Amniotic Fluid Index Measurements Research Articles

Next-generation monitoring in obstetrics: Assessing the accuracy of non-piezo portable ultrasound technology.

The emergence of handheld ultrasound devices capable of connecting to cell phones or tablets heralds a significant advancement in medical technology, particularly within the field of obstetrics. These devices offer the promise of immediate bedside ultrasound examinations, potentially revolutionizing patient care by enabling fetal assessments in diverse settings. This prospective study aimed to validate the reliability of non-piezo, chip-based handheld ultrasound devices in clinical obstetric practice. Conducted in a university hospital obstetric ward, the study included 100 pregnant women between 17 and 41 weeks of gestation. Participants underwent ultrasound examinations using both conventional and portable point-of-care ultrasound (POCUS) devices to compare the accuracy in estimating fetal weight and other parameters, such as cardiac activity, fetal presentation, placental location, and amniotic fluid volume. The reliability and agreement between the devices were assessed using intraclass correlation coefficients, Bland-Altman plots, and Pearson correlation coefficients. The results show a near-perfect agreement (0.98) and correlation (r = 0.98, p < 0.001) for estimated fetal weight and most biometry measurements between the two types of ultrasound devices, with slight deviations in head circumference and amniotic fluid index measurements. Subgroup analysis revealed variations in agreement and correlation rates with higher BMI and advanced gestational age, indicating areas for further refinement. These findings affirm the high reliability of handheld ultrasound devices for basic obstetric ultrasound evaluations, supporting their integration into daily clinical practice. This technology improves the flexibility and immediacy of prenatal care, although further research is needed to optimize its application across patient populations and treatment settings.

Trans-Vaginal Cervical Length and Amniotic Fluid Index in Prediction of Delivery Latency Following Preterm Pre-Labor Rupture of Membranes

Abstract Background After premature pre-labor rupture of membranes (PPROM), it is challenging to forecast with precision the time to delivery (latency). Predicting delivery delay may be useful in determining when to recommend hospitalization, close observation, prenatal steroid use, and magnesium sulfate for neuroprotection. In women who report with preterm pre-labor rupture of membranes (PPROM), our goal is to ascertain if transvaginal cervical length (TVCL), amniotic fluid index (AFI), or a combination of both can predict delivery latency. Methods 70 pregnant women presented with PPROM between the gestational age of 28 weeks and 36 weeks +6 days were enrolled. Transvaginal ultrasound measurement of cervical length and amniotic fluid index was performed within 24 hours of admission, to assess number of women reached latency period of 7 days or more and assess other maternal and fetal parameters as number of women reached 36 +6 weeks, mode of delivery, development of chorioamnionitis, gestational age at PPROM and delivery, birthweight at delivery, presence of neonatal sepsis, Apgar score at 1 and 5 minutes and need for NICU admission and indication. Results The best sensitivity of TVCL in prediction of delivery latency was 100 % at TVCL&amp;gt;3 cm in women with AFI &amp;gt;5 cm. On the other hand, the best specificity was 80.5% at TVCL&amp;gt;3 cm in women with AFI ≤5 cm. Conclusion When a woman presents with preterm pre-labor rupture of the membranes, it is recommended to employ either transvaginal cervical length, amniotic fluid index, or both to forecast delivery delay.

EVALUATION OF MATERNAL AND PERINATAL OUTCOME IN WOMEN WITH BORDERLINE AFI AND OLIGOHYDRAMNIOS IN THIRD TRIMESTER: A TERTIARY CARE HOSPITAL-BASED STUDY

Objectives: Objectives of our study were (1) to study and compare obstetric outcome in women with oligohydramnios, borderline amniotic fluid index (AFI), and normal AFI in terms of (a) type of labor (spontaneous/induced) and (b) mode of delivery-C-section or vaginal delivery and (2) to study and compare perinatal outcome in women with oligohydramnios, borderline AFI, and normal AFI in terms of (a) prematurity, (b) APGAR score at 1 and 5 min, (c) fetal distress, (d) low birth weight, (e) weight for gestational age, (f) neonatal intensive care unit (NICU) admission, (g) cause of NICU admission, and (h) neonatal deaths. Methods: This prospective and comparative study was conducted in Rajindra Hospital Patiala, over a period of 1 year. Women with ≥34 weeks POG were subjected to ultrasonography. They were then divided into following three groups of 50 women each depending upon AFI: Group A – oligohydramnios (AFI &lt;5 cm), Group B – borderline AFI (AFI 5–8 cm), and Group C – normal AFI (AFI &gt;8–25 cm). Patients were followed up to 40 weeks POG or till delivery occurred or decision for C-section was taken. Results: Perinatal outcome was adversely affected by decrease in AFI in terms of increase in rate of preterm delivery, small for gestational age babies, low birth weight babies, and neonatal deaths. Conclusion: Measurement of AFI is an important tool for prediction of adverse neonatal outcome

Amniotic Fluid Index and its relationship with Poor Apgar Score in Term Pregnancy

Background: The Amniotic Fluid Index (AFI) is an essential indicator of fetal well-being during pregnancy. Abnormalities in AFI, such as oligohydramnios (low AFI) or polyhydramnios (high AFI), can have significant implications on neonatal outcomes. The Apgar score, a quick assessment of a newborn's health post-delivery, may be influenced by these variations in AFI. Objective: This study aimed to investigate the relationship between AFI measurements and Apgar scores in term pregnancies, emphasizing the potential impact of amniotic fluid volume variations on neonatal health. Methods: Conducted at the Department of Obstetrics and Gynecology, Cantt General Hospital Rawalpindi, this descriptive study spanned six months, from October 2022 to March 2023. It involved 224 pregnant women aged 20-40 years, with gestational ages ranging from 37 to 42 weeks. Exclusion criteria included congenital abnormalities, intrauterine growth restriction, multiple gestations, and high-risk pregnancies. A non-probability purposive sampling technique was used. Ultrasonography was performed to measure AFI, categorizing it into two groups: AFI &lt;50mm and AFI &gt;50mm. Apgar scores were assessed at birth, with scores less than 6 categorized as poor. Results: The mean age of participants was 31.03±6.18 years, and the mean gestational age was 39.26±1.70 weeks. Of the 224 subjects, 74 (33.0%) had AFI &lt;50mm, and 150 (67.0%) had AFI &gt;50mm. Poor Apgar scores were observed in 61 (40.7%) newborns from the low AFI group and 5 (6.8%) from the high AFI group. The overall incidence of poor Apgar scores was 29.5%, with a significant statistical correlation (p-value = 0.00) between low AFI and poor Apgar scores. Conclusion: The study demonstrated a significant association between low AFI (&lt;50mm) in full-term pregnancies and poor Apgar scores. These findings highlight the necessity for diligent monitoring and management of amniotic fluid levels to improve neonatal outcomes.

A Randomized Trial of Inpatient and Home-Based Maternal Oral Hydration Therapy in Isolated Oligohydramnios and Its Effect on Amniotic Fluid Index and Perinatal Outcome.

Background Isolated oligohydramnios, without any known fetal/maternal abnormality, may be associated with insufficient oral intake (such as water, glucose, and rehydration therapy). Therefore, the present study was conducted to assess the improvement following maternal hydration. Method A total of 50 cases of isolated oligohydramnios (other high-risk pregnancy conditions not present) were included in the study (25 in each group). Patients were encouraged for an additional 2 liters of oral rehydration solution intake daily along with regular diet. The fluid intake was unsupervised in the home group and supervised in the hospital group. Serial amniotic fluid index (AFI) measurements and fetal monitoring were performed. Birth weight and APGAR scores were recorded, and data were analyzed. Results The two groups were comparable in terms of demographics and baseline laboratory findings. AFI significantly improved in the hospital group compared to the home group (p-value: <0.001). Birth weight, placental weight, and APGAR scores were also significantly better in the hospital group than in the home group. Conclusion Maternal oral hydration therapy improves the amniotic fluid volume and subsequently improves the perinatal outcome. Due to poor compliance with home-based treatment, institution of supervised hydration therapy is recommended.

Effect of Maternal Intravenous Hydration in Management of Oligohydramnios and The Changes in the Fetal Doppler

Background and aim: Oligohydramnios is linked to different fetal and maternal conditions. Maternal hydration improves amniotic fluid content, because it promotes uteroplacental perfusion. The current work aimed to determine the results of intravenous hydration on the amniotic fluid index (AFI) and Doppler measurements of uteroplacental blood circulation during pregnancy with the third trimester oligohydramnios.&#x0D; Patients and methods: The current including 50 pregnant women in their third trimester with oligohydramnios. They were selected from the outpatient clinic at Al-Azhar University Hospitals. All were submitted to clinical evaluation by history and examination, followed by abdominal ultrasound and intravenous hydration therapy. Values before and after hydration were compared, delivery mode and fetal outcome were documented.&#x0D; Results: Maternal age was 30 ± 2.28. The majority of them were multigravida (58.0%) and higher percentage were multiparous (70.0%). The GA at delivery ranged between 32 and 37 weeks of gestation. There was a significant reduction of pulse, mean arterial pressure, temperature, hematocrit after hydration than before hydration. The birth weight ranged between 2765 and 3654 g. AF volume, AMF and uterine artery PI were significantly increased while umbilical artery PI was statistically decreased after hydration that corresponding values before hydration. The mode of delivery was normal vaginal delivery among 34% and cesarean section among 66.0% and the mean Apgar score was 7.8±1.9 and 8.9±0.87 at the first and fifth minutes, respectively.&#x0D; Conclusion: Intravenous maternal hydration therapy was safe and effective in terms of improvement of amniotic fluid index in pregnant females with isolated oligohydramnios in the third trimester. It enhanced the amniotic fluid volume and AFI in females with oligohydramnios.

Doppler velocity of fetal renal arteries in case of oligohydramnios

Background: Oligohydramnios is a relatively common complication of pregnancy and such a case is often encountered in clinical practice. Oligohydramnios is often to describe pregnancies with AFI <5 and borderline/ low normal amniotic fluid volume to describe pregnancies with AFI 5 to 8 (4) Alternatively, some clinicians prefer the single vertical pocket (SVP) with severe oligohydramnios defined as SVP less than 1 and mild oligohydramnios defined as SVP 1 to 2 Aim of this current study sought to determine the relation of fetal renal artery Doppler with normal pregnancies and pregnancies complicated by oligohydramnios.Methods: Sample size was 50 patients in the 2nd trimester; they subdivided into two groups based on the amount of the amniotic fluid as follow: Group I: Control group (AFI 5-25) N = 25 cases.Group II: Oligohydramnios group (AFI less than 5) N = 25 cases.All patients in this study subjected to the following:Ultrasound study: Measurement of fetal biometry, Detection of congenital malformation. And Amniotic fluid index measurement. Doppler study: Renal artery (RA) and Umbilical artery (UA).Results: There was statistically significant difference between groups according to Renal and umbilical artery Doppler indices PI & RI in Gestational Age 26 weeks, statistically significant difference over the periods through renal artery Doppler indices RI, statistically significant difference over the periods through umbilical artery Doppler indices PI in each group and Renal Artery PI Which was 2.681, with sensitivity of 44.6% specificity of 53% with diagnostic accuracy of 47%, (p-value >0.05 NS). Renal Artery RI Which was 0.989, with sensitivity of 43.5% specificity of 43% with diagnostic accuracy of 33%, (p-value >0.05 NS). Umbilical Artery PI Which was 1.044, with sensitivity of 42.1% specificity of 39.5% with diagnostic accuracy of 29.7%, (p-value >0.05 NS). Umbilical Artery RI Which was 0.645, with sensitivity of 48.5% specificity of 42.1% with diagnostic accuracy of 41.6%, (p-value >0.05 NS). Conclusions: We recommend introducing renal artery resistance index as auxiliary ante partum test for women with Amniotic fluid abnormalities in addition to other ante partum fetal wellbeing tests to predict fetuses at risk of hypoxia.

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.

Oligohydramnios is defined as amniotic fluid index (AFI) less than or equal to 5cm. A borderline AFI has been defined as an AFI of 5.1cm to 8cm. The incidence of borderline AFI compared with a normal AFI (8.1cm to 18cm) is 6% to 44% in different studies. A decrease in amniotic fluid 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. A randomized controlled trial was conducted at a tertiary care obstetric center, involving a total of 130 participants. Inclusion criteria include participant in 3rd trimester of pregnancy, singleton pregnancy, intact amniotic membranes, and no known medical disorder. Patients with multiple pregnancies, ruptured amniotic membranes, anomalous fetuses, and known medical disorders were excluded. 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 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. 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. 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.

A Clinical Study on Maternal and Perinatal Outcome of Oligohydramnios

Background : Oligohydramnios is one of the pregnancy associated common complications facing by obstetrician which is associated with adverse maternal and perinatal outcome such as birth defects, miscarriage, intrauterine growth restriction, still birth, preterm birth, increased operative interference etc. Objective: To assess the impact of oligohydramnios on maternal and perinatal outcome. Methods: This cross-sectional descriptive study was conducted at Department of Obstetrics and Gynecology, BSMMU, Dhaka from October 2017 to March 2018.Total 50 patients were enrolled by purposive sampling method according to the inclusion and exclusion criteria. Clinical evidence of oligohydramnios was looked for &amp; confirmed by ultrasonography (USG). Based on Amniotic fluid index (AFI)measurements patients were divided into two groups. Those who have AFI &lt;5cm and 5-8cm. The significance of difference or comparison of means was measured by Chi square test. Maternal and perinatal outcome in pregnancies with oligohydramnios were compared with those with 5-8cm amniotic fluid volume. Results: The mean age of the study population was 23.3±4.06 years and majority of the cases were multipara (56%) and presented at term (58%). Borderline oligohydramnios (AFI 5-8cm) was found in 74% cases and severe oligohydramnios (AFI &lt;5cm) were found in 26% cases. Most common etiological factor was idiopathic. Fifteen cases (30%) had vaginal delivery and caesarean section rate 70%, no maternal mortality occurred in this study, perinatal mortality rate was 10%, low birth weight baby was 63.6% and NICU admission rate was 53.8%. Conclusion: An antepartum or intrapartum oligohydramnios is associated with significantly increased incidence of caesarean section for fetal distress and increased incidence of low-birth-weight babies and increased rate of neonatal complications. Northern International Medical College Journal Vol. 12 No.1 July 2020, Page 489-492

Vaginal fluid index - The fifth amniotic pocket.

The forebag is a pocket of amniotic fluid preceding the fetal presenting part. Herein we describe the feasibility of transvaginal measurements of the forebag and assess its correlation with the standard amniotic fluid index (AFI). A prospective study was carried out between January 2019 and July 2020. Eligible cases were women with singletons, vertex presentation, and normal AFI at term. We assessed the implementation and acceptance of a novel process in the clinical practice setting. Feasibility was assessed by using transvaginal ultrasound to measure the three orthogonal planes of the forebag. The vaginal fluid index (VFI) was defined as the volume composite of the three orthogonal planes. Correlations of the forebag measurements with both AFI and maximal vertical pocket were then calculated. In total, 292 out of 305 (95.7%) women were enrolled. All participants completed both transabdominal and transvaginal ultrasound, of which the vaginal pocket was demonstrated in 266 (91.1%) cases. We found significant correlations, in both nulliparas and multiparas, between the vaginal pocket measurements and the VFI to both the AFI and maximal vertical pocket measurements (R= 0.38, P< 0.001; R= 0.3, P< 0.001, respectively). We introduced a new ultrasound variable, the VFI, with a high feasibility rate. This may provide invaluable information for future decision making around the time of delivery.

A Comparison of Amniotic Fluid Index versus Single Deepest Vertical Pocket Measurement at Term as a Predictor of Adverse Perinatal Outcome

Introduction: Oligohydramnios is an important sign of fetal jeopardy and amniotic fluid index (AFI) and single deepest vertical pocket (SDVP) have been used to detect it. Objective: To compare AFI vs. SDVP at term as a predictor of adverse perinatal outcomes. Methods: A prospective observational study was conducted in Teaching Hospital Kandy, Sri Lanka for eight months from July 2015 to March 2016. 448 Singleton pregnancies admitted after 37 completed weeks were included. AFI ≤ 5 cm and SDVP to outcome variables. Results: Mean AFI was 11.35 cm (SD = 5.15) and Mean SDVP was 4.07 cm (SD = 1.88). AFI and SDVP values showed a significant positive correlation (r = 0.954; p Conclusion: AFI better predicted oligohydramnios and subsequent labour induction than SDVP. Low SDVP was a risk factor for adverse perinatal outcomes (such as induction of labour, meconium-stained liquor, operative delivery, 5-minute Apgar less -off values of SDVP and AFI for each perinatal outcome, an in-depth experimental analysis is required in future research.

Amniotic Fluid Volume Estimation from 20 Weeks to 28 Weeks. Do You Measure Perpendicular to the Floor or Perpendicular to the Uterine Contour?

ObjectiveTwo different techniques are described in the literature for measuring amniotic fluid pockets to estimate amniotic fluid volume. This study was undertaken to determine if ultrasound estimates using amniotic fluid index (AFI) and single deepest pocket (SDP) techniques should be measured perpendicular to floor vs perpendicular to uterine contour in pregnancies between 20 and 28 weeks.Study DesignAmniotic fluid was measured using AFI and SDP techniques in low risk pregnant women undergoing an indicated ultrasound between 20 and 28 weeks of gestation. Measurements of both AFI and SDP were made holding the ultrasound transducer perpendicular to the floor and then perpendicular to the uterine contour. Pearson’s correlation coefficient was used to assess the association between estimated amniotic fluid volumes determined by the transducer perpendicular to the floor versus transducer perpendicular to the uterine contour; intra-class correlation coefficient was used to test agreement of the two techniques.ResultsMeasurements were collected on 160 women between 20 and 28 weeks. For pregnancies between 20 and 28 weeks, the level of correlation for AFI was 0.67 (95% CI 0.57–0.74) [moderate] and for SDP was 0.47 (95% CI: 0.34–0.58) [poor].ConclusionIn pregnancies between 20 and 28 weeks, the correlation of AFI values perpendicular to floor and perpendicular to the uterine contour remains moderate, either measurement can be used to estimate amniotic fluid volume. The correlation for SDP is poor and it remains uncertain which technique, perpendicular to floor or perpendicular to uterine contour, should be used for estimating amniotic fluid volume.

Amniotic fluid index measurements in the second and third trimester and correlation to fetal biometric parameters – new reference based on a big retrospective data

Introduction Estimation of amniotic fluid volume (AFV) is part of routine obstetric sonography which reflects maternal–fetal circulation efficiency, fetal hemodynamic status, and a parameter for predicting adverse neonatal outcome. Fetal weight is positively correlated with AFV. Therefore, our objective is to provide a new nomogram of AFV indices and to evaluate the relation between AFV and fetal biometric parameters. Materials and methods Retrospective cohort study between 2011 and 2018, at a large tertiary medical center. Data were collected from medical charts of prenatal sonographic evaluation of normal pregnancies, including routine estimation of AFV by using amniotic fluid index (AFI). Generalized estimating equations model was used to study the association between AFI, gestational age and fetal biometric parameters. Centiles were calculated using the Generalized Additive Models for Location, Scale, and Shape model. Box-Cox-t distribution and smoothing splines were used. Results Analysis included 28,650 pregnancies. From 25 to 41 weeks gestation, the median and fifth percentile AFI gradually decreased from 174 (IQR 157–193) to 138 mm (IQR 107–173) and from 125 to 68 mm, respectively. The change in the 95th percentile was less significant, ranging around 230 mm throughout pregnancy. Multivariate regression analysis demonstrated a significant correlation between AFI and maternal body mass index (B = −0.147; CI = −0.27 to −0.02), gestational age (B = −11.8; CI = −12.5 to −11.4), estimated fetal weight (EFW) (B = 0.05; CI = 0.049–0.053) and abdominal circumference (AC) (B = 0.94; CI = 0.95–1). There was no correlation between AFI and other fetal biometric parameters. Conclusions We suggest new AFI indices of singleton pregnancies. We found a positive correlation between AFI and EFW and AC.

453 The vaginal fluid index (VFI), a hidden 5th amniotic fluid pocket

Abnormal amniotic fluid volume has been associated with a variety of adverse pregnancy outcomes. Transabdominal ultrasound is used to assess quantitatively the amniotic fluid volume, by either the amniotic fluid index (AFI) or the maximum vertical pocket (MVP) methods. The fore-bag is a pocket of hidden amniotic fluid preceding the fetal presenting part. Its dimensions and significance have not been studied. In this feasibility study, we described the transvaginal measurements of the this fore-bag, and assessed its correlation with the standard AFI and MVP. A prospective observational study between July 2018 and July 2020. Eligible cases were non-laboring women with singleton pregnancies, vertex presentation and normal AFI at 36-41 weeks’ gestation. The AFI and MVP were obtained abdominally from the biophysical profile. Feasibility was assessed by using the transvaginal ultrasound to measure the three orthogonal planes of the fore-bag (Figure 1). The vaginal fluid index (VFI) was defined as the volume composite of the vertical, horizontal and axial vaginal measurements. Correlations of the fore-bag measurements with both AFI and MVP were then calculated. During the recruitment process, 292/305 (95.7%) women were enrolled. Their demographic and ultrasound characteristics are given in table 1. All participants completed both transabdominal and transvaginal ultrasound, of which the vaginal pocket was demonstrated in 266/292 (91.1%) of cases. We found a significant correlation, for nulliparous and multiparous, between the individual vaginal pocket measurements and the VFI, to both the AFI and MVP measurements (R=0.35, p<0.001; R=0.34, p<0.001, respectively). We introduced a new transvaginal ultrasound variable, the VFI, which was feasible to measure in the majority of women. The VFI may provide invaluable information into the future decision-making around the time of delivery, especially in women with suspected oligohydramnios. A multicenter trial is currently being launched to implement our findings into the traditional AFI.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Automated ultrasound assessment of amniotic fluid index using deep learning.

The estimation of antenatal amniotic fluid (AF) volume (AFV) is important as it offers crucial information about fetal development, fetal well-being, and perinatal prognosis. However, AFV measurement is cumbersome and patient specific. Moreover, it is heavily sonographer-dependent, with measurement accuracy varying greatly depending on the sonographer's experience. Therefore, the development of accurate, robust, and adoptable methods to evaluate AFV is highly desirable. In this regard, automation is expected to reduce user-based variability and workload of sonographers. However, automating AFV measurement is very challenging, because accurate detection of AF pockets is difficult owing to various confusing factors, such as reverberation artifact, AF mimicking region and floating matter. Furthermore, AF pocket exhibits an unspecified variety of shapes and sizes, and ultrasound images often show missing or incomplete structural boundaries. To overcome the abovementioned difficulties, we develop a hierarchical deep-learning-based method, which consider clinicians' anatomical-knowledge-based approaches. The key step is the segmentation of the AF pocket using our proposed deep learning network, AF-net. AF-net is a variation of U-net combined with three complementary concepts - atrous convolution, multi-scale side-input layer, and side-output layer. The experimental results demonstrate that the proposed method provides a measurement of the amniotic fluid index (AFI) that is as robust and precise as the results from clinicians. The proposed method achieved a Dice similarity of 0.877±0.086 for AF segmentation and achieved a mean absolute error of 2.666±2.986 and mean relative error of 0.018±0.023 for AFI value. To the best of our knowledge, our method, for the first time, provides an automated measurement of AFI.

Evaluation of cerebroplacental ratio as a new tool to predict adverse perinatal outcomes in patients with isolated oligohydramnios

Aim: There is conflicting information in the literature regarding perinatal outcomes and management of isolated oligohydramniotic (IO) pregnancies. Recent studies show that IO is associated with poor perinatal outcomes. However, there is still no definitive method for deciding the optimal delivery timing for these patients. In this study, we aimed to assess the relationship between Doppler parameters, especially cerebro-placental ratio, and perinatal outcomes in isolated oligohydramnios (IO) patients. Methods: This prospective case control study was conducted between October-November 2018. A total of 98 patients were recruited and divided into two groups, as pregnant women with normal amounts of amniotic volume and the isolated oligohydramnios group. Oligohydramnios diagnosis was made by amniotic fluid index measurement (AFI<5 cm). Pregnancies with hypertension, fetal growth restriction, thrombophilia, preeclampsia, diabetes mellitus, preterm births and chromosomal/structural abnormalities were excluded. Cerebro placental ratios of groups were compared in terms of composite adverse outcomes, low APGAR score in 1st and 5th minutes, C/S operation due to non-reassuring fetal heart rate patterns, admission to neonatal intensive care unit and still births. Results: In the isolated oligohydramnios group (n=45) cerebro-placental ratio (CPR) was lower compared to control group (P<0.001). IO was associated with lower (APGAR score<7) 1st (55.6% vs. 7.5%, P<0.001) and 5th (13.3% vs. 1.9% P=0.028) minute APGAR scores and higher rates of NICU admission (26.7% vs. 3.8% P=0.001). Number of fetal distress cases was higher in patients with low CPR in the IO group (9 vs. 6 P=0.023). Conclusion: Measurement of CPR among IO patients seems useful for detection of fetuses with higher risk for poor neonatal outcomes.

Measurement of Cerebro-Placental Doppler Ratio and Amniotic Fluid Index as a Predictor of Perinatal Outcome in Prolonged Pregnancy

Background: The terms post-term, prolonged, postdates and post mature are often loosely used interchangeably to signifypregnancies that have exceeded a duration considered to be the upper limit of normal.Objective: The aim of this work was to study the role of Doppler velocimetry of the umbilical and middle cerebral arteriesrepresented by the cerebroplacental ratio and amniotic fluid volume in the prediction of adverse fetal outcome in post-termpregnancies.Materials and Methods: This is a prospective case control study conducted at Ain-Shams University Teaching Hospitalfor Obstetrics and Gynecology, Egypt. The study included 50 pregnant patients who were divided into two groups; group1included 25 pregnant ladies with gestational age of 41 weeks attending the casuality department in labour or in prodromaof labor. while, group 2 included 25 pregnant ladies with gestational age of 41 weeks not in labor and reaching thehospital for ANC, who were selected for termination based on the biophysical profile and poor Doppler indices or CTGchanges. All patients were submitted to antenatal fetal surveillance tests including modified biophysical profile (MBPP)which consists of the non-stress test (NST), amniotic fluid index (AFI), and color Doppler velocimetry of fetoplacentaland fetal vessels including MCA PI, UA PI, and CPR. The accuracy of cerebroplacental ratios (the middle cerebral arteryPI divided by the umbilical artery PI) and amniotic fluid volume as a means of predicting intrauterine fetal distress andadverse perinatal outcome in post-term pregnancies.Results: Cerebroplacental ratio showed the highest sensitivity (95%) in comparison with other parameters, so it is a goodtest to reassure the obstetricians of the fetal well being. Prominent changes in AFI (i.e. 5.0 cm. Asignificant association with FHR decelerations and presence of meconium is proved to exist when AFI is <5.0 cm.Conclusion: The addition of cerebral/umbilical ratios to antenatal surveillance protocols is expected to improve the perinataloutcome. It should be tried in the various high risk pregnancies whenever uteroplacental insufficiency is suspected.

Amniotic fluid index curves in the obese gravida.

To determine whether amniotic fluid volume as measured by amniotic fluid index (AFI) is influenced by maternal pre-gestational obesity as measured by body mass index (BMI). This was a retrospective cohort study of pregnant women between 20 and 43 weeks gestation receiving ultrasounds with AFI measurements at Augusta University Medical Center between 2003 and 2017. A subset of 500 charts that met inclusion and exclusion criteria were reviewed to obtain maternal clinical data. The study cohort was subdivided by maternal BMI at initial obstetric visit into three groups: normal weight (18.5 kg/m2-24.9 kg/m2), overweight (25.0 kg/m2-29.9 kg/m2), and obese (≥ 30 kg/m2). Chi-square analysis was used to compare BMI groups in terms of categorical clinical characteristics and outcome variables, and analysis of variance (ANOVA) was used for continuous variables. Mixed effects regression models (MRMs) were used to evaluate AFI throughout gestation separately in each group, and MRM-based analysis of covariance was used to compare AFI throughout gestation among groups. AFI curves were constructed for the 5th, 50th, and 95th percentiles for all study subjects combined and separately for normal weight, overweight, and obese subjects. Fitted curves relating AFI percentiles to estimated gestational age (EGA) showed statistically significant differences among BMI groups. There was also a significant difference in AFI over gestation across the obesity groups. Fitted curves for AFI throughout pregnancy showed statistically significant differences among BMI groups.

The Correlation Between Amniotic Fluid and Neonatal Weight

Aim:This study focused on determining whether or not amniotic fluid index (AFI) values were affected by last menstruation period (LMP), age and parity and assessing the correlation between such variables as neonatal weight and AFI, last menstruation period, age and parity.Material and Method:The study was prospectively planned and designed in descriptive and cross-sectional model. 153 successive healthy pregnant women who presented to Necip Fazıl City Hospital, Clinic of Obstetrics and Gynecology as full term pregnant women with pain (FTPWP) between the 1st of August and the 1st of November, 2017 and who gave birth between 37th and 42nd weeks were included in the study. Written official permission to undertake this study was gained from the hospital and informed consent was obtained from each participant. Approval of the ethics committee of Elazığ Medicine Faculty was also obtained. Detailed obstetric history of the participants was taken. Whether or not they had a chronic disease history and family disease history was asked. Pregnancy weeks were separately determined according to both LMP and ultrasonography (USG) measurements. Tensions were measured. Following routine vaginal examination; full blood tests, biochemical tests and full urine tests were performed. All the patients received USG assessments following Non-Stress Test. For standardization, USG assessments were performed by the same doctor from radiology unit using Toshiba Aplio 300 ultrasound device and 3.5 mhz abdominal probe. With USG; biparietal circumference (BPD), head circumference (HC), abdominal circumference (AC), femur length (FL) were assessed. According to USG; estimated fetal weights were found (16). While performing AFI measurements, uterus was divided into 4 equal quadrants. Ultrasound probe is placedperpendicular to the floor and parallel to the maternal axis. The deepest bags in 4 different areas are separately measured and added (13-15). After labor, neonatal weightings were done with EKS 8006 weighing machine and the data were recorded.To the study, those healthy women who were 37-42 weeks pregnant and were aged between 17 and 35 years were recruited. Those women who had chronic diseases (diabetes, hypertension, renal diseases, collagenous tissue diseases), fetal anomalies, serious anemia, membrane rupture in medical examination and pregnancy history were excluded from the study. AFI values of the participant patients were classified into five groups: AFI values ≤5 cm, 5.1-10 cm, 10.1-15 cm, 15.1-20 cm and 20.1-24 cm. Two pregnant women with an AFI value of ≥25 cm were dropped off the study because one patient had diabetes and the other one had fetal anomaly. After birth, neonatal weights were sorted out four groups: &amp;lt;2800 gr, 2800-3299 gr, 3300-3799 gr and 3800-4500 gr and data were recorded for comparison.Results:In this study; it was explored that demographic factors that we assessed did not AFI values and neonatal weight but among pregnant women with oligohydramniosis, neonatal weights were considerably lower. The reason why studies that investigated the correlation between LMP and AFI and that were done in different geographical regions demonstrated different results may be that AFI is influenced by such factors as genetic structure, socio-economic status and geographical location and we are of the opinion that we need new nomograms that take these variables into consideration.Conclusion:As a conclusion; in this study we found that age and parity status did not affect AFI and neonatal weight. As for LMP, we identified that it increased neonatal weight; which was in line with literature results. On the other side, we found that increase in LMP did not influence AFI. When studies that were undertaken in different regions and that investigated the correlation between AFI and LMP were examined, we understood that there were different studies suggesting that as LMP increases; AFI reduces or increases or does not change. We are of the opinion that the reason behind these outcomes is that AFI may change depending on many factors such as ethnicity, geographical region, socio-economical factors. Therefore; there is a need for new nomograms that take these variables and geographical regions into consideration. Another result of this current study was that pregnant women with oligohidramnios presented lower neonatal weight as compared to those women with normal AFI values. Yet, comparison which was madeafter dividing pregnant women with normal AFI values into groups did not show any statistically significant difference in terms of neonatal weight.There is a need for wide scale and large series studies in which such factors as expanded age ranges, participation of pregnant women with polyhydramnios, socio-economical differences, smoking status are examined.

Is There a Difference in Sonographic Estimation of Amniotic Fluid Volume When Measuring With the Probe Perpendicular to the Floor Compared With Perpendicular to the Uterine Contour?

This study sought to determine whether there is a significant difference in amniotic fluid measurements when measuring perpendicular to the floor compared with perpendicular to the uterine contour using both amniotic fluid index and single deepest pocket. This was a single-centre, prospective study of women with singleton gestation who were undergoing fetal ultrasound examination. A total of 240 women were enrolled, and single deepest pocket and amniotic fluid index were measured with both techniques. Correlation coefficient and intraclass correlation coefficient were used to assess the agreement between the values using the two methods of measurement (Canadian Task Force Classification II-2). A strong correlation was found between amniotic fluid index measurements (correlation coefficient 0.82; intraclass correlation coefficient 0.7). A strong correlation also was found between single deepest pocket measurements (correlation coefficient 0.7; intraclass correlation coefficient 0.6). The measurement of amniotic fluid index and single deepest pocket can be performed either perpendicular to the floor or perpendicular to the uterine contour. There is no significant difference between these measurements and they correlate well.