Amniotic Fluid Index Research Articles

MATERNAL AND PERINATAL OUTCOME IN BORDERLINE OLIGOHYDRAMNIOS: A HOSPITAL-BASED STUDY

Introduction: Amniotic fluid index (AFI) between 5.1 to 8 is termed as borderline oligohydramnios. Oligohydramnios has been linked with perinatal morbidity and mortality, however there are paucity of data on the effect of outcome of pregnancy among the isolated borderline oligohydramnios. This study studied the outcome of borderline oligohydramnios.
 Methods: Pregnant women after 30 weeks period of gestation, with AFI 5-8 were included in the study. Pregnancy with hypertension, diabetes, heart disease, congenital anomalies in fetus, previous cesarean section or any uterine surgery were excluded from the study. Collected data were analyzed using descriptive statistics.
 Results: 140 pregnancy were enrolled. The mean age(SD) of study population was 24.7(4.0) years. 60%. The mean(SD) gestational age at the presentation was 38.8(1.6) weeks, with range from 35.3 weeks to 42.5 weeks. Induction of labour was done in 80.2%, normal delivery was possible only in 42.1%. Meconium-stained liquor was present in 27.1%. The most common indication of cesarean section was Non-reactive Non-Stress Test (NRNST) among 51.9%. Postpartum Haemorrhage(PPH) was observed in 11.4%. There was no perinatal depression, the mean(SD) of birth weight was 2.9(0.4) kgs. 6.4% of the cases required nursery admission, among them the common causes of nursery admission were neonatal sepsis (45%) and various causes of respiratory-distress (55%. There was no neonatal or maternal death.
 Conclusions: Borderline oligohydramnios was more among nulliparous with higher rate of caesarean section. However, adverse outcome like PPH, neonatal infection and respiratory distress are less frequent findings and there was no perinatal mortality.
 Keywords: Borderline oligohydramnios, perinatal, maternal, neonatal, outcome.

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.

ACUTE ORAL HYDRATION IN MANAGEMENT OF OLIGOHYDRAMNIOS AND DOPPLER CHANGES

Background: For many women, oligohydramnios is a time of reappraisal of behavior, nutrition, and lifestyle to ensure that their fetus has the best and healthiest start in life. Most pregnant women are likely to pay more attention to living healthily and eating a healthy diet than they did before pregnancy. Acute oral hydration is an effective way of increasing AFI. It is a noninvasive, easily accessible and cheap intervention, which should be encouraged. Objective: To assess the effect of acute oral hydration on amniotic fluid index (AFI) and associated Doppler changes. Patients and methods: This study was conducted at El-Mahalla General Hospital aiming to evaluate the role of maternal hydration on oligohydramnios and Doppler changes. A total of 40 pregnant ladies with oligohydramnios were included and they were divided into two equal groups; group A received oral hydration therapy, and group B received the normal amount of fluid intake. Results: The mean AFI in group A before treatment was 3.6 ± 1.3 and in group B was 3.4 ± 1.5 with no significant difference between the two groups (p=0.367). The mean AFI in group A after treatment was 8.6 ± 1.3 and in group B it was 5.8 ± 1.2 with statistically significant difference between the two groups (p=0.005). There was a statistically significant difference between the values of AFI before and after treatment in group A (p < 0.001), but not in group B (0.052). Conclusion: Oral hydration therapy was effective in improving oligohydramnios status in pregnant women. Moreover, renal and uterine arteries pulsatility indices also improved via such method of management. Nevertheless, umbilical artery pulsatility and resistance indices showed non-significant improvement.

ACUTE ORAL HYDRATION IN MANAGEMENT OF OLIGOHYDRAMNIOS AND DOPPLER CHANGES

Background: For many women, oligohydramnios is a time of reappraisal of behavior, nutrition, and lifestyle to ensure that their fetus has the best and healthiest start in life. Most pregnant women are likely to pay more attention to living healthily and eating a healthy diet than they did before pregnancy. Acute oral hydration is an effective way of increasing AFI. It is a noninvasive, easily accessible and cheap intervention, which should be encouraged. Objective: To assess the effect of acute oral hydration on amniotic fluid index (AFI) and associated Doppler changes. Patients and methods: This study was conducted at El-Mahalla General Hospital aiming to evaluate the role of maternal hydration on oligohydramnios and Doppler changes. A total of 40 pregnant ladies with oligohydramnios were included and they were divided into two equal groups; group A received oral hydration therapy, and group B received the normal amount of fluid intake. Results: The mean AFI in group A before treatment was 3.6 ± 1.3 and in group B was 3.4 ± 1.5 with no significant difference between the two groups (p=0.367). The mean AFI in group A after treatment was 8.6 ± 1.3 and in group B it was 5.8 ± 1.2 with statistically significant difference between the two groups (p=0.005). There was a statistically significant difference between the values of AFI before and after treatment in group A (p < 0.001), but not in group B (0.052). Conclusion: Oral hydration therapy was effective in improving oligohydramnios status in pregnant women. Moreover, renal and uterine arteries pulsatility indices also improved via such method of management. Nevertheless, umbilical artery pulsatility and resistance indices showed non-significant improvement.

Технология прогнозирования дородового излития околоплодных вод

Aim of study. To create a technology for prediction of preterm discharge of amniotic fl uid based on universally accessible methods of laboratory and instrumental evaluation. Material and methods. A retrospective analysis of 200 birth cases dated 2018-2021 at the premises of obstetric facilities in Chita and Ufa cities featuring patients admitted to the inpatient unit shortly before term labour (1-2 days). In the course of the study, 2 groups were distinguished: Group 1 included 128 female patients with term discharge of amniotic fluid and Group 2 was constituted by 72 female patients with preterm discharge of amniotic fluid. The groups were comparable in age, anthropomorphic parameters and extragenital pathology. On admission, all women underwent general medical examination and ultrasonography. Statistical processing of the results was performed via the IBM SPSS Statistics Version 25.0 soft ware. Results. The technology for prediction of preterm discharge of amniotic fluid was based on multilayer perceptron learning. The structure of the learning neural network included 5 input neurons: body mass index, fundal height, the total bilirubin level, activated partial thromboplastin time and the amniotic fluid index. Th e percentage of incorrect predictions of the neural network totalled 28.5 %. Conclusion. A complex approach based on integration of universally accessible methods for laboratory and instrumental tests shortly before the labour based on a neural network makes it possible to predict possible preterm discharge of amniotic fl uid with an accuracy of up to 75 %. Application of this technology in clinical practice will make it possible not only to perform timely preparation of the parturient canal but also to reduce the frequency of adverse obstetric and perinatal outcomes

Considering evidence in the management of fetal growth restriction.

Considering evidence in the management of fetal growth restriction.

Successful management of early onset fetal growth restriction: A case report

FGR (Fetal Growth Restriction) is a condition in which a fetus fails to attend its predetermined biological genetic growth potential. Growth-restricted fetuses are at increased risk of perinatal mortality and morbidity. Growth restricted babies also have poor long term outcomes of cardiovascular, neurological, cognitive or neurological system. The present case of Early FGR where patient presented to us at at 29+6 weeks of gestation with lag in fetal growth of 3 weeks &amp; an Amniotic fluid Index of 3.2 cm and her pregnancy could be successfully prolonged up to 35+2 two weeks of gestation. The protocol for management of the fetus was as per Delphi consensus and ISUOG guidelines, and we could prolong pregnancy to the maximum possible gestation and delivered a low birth weight fetus with good Apgar score and who did not require Neonatal Intensive Care Unit admission. Tools for diagnosis and follow up of FGR fetus are customized growth charts, sequential ultrasound measurements focusing on declining/crossing growth centiles, functional parameters such as Doppler waveform analysis (umbilical artery (UA), fetal middle cerebral artery, and ductus venosus), Biophysical profile scoring, Cardio tocography and serum biomarkers.

Oligohydramnios and fetal outcome in term pregnancy

Background and objective: Oligohydramnios is defined as an amniotic fluid index less than 5th centile for gestation. It presents a threat to the fetus and has been correlated with increased risk of intrauterine growth retardation, meconium aspiration syndrome, severe birth asphyxia, low APGAR scores, and congenital abnormalities. It is associated with perinatal morbidity and mortality and maternal morbidity in a significant number of cases. Therefore, early detection of oligohydramnios and its management is important. This study aimed to determine the perinatal and maternal outcomes in oligohydramnios. Methods: This retrospective cohort study was carried out at the Maternity Teaching Hospital in Erbil from March 2018 to March 2019. A total of 300 patients were recruited, including 150 pregnant women with oligohydramnios and 150 with normal amniotic fluid index. Results: There was a significant difference between the oligohydramnios group and the comparison group in relation to parity and gestational age. Oligohydramnios was more among primigravids. The rate of cesarean section was higher in oligohydramnios group compared to the comparison group. Intrauterine growth retardation among oligohydramnios group was 13%. Oligohydramnios was associated with birth weight &lt;2500 gm (21.3%). Conclusion: Antepartum diagnosis of severe oligohydramnios at term was associated with an increased cesarean section rate, a higher rate of admission of neonatal care unit, and low birth weight. Therefore, antepartum oligohydramnios is associated with increased perinatal morbidity and mortality. Keywords: Amniotic fluid index; Maternal outcome; Fetal outcome; Oligohydramnios.

Evaluation of Modified Biophysical Profile in Pre-Eclamptic Patients and Measure its Impact on Perinatal Outcome

Introduction: Hypertensive disorders in pregnancy are a major cause of maternal and perinatal morbidity and mortality worldwide. Modified biophysical profile (MBPP) combines Non stress test as a short term marker of fetal status and the amniotic fluid index as a marker of long term placental function which is easier to perform and less time consuming. Aim: To study the antepartum fetal surveillance with modified biophysical profile and perinatal outcome in pre-eclamptic women. Materials and Methods: Prospective descriptive study of perinatal outcome included 150 ANC patients gestational age between 34 to 40 weeks both primi gravida and multigravida with pre-eclampsia admitted in SMIMER hospital during January 2017 to June 2018. Patients were treated in line with standard protocol and perinatal outcome were then studied. Results: Of the 150 NST’s in MBPP, 77% were reactive and 23% were non-reactive. When the MBPP was abnormal with respect to both parameters 60% of the cases had LSCS and 40% of them had vaginal delivery. When both parameters were normal there were only 3.63% cases were MSL. When NST was abnormal and AFI normal 45.45% cases were MSL and when NST was normal and AFI abnormal 42.8% cases were MSL. When both the parameters were abnormal 63.6% of the cases had APGAR &lt;7 `whereas when NST was normal and AFI was abnormal 2(28.5%) the cases had APGAR &lt;7. When AFI was normal and NST was abnormal 36.3% of the cases had APGAR &lt;7. Conclusions: Modified biophysical profile (MBPP) is easier, less time consuming, cost effective and patient compliant test.

Prenatal ultrasonographic findings of esophageal atresia: potential diagnostic role of the stomach shape.

ObjectiveWe investigated prenatal sonographic characteristics of esophageal atresia (EA) with advancing gestation. We focused on the degree of polyhydramnios and the stomach shape.MethodsThis study included 27 EA cases (EA group) and 81 idiopathic polyhydramnios cases (non-EA group). The non-EA group consisted of cases without any fetal structural anomaly, musculoskeletal disorder, chromosomal abnormality, or maternal diabetes. Both groups included only singleton pregnancies. Amniotic fluid index (AFI) and width/length (W/L) ratio as well as the product of width and length (W×L) of stomach were serially assessed during gestation and compared between the 2 groups. To predict EA using W/L ratio and W×L, receiver operating characteristic curve analysis was performed.ResultsPolyhydramnios was evident in 77.8% of EA cases. We observed 25.9% and 22.2% EA cases with an absent stomach and a small visible stomach, respectively. After 28 weeks, the EA group manifested significantly higher AFI than the non-EA group. After 32 weeks, W/L ratio in the EA group tended to be lower than that in the non-EA group (32–36 weeks: 1.36 vs. 1.72, P=0.092; >36 weeks: 1.43 vs. 1.63, P=0.024). To predict EA, the calculated area under the curve for W/L ratio was 0.651 after 32 weeks. The diagnosis of EA using a cut-off value of W/L ratio <1.376 showed sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio to be 84.6%, 52.9%, 1.796, and 0.081, respectively.ConclusionA low W/L ratio of stomach after 32 weeks with progressive idiopathic polyhydramnios may be used to predict EA.

A systematic scoping review to identify the design and assess the performance of devices for antenatal continuous fetal monitoring.

Antepartum fetal monitoring aims to assess fetal development and wellbeing throughout pregnancy. Current methods utilised in clinical practice are intermittent and only provide a 'snapshot' of fetal wellbeing, thus key signs of fetal demise could be missed. Continuous fetal monitoring (CFM) offers the potential to alleviate these issues by providing an objective and longitudinal overview of fetal status. Various CFM devices exist within literature; this review planned to provide a systematic overview of these devices, and specifically aimed to map the devices' design, performance and factors which affect this, whilst determining any gaps in development. A systematic search was conducted using MEDLINE, EMBASE, CINAHL, EMCARE, BNI, Cochrane Library, Web of Science and Pubmed databases. Following the deletion of duplicates, the articles' titles and abstracts were screened and suitable papers underwent a full-text assessment prior to inclusion in the review by two independent assessors. The literature searches generated 4,885 hits from which 43 studies were included in the review. Twenty-four different devices were identified utilising four suitable CFM technologies: fetal electrocardiography, fetal phonocardiography, accelerometry and fetal vectorcardiography. The devices adopted various designs and signal processing methods. There was no common means of device performance assessment between different devices, which limited comparison. The device performance of fetal electrocardiography was reduced between 28 to 36 weeks' gestation and during high levels of maternal movement, and increased during night-time rest. Other factors, including maternal body mass index, fetal position, recording location, uterine activity, amniotic fluid index, number of fetuses and smoking status, as well as factors which affected alternative technologies had equivocal effects and require further investigation. A variety of CFM devices have been developed, however no specific approach or design appears to be advantageous due to high levels of inter-device and intra-device variability.

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.

Assessment of renal volume by 3D VOCAL Ultrasonography method in late-onset growth-restricted fetuses with normal amniotic fluid index.

The aim of this study was to study renal volumetric alterations and renal artery doppler changes in late-onset fetal growth restricted (FGR) fetuses with normal amniotic fluid compared to healthy pregnancies. This prospective study was composed of pregnant women with late-onset FGR and a control group of uncomplicated pregnancies within 32-37 weeks of gestation. Following the assessment of umbilical, bilateral uterine, middle cerebral using Doppler Ultrasonography (US), three dimensional (3D) US Virtual Organ Computer-aided Analysis (VOCAL) was executed to calculate bilateral renal volumes. A total of 76 fetuses with FGR and 51 healthy fetuses (control group) were evaluated. Umbilical artery Doppler systole/diastole and Pulsatility index values were found to be significantly different between the two groups (p = 0.001 and p = 0.001, respectively). Middle cerebral, bilateral uterine, and bilateral renal arteries' Doppler indices revealed no difference between the two groups. Right, left, and mean renal volume of the fetuses with FGR were smaller than the control group, and the differences were statistically significant (p = 0.025, p = 0.004, p = 0.004, respectively). Left renal volume was significantly greater than the right renal volume in the control group (p = 0.009). Although not accompanied by oligohydramnios, and having similar renal vascular resistance as the control group, renal volumes of fetuses with late-onset FGR were still observed lower than the control group. This difference was explained by not decreased blood flow via redistribution but other mechanisms like glomeruli reduction and glomerular apoptosis.

Anesthetic Management of a Parturient With Spinal Muscle Atrophy for Cesarean Section: A Case Report

Spinal muscular atrophy is a rare genetic neuromuscular disease characterized by loss of anterior horn cells of spinal cord and brain stem nuclei, resulting in progressive muscle weakness. Anesthesia for these patients is risky because of the risk of worsening of muscle weakness and consequent postoperative respiratory complications. We report anesthesia management in a nulliparous parturient with type 3 disease who underwent urgent cesarean delivery due to progressive decline of amniotic fluid index.

Role of Modified Biophysical Profile in High Risk Pregnancy in Predicting Fetal Outcome.

High risk pregnant women have increased risk of maternal and neonatal morbidity and mortality. Antepartum surveillance is important and should be effective in such conditions. Modified biophysical profile is the method of antepartum surveillance which comprises of cardiotocography and amniotic fluid index. A cross-sectional study was carried out in Paropakar Maternity and Women's Hospital from February 2019 to January 2020 to determine the effectiveness of modified biophysical profile. Cardiotocography was interpreted as reactive, equivocal and non-reactive. AFI was considered normal if it was 5 to 24 cm. In the study 172 high risk cases at term and not in labor were included. Each case was subjected to cardiotocography then amniotic fluid index was obtained using real time sonography where it was measured from all four quadrants. Modified biophysical results were obtained and then were divided into 2 arms as normal modified biophysical profile and abnormal modified biophysical profile then analysis was done. Of 172 cases, there were 97 (56.4%) cases in normal modified biophysical profile and remaining 75 (43.6%) in abnormal modified biophysical profile group. The rate of cesarean section increased when there was abnormal modified biophysical profile. Neonatal resuscitation and admission was increased in abnormal modified biophysical profile. Normal modified biophysical profile in high risk pregnancy had more cases of vaginal delivery and less adverse fetal outcome like low APGAR score, neonatal resuscitation and neonatal intensive care admission.

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.

Active Versus Expectant Management for Preterm Premature Rupture of Membranes at 34-36 Weeks of Gestation and the Associated Adverse Perinatal Outcomes.

To compare the type of management (active versus expectant) for preterm premature rupture of membranes (PPROM) between 34 and 36 + 6 weeks of gestation and the associated adverse perinatal outcomes in 2 tertiary hospitals in the southeast of Brazil. In the present retrospective cohort study, data were obtained by reviewing the medical records of patients admitted to two tertiary centers with different protocols for PPROM management. The participants were divided into two groups based on PPROM management: group I (active) and group II (expectant). For statistical analysis, the Student t-test, the chi-squared test, and binary logistic regression were used. Of the 118 participants included, 78 underwent active (group I) and 40 expectant management (group II). Compared with group II, group I had significantly lower mean amniotic fluid index (5.5 versus 11.3 cm, p = 0.002), polymerase chain reaction at admission (1.5 versus 5.2 mg/dl, p = 0.002), time of prophylactic antibiotics (5.4 versus 18.4 hours, p < 0.001), latency time (20.9 versus 33.6 hours, p = 0.001), and gestational age at delivery (36.5 versus 37.2 weeks, p = 0.025). There were no significant associations between the groups and the presence of adverse perinatal outcomes. Gestational age at diagnosis was the only significant predictor of adverse composite outcome (x2 [1] = 3.1, p = 0.0001, R2 Nagelkerke = 0.138). There was no association between active versus expectant management in pregnant women with PPROM between 34 and 36 + 6 weeks of gestation and adverse perinatal outcomes.

Diagnostic Accuracy of Insulin-like Growth Factor–Binding Protein-1/alpha-Fetoprotein (AmnioQuick Duo) in Ruptured Fetal Membranes

Failure to identify women with ruptured fetal membranes (RFM) is associated with subsequent infectious morbidity. To evaluate the diagnostic accuracy of AmnioQuick Duo in the detection of RFM, One hundred and twenty-five women (125) in the preterm premature rupture of fetal membranes/premature rupture of fetal membranes (PPRFM/PRFM) group were compared to one hundred and twenty women (120) controls in this study. On admission, after thorough history, the participants were examined by trans-abdominal sonography for evaluation of the amniotic fluid index (AFI), followed by sterile vaginal speculum examination to detect leaking amniotic fluid from the cervix, and for collection of samples for nitrazine, fern, and AmnioQuick Duo tests. The RFM were confirmed at delivery and compared using the recorded data of admission to evaluate the diagnostic accuracy of the AmnioQuick Duo in the detection of RFM (primary outcome). The AmnioQuick Duo test had 97.6% sensitivity, 98.3% specificity, 98.4% positive predictive value (PPV), 97.5% negative predictive value (NPV), and 97.95% overall accuracy in the detection of PPRFM/PRFM. The Nitrazine test had 64.8% sensitivity, 64.2% specificity, 65.3% PPV, 63.6% NPV, and overall accuracy 64.5% in the detection of PPRFM/PRFM. Fern test had 63.2% sensitivity, 59.2% specificity, 61.7% PPV, 60.7% NPV, and 61.2% overall accuracy in the detection of PPRFM/PRFM. The combined IGFBP-1/AFP (AmnioQuick Duo) test is an accurate bedside test with 97.6% sensitivity, 98.3% specificity, 98.4% PPV, 97.5% NPV, and 97.95% overall accuracy in the detection of PPRFM/PRFM. The sensitivity, specificity, PPV, NPV, and the overall accuracy of the AmnioQuick Duo were significantly higher than in the standard diagnostic nitrazine or fern tests in the detection of RFM.

Relation of the Renal Artery Color Doppler With the Umbilical Artery and Amniotic Fluid Index in Fetuses Affected by Intrauterine Growth Retardation

Objectives: This study was performed to investigate the relationship between the renal artery color Doppler with the umbilical artery and amniotic fluid index (AFI) in fetuses affected by intrauterine growth retardation (IUGR). Materials and Methods: This was a descriptive cross-sectional diagnostic study and the target population included pregnant mothers who were diagnosed to have fetuses with IUGR referring to the Al-Zahra treatment center in Tabriz. At least 40 samples were referred between October 2019 and May 2020. The patients were evaluated using the transabdominal ultrasound of the umbilical artery and fetal renal artery, and then using the color Doppler values of the umbilical artery and fetal renal artery. Results: The present research was performed on 40 pregnant females with an IUGR fetus with umbilical artery percentile upper that 95% whose minimum to maximum age range was 22-38 years. There is no relationship between umbilical artery and renal artery color Doppler. In addition, umbilical artery color Doppler is not related to amniotic fluid, also renal artery color Doppler demonstrated no significant correlation with amniotic fluid index. Conclusions: Based on our results, the PI of the umbilical artery had no significant correlation with that of the renal artery. In addition, there was no significant correlation with the PI of the renal artery and AFI.

Effect of Low Amniotic Fluid Index in Perinatal Outcome of Term Low-Risk Pregnancy

Effect of Low Amniotic Fluid Index in Perinatal Outcome of Term Low-Risk Pregnancy