Amniotic Fluid Index Research Articles

Prevalence of Congenital Anomalies in Oligohydramnios: A Hospital Based Study in Western Nepal

Introduction: Amniotic fluid serves as a cushion for growing fetus. Oligohydramnios is decreased amount of amniotic fluid and is associated with increased incidence of congenital anomalies. The aim of this study was to detect the prevalence of congenital anomalies in oligohydramnios
 Methods: Singleton pregnancy irrespective of gestational age with amniotic fluid deepest vertical pocket (DVP) of less than two centimeters was included in the study. Grading of oligohydramnios was done as mild and severe. Detailed anomaly scan was done to look for any congenital malformations. Congenital anomalies were confirmed with post natal findings.
 Results: There were 60 pregnant women with amniotic fluid index less than two centimeters with respect to deepest vertical pocket. Congenital anomalies were detected in 18.33% pregnant women with oligohydramnios. In patients with severe oligohydramnios 33.33% had congenital anomalies. Renal anomalies were the most common anomalies in our study followed by musculoskeletal anomalies. Central nervous system, gastrointestinal and cardiac and anomalies were also common in association with oligohydramnios.
 Conclusion: Our study showed that various congenital anomalies are associated with oligohydramnios and incidence of anomalies increases with increased severity of oligohydramnios. Hence, detailed ultrasound scan should be done to look for congenital malformations whenever oligohydramnios is encountered.

Impact de l’intégration de la simulation en échographie obstétricale dans le cursus des étudiants sages-femmes

ObjectiveDuring their studies, French midwives need to acquire basic ultrasound skills to measure the amniotic fluid index, fetal biometry and identify fetal lie and placental positions. They have a clinical ultrasound training during their curriculum to acquire these skills. Assess the contribution that a training on an obstetrical ultrasound simulator (OUS) could make to the competence of midwives and to evaluate the best time to integrate it into their curriculum. MethodsForty students in their 4th and final year in midwifery were randomized into 2 groups. Group A learned with the traditional academic course, with a clinical ultrasound training which was followed by an evaluation on an OUS (E1A). Group B was evaluated on a simulator before the clinical ultrasound training (E1B). After these initial assessments, both groups were provided with learning and training sessions on OUS, and re-evaluated in the same exercise (E2A and E2B). Group B then completed its clinical ultrasound training and was evaluated one month later on the simulator (E3B). The evaluation consisted of scoring the biometry images according to previously published quality criteria, and of assessing their competence based on a published objective and structured assessment score of ultrasound skills (OSAUS). ResultsEvaluation 1 found comparable OSAUS scores (2.375/5 vs. 2.24/5 P=0.52) between the two groups (E1A vs. E1B) but a significantly higher image quality score for Group A (P=0.02). In Evaluation 2, an improvement was noted for both groups with comparable OSAUS averages between the two groups (P=0.76). After the clinical training of Group B, their OSAUS score (E3B) was significantly better than that of Group A (E1A) after their clinical training (3.45/5 vs. 2.375/5 [P=0.00017]). The same was true for the quality of their images (12.67/16 vs. 9.95/16 [P=0.003]). ConclusionUltrasound simulation-based training, as an adjunct to ultrasound clinical training, significantly improves obstetrical ultrasound skills. The best time to train on simulators seems to be prior to clinical training on real patients.

Correlation Between Fetal Ductus Venosus Doppler and Amniotic Fluid Index in Prediction of Perinatal Outcome in Preeclamptic Pregnancies

Correlation Between Fetal Ductus Venosus Doppler and Amniotic Fluid Index in Prediction of Perinatal Outcome in Preeclamptic Pregnancies

Early-onset preeclampsia with or without fetal growth restriction: an analysis of 591 cases

Objective To investigate whether fetal growth restriction (FGR) could be used as an indicator for severe early-onset preeclampsia. Methods A retrospective analysis was conducted on 591 women with early-onset preeclampsia and their fetuses and newborns in Departments of Obstetrics and Gynecology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, and the Third Affiliated Hospital of Guangzhou Medical University from January 2011 to December 2017. These cases were divided into two groups according to whether they were complicated by FGR (n=206, FGR group) or not (n=385, non-FGR group). Clinical datas were analyzed by t test or Chi-square test. Results (1) There was no significant difference between the two groups in terms of average maternal age, the ratio of primipara, the proportion of women with hypertension history, abnormal blood glucose or who received regular antenatal examination, gestational age at onset and termination or cesarean section rate. No maternal death was reported. (2) The systolic blood pressure and the incidence of hemolysis, elevated liver enzyme, low platelet count (HELLP) syndrome in the FGR group were lower than those in the non-FGR group [(167.0±21.5) vs (174.0±21.8) mmHg, t=-3.729 (1 mmHg=0.133 kPa); 6.8% (14/206) vs 13.8% (53/385), χ2=6.486]. Although the incidence of absent or reverse diastolic umbilical artery flow in the FGR group was significantly higher [24.3% (50/206) vs 14.5% (56/385), χ2=8.625], and the amniotic fluid index and placental weight were lower than those in the non-FGR group [(77.82±29.78) vs (90.53±43.83) mm, t=-2.837; (302.83±80.01) vs (330.98±61.01) g, t=-2.823], the stillbirth rate was lower[2.4% (5/206) vs 6.5% (25/385), χ2=4.605] (all P<0.05). (3) Platelet counts in the FGR group were higher than those in the non-FGR group [(189.96±65.43) vs (173.77±62.88)×109/L, t=2.923], while serum creatinine and D-dimer were lower [(70.99±22.97) vs (78.98±50.87) μmol/L, t=-2.109; (491.01±401.98) vs (635.67±386.21) μg/L, t=-2.276] (all P<0.05). There was no significant difference in 24-hour urine protein excretion between the two groups. Conclusions FGR should not be used as an indicator for severe early-onset preeclampsia. Key words: Pre-eclampsia; Fetal growth retardation

Predictive Factors for Perinatal Outcomes of Infants Diagnosed With Micrognathia Antenatally.

Advances in fetal imaging have allowed us to identify abnormalities previously not appreciated. With this study, we hope to identify factors predicting a difficult airway at birth and review the perinatal outcomes of these patients. Sixteen patients with antenatally diagnosed micrognathia were reviewed from a tertiary care hospital database from 2011 to 2016. Jaw index (JI), amniotic fluid index (AFI), glossoptosis, gastric size, and oropharynx obliteration were assessed. The airway support required at birth, specialist team involvement, and outcomes were evaluated. Nine (56.3%) of 16 patients had JI <5th percentile, 3 (33.3%) of 9 had difficult intubation, 2 (22.2%) of 9 needed an emergency tracheostomy, and 1 (11.1%) of 9 died. Seven patients had polyhydramnios, 2 (28.6%) of 7 had difficult intubation, 2 (28.6%) of 7 required tracheostomy, and 1 (14.3%) of 7 died. Twelve patients had either JI <5th percentile or abnormal AFI, 5 (41.7%) of 12 had difficult intubation, 2 (16.7%) of 12 required tracheostomy, and 1 (8.33%) of 12 died. For the group without otolaryngology consultation, 8 (50%) of 16, 1 (12.5%) of 8 had difficult intubation and 1 (12.5%) of 8 died because airway was not secured after 45 minutes of resuscitation. Jaw index <5th percentile or abnormal AFI predicts a difficult airway. A multidisciplinary approach with otolaryngology involvement for airway intervention may be required at birth.

The Added Contribution of Transvaginal Sonographic Evaluation of Amniotic Fluid Index

The Added Contribution of Transvaginal Sonographic Evaluation of Amniotic Fluid Index

The Relationship between Amniotic Fluid Index (AFI) &amp; Single Largest Vertical Pocket and Perinatal Outcome in Late Severe Preeclampsia

Backgound: the amniotic fluid is a clear fluid that surrounds the fetus, and produced in part by the amniotic cells, maternal blood during the first trimester of pregnancy and fetal urine and lung fluid during the second trimester of pregnancy. It serves as a cushion to the fetus allowing musculoskeletal development and protecting it from trauma. It also maintains temperature and has a minimal nutritive function. Evaluation of AFV through ultrasound measurement is an essential part in tests of fetal well-being (BPP), by measuring the AFI or the MVP. Objective: the aim of this study was to evaluate both AFI and single deepest pocket in patients with late severe preeclampsia, and to correlate both markers with different parameters of fetal outcome. Patients and Methods: the study was a prospective controlled study involving 100 women with severe preeclampsia >34w managed at Al Hussein University Hospital and Al Arish General Hospital with the following inclusion criteria, pregnant patients, age 18- 40 years old, with variable parity and a singleton living fetus >34 weeks gestation, and with severe preeclampsia. Results: the neonatal outcomes regarding meconium is more with AFI group than MVP group while the neonatal outcome regarding NICU, RDS & Neonatal death in both groups were similar with no evidence of a statistical difference between both techniques. Conclusion: we concluded that AFI had more significant statistical relationship with perinatal outcome, hence AFI appeared to be a better predictor of perinatal outcome in preeclamptics in late severe preeclampsia.

Effect of Sildenafil Citrate When Added to Low Molecular Weight Heparin and Small Dose Aspirin on Uteroplacental Perfusion in Cases of High-Risk Pregnancy

Background: incubation with sildenafil citrate limits the effects of vasoconstrictors on myometrial small arteries of normal pregnancy women and pregnant women with fetal growth restriction. So that phosphodiesterase inhibitors seem to improve uterine perfusion safely in pregnancies with fetal growth restriction. Objective: the main aim of this study was to demonstrate the effect of sildenafil citrate when added to low dose aspirin and low molecular weight heparin on the uterine and umbilical artery Doppler to improve neonatal outcome in patients with high risk pregnancy. Subjects and Methods: the study was conducted at Al-Azhar University Hospitals, Cairo, Egypt. From March 2017 to March 2019 over a period of two years duration. One hundred patients (50 in each arm of the study), who had or have a high-risk pregnancy, were selected and enrolled into a randomized clinical trial. Results: there was significant increase in amniotic fluid index (AFI) and umbilical artery Doppler parameters. Group B (heparin/aspirin) also showed significant improvement in fetal biometry and Doppler parameters but when comparing the differences between the two groups, none of these changes were statistically significant except for the femur length measurement and the uterine artery resistance index. Conclusion: from the results of our study we concluded that heparin and aspirin combination or when sildenafil is also added have beneficial effects in the treatment of pregnant women whom vascular impairment is expected showing improvement in the fetal growth parameters and reduction of admission.

Efficacy of oral L-arginine on amniotic fluid index in pregnant women with oligohydramnios attending antenatal clinic in a tertiary care hospital in Telangana, India

Background: Oligohydramnios leads to feto-maternal morbidity and mortality. Though there is no specific treatment for oligohydramnios, use of L-arginine seems to be promising. As a nitric oxide donor, it causes vasodilatation, increases placental perfusion and finally increases amniotic fluid. However, data on the use of L-arginine for oligohydramnios is scarce. Hence, this study was aimed to evaluate the efficacy of oral L-arginine on Amniotic Fluid Index (AFI) and to document the pregnancy outcomes in women with oligohydramnios.Methods: This was a prospective observational study conducted on pregnant women attending antenatal clinic (ANC) at Mediciti Institute of Medical Sciences (MIMS), Ghanpur, Telangana, India from 1st January 2018 to 30th June 2018.Results: A total of 50 participants were enrolled and 4 participants among them were lost to follow- up. Mean age (SD) of the women enrolled was 23.3 (3.49) years. Mean gestational age (SD) at the time of diagnosis was 34.61 (1.53) weeks. Mean AFI (SD) at the time of diagnosis and after treatment with L-arginine were 6.8 (1.3) cm and 9.4 (2.82) cm respectively. After a mean treatment duration (SD) of 3.23 (1.38) weeks, a mean (SD) increase of AFI by 2.6 (1.57) cm (P &lt;0.0001) was observed. An increase of AFI was noted in 84.78% of cases (P &lt;0.0001). Mean (SD) Gestational age at the time of delivery was 38.25 (1.48) weeks. Only 37% of participants required operational deliveries. Mean (SD) birth weight of the new borns was 2.54 (0.47) kg. Neonatal Intensive Care Unit (NICU) admissions were required in 32.6% of new borns.Conclusions: L-arginine is efficacious in improving AFI in oligohydramnios. AFI improvement could possibly lead to better neonatal outcomes by reducing preterm deliveries and operative interventions.

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.

How Well Do the Popular Ultrasonic Techniques Estimate Amniotic Fluid Volume and Diagnose Oligohydramnios, in Fact?

The aims of the study were to compare the different estimation methods for the diagnosis of oligohydramnios and to determine concordance between estimated amniotic fluid volume (AFV) measured by ultrasonography and actual AFV measured directly. Another purpose was to investigate the effect of oligohydramnios on neonatal outcome. This study was done at a tertiary care center. The participants were scheduled between 37 and 40 weeks for cesarean delivery. Estimated AFV was ultrasonographically assessed, and then actual AFV was directly measured during the cesarean delivery to compare the subjective method (SM), amniotic fluid index (AFI), single deepest pocket (SDP), and 2-diameter pocket. Totally, 138 patients were included in the present study. Of 35 (34%), 24 (21%), 12 (9.5%), and 10 (7.8%) were defined as oligohydramnios by the SM, AFI, SDP, and 2-diameter pocket, respectively. The number of patients with actual oligohydramnios was 35 (34%). Most authors suggest as a method use of the SDP more than the AFI, because of overmanagement through the AFI. However, this study, which was conducted using both nonprejudiced and criterion-standard methods, showed that the SM and AFI technique were more successful to estimate oligohydramnios than other methods. Also, adverse pregnancy outcome was not closely associated with isolated oligohydramnios.

Effect of oligohydramnios on the accuracy of sonographic foetal weight estimation in at term pregnancies

ObjectiveUltrasound estimation of foetal weight is a very important aspect of antenatal care. The role of amniotic fluid volume as a potential factor which may impede the relevance of ultrasonographic foetal weight estimation is still questionable. The aim of our study was to evaluate the impact of isolated oligohydramnios on the accuracy of ultrasound foetal weight estimation in at term pregnancies when examination was performed within 48 h before delivery. Materials and methodsThe retrospective cohort study included 1831 women with low-risk, singleton, at term pregnancy. Estimated foetal weight (EFW) was calculated using Hadlock-4 formula. Exclusion criteria consisted of multiple pregnancies, active phase of labour, preeclampsia, foetal growth restriction, foetal anomalies, gestational diabetes mellitus and the evidence of intrauterine infection. Isolated oligohydramnios was defined as Amniotic Fluid Index (AFI) ≤50 mm without any other foetal anomalies. EFW and actual birth weight (ABW) were compared by calculation of: absolute error (AE), absolute percentage error (APE) and substantial error (SE) = APE >10%. ResultsParticipants were divided into 2 groups: Group 1: patients with normal AFI (50 ≤ AFI ≤250 mm; n = 1602) and Group 2: (isolated oligohydramnios, n = 229). There were not observed statistically significant differences between mean ABW and mean EFW in both groups (Group 1: p = 0.525; Group 2: p = 0.317). Mean AE in Group 1 was 221.8 g and 223.1 g in Group 2 (p = 0.919). Mean APE was 6.54% and 6.64% in Group 1 and 2 respectively (p = 0.816). SE ratio was 21.9% in Group 1 and 19.2% in Group 2. Underestimation to overestimation ratio in Group 1 was 1.01 and 0.84 in Group 2. ConclusionsAmniotic fluid volume has limited impact on ultrasound foetal weight estimation. In oligohydramnios group there might be a tendency of overestimation of neonatal ABW.

A contemporary amniotic fluid volume chart for the United States: The NICHD Fetal Growth Studies–Singletons

Amniotic fluid is essential to normal fetal development and is estimated clinically with ultrasound scanning to identify pregnancies that are at risk for poor perinatal outcome. Our goal was to develop a United States standard for amniotic fluid volume that is estimated by the amniotic fluid index and single deepest pocket. We performed a planned secondary analysis of a multicenter observational study of 2334 low-risk women with normal singleton gestations from 1 of 4 self-reported racial/ethnic groups. Eligible women had confirmed first-trimester dating criteria with health status, lifestyles, and medical and obstetric histories that were associated with normal fetal growth. Consenting women underwent serial (up to 5) sonographic evaluations of amniotic fluid between 15 and 40 weeks of gestation after being assigned randomly to 1 of 4 gestational age observation schedules. Twelve United States perinatal centers participated, and all sonograms were performed by credentialed sonographers who used identical, high-resolution equipment; caregivers were unaware of results but were notified for oligohydramnios. Women (n=597) who were subsequently found to have clinically significant antepartum complications were excluded. Racial/ethnic-specific nomograms for amniotic fluid index and single deepest pocket across gestation were developed with the use of linear mixed models with cubic splines; racial/ethnic differences were evaluated both with global and between-group tests. Median, 3rd, 5th, 10th, 90th, 95th and 97th percentile values were also estimated. We further considered the possible confounding effects of selected maternal characteristics and the estimated fetal weight at each sonogram. A total of 1719 pregnant women met inclusion criteria and had available data. These included 480 non-Hispanic white women, 418 non-Hispanic black women, 485 Hispanic women, and 336 Asian women. Both the amniotic fluid index and the single deepest pocket varied across gestation with maximal values at 26 and 33 weeks of gestation, respectively. Statistically significant differences were observed by maternal race/ethnicity. The between-group differences that were observed at 17-22 and 35-40 weeks of gestation remained statistically significant after adjustment for maternal characteristics and estimated fetal weight. These between-group racial/ethnic differences were most prominent after 35 weeks of gestation and at the extremes of dispersion (3rd and 97th percentiles). All 3rd and 97th percentile amniotic fluid index values were within the range of commonly used cutoffs to define oligohydramnios (≤5 cm) and polyhydramnios (≥25 cm). However, the 3rd percentile values ranged between 5.9 cm at 40 weeks of gestation and 10.1 cm at 25-27 weeks of gestation; the 97th percentile values ranged between 24.8 cm at 38 weeks of gestation and 15.7 cm at 15 weeks of gestation. Sonographic amniotic fluid volume estimates vary by racial/ethnic group, but the absolute differences appear to be small and may not be clinically significant. Selected maternal characteristics and estimated fetal weight did not affect the racial/ethnic differences. Between-group differences are maximal after 35 weeks of gestation and at the extremes of the upper and lower dispersion estimates. Given the observed variability in extreme (3rd and 97th percentile) dispersion values over the gestation, use of single cutoffs to define out-of-range measurements may not be appropriate clinically. These data might form a contemporary United States standard for amniotic fluid estimation that uses the amniotic fluid index and the single deepest pocket.

Relationship between higher intra-amniotic pressures in polyhydramnios and maternal symptoms

ObjectivesOur study aimed to analyze the differences in intra-amniotic pressures in patients with polyhydramnios with and without symptoms. Study designWe recruited patients with pregnancies in which amnioreduction was performed for polyhydramnios in the Department of Fetal-Maternal Medicine at Nagara Medical Center between April 2017 and August 2018. Amnioreduction was performed for severe polyhydramnios with maternal symptoms [symptomatic group] or polyhydramnios without maternal symptoms [asymptomatic group] such as abdominal distension, dyspnea, or threatened premature labor. We measured the intra-amniotic pressure after every 200 ml volume reduction during the amnioreduction. ResultsA total of 27 patients who underwent amnioreduction were classified into symptomatic (66.7%, 18/27) and asymptomatic (33.3%, 9/27) groups. Gestational age, amniotic fluid index at the time of amnioreduction, and the volume of amniotic fluid removed were not significantly different between the symptomatic and asymptomatic groups [median 32.4 weeks vs. 33.1 weeks, median 38.0 cm vs. 39.0 cm, and median 1500 ml vs. 2500 ml, respectively]. However; the intra-amniotic pressure before amnioreduction was significantly higher in the symptomatic group than in the asymptomatic group [median 15.0 mmHg (range, 10–27) vs. 10.0 mmHg (range, 6.0–13); p < 0.005]. After amnioreduction, these pressures decreased significantly to median 9.0 mmHg (range, 5.0–13) (p < 0.001) in the symptomatic and 7.0 mmHg (range, 4.0–11) (p < 0.05) in the asymptomatic group. The median intra-amniotic pressure gradually decreased and reached a plateau during the amnioreductions in both groups. ConclusionsWith polyhydramnios, the intra-amniotic pressure was significantly higher in the symptomatic group than in the asymptomatic group. Therefore, uterine pressure tolerance might vary according to the individual. In addition, intra-amniotic pressure monitoring might enhance the safety during amnioreduction procedures to avoid drastic and potentially harmful pressure changes.

Pregnancy Outcome in Women Having Oligohydramnios in Gandaki Medical College Teaching Hospital, Pokhara, Nepal

Background: Amniotic fluid index is one of the most commonly used methods of amniotic fluid volume assessment and is a predictor of adverse maternal and perinatal outcome.&#x0D; Objectives: To compare the maternal and perinatal outcome in women with singleton term pregnancies having amniotic fluid index (AFI) ≤5 cm to those having AFI ≥5 to 20 cm.&#x0D; Methods: This is a prospective, case-control study which was conducted at Gandaki Medical College Teaching Hospital over a period of one year from July 2017 to July 2018. It included 60 pregnant women at term pregnancy with amniotic fluid index ≤5 cm. The control group included 60 pregnant women at term pregnancy with amniotic fluid index ≥5 cm. The two groups were compared. Statistical analysis was done using the Chi-square test to calculate the P- value.&#x0D; Results: There was a significantly higher incidence of overall cesarean rates due to fetal distress, low birth weight babies and adverse neonatal outcome like 5 minute Apgar score ≤7, neonatal intensive care unit (NICU) admission rates, and meconium aspiration syndrome in the group with oligohydramnios as compared to the group with normal liquor volume.&#x0D; Conclusion: Oligohydramnios adversely affects the perinatal outcome. However a favorable outcome can be expected by good antenatal and intrapartum surveillance and neonatal care.

Fetal Outcome in Pregnancies Complicated with Polyhydraminos: Study Done in Pokhara, Nepal

Introduction: Amniotic fluid plays an important role in the development of fetus. Any abnormality in the production amniotic fluid may have adverse effect on the fetus and the mother. Polyhydraminos is one of the common complications occurring during pregnancy and complicates around 0.2 - 2% of pregnancies.&#x0D; Methods: It is a prospective study conducted in Manipal Teaching Hospital, Pokhara, Nepal from January 2013 to December 2015. All the pregnant ladies irrespective of gestational age with amniotic fluid index (AFI) 25 cm or more were enrolled for the study. According to the AFI, polyhydraminos was classified as mild (25 – 30 cm), moderate (30.1 - 35 cm) and severe (&gt;35 cm). Fetal outcome, mode of delivery, presence of congenital anomalies, NICU admission and maternal glucose intolerance were recorded.&#x0D; Results: Out of 8232 deliveries, 24 were diagnosed and admitted with the diagnosis of polyhydraminos. Mild polyhydraminos, 50% (n=12) occurred after 37 weeks of gestation and 12.5% (n=3) had severe polyhydraminos. All pregnant ladies 50% (n=12), beyond 37 weeks gestation had cesarean section, whereas 25% (n=6) had vaginal deliveries. 33.3% (n=8) had preterm labor, 12.5% (n=3) had premature rupture of membrane, 25% (n=6) had congenital anomalies, one IUFD, one case of Rh isoimmunisation and one case of twin pregnancy. NICU admission needed in 20.5% (n=5). Pregnant ladies with impaired glucose intolerance were 8.3% (n=2).&#x0D; Conclusions: Polyhydraminos is associated with increased incidence of cesarean section, preterm labor, fetal malformation and NICU admission.

The Effect of L-Arginine on Amniotic Fluid Index in Pregnant Women with Oligohydramnios

Aim of the study: To evaluate the effect of L-arginine in the treatment of oligohydramnios. This prospective cohort study included 90 pregnant ladies who were diagnosed according to clinical and ultrasound findings as having oligohydramnios. The study was carried out in Al-Diwaniyah maternity and child hospital during the period from June 2017 through December 2018. Maternal and gestational age were obtained for all participants and the amniotic fluid index (AFI) was assessed by ultrasound. Women were all informed about the aim and the procedure of the study and verbal consent was obtained from all of them, in addition, the study was approved by the institutional approval committee. Women were given L-arginine treatment for a duration ranging from 8 to 28 days. The change in AFI following treatment was highly significant (P <0.01) and the mean change was 2.19 ±0.36 cm. Mean duration of treatment with L-arginine was 20.70 ±5.47 days and it ranged from 8 to 28 days. The change in AFI was higher with increasing duration of treatment in women within approximately the same weeks of gestation; the change in AFI among all women with respect to duration of treatment was highly significant (P < 0.001).

Detection of Β -Human Chorionic Gonadotrophin in Vaginal Fluid For The Diagnosis of Preterm Premature Rupture of Membranes

Background: The purpose of the present study is to evaluate β-hCG in vaginal washing fluid for the diagnosis of preterm premature rupture of membranes (PROM). Methods: This clinical trial was carried out at El-Galaa Maternity Teaching Hospital. The study included 100 women who were in their 3rd trimester of pregnancy. They were divided into 2 groups; group І (case group): Pregnant women with definite history of premature rupture of membranes confirmed by speculum examination as patients' (PROM) group. (n =50) and group ІІ (control group): Pregnant women with no history of rupture of membranes as control group. (n = 50) Results: There was significant statistical difference in the prediction of PROM between the case group and the control group. Conclusion: The presence of vaginal HCG is highly predictive of membranes rupture and is a more accurate diagnostic test than the amniotic fluid index (AFI) assessment in the diagnosis of ROM.

Report of a deadly case of potter syndrome: A case report.

Background: Potter’s syndrome is a rare congenital disorder that refers to a set of clinical manifestations that are associated with oligohydramnios caused by fetal kidney failure. The hallmark of this syndrome is the special clinical picture that in addition oligohydramnios characteristic with pulmonary hypoplasia, bilateral renal agenesis; limb deformities and specific face. The embryo dies before or immediately after birth due to respiratory failure. The aim of this study is to report a fetus with Potter’s syndrome that was born by vaginal delivery. Case report: Ultrasound examination of pregnant woman revealed that her male fetus with gestational age of 25 weeks with Potter’s syndrome and the amniotic fluid index is zero. The mother was hospitalized in unit labor and delivered in a natural course. The baby had a clinical picture of Potter’s syndrome and severe respiratory distress and died shortly after birth. Conclusion: Potter’s syndrome is a very serious condition and most of the time it is deadly. Prenatal ultrasound by examining oligohydramnios and kidneys helps to diagnose.

Clinical Significance of Fetal Subcutaneous Thickness via Ultrasonography Biometry in the Third Trimester for Estimating Fetal Birth Weight

Objective: In Korean population, information is lacking regarding fetal subcutaneous tissue thickness (SCTT) detected during pregnancy in the normal maternal condition. Thus, the aim of this study is to evaluate SCTT in the basic fetal biometry measurement plane, and to identify the clinical significance of SCTT in estimating fetal weight. Methods: In this retrospective observational study, 856 term pregnant women were recruited between 1st January 2013 and 31st December 2015. Estimated fetal weight (EFW) and fetal SCTT were measured routine ultrasonography within one week before delivery. The women were divided in two groups: SCTT group (n=46) and non-SCTT group (n=810). Pregnancy outcomes including birth weight (BW) and EFW were compared between the two groups. Results: The incidence of SCTT was 5.4% and no significant differences in parity, maternal age, maternal pre-pregnancy body mass index or gestational age at delivery were found between the groups. EFW, BW, amniotic fluid index, and cesarean section rate were higher in the SCTT group than in the non-SCTT group. The difference between EFW and BW was only significant in the SCTT group. Moreover, SCTT and EFW were positively correlated with BW (SCTT group: EFW 3,460±472 g vs. BW 3,779±496 g, P=0.013; non-SCTT group: EFW 3,011±436 g vs. BW 3,090±468 g, P=0.324). Conclusion: Fetal SCTT detected during routine biometric ultrasonography evaluation in the third trimester of pregnancy could suggest larger BW than EFW. Therefore, physicians should pay careful attention in such cases during assessments for delivery.