100 100 11.567 5.364
PB0.001 (very highly significant)
J. Fetal Med. (June 2015) 2:61–67 63
123
Table 4 AFI in relation to delivery outcomes
Mode of delivery in relation to AFI
a
Mode of delivery No. of cases % Mean AFI (cm) SD
Normal 63 63 12.162 4.999
Forceps 8 8 9.663 5.808
Cesarean 29 29 10.800 5.959
Total 100 100 11.567 5.364
Labor (spontaneous or induced) in relation to AFI
b
Labor No. of cases % Mean AFI SD
Spontaneous 54 98.35 11.976 4.385
Induced 25 31.64 11.024 6.255
Total 79 100 11.675 5.030
AFI in relation to meconium staining of liquor
c
Meconium staining of liquor No. of cases % Mean AFI SD
Absent 85 85 11.754 5.020
Present 15 15 10.507 7.131
Total 100 100 11.567 5.364
Relation of AFI with fetal heart rate
d
FHR No. of cases % Mean AFI SD
Normal 84 84 11.429 4.841
Bradycardia 12 12 11.975 7.507
Tachycardia 4 4 13.250 9.465
Total 100 100 11.567 5.364
AFI and its relation to birth weight
e
Birth weight (g) N % Mean AFI SD
\2000 17 17 7.976 2.467
2001–2500 27 27 12.448 6.526
2501–3000 43 43 12.247 4.106
[3000 13 13 12.185 7.476
Total 100 100 11.567 5.364
Apgar (5 min) versus AFI
f
Apgar N % Mean AFI SD
\9 10 10 11.550 8.448
9–10 90 90 11.569 4.976
Total 100 100 11.567 5.364
Congenital anomalies in the study group
g
Congenital anomaly Number AFI (cm)
Bilateral CTEV 1 6.3
Osteogenetis imperfecta 1 7.0
Fetal ascites ?treacheoesophageal interval ?laryngeal stenosis 1 26.0
Tracheoesophageal fistula ?anal agenesis 1 10.0
64 J. Fetal Med. (June 2015) 2:61–67
123
maternal age of 24.8 ±5.3 and 24.5 ±0.5 years, respec-
tively, which was comparative to our study. In our study
parity has no relation to the distribution of cases as was
seen in the study conducted by Magann et al. [10].
In our study anemia was the commonest complication,
seen in 27 (27 %). Other significant complications were
IUGR (24 %), PIH (20 %), previous LSCS (11 %), oligo-
hydramnios (8 %), post-term pregnancy (6 %), and poly-
hydramnios (5 %). Magann et al. [11] reported IUGR in
4.74 %, PIH 3.16 %, and post-term pregnancy in 24.65 %
patients. Golan et al. [12] reported IUGR in 24.5 % and
hypertension in 22.1 %. In our study, among 27 % cases
that had anemia, no correlation was found between anemia
and AFI.
In our study, out of 29 patients with AFI \8 cm, 12
(41.4 %) patients had IUGR. O’Brien et al. [13] concluded
that fetal growth retardation is significantly associated with
an AFI of 7 cm, or less (P B0.001).
In the present study, 20 (20 %) patients were hyper-
tensive. Out of these patients, eight (40 %) had low AFI
scores (\8 cm). In a study conducted by O’Brien et al.
[13], out of 14 patients of mild PIH, only two patients i.e.,
14 % had a low AFI score (B7 cm). In a study by Magann
et al. [14] on patients with AFI \5 cm, 7.16 % patients
were found to be hypertensive.
In this study, out of six patients with post-term preg-
nancy, oligohydramnios (AFI \5 cm) was seen in 2
(33.3 %) cases. In a study conducted by Marks and Divon
[14] on post-term pregnancy, oligohydramnios was
demonstrated in 59 (11.5 %) patients. If diabetes is asso-
ciated with macrosomia and neural tube defects, polyhy-
dramnios may develop. In our study, it was observed that
mean AFI of five patients with diabetes was more
(12.3 cm) than nondiabetic patients (11.5 cm) though it
was not statistically significant (P value C0.1).
In the present study, AFI according to gestational age
was studied. The mean AFI was 11.567 cm. Maximum AFI
of 13.13 cm (mean) was seen at 34–36 weeks of gestation,
which gradually decreased to 9.085 (mean) after 40 weeks.
Similarly, Phelan et al. [7] demonstrated a mean AFI of
12.9 ±4.6 in 353 pregnancies at the gestational age
ranging from 36–42 weeks. Bowen-Chatoor and Kulkarni
[15] demonstrated a mean AFI of 9.93 ±4.37 cm at
42 weeks, which is comparable to our study.
In our study, it was observed that mean AFI of five
patients with Rh-negative pregnancy was more i.e.,
12.84 cm than rest of patients i.e., 11.5 cm. Mean maternal
weight in our study was 64.87 ±9.66 kg, with majority of
cases between 50–65 kg. Fifty four (68.35 %) patients had
spontaneous onset of labor while 25 (31.64 %) were
induced. The main indication for induction was PIH, IUGR
followed by postdated pregnancy.
In this study, out of 29 patients with low AFI (\8 cm),
six (20.7 %) had forceps delivery, whereas 13 (44.8 %)
Table 4 continued
AFI versus perinatal mortality
h
Perinatal mortality AFI (cm)
\8 8–18 [18
Fresh stillbirth 1
Neonatal death 2 3 1
AFI amniotic fluid index, CTEV congenital talipes equinovarus, FHR fetal heart rate, SD standard deviation
a
Mean AFI in patients undergoing assisted delivery was found to be lower (9.66 cm in forceps and 10.8 cm in cesarean group) than mean AFI in
patients undergoing normal delivery (i.e., 12.16 cm). It was also found that among 28 patients who had low AFI, 6 patients (42 %) had forceps
delivery whereas 13 (46.42 %) had cesarean section
b
The commonest cause of induction of labor in the study group was PIH (32 %), IUGR (16 %) and post-dated pregnancy (12 %)
c
PC0.1. The mean value of AFI (10.5 cm) in patients with meconium staining of liquor was not significantly different from those without
meconium staining of liquor (11.7 cm). P C0.1 (not significant)
d
PB0.1 (not significant). There was no correlation between the FHR and AFI. Out of 28 patients with low AFI, six (21.42 %) had fetal
bradycardia and two (7.14 %) had fetal tachycardia
e
PB0.05 (significant relation). Mean AFI was found to be significantly lower (7.9 cm) in low birth weight group \2000 g (P value \0.05),
implies significant relation between birth weight and AFI
f
PC0.1 (not significant). Mean AFI in patients with APGAR \9 was not found to be significantly different from mean AFI in patients with
Apgar [9
g
Congenital anomalies were found in 4 % patients in our study. The salient feature noted was that three (75 %) out of these four cases had
abnormal AFI scores, two cases had low AFI scores (\8 cm) and one had high AFI value ([24 cm) while mean AFI of the remaining study
group was 11.54 cm
h
Out of seven cases of perinatal mortality encountered in our study, four (57 %) had abnormal AFI values, of which two had low AFI
(i.e., \8 cm) and two had abnormally-high AFI values (i.e., [18 cm). Three neonates had serious congenital malformations which resulted in
early neonatal death, of which one patient had low AFI (i.e., \8 cm) and one had abnormally-high AFI value (i.e., [24 cm)
J. Fetal Med. (June 2015) 2:61–67 65
123
patients had cesarean section. Out of 61 patients with
normal AFI, 47 (77 %) had normal delivery. According to
Rutherford et al. [16], incidence of cesarean section was
58 % in patients with AFI \8 cm which is slightly more
than our study. Their cesarean section rate in patients with
AFI [18 cm was 41 %, which was low (30 %) in our
study.
In our study, 15 cases had meconium-stained liquor, out
of which eight (53.33 %) had low AFI scores (B8 cm). In a
study by Golan et al. [12], a high incidence of meconium
staining of liquor (29.1 %) was seen in oligohydramnios. In
another study by Magann et al. [11], meconium-stained
amniotic fluid was seen in 13.8 % patients with
AFI B5 cm. In our study, out of eight patients with low
AFI (B5 cm), two (25 %) had fetal bradycardia. In a
similar study by Magann et al. [11], it was found that in
patients with AFI \5 cm, 24 % patients had fetal brady-
cardia, which was comparable to our study.
In our study, out of 29 patients with low AFI (B8 cm),
17 (58.62 %) had low birth weight babies (B2500 g). In 10
patients with AFI [18 cm, five (50 %) had low birth
weight babies. Martinez-Frias et al. [17] also observed
similar results in their study. According to Chauhan et al.
[18], AFI of \5 cm is associated with an increased risk of
low (\7) Apgar score.
In our study, four patients had babies with congenital
anomalies, out of which, two (50 %) had low AFI \8cm
and one had AFI [18 cm. In the study conducted by
Martinez- Frias et al. [17] on malformed newborns, 3.01 %
had oligohydramnios. Renal anomalies and lung defects
were associated with oligohydramnios. They reported
polyhydramnios in 3.69 % cases in their study. Esophageal
and gastrointestinal anomalies, neural tube defects, and
other central nervous system malformations were associ-
ated with polyhydramnios. In our study, osteogenesis
imperfecta and bilateral CTEV were associated with low
AFI of \8 cm, and tracheoesophageal fistula was associ-
ated with AFI [18 cm.
In our study perinatal mortality rate was 7 %. Of these
seven cases, three babies (42.85 %) had serious congenital
malformations, two cases (28.57 %) had low AFI
of \8 cm and two cases (28.57 %) had AFI [18 cm.
Biggio et al. [19] reported 6 % perinatal mortality in their
study of 370 women, which was comparable to our study.
Conclusion
Amniotic fluid provides a more accessible means than fetal
blood for surveillance of the fetus and its environment.
Amniotic fluid assessment is an integral part of the ante-
natal evaluation of pregnancies at risk for an adverse
pregnancy outcome. Our study supports the view that AFI
is a quick, noninvasive and good indicator of fetal outcome
in high-risk pregnancy.
Funding None.
Compliance with Ethical Standards
Conflict of interest None.
References
1. Magann EF, Chauhan SP, Bofil JA, et al. Comaparability of
the amniotic fluid index and single deepest pocket measure-
ment in clinical practice. Aust N Z J Obstet Gynecol.
2003;43:75–7.
2. Kofinas A, Kofinas G. Differences in amniotic fluid pattern and
fetal biometric parameters in third trimester pregnancies with and
without diabetes. J Matern Fetal Neonatal Med. 2006;19(10):
633–8.
3. Manning FA. Antepartum fetal testing: a critical appraisal. Curr
Opin Obstet Gynecol. 2009;21(4):348–52.
4. Moore TR. Amniotic fluid dynamics reflect fetal and maternal
health and disease. Obstet Gynecol. 2010;116:759–65.
5. Hashimoto BE, Kramer DJ, Brennan L. Amniotic fluid volume:
fluid dynamics and measurement technique. Semin Ultrasound
CT MR. 1993;14:40–55.
6. Sarno AP Jr, Ahn MO, Phelan JP. Intrapartum amniotic fluid
volume at term. J Reprod Med. 1990;35:719–23.
7. Phelan JP, Smith CV, Broussard Small M, et al. Amniotic fluid
volume assessment using four quadrant technique in pregnancy
between 36 and 42 weeks gestation. J Reprod Med. 1987;32:
540–2.
8. Nageotte MP, Towers CV, Asat T, et al. Perinatal outcome with
the modified biophysical profile. Am J Obstet Gynecol. 1994;
170(6):1672–6.
9. Magann EF, Nevils BG, Chauhan SP, et al. Low amniotic fluid
volume is poorly identified in singleton and twin pregnancies
using the 2 92 cm pocket technique of the biophysical profile.
South Med J. 1999;92:802–5.
10. Magann EF, Perry KG Jr, Chauhan SP, et al. The accuracy
of ultrasound evalution of amniotic fluid volume in singleton
pregnancies: the effect of operator experiences and ultra-
sound interpretative technique. J Clin Ultrasound.
1997;25:249–53.
11. Magann EF, Kinsella MI, Chauhan SP, et al. Does amniotic
fluid index of B5 cm necessitate delivery in high-risk pregnan-
cies? A case control study. Am J Obstet Gynecol. 1999;
180(6):1354–9.
12. Golan A, Lin G, Evron S, et al. Oligohydramnios: maternal
complications and fetal outcome in 145 cases. Gynecol Obstet
Invest. 1994;37(2):91–5.
13. O’Brien JM, Mercer BM, Friedman SA, et al. Amniotic fluid
index in hospitalized hypertensive patients managed expectantly.
Obstet Gynecol. 1993;82:247–50.
14. Marks AD, Divon MY. Longitudinal study of the amniotic
fluid index in post date pregnancy. Obstet Gynecol. 1992;
79:229–33.
15. Bowen-Chatoor JS, Kulkarni SK. Amniotic fluid index in the
management of the postdates pregnancy. West Indian Med J.
1995;44(2):64–6.
66 J. Fetal Med. (June 2015) 2:61–67
123
16. Rutherford SE, Phelan JP, Smith CV, et al. The four-quadrant
assessment of amniotic fluid volume: an adjunct to antepartum
fetal heart rate testing. Obstet Gynecol. 1987;70:353–6.
17. Martinez-Frias ML, Bermejo E, Rodriguez-Pinilla E, et al.
Maternal and fetal factors related to abnormal amniotic fluid.
J Perinatol. 1999;19(7):514–20.
18. Chauhan SP, Roberts WE, Martin JN Jr, et al. Amniotic fluid
index in normal pregnancy: a longitudinal study. J Miss State
Med Assoc. 1999;40(2):221–4.
19. Biggio JR, Wenstrom KD, Dubard MB, et al. Hydramnios pre-
diction of adverse perinatal outcome. Obstet Gynecol.
1999;94:773–7.
J. Fetal Med. (June 2015) 2:61–67 67
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... 9,10 An antepartum amniotic fluid index (AFI) of 5 cm or less and AFI of >18 cm are predictors of adverse perinatal outcomes. 11 In an Indian study, cesarean section was more in oligohydramnios, 42.8% as against 22.2% in polyhydramnios subjects. Perinatal mortality in polyhydramnios subjects (42.25%) was significantly higher than in oligohydramnios subjects (12.9%) and the incidence 107 of congenital anomalies was 8.5% in the oligohydramnios group while it was 31% in polyhydramnios. ...
... 21 In a study by Madaan S et al, 20 % of patients were hypertensive, and 40 % of them had low AFI scores (<8 cm). 22 In the present study, GDM (53.33%) was the commonest complication seen in patients with polyhydramnios, followed by preeclampsia (20%) and gestational hypertension (13.13%). A commonly supported theory is that polyhydramnios in diabetic pregnancies could be a result of maternal hyperglycemia, which in turn, produces fetal hyperglycemia and osmotic diuresis. ...
... 27 In the present study, among oligohydramnios patients, the majority (56.94%) had low birth weight babies ≤ 2.59 kg followed by normal birth weight and among the polyhydramnios patients, the majority (61.54%) had normal birth weight babies followed by overweight babies. In contrast, in a study by Madaan et al 22 , out of the patients with low AFI (<8 cm), 58.62 % had low birth weight babies, and among patients with AFI>8 cm, 50 % had low birth weight babies. Martinez-Frias ML et al also observed similar results in their study. ...
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Objective: The present study was conducted to study fetomaternal outcomes in oligohydramnios and polyhydramnios. Methods: This prospective observational study was conducted in the department of obstetrics and gynecology at Dhanalakshmi Srinivasan Medical College and Hospital, Perambalur, on 150 cases of oligohydramnios and 50 cases of polyhydramnios. Amniotic fluid index was calculated according to Phelan index. Women with amniotic fluid index (AFI) of ≥ 25 were taken as polyhydramnios group, and AFI of ≤ 5 were taken as oligohydramnios group. These women were closely monitored throughout their antenatal, intrapartum, and postpartum period until one week after birth. Categorical outcomes were compared between study groups using the chi-square test. P value < 0.05 was considered statistically significant. Result: In the present study, majority of the oligohydramnios patients underwent cesarean section (CS) (61.33%) and fetal distress (78.26%) was the common cause for CS. Preeclampsia (66.67%) was found to be the major maternal complication in the oligohydramnios group and GDM (53.33%) in the polyhydramnios patients. Majority of the babies of oligohydramnios patients had low birth weight (56.94%). A high perinatal mortality rate was observed in the polyhydramnios (28%) group and more than half of the babies (53.33%) of the oligohydramnios patients were admitted in NICU compared to 28% in the polyhydramnios group. Conclusion: The abnormal liquor volume is often associated with an increased incidence of labor complications, cesarean section, and adverse perinatal outcomes.
... Among a total n = 280 subjects majority n = 124 (44.4%) were in the age group 25-30 years, followed by n = 108 (38.5%) in 18-25 years age group and least n = 9 (3.2%) were between 35-40 years age group. The study conducted by Sonian Madaan et al. [9] observed that the majority of subjects 62% were in the age group 21-25 years, followed by 27% in the age group 26-30 years, and the least (2%) were in the age group >31 years. The results of the study conducted by Biradar and Shamanewadi [10] recorded that the mean age of the subjects was 22.4 ± 3.5 year with majority 64% were belonging to the age group 21-25 years. ...
... Runoo Ghosh [13] study results recorded 65.5% study participants belonged to the age group 20-25 years. In the present study 50.9% subjects were primipara while 49.2% were multiparous similar results were reported earlier by Sonian Madaan et al. [9] recording 48% study participants were primigravida and 52%) multigravida. Patel et al. [14] observed 58.75% of the study participants were primipara and 41.25% were multipara. ...
... The present study results noted that 14.6% subjects were between 37-38 weeks of gestational age, 78.1% were between 38-39 weeks of gestation followed by 7.5% with 39-40 week of gestation. Sonian Madaan et al. [9] study results recorded that the maximum cases 36% participant's gestational age was between 36-38 weeks at the time of enrolment. Bhagat and Chawla [15] study results showed that gestational age was < 37 weeks in 56% participants. ...
... So optimum level of amniotic fluid is essential for fetal well-being. This is also an integral part of the antenatal evaluation of pregnancies at risk for any adverse pregnancy outcome especially in the third trimester [2] . Quantity of the liquor volume changes throughout pregnancy, increasing linearly until the early third trimester and then remaining constant until term. ...
... Majority (57%) of the patients in this study are multigravida whereas 43% of patients are primigravida. Similarly, Madaan et al [2] considered patients with 52% multi and 48% primigravida. Another study conducted by Bakhsh et al. [14] where 75.1% were mutigravida and 24.9% were primigravida. ...
... These abnormal umbilical arterial Doppler velocimetric findings and aberrant spectral flow patterns have an association with perinatal mortality that ranges from 28% to 80% 1,2,8,9 . Amniotic fluid assessment is an integral part of the antenatal evaluation of pregnancies that are at high risk of an adverse outcome 10 . A reduction in the amniotic fluid termed oligohydramnios, reflects a fetus in chronic distress which produces reduced urinary output due to the re-direction of blood to the brain at the expense of renal blood perfusion, is intimately associated with IUGR 5,10-12 . ...
... cm and we accordingly postulated that probably in the vicinity of this study, pregnant women in the last trimester with borderline oligohydramnios should be closely monitored for IUGR with scrupulous evaluation of UADI. In consonance with our disposition, Madaan et al. 10 , whose research involved high-risk pregnancies above 30 weeks of gestation, noted that the mean value of AFI in women with IUGR was 9.82 cm, and this value is within our range for borderline oligohydramnios. The study was conducted in a single center which limited the enrollment of subjects from other facilities within the city, who might possibly demonstrate abnormal UADI. ...
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Intrauterine growth restriction (IUGR) may occur in the presence of normal fetal growth parameters, with resultant unanticipated perinatal morbidity and mortality. Umbilical arterial Doppler evaluation determines the fetuses susceptible to compromise by detecting IUGR early enough for successful intervention measures to be implemented. This study was aimed at determining the prevalence of abnormal umbilical arterial Doppler indices (UADI) in apparently normal pregnancies and to assess its correlation with amniotic fluid index (AFI). In this prospective cross-sectional study, obstetric sonographic examination and UADI evaluation were done on 310 apparently normal pregnant women between 26 to 40 weeks within a 6-months period. Abnormal UADI had a prevalence of 10.3%. Educational level (P = 0.000) and employment status (P = 0.000) were significantly associated with abnormal UADI. Abnormal umbilical arterial resistivity index (RI) had a significant correlation with EFW (P = 0.000) and HC/AC (P = 0.000) but no significant relationship with AFI (P = 0.593). The prevalence of abnormal umbilical arterial Doppler indices was high in apparently normal pregnancies mostly among women with low socio-economic status, with no demonstrable association with AFI.
... [7] . Madaan et al. suggested that oligohydramnios is a predictor of adverse perinatal outcome in terms of meconium staining, caesarean section for fetal distress, low apgar score [8] . In our study, the mean AFI in the patients undergoing LSCS was 10.63 cm, instrumental delivery was 10.63 cm and normal delivery was 11.36 cm. ...
... Indicating that the assessment of maternal serum HPL concentration mirrors the intrauterine status of the amniotic fluid. Oligohydramnios and borderline oligohydramnios have been found to be associated with adverse effects such as IUGR, fetal distress, congenital anomalies and perinatal mortality (Madaan et al., 2015). Healy et al, (1985) in a move to illuminate the relationship between both, postulated that the human chorionic laeve in a developing pregnancy has HPL receptors on its surface that are exclusively bound to by HPL which consequently affects amniotic fluid volume and in the index study it might appear that when the maternal serum HPL concentration reduces, the binding sites for the hormone becomes incompletely occupied and this likely reduces amniotic fluid production. ...
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Summary: Human placental lactogen (HPL) is a pregnancy-related hormone produced by the placenta. The overall functions of serum HPL impacts the developing fetus and placenta. The objective of this study was to determine the relationship between maternal serum concentration of HPL and sonographic fetal growth parameters in pregnancy induced hypertension as a marker of placental function. This prospective cross-sectional study was conducted over a 9-month period in the University of Calabar Teaching Hospital, Calabar, Nigeria that involved 100 women with pregnancy induced hypertension. An obstetric ultrasound scan was done on all the subjects and their blood was collected for HPL evaluation using Enzyme-linked Immunosorbent Assay (ELISA). ANOVA and Pearson’s correlation were used to analyze the data. Maternal serum HPL had a significant positive correlation with PLA (P=0.000), EGA (P=0.000), EFW (P=0.000) and AFI (P=0.000) and a significant negative correlation with Proteinuria (P=0.047), FHR (P=0.032) and HC/AC (P=0.000). It is concluded that maternal serum HPL concentration increases as pregnancy advances and causes a significant increase in placental thickness, fetal weight and amniotic fluid volume, however, its reduction is significantly associated with the onset of pre-eclampsia, fetal distress and asymmetrical intra-uterine growth restriction. Thus, the evaluation of maternal serum HPL concentration is a reliable marker of placental function in the second half of pregnancy.
... Amniotic fluid act as protective fluid which provides cushion like effect on fetus as well as provide the space for physical growth and musculoskeletal growth of the growing fetus, promote development of fetal lung, and also helps in aversion of umbilical cord compression. 11,12 Low AFI has been associated with adverse fetal and maternal outcome. This study was conducted on 100 antenatal females with mean age of 24.6±3.9 ...
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AFI may be an important predictor for deciding timing of delivery and adverse maternal and fetal outcome. Hence, we aimed at determining whether an antepartum low amniotic fluid index (AFI) is a predictor of adverse perinatal outcome in normal pregnancy and to determine a threshold level of AFI that could predict an adverse outcome. This study was conducted as an observational study on a total of 100 antenatal females presenting with term pregnancy at Department of Obstetrics and Gynecology, Lord Mahavir Civil Hospital, Ludhiana during study period. Detailed history and clinical examination was done. AFI was assessed with help of USG. The study was conducted on a total of 100 antenatal females. AFI was <5 in 38%. Low AFI was associated with LSCS and negative fern test was statistically significant (p<0.05). We observed a significant association of low AFI with low birth weight, poor APGAR score at 1 as well as 5 minutes and higher risk of NICU admission (p<0.05). The area under the curve and sensitivity as well as specificity at cutoff (4.5) was maximum for NICU admission followed by LSCS (p<0.05). AFI is an important determinant of adverse maternal and fetal outcome. AFI <5 is associated with adverse maternal outcome in the form of higher operative delivery and adverse fetal outcome i.e. low birth weight, meconium stained liquor, low APGAR score and higher NICU admission. Intensive intrapartum care along with fetal surveillance may help in minimizing adverse perinatal outcomes.
... Detecting the fetus at risk for in utero damage or death, quantifying, and balancing the fetal risk against the risk of neonatal complications from immaturity, and determining the optimal time and mode of intervention is the cornerstone of modern day obstetrics care and perinatal medicine. 1 Assessment of amniotic fluid volume by ultra sonography is more reliable. 2 Amniotic fluid index (AFI) is the preferred method of amniotic fluid measurement in pregnancy although single deepest pocket is used in pregnancies. ...
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Objectives: To determine the frequency of perinatal outcome in pregnant females at term having low amniotic fluid index. Study Design: Descriptive, Case Series study. Setting: Department of Obstetrics & Gynecology, Independent University Hospital, Faisalabad. Period: 1st October 2019 to 31st March 2020. Materials & Methods: A total of 90 women having singleton pregnancy with cephalic presentation having 37-40 weeks of gestation with AFI <8cm, 20 to 35 years of age were included. Patients with multiple pregnancy, ruptured membrane, fetal anomaly, gestational diabetes and Rh Incompatibility were excluded. Cesarean delivery, meconium stained liquor, low birth weight, NICU admission and APGAR score <7 at 5 min were assessed by consultant gynecologist. Results: Age range in this study was from 20 to 35 years with mean age of 28.92 + 4.45 years. Majority of the patients 43 (47.77%) were between 31 to 35 years of age. Mean gestational age was 38.31 + 1.20 weeks. Mean parity was 2.72 + 1.02. In this study, frequency of perinatal outcome in pregnant females at term having low amniotic fluid index was as follows; cesarean section was performed in 60 (66.67%), low birth weight was observed in 58 (64.44%) patients, APGAR score <7 at 5 minutes in 56 (62.22%), meconium stained liquor in 24 (26.67%) and NICU admission in 17 (18.89%) patients. Conclusion: This study concluded that proper antenatal monitoring and management should be done in these high risk patients in order to reduce the morbidity and mortality of the fetus.
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Introduction: Oligohydramnios is an abnormality of amniotic fluid which is one of the common complications during pregnancy and a threat to foetal development. Often it is associated with maternal risk factors like uteroplacental insufficiency, hypertension and preeclampsia which by themselves can affect perinatal outcome. Aim: To determine the perinatal outcome in isolated oligohydramnios with Amniotic Fluid Index (AFI) ≤5cm at term pregnancies. Materials and Methods: This was a hospital-based prospective case-control study done in Department of Obstetrics and Gynaecology at District Hospital Tumakuru, Karnataka, India, from January 2019 to July 2020. The study included two groups i.e, case group included 150 pregnant females with Amniotic Fluid Index (AFI) ≤5 cm and control group included 150 pregnant females with AFI range between 6-24 cm. After interview of all participants, all the information was entered in the proforma. All newborn babies birth weight, APGAR scores (Appearance, Pulse, Grimace, Activity, and Respiration) at 1st and 5th minute was recorded. Categorical outcomes were compared between the groups using Chi-square test. A p-value
Article
One hundred and forty-five cases of oligohydramnios in the second and third trimester were diagnosed by ultrasonography out of 25,000 obstetrics patients (0.58%). In this group, pregnancy complications included hypertension (22.1%) and bleeding in the second trimester (4.1%). We found a high incidence of meconium-stained amniotic fluid (29.1%), fetal distress (7.9%) and premature placental separation (4.2%). IUGR occurred in 24.5% of cases. Asphyxia during labor occurred in 11.5% and different other perinatal problems in 23.5%. Cesarean section was performed in 35.2% of these pregnancies. Seventeen percent of the cases presented as breech. Intrauterine fetal death occurred in 5.5% of these pregnancies. The gross perinatal mortality was 16% and the corrected perinatal mortality was 10.7%. The overall rate of fetal malformations was 11% and that of lethal malformations 4.8%. The skeletal (7.6%) and urinary system (4.1%) were the predominant systems affected. Oligohydramnios is associated with a higher rate of pregnancy complications and increased fetal morbidity and mortality, and thus termination should be considered when pulmonary maturity is present or in cases of fetal distress.
Article
Compared with the era in obstetric practice before the advent of ultrasonography, much is presently known about the normative values for amniotic fluid volume and the mechanisms by which this important fluid is regulated. Certainly the management protocols for conditions with extremes of amniotic fluid volume have evolved and become more exact, resulting in interventions more likely to improve outcome. However, much is still unclear: we do not have tools to measure amniotic fluid volume with precision, and measurement of fetal urinary output is cumbersome and error prone. Future research should focus on achieving a better understanding of these issues so fundamentally related to the maintenance of maternal- fetal homeostasis. © 2010 by The American College of Obstetricians and Gynecologists. Published by Lippincott Williams &Wilkins.
Article
Recognition of the fetus at risk for death or damage in utero, quantifying the risk, balancing fetal risk against the risk of neonatal complications from immaturity and determining optimal time and mode of intervention, is a cornerstone of modern perinatal medicine. Antepartum fetal testing is essential in making these crucial decisions. The art and science of fetal assessment is fluid. In this treatise, the evolution of testing is reviewed, test accuracy results examined and suggestions for future applications are considered. Composite testing of a range of fetal biophysical variables is an excellent predictor of fetal acidemia and risk of death or damage. Confusion regarding the optimal means of measuring one of these variables, amniotic fluid volume, has been addressed in the literature and contemporary studies from several independent sources indicate that the amniotic fluid index method should be abandoned in favor of the maximal vertical pocket method. It is becoming increasingly more evident that a spectrum of fetal testing modalities based on interrogation of different aspects of fetal adaptive responses to adversity is preferable in fetal testing. Further it is evident that in some fetal diseases, such as intrauterine growth restriction, fetal condition may change acutely and accordingly best outcome is achieved by much more frequent testing. The question of whether intervention for fetal compromise can prevent subsequent neurological sequelae remains open. There has been remarkable advancement in identifying the fetus at risk. The concept of multispectral combined fetal testing including acute biophysical variables, amniotic fluid volume and arterial and venous Doppler flow velocity waveforms is established.
Article
Amniotic fluid (AF) was measured in 511 post-dates pregnancies (at least 41 weeks of gestational age) with the use of the AF index. Ultrasonographic evaluations were conducted on a semiweekly basis. Only patients with reliable gestational ages calculated from certain last menstrual period and confirmed by early sonographic estimates participated in the study. Oligohydramnios (AF index of 5.0 cm or less) was detected in 11.5% of the study population. Longitudinal data were available from 121 patients who demonstrated a mean 25% decrease in AF index per week beyond 41 weeks' gestation. The longitudinal change in AF index was statistically significant (P less than .0005). Amniotic fluid index measurements ranged from 1.7-24.6 cm, with a mean of 12.4 at 41 weeks' gestation. Compared with previous cross-sectional studies, this longitudinal study provides a more accurate estimate of changes in AF levels as a function of gestational age.
Article
The amniotic fluid index (AFI), a semiquantitative technique for assessing amniotic fluid volume, has been shown to be a useful adjunct in antepartum surveillance. We evaluated the usefulness of the AFI in the early intrapartum period as it relates to subsequent fetal morbidity and fetal heart rate patterns. Two hundred term gravidas presenting in the latent phase of labor with vertex-presenting fetuses were studied. An intrapartum AFI less than or equal to 5.0 cm was associated with a significant increase in the risk of cesarean section for fetal distress and of an Apgar score of less than 7 at one minute as well as abnormal fetal heart rate patterns in late labor. The majority (71.4%) of the patients with an intrapartum AFI less than or equal to 5.0 cm had ruptured membranes on entry; however, there was no significant difference in outcome when they were compared to patients with intact membranes and oligohydramnios. Variable decelerations on entry were associated with oligohydramnios in 43.8% of the patients. An AFI less than or equal to 5.0 cm in the early intrapartum period is a risk factor for perinatal morbidity and abnormal fetal heart rate patterns in subsequent labor, and ruptured membranes in early labor are a risk factor for oligohydramnios.
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An ultrasound approach was developed to identify normal amniotic fluid volume. The uterine cavity was divided into four quadrants. With the use of linear-array, real-time B-scanning, the vertical diameter of the largest pocket in each quadrant was measured. The sum of these four quadrants was used to provide a single number for the amniotic fluid volume and termed the amniotic fluid index. This approach is simple, requires little time and gives a semiquantitative estimate of amniotic fluid volume. Based on our observations, the normal amniotic fluid index in term gestation is 12.9 +/- 4.6 cm. Evaluation of the relationship between amniotic fluid volume and fetal outcome is under investigation.
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Amniotic fluid volume assessment using a semiquantitative four-quadrant technique, the amniotic fluid index, was evaluated in relationship to fetal heart rate (FHR) testing and perinatal morbidity in 330 high-risk pregnancies. An inverse relationship was found between the amniotic fluid index and nonreactive nonstress tests (NST), FHR decelerations, meconium staining, cesarean section for fetal distress, and low Apgar scores. More important, adverse perinatal outcome was significantly more frequent with diminished compared with normal amniotic fluid volume, even if the NST was reactive.
Article
This is a prospective evaluation of the relationship between the amniotic fluid index (AFI) and perinatal outcome in 55 postdates pregnancies. The gravid abdomen was divided into four quadrants, using real-time ultrasound with a 3.5 mHz transducer, the largest pocket of amniotic fluid in each quadrant was measured and their sum totalled to arrive at the amniotic fluid index. AFI in this study ranged from 2.8 cm to 22.6 cm. The mean for 41 weeks was 13.52 +/- 4.6 cm and for 42 weeks, 9.93 +/- 4.37 cm. Oligohydramnios was noted in four patients, AFI less than 5.3 cm. Two of these cases developed intrapartum foetal distress and had Caesarean Section. All four babies were admitted with meconium aspiration and one died from this complication.
Article
Our purpose was to evaluate perinatal outcomes in high-risk pregnancies monitored with a modified biophysical profile. All non-insulin-dependent patients referred for antepartum fetal surveillance received a modified biophysical profile biweekly. A modified biophysical profile is a combination of a nonstress test and an amniotic fluid index. Patients with a singleton gestation and intact membranes were entered into a protocol of randomized backup testing for an abnormal modified biophysical profile. Those patients having a nonreactive fetal heart rate, significant variable decelerations, late decelerations, or an amniotic fluid index < or = 5.0 cm received either a contraction stress test or a biophysical profile immediately. Once randomized, a patient received the same backup test, when indicated, with subsequent testing. A total of 2774 patients had 17,429 tests with an uncorrected perinatal mortality rate of 2.9 per 1000. The overall incidence of an adverse perinatal outcome (i.e., perinatal death or nursery death before infant hospital discharge, cesarean delivery for fetal distress within the first 2 hours of labor, 5-minute Apgar score < 7, neonatal seizures or grade III or IV central nervous system hemorrhage) was 7.0%. When compared with patients having persistently normal modified biophysical profile, patients requiring a backup test had a significantly greater incidence of adverse perinatal outcome (9.3% vs 4.9%, p < 0.001, odds ratio 2.0, 95% confidence interval 1.5 to 2.7) and small-for-gestational-age infants (5.2% vs 2.4%, p < 0.001, odds ratio 2.2, 95% confidence interval 1.5 to 3.5). No differences in outcomes between patients randomized to a contraction stress test versus a biophysical profile could be identified either overall or in limiting the analysis to outcome after a negative last test. However, patients having contraction stress test as a backup test had a significantly higher rate of intervention for an abnormal test result than did those having a biophysical profile backup test (23.7% vs 16.6%, p < 0.002, odds ratio 1.6, 95% confidence interval 1.2 to 2.1). The modified biophysical profile is an excellent means of fetal surveillance and identifies a group of patients at increased risk for adverse perinatal outcome and small-for-gestational-age infants. There does not appear to be a significant benefit with the contraction stress test compared with the biophysical profile as a backup test. Further, the contraction stress test is associated with a higher rate of intervention for an abnormal test than is the biophysical profile.
Article
To determine the relationship between low amniotic fluid (AF) index and fetal growth retardation (FGR), fetal distress, and cesarean delivery in patients hospitalized for hypertensive disease, and to describe changes in AF status in relation to the severity of maternal disease. The AF index in 142 hospitalized hypertensive patients was followed per an inpatient protocol with semi-weekly testing; medical records were reviewed to obtain delivery data. Fetal growth retardation was significantly associated with an AF index of 5.0 cm or less or 7.0 cm or less (P < .001) at initial assessment, with positive predictive values of 86 and 52%, respectively. However, the sensitivity of an AF index of 5.0 cm or less or 7.0 cm or less to detect FGR was limited (21 and 46%, respectively). Fetal distress and cesarean delivery were not associated with an AF index of 5.0 cm or less or 7.0 cm or less throughout observation in this cohort. Based upon a definition of oligohydramnios as an AF index of 7.0 cm or less, the AF status worsened from an initial normal value in 39% of patients whose final diagnosis was severe preeclampsia, versus only 14% of patients who were diagnosed as having mild disease. The AF index also normalized in ten patients who were originally diagnosed with oligohydramnios and admitted for expectant management. Only one of these women was diagnosed with severe preeclampsia. 1) Depending on the definition, the incidence of oligohydramnios ranges from 10-30% in hypertensive patients requiring hospitalization; 2) an AF index of 5.0 cm or less at initial evaluation predicts FGR but lacks sensitivity; 3) the AF status frequently changes with serial assessment, and these changes appear to be related to the severity of hypertensive disease; and 4) the frequency of the obstetric complications studied depends more upon the severity of hypertensive disease than on its potential effect of inducing oligohydramnios.