Single Deepest Vertical Pocket Research Articles

A Comparison of Amniotic Fluid Index versus Single Deepest Pocket Method in Terms of Maternal and Perinatal Outcome in Late Term Pregnancies

Background: Over diagnosis of isolated oligohydramnios is associated with increased obstetrical intervention without improving maternal and perinatal outcome. Objective of this study is to evaluate two methods of amniotic fluid volume assessment regarding obstetrical intervention frequency and its effect on maternal and perinatal outcome. Materials and Methods: This prospective study was conducted at a Private Hospital of Dera Ismail Khan and Khyber Teaching Hospital, Peshawar from 1st January 2017 till 31st December 2019. All pregnant patients with singleton, un-complicated pregnancy with period of gestation from 41 weeks to 41 weeks 6 days, live fetus were included in the study. Women who met the eligibility criteria were assigned to two different techniques of amniotic fluid assessment, first amniotic fluid index( AFI) method and second single deepest vertical pocket(SDVP) method. Data was recorded on a specially designed proforma. The socio-demographic variables were age in years, parity. Continuous variable was measured on numerical scale and expressed as mean and SD. Research variables were maternal outcome and perinatal outcome in terms of oligohydramnios frequency, induction of labour, caeserean section, fetal distress, NICU admission, A/S < than 7 at 5 minutes. Chi-sq test of significance was applied. Results: A total of 160 patients met the inclusion criteria. In first group 30 (37.5%) and in second group18 (22.5%) had oligohydramnios. In AFI group 10 (33.3%) and in SDVP group 3(16.66%) had caesereans section. Induction of labour was 30(37.5%) in AFI group and 18(22.5%) in SDVP group. These results were statistically significant with a p value less than .05 at 5% significance level. Fetal distress, A/S < than 7 at 5 minutes, NICU admission results were not statistically significant for two groups. Conclusion: SDVP technique gave less abnormal results, less intervention with no significant difference in maternal and perinatal outcome. Keywords: Amniotic fluid, Oligohydramnios, Caesarean section.

Comparison of Amniotic Fluid Index and Single Deepest Vertical Pocket

Background: The best method of estimation of amniotic fluid volume is a matter of ongoing debate. Objectives: To determine the perinatal & maternal outcomes in pregnant patients when the amniotic fluid volume was assessed by the amniotic fluid index (AFI) in comparison to the single deepest vertical pocket (SDVP). Methods: We studied abnormal Cardiotocograph, meconium stained amniotic fluid, birth weight <2.5kg, Apgar score at 5 min <7, cord blood pH <7.2 & necessity for NICU admission as perinatal outcomes. Rate of diagnosis of oligohydramnios, induction of labor for oligohydramnios & mode of delivery were observed in maternal outcomes. Results: Of the 697 pregnant patients recruited, 353 were in the AFI and 344 in the SDVP group. Perinatal outcomes were similar in both. In the AFI group, the number of women diagnosed with oligohydramnios was higher (p = 0.0333) & the rate of induction was also higher (p = 0.003378). Vaginal deliveries were more in the SDVP group. The Receiver Operating Characteristic curves showed statistically significant correlation with NICU stay, birth-weight, and mode of delivery. While an AFI of >5cm and SDVP of >1.9cm had good sensitivity in predicting babies with a birth weight of ≥ 2.5kg and avoiding NICU admissions, an AFI of > 5.8cm and an SDVP of > 1.9 cm had a sensitivity of around 80% in predicting successful vaginal deliveries. Conclusion: The SDVP method has a slight edge over the AFI in terms of lower inductions and higher vaginal deliveries with comparable perinatal outcomes.

An Observational Study to Evaluate Single Deepest Vertical Pocket (SDP) and Color Doppler Indices (CDI) with Severity of Covid in Pregnant Women with COVID-19

An Observational Study to Evaluate Single Deepest Vertical Pocket (SDP) and Color Doppler Indices (CDI) with Severity of Covid in Pregnant Women with COVID-19

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.

Hydration Therapy to Improve Amniotic Fluid Index and its Association with Improved Obstetric Outcome in a Teaching Hospital of Eastern India

Introduction: Oligohydramnios is associated with fetal complications and a higher incidence of maternal operative morbidity. A study was planned to determine the effect of hydration therapy in the correction of oligohydramnios in pregnancy and to assess if improvement in amniotic fluid index (AFI) is associated with better obstetric outcomes. Materials and Methods: Analytical study with a prospective design, conducted over 1 year from July 2020 to December 2021. Pregnant women in their third trimester with singleton pregnancy and intact membranes, diagnosed to have oligohydramnios were the participants. All women undertook oral rehydration therapy. The proportion of women achieving posthydration cutoff values of AFI and single deepest vertical pocket, was recorded by abdominal ultrasound examination at 24, 48, and 72 h. Adequacy of hydration was assessed by urinary specific gravity, before and after hydration therapy. Results: There were 120 participants. The mean age of the participants was 25.6 years (standard deviation = 5.7). Majority were multigravida. About 60%–80% of women improved with hydration therapy and the proportion of women showing improvement increased with time. Women with uncorrected AFI (<5 cm) at 24 and 48 h had significantly higher odds of preterm delivery, cesarean delivery, low-birth-weight baby, baby having 5 min Apgar score < 6, higher likelihood of Sick Newborn Care Unit admission and neonatal death. Conclusion: Maternal hydration therapy can be of value to improve the fetomaternal outcome in pregnancies with oligohydramnios by preventing preterm termination and reducing cesarean deliveries with good neonatal outcomes. Such simple intervention can be home based and assures universal health coverage.

Évaluation des pratiques professionnelles pour le suivi des grossesses prolongées dans un réseau de périnatalité

ObjectiveTo assess professional practices of prolonged and post-term pregnancies in accordance to French guidelines. The secondary outcome was to evaluate neonatal and maternal morbidity during prolonged pregnancy. MethodsDescriptive retrospective study was conducted in the 23 maternity hospitals of perinatal network between September and December 2018. The inclusion criterion was a birth term of≥41+0 weeks of gestation. Primary outcome was conformity to the national guidelines based on 10 items (conformity score≥80%). The secondary outcome was a composite criteria of neonatal morbidity (ventilation, resuscitation and/or Apgar score<7 at 5minutes) and maternal morbidity (obstetrical anal sphincter injury and/or postpartum hemorrhage). ResultsA total of 596 patients were included and the conformity was obtained in 65.3% of cases. Inconsistent criteria were amniotic fluid evaluation by the deepest vertical pocket (46.8%, n=279), and information of patients on prolonged pregnancy management (14.8%, n=88). Adverse perinatal outcome occurred for 40 newborns (6.0%) with shoulder dystocia (OR=5.2; CI 95%: 1.4–19.7) as a principal risk factor. Maternal morbidity outcome occurred in 70 cases (10.6%) primarily with increase in labour duration (OR=1.1 by hour of labour; CI 95%: 1.02–1.24) and prior caesarian section (OR=4.4; CI 95%: 1.8–11.0). ConclusionsManagement of prolonged and post-term pregnancies matching with the French national guidelines. Points of improvement are amniotic fluid evaluation at term by a single deepest vertical pocket, and the information about induction of labour at term.

Utility of the modified myocardial performance index in growth-restricted fetuses.

The modified myocardial performance index (Mod-MPI) can be used to assess myocardial function. Fetal growth restriction can affect fetal myocardial function, thereby altering the Mod-MPI. The results of previous studies on the utility of the Mod-MPI in growth-restricted fetuses are conflicting. The aim of this study was to calculate the left modified-MPI in growth-restricted fetuses and to compare the results with those of healthy fetuses. This was a prospective cross-sectional case-control study. In total, 40 women with growth-restricted fetuses and 40 women with fetuses of normal weight (controls) at 29-39 gestational weeks were enrolled in the study. An experienced obstetrician calculated the Mod-MPI for each fetus. Women with systemic diseases or fetuses with chromosomal/structural abnormalities were excluded from the study. The results of Mod-MPI measurements of the two groups were compared. The mean single deepest vertical pocket (SDVP) of amniotic fluid, estimated fetal weight (EFW), and isovolumetric relaxation time (IRT) was significantly lower in the fetal growth restriction (FGR) group as compared with these parameters in the control group (P<.05). The uterine artery (UtA) pulsatility index (PI) was significantly higher in the FGR group as compared with that in the control group (P<.05). There were six cases of absent end-diastolic flow (AED) in the FGR group. There were no statistically significant between-group differences in the Mod-MPI, isovolumetric contraction time (ICT), and ejection time (ET) (P>.05). There was also no statistically significant correlation between the Mod-MPI in the fetuses with AED and the control group for Mod-MPI (P>.05). The utility of the Mod-MPI in FGR remains unclear. Future studies with larger populations are needed to determine the utility of the Mod-MPI as a predictor of cardiac compromise in FGR.

Maternal and Perinatal Outcomes in Pregnancies after Preterm Premature Rupture of Membranes Determined by Single Deepest Vertical Pocket

Maternal and Perinatal Outcomes in Pregnancies after Preterm Premature Rupture of Membranes Determined by Single Deepest Vertical Pocket

Single Deepest Vertical Pocket or Amniotic Fluid Index as Evaluation Test for Predicting Adverse Pregnancy Outcome (SAFE Trial): A Multicenter, Open-Label, Randomized Controlled Trial

(Abstracted from Ultrasound Obstet Gynecol 2016;47:674–679) One of the important aspects of fetal well-being assessment is amniotic fluid volume, lack of which leads to oligohydramnios and consequently adverse perinatal outcomes. Amniotic fluid estimation by ultrasound can be performed by assessment of the amniotic fluid index (AFI) or the single deepest vertical pocket (SDP) technique.

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).

Single deepest vertical pocket or amniotic fluid index as evaluation test for predicting adverse pregnancy outcome (SAFE trial): a multicenter, open-label, randomized controlled trial.

To determine whether the amniotic fluid index (AFI) or the single deepest vertical pocket (SDP) technique for estimating amniotic fluid volume is superior for predicting adverse pregnancy outcome. This was a multicenter randomized controlled trial including 1052 pregnant women with a term singleton pregnancy across four hospitals in Germany. Women were assigned randomly, according to a computer-generated allocation sequence, to AFI or SDP measurement for estimation of amniotic fluid volume. Oligohydramnios was defined as AFI ≤ 5 cm or the absence of a pocket measuring at least 2 × 1 cm. The diagnosis of oligohydramnios was followed by labor induction. The primary outcome measure was postpartum admission to a neonatal intensive care unit. Further outcome parameters were the rates of diagnosis of oligohydramnios and induction of labor (for oligohydramnios or without specific indication), and mode of delivery. Postpartum admission to a neonatal intensive care unit was similar between groups (4.2% (n = 21) vs 5.0% (n = 25); relative risk (RR), 0.85 (95% CI, 0.48-1.50); P = 0.57). In the AFI group, there were more cases of oligohydramnios (9.8% (n = 49) vs 2.2% (n = 11); RR, 4.51 (95% CI, 2.2-8.57); P < 0.01) and more cases of labor induction for oligohydramnios (12.7% (n = 33) vs 3.6% (n = 10); RR, 3.50 (95% CI, 1.76-6.96); P < 0.01) than in the SDP group. Moreover, an abnormal cardiotocography was seen more often in the AFI group than in the SDP group (32.3% (n = 161) vs 26.2% (n = 132); RR, 1.23 (95% CI, 1.02-1.50); P = 0.03). The other outcome measures were not significantly different between the two groups. Use of the AFI method increased the rate of diagnosis of oligohydramnios and labor induction for oligohydramnios without improving perinatal outcome. The SDP method is therefore the favorable method to estimate amniotic fluid volume, especially in a population with many low-risk pregnancies. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.

A comparison between amniotic fluid index and the single deepest vertical pocket technique in predicting adverse outcome in prolonged pregnancy.

to compare perinatal outcome in induced postterm pregnancies with normal amniotic volume and in patients with prolonged pregnancy undergone induction for oligohydramnios, evaluated by two different ultrasonographic methods. amniotic fluid volume was measured, using Single Deepest Vertical Pocket (SDVP) and Amniotic Fluid Index (AFI), in 961 singleton uncomplicated prolonged pregnancies. In 109 of these patients, hospitalization was planned for induction of labor, during or after 42 weeks of gestation, for oligohydramnios, postterm pregnancy and other indications in 47, 51 and 11 cases, respectively. Perinatal outcome included: rate of caesarean section, fetal distress, non reassuring fetal heart tracing, presence of meconium, umbilical artery pH < 7.1, Apgar score at 5 minutes < 7, admission to neonatal intensive care unit (NICU). oligohydramnios was diagnosed in 4.89% of cases, when at least one of the two methods was used. A reduced AFI and SDVP value identified 4.47% and 3.75% of cases, respectively, even if without statistical difference. No statistical differences were reported in perinatal outcomes in postterm versus prolonged pregnancies with oligohydramnios, also in relation to the two different ultrasonographic methods. oligohydramnios is more frequently diagnosed using AFI than SDVP, consequently determining a higher rate of induction of labor. Moreover, perinatal outcome in prolonged induced pregnancies is not affected by oligohydramnios.