Assessment Of Amniotic Fluid Volume Research Articles

Amniotic fluid volume assessment at the present stage of development

Amniotic fluid not only provides conditions for normal growth and development of the fetus, but also prevents umbilical cord compression and infection of the uterine cavity due to the existing bacteriostatic effect. In addition, amniotic fluid volume varies in pathological conditions of the fetus and the uteroplacental complex, which can lead to irreversible consequences. The aim of this study was to analyze features of assessing amniotic fluid volume at the present stage of development. In this review article, we analyzed, systematized, and summarized data obtained by foreign and domestic authors from 1980 to 2017. Reliable determination of amniotic fluid volume will optimize the management of pregnant women threatened by risk of perinatal pathology.

AMNIOTIC FLUID ASSESSMENT;

Objectives: To assess amniotic fluid volume in second and third trimester ofpregnancy in Pakistani population. Period: Three months. Setting: Talha ultrasound, Multan.Material and Methods: I have started my work by collecting data from the month of November,2015 to February, 2016. The machines which have been used for data collection were Xarioand Z-5 ultrasound Doppler machines with transabdominal (3.5-5MHz) probes. A group of 100Pakistani married female patients of different age groups was included. These patients werehaving normal criteria of second and third trimester (14-40 weeks gestational age). Results:100 married female patients were selected having different age group. There were no significantdifference found in the means of large pocket volume and four pocket volumes of second andthird trimester of pregnancy. Conclusion: Ultrasound plays an important role in assessment ofamniotic fluid volume. If there is one unit change in large pocket volume (LPV) than four pocketvolume (FPV) will change by 2.37 and 2.146 in second and third trimester, respectively.

No. 214-Guidelines for the Management of Pregnancy at 41+0 to 42+0 Weeks.

To provide evidence-based guidelines for the management of pregnancy at 41+0 to 42+0 weeks. Reduction of perinatal mortality associated with Caesarean section at 41+0 to 42+0 weeks of pregnancy. The Medline database, the Cochrane Library, and the American College of Obstetricians and Gynecologists and the Royal College of Obstetricians and Gynecologists, were searched for English language articles published between 1966 and March 2007, using the following key words: prolonged pregnancy, post-term pregnancy, and postdates pregnancy. The quality of evidence was evaluated and recommendations were made according to guidelines developed by the Canadian Task Force on Preventive Health Care.

Is transabdominal ultrasound measurement of single deepest vertical pocket effective for ruling out oligohydramnios and predicting complications?

EVIDENCE-BASED ANSWER Single deepest vertical pocket (SDVP) leads to fewer diagnoses of oligohydramnios than amniotic fluid index (AFI). Use of the SDVP test decreases rates of both labor induction and cesarean sections for fetal distress compared with AFI without differences in other neonatal outcomes (SOR: A, meta-analysis of RCTs and single RCT). Yet SDVP has poor sensitivity for oligohydramnios compared with the “gold standard” of dye-dilution spectrophotometry (DDS) for amniotic fluid volume assessment (SOR: C, disease-oriented evidence).

ISUOG Practice Guidelines: role of ultrasound in twin pregnancy.

ISUOG Practice Guidelines: role of ultrasound in twin pregnancy.

Fetal Lower Urinary Tract Obstruction: An Update

Fetal lower urinary tract obstruction [LUTO] represents a rare, heterogeneous group of uropathies involving mechanical or functional blockage at the bladder outlet of varying severity. While ultrasound is a fair screening tool for the antenatal detection of this condition, it cannot reliably determine the underlying etiology of LUTO presentations. Sonographic assessment of renal appearance and amniotic fluid volume, as well as urinary analyte analysis, are the most useful predictors of preserved renal function in fetal LUTO, although they, too, are limited in their ability to predict outcomes on an individual basis. Animal models suggest that obstructive uropathy likely causes irreparable damage to the renal and urinary collecting system injury early in pregnancy. When LUTO is associated with abnormal amniotic fluid volume, long-standing oligohydramnios may result in lethal pulmonary hypoplasia. Data evaluating the efficacy of vesicoamniotic shunt therapy for the treatment of fetal LUTO are inconclusive. While vesicoamniotic shunting may modify disease lethality by restoring fluid volume, renal and other genitourinary benefits are minimal if not altogether absent, arguably supporting the belief that bladder decompression is being performed after irreversible injury has already been sustained.

Influence of parity on fetal hemodynamics and amniotic fluid volume at term

Pregnancy complications, particularly those associated with placental dysfunction, occur more frequently in nulliparous than in parous women. This difference may be a consequence of improved trophoblastic invasion and, as a result, improved placental function following previous pregnancy. Placental dysfunction in cases of fetal growth restriction may be identified by ultrasound assessment of fetoplacental hemodynamics and amniotic fluid volume. In this prospective observational study, we investigated whether differences in these measures of placental function exist between nulliparous and parous women, prior to active labor. Over a 2-year period, 456 nulliparous and 152 parous women with uncomplicated singleton pregnancies were recruited to this prospective observational study. Each participant underwent an ultrasound assessment prior to active labor, during which fetal biometry, umbilical artery, middle cerebral artery and umbilical venous Dopplers, as well as amniotic fluid volume, were assessed. All cases were followed up within 48 h of delivery. Ultrasound parameters and intrapartum outcomes were then compared between the nulliparous and parous groups. Compared with nulliparous women, parous women had significantly higher fetal middle cerebral artery pulsatility index, cerebroplacental ratio and amniotic fluid volume. In nulliparous women, middle cerebral artery flow rate was also significantly higher and represented a greater percentage of umbilical venous flow than was observed in parous women. Prior to the active phase of labor, ultrasound parameters indicative of placental function differ significantly between nulliparous and parous pregnancy, even amongst an uncomplicated, low-risk cohort.

A systematic review of amniotic fluid assessments in twin pregnancies.

The objectives of this systematic review were to examine the reproducibility of sonographic estimates of amniotic fluid volume (AFV) in twin pregnancies, compare the association of sonographic estimates of AFV with dye-determined AFV, and correlate AFV with antepartum, intrapartum, and perinatal outcomes in twin pregnancies. Studies were included if they were adequately powered and investigated antepartum, intrapartum, and/or perinatal adverse outcome parameters in twin gestations. Studies with comparable populations and exclusion criteria were merged into forest plots. Data comparing the accuracy of AFV assessment, correlation of AFV with gestational age, and adverse outcomes were tabulated. Five of the 6 studies investigating AFV by the amniotic fluid index as a function of gestational age reported data fitting a quadratic equation, with fluid volumes peaking at mid gestation and then declining. This trend was less pronounced when AFV was assessed by the single deepest pocket (2 of 4 studies reporting a quadratic fit). Polyhydramnios was associated with prematurity in 2 of 4 studies (1 amniotic fluid index and 1 single deepest pocket), and oligohydramnios was associated with prematurity in 1 single deepest pocket study. Stillbirth was the only intrapartum outcome reported in more than 1 study. Perinatal outcomes associated with polyhydramnios included neonatal death (P < .05 in 1 of 2 studies), low Apgar scores (1 of 2 studies), neonatal intensive care unit admission (1 of 2 studies), and low birth weight (2 of 3 studies).

Evaluación Crítica, Interpretación, Utilidad y Resultados del Perfil Biofísico Ecográfico. Hospital Guillermo Almenara, Lima-Perú

OBJETIVOS: Evaluar en forma crítica la utilidad del Perfil Biofísico Ecográfico (PBE) en la evaluación del bienestar fetal, definir con precisión sus variables, interpretarlo y proponer un flujograma de manejo de valoración del bienestar fetal de acuerdo al puntaje obtenido en la prueba. MATERIALES Y MÉTODOS: Estudio observacional, prospectivo y ciego en el Servicio de Obstetricia de Alto Riesgo del Hospital Guillermo Almenara - EsSalud en Lima, desde octubre de 1997 a setiembre de 1998. Se incluyó a 120 pacientes con edad gestacional ³28 semanas, cuyo estado requería valoración del bienestar fetal y decisión de culminar el embarazo en forma oportuna. Durante la prueba se evaluó la dificultad y beneficios de medir ultrasonográficamente la frecuencia cardíaca fetal basal y la reactividad cardíaca; la utilidad de evaluar ultrasonográficamente el volumen de líquido amniótico, la senescencia placentaria y el envejecimiento precoz de la placenta, y la utilidad de establecer un puntaje crítico de la prueba que defina una población en riesgo. RESULTADOS: La aplicación de esta estrategia reveló una alta sensibilidad (87,5%) de la prueba, un buen valor predictivo positivo (63,6%) y disminución importante del índice de falsos positivos y negativos (36,3% y 2,0%, respectivamente). CONCLUSIONES: Al establecer un flujograma de evaluación del bienestar fetal según los resultados de la prueba y al individualizar clínicamente cada caso para interpretar sus resultados se hace uso eficiente y eficaz del PBE.

Fetal middle cerebral and umbilical artery Doppler after 40 weeks gestational age

Objective: To determine the value of fetal Doppler indices named middle cerebral artery (MCA)-PI, umbilical artery (UA)-PI and MCA-PI/UA-PI ratio, and amniotic fluid volume assessment in pregnancies 280–294 d and their correlation with the mode of delivery and perinatal outcome.Study design: Prospective observational study conducted on 100 whose gestational age (GA) from 40 to 42 weeks. MCA and UA Doppler and MCA-PI/UA-PI ratio, amniotic fluid volume (AFV) were assessed. They were divided into two groups based on the presence or absence of adverse perinatal outcome.Results: Women with adverse perinatal outcome showed lower MCA-PI (0.92 versus 1.29), MCA-PI:UA-PI ratio (1.04 versus 1.83), lower gestational age when assessed by ultrasound (37.82 versus 39.48 weeks), lower neonatal birth weight (2705 versus 3108 g), fetal biophysical profile (BPP) (4.55 versus 7.21) when compared to women with normal perinatal outcome. They also had higher cases with oligohydramnios (34 versus 5), and higher UA-PI (0.89 versus 0.72).Conclusion: Women with adverse neonatal outcome had higher UA-PI and lower MCA-PI, MCA-PI:UA-PI ratio, GA (by US), AFV, BPP, estimated fetal weight, neonatal birth weight when compared to those with normal perinatal outcome. Women with adverse neonatal outcome had a higher rate of cesarean section mostly due to fetal distress and induced VD due to oligohydraminos compared to the normal outcome group.

Effect of Oral Hydration Therapy on Isolated Oligo-Hydroamnios Cases &amp; Perinatal Outcome

Effect of Oral Hydration Therapy on Isolated Oligo-Hydroamnios Cases & Perinatal Outcome Oligohydroamnios means reduced amount of amniotic fluid and it has been defined as a harbinger of adverse perinatal outcome commonly associated with higher incidence of abnormal labour, intra-partum fetal distress, increased operative deliveries and low Apgar scores. Clinically it is not possible to quantify the amniotic fluid. Best non invasive semi-quantitative & reproducible method of assessment of amniotic fluid volume is Amniotic Fluid Index (AFI) measured by ultrasonographic four quadrant technique.

Study of Oligohydramnios Cases by Modified Biophysical Profile &amp; Their Perinatal Outcome

Background:Assessment of foetal wellbeing is important, in timely diagnosis of foetalcompromise and management. Oligohydramnios is associated with increasedincidence of adverse perinatal outcomes like foetal distress, meconium stained liquor, lowAPGAR score, low birth weight, NICU admission, perinatal morbidity and mortality.Foetal biophysical profile is a well-established method of antepartumsurveillance. Classical biophysical profile needs two phase testing by ultrasound and external doppler monitor to record foetal heart rate, is more cumbersome, time consuming and expensive. The modified biophysical profile (MBPP) suggested by Nageotte et al combines non stress test (NST) as a short term marker of foetal status and the amniotic fluid index (AFI) as marker of long term placental function is easier to perform and less time consuming than classical biophysical profile. Objectives: 1) To assess the role of modified biophysical profile as a method ofantepartum foetalsurveillance test in predicting perinatal outcome in oligohydramnios cases. 2) To compare the morbidity and mortality with respect to each of the parameters ofmodified biophysical profile, that is NST and AFI individually. Methods:This study was a prospective clinical study which consisted of 60 pregnant women with oligohydramnios. The patients were evaluated with themodified biophysical profile consisting of NST recording for 20mins, followed byultrasound assessment of amniotic fluid volume, using four quadrant technique. Results: • When the Modified biophysical profile is normal, it gives reassurance that thefoetal status is good with good perinatal outcome. • When the MBPP is abnormal there is increased incidence of perinatalmorbidity as well as mortality. When considered individually, abnormal AFI was associated with increasedincidence of perinatal morbidity and abnormal NST was associated with increasedincidence of perinatal morbidity as well as perinatal mortality. Interpretation and conclusion:Modified biophysical profile is an effective method ofantepartum

Definition and management of fetal growth restriction: a survey of contemporary attitudes

ObjectiveTo evaluate opinions among Irish obstetricians and obstetric trainees regarding the optimal definition, assessment and management of pregnancies affected by intrauterine growth restriction (IUGR). Study designAn anonymous, structured, web-based survey that comprised 14 questions was sent to 200 obstetricians and obstetric trainees in Ireland. ResultsOf the 113 participants (57% response rate), the majority (50%) were consultants, with over 10 years’ clinical experience (46%), who worked in large maternity units (58%) with neonatal units providing care for preterm IUGR fetuses (94%). Eighty-three clinicians (74%) agreed that an estimated fetal weight (EFW) below the 10th centile constitutes small-for-gestational age (SGA). The majority (n=93; 82%) would deliver the SGA fetus between 37+0 and 39+6 weeks gestation. In total, the survey yielded 30 different IUGR definitions; the top three definitions were (i) an EFW below the 5th centile (n=18; 16%), (ii) an EFW below the 10th centile with oligohydramnios and abnormal umbilical artery (UA) Doppler (n=16; 14%), and (iii) an EFW below the 10th centile (n=12; 11%). In the evaluation of the preterm IUGR fetus with abnormal UA Doppler, the assessment of amniotic fluid volume, middle cerebral artery, ductus venosus, cardiotocograph (CTG) and biophysical profiling was performed in 74%, 60%, 60%, 54% and 52% respectively. The majority of clinicians applied three or more assessment modalities and 60% referred to a maternal-fetal medicine (MFM) subspecialist. Interestingly, even among MFM subspecialists there was no common consistent management approach. Most doctors (81%) would deliver the IUGR fetus for CTG abnormalities but MFM subspecialists more commonly deliver on the basis of absent end-diastolic flow in the UA alone (37% vs. 10%; p=0.006). Two-thirds of doctors (n=74) would implement customised growth charts if they became available for their population and over 80% thought that a national guideline on IUGR would be beneficial. ConclusionThe results of this survey confirm the inconsistencies surrounding the clinical management of IUGR pregnancies and highlight the need for standardisation of terminology and antenatal surveillance, implementation of fetal weight customisation and national guidance for Ireland.

Amniotic Fluid Volume Assessment Using the Single Deepest Pocket Technique in Bangladesh

Background Assessment of amniotic fluid volume (AFV) is important for determining fetal well-being in the uterus. This assessment can be made subjectively or objectively by measuring the amniotic fluid pockets. Methods Single deepest pocket (SDP) measurement was the first method for objectively determining AFV in a noninvasive manner. This is a faster technique compared with the Amniotic Fluid Index method and is the only easy objective way in case of multiple pregnancies, especially in dizygotic gestation. Results In this study, SDP was found to range between 1.7 and 7.6 cm from 14 to 41 weeks of gestational age. Conclusion Therefore, SDP >7.6 cm can be considered as polyhydramnios and SDP

Longitudinal assessment of amniotic fluid volume in monoamniotic twin gestations

The aim of this study is to describe normal amniotic fluid volume through gestation in a cohort of normal monoamniotic (MA) twins. Our ultrasound database was queried for MA twin gestations from 2004 to 2011. Monochorionic twin pregnancies mimicking MA gestations, such as twin-twin transfusion syndrome, were excluded. Complicated MA gestations and higher-order multifetal gestations involving an MA pair were excluded. Thirty subjects were followed with serial amniotic fluid index (AFI) measurements from 15 to 32 weeks gestation. Using each AFI measurement as a unique data point, a quadratic regression model and a multi-level growth model were developed against gestational age (GA), providing a predicted AFI at each completed week, with a 95% confidence interval. The quadratic regression least squares and multi-level growth models yielded the same curve comparing the AFI to the GA. Figure 1 depicts the model with the 95% confidence interval for normal amniotic fluid volume by GA for normal MA twins. Table 2 shows the 5th, 50th, and 95th percentiles for AFI by week from 15 to 32 weeks. We have generated normative data for amniotic fluid volume across gestation in uncomplicated MA twins. This can be used as a reference when managing MA pregnancies.

English

Introduction Twin pregnancies are at increased risk, compared to singleton pregnancies, for spontaneous abortions, malformations, low birth weight neonates, and preterm deliveries. Additionally the pregnancies are at greater risk for gestational diabetes, hypertension/ preeclampsia, acute fatty liver, and placental abruption. Because of these increased risks for pregnancy complications and adverse pregnancy outcomes, the assessment of amniotic fluid volume is even more important in twin pregnancies during the foetal anatomic survey, growth assessment, and as a component of antenatal testing. This paper discusses the different methods we have to evaluate amniotic fluid volume in twins. Short Communication The amniotic fluid volume in twins is estimated by many different techniques including amniotic fluid index, single deepest pocket, 2diameter pocket, and subjective assessment method. Conclusion Twin pregnancies are at significantly higher risk for pregnancy complications, perinatal morbidity and mortality compared to singleton pregnancies. The amniotic fluid volume can be measured accurately in each sac but the techniques to measure those fluid volumes are impractical for everyday use.

Amniotic fluid as a vital sign for fetal wellbeing.

Introduction: Amniotic fluid, once thought to merely provide protection and room for necessary movement and growth for the fetus, is now understood to be a highly complex and dynamic system that is studied as a data point to interpret fetal wellbeing. Methods: Assessment of amniotic fluid volume is now routine when performing a sonographic evaluation of fetal status and is an important consideration in the assessment and management of perinatal morbidity and mortality. 1 , 2 In this review, we will cover the dynamics that affect amniotic fluid volume, review methods for measurement and quantification of volume, review definitions for normative data as related to neonatal outcomes, and provide evidence based guidance on the workup and management options for oligoydramnios and polyhydramnios in singleton and twin pregnancies. Conclusions: When abnormalities of fluid exist, appropriate workup to uncover the underlying etiology should be initiated as adverse fetal outcomes are sometimes associated with these variations from normalcy.

Evaluation of Amniotic Fluid Volume among Sudanese Diabetic Patients in Third Trimester Using Ultrasound

Assessment of amniotic fluid volume in diabetic pregnancies is important for maternal and fetus health judgment and pregnancy outcome and for this reason the purpose of this study is relevant using two ultrasonographic methods. The study included 49 Sudanese pregnant women with diabetes mellitus and 20 subjects as control group .The study was conducted at Omdurman Military hospital and Al -Saudi hospital in the period from December 2011 to April 2012. Ultrasound was done by using Mindray 6600, 2200 ultrasound machine fitted with 3.5 MHZ convex probe. Amniotic fluid volume (AFV) was measured by largest pocket and Amniotic fluid index (AFI) .The mean AFI for control group was found to be (16.6±2.4) and the largest pocket was (6.6±0.7),for diabetic sample AFI was (20.3±5.6), largest pocket was (7.4±1.9).T-test showed that AFI was found to be 4.66 at p <0.001, largest pocket was 2.93 at p-value 0.005. There is significant difference between AFI measurements and largest pocket for diabetic pregnant ladies compared to the control group.Measurements of AFV using ultrasound compared with type of diabetic and diabetic status is of great value to categorize the relative risk of complications related to diabetes.

Usefulness of fetal monitoring in intrahepatic cholestasis of pregnancy: a prospective study

To study the role of fetal surveillance in intrahepatic cholestasis of pregnancy. A total of 69 women with obstetric cholestasis were included. Fetal surveillance began at 34 weeks or later at diagnosis and included daily maternal record of fetal movements, biophysical profile (i.e., non-stress test, amniotic fluid volume assessment using the four quadrant amniotic fluid index), and Doppler flow velocimetry. Fetal monitoring was done weekly before 36 weeks and biweekly after that. There were no abnormal non-stress test readings and all pregnancies had good biophysical profile. One hundred and sixty Doppler measurements [Systolic-Diastolic (S/D ratio) and Pourcelot index (PR)] were taken from 67 patients at scheduled intervals during the study period. Findings were compared to gestation matched reference values of Doppler flow velocities of umbilical artery of normal pregnant population. Fifty-six out of 160 PR indices and 33 out of 162 S/D ratio readings were above 2 SD and these results were found to be statistically significant. However, there was no significant correlation with the serum levels of alanine transaminase (r=-0.071) or with aspartate transaminase (r=0.058). Further, there was no correlation of Doppler with rates of preterm delivery or meconium-stained liquor. Doppler investigation of the umbilical artery might be of some value in recognition of the specific risk of fetal compromise in pregnancies complicated by intrahepatic cholestasis.

ACR Appropriateness Criteria® Multiple Gestations

Multiple gestations are high-risk compared with singleton pregnancies. Prematurity and intrauterine growth restrictions are the major sources of morbidity and mortality common to all twin gestations. Monochorionic twins are at a higher risk for twin-twin transfusion, fetal growth restriction, congenital anomalies, vasa previa, velamentous insertion of the umbilical cord and fetal death. Therefore, determination of multiple gestation, amnionicity and chorionicity in the first trimester is important. Follow up examinations to evaluate fetal well-being include assessment of fetal growth and amniotic fluid volume, umbilical artery Doppler, nonstress test and biophysical profile. To date, there is a paucity of literature regarding imaging schedules for follow-up. At the very least, antepartum testing in multiple gestations is recommended in all situations in which surveillance would ordinarily be performed in a singleton pregnancy.The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed biennially by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging.