Amniotic Fluid Index Values Research Articles

Fetal Outcome Evaluation in High-risk Term Pregnancy Using Biophysical Profile at a Tertiary Hospital in Anambra State, Nigeria

Introduction: A high-risk pregnancy is defined as a pregnancy in which there is a significant probability of an adverse maternal or fetal outcome that is more than the incidence of that outcome in the general population. Aim: To determine the usefulness of biophysical profile evaluation in women with high-risk term pregnancies. Methods: Biophysical profile (BPP) parameters were used to evaluate 160 high-risk women with term pregnancies. Results: All the participants had normal amniotic fluid index values [AFI] of 8.1-24.0cm. Most of the participants 115 (71.9%) showed good BPP scores. Outcome at delivery was as follows; fetal distress [presence 8.9%, absence 91.1%], stillbirth = none, admission into the intensive care unit (ICU) [Yes 2.0%, No 88%], meconium staining [Yes 8.2%, Clear 91.8%], birth weight [< 2.5kg = 5.7%, > 2.5kg = 94.3%]. APGAR score at 1 minute [<7 = 5.1%, >7 = 94.9%] while at 5 minutes [<7 = 3.2%, > 7= 96.8%]. The commonest mode of delivery was vaginal 84 (52.8%). The association between gross body movement, fetal breathing movement, and fetal outcome was not statistically significant p > 0.05. Conclusion: BPP parameters were found to be associated with fetal outcomes.

Clinical and Sonological Evaluation of Borderline Amniotic Fluid Index and Oligohydramnios-Its Correlation with Perinatal Outcomes

Objective: To evaluate the correlation of low borderline amniotic fluid index and oligohydramnios with perinatal outcomes among pregnant females presenting at the tertiary care hospital of Karachi. Study Design: Cross-sectional study.Place and Duration of Study: The study was conducted at the Department of Obstetrics and Gynecology, Hamdard University, Karachi, Pakistan, from March 2021 to March 2022.Methods: Females aged 18-45 years, with a gestational age of 20-42 weeks assessed on the last menstrual period and a single fetus on ultrasound were enrolled. The final sample size for the study was determined to be 260 with 130 participants in each group, i.e., the females with Amniotic Fluid Value (AFI) value of ≤5 cm considered as oligohydramnios (group-1) and AFI value of 5.1 to 8 cm considered as borderline AFI (group-2)The amniotic fluid index value was determined in all the females using ultrasonographic reports by the consultant physicians. Females were classified as having oligohydramnios if their amniotic fluid index value was less than 5 cm and borderline amniotic fluid index between 5.1 and 8 cm. To evaluate the maternal and perinatal outcomes, all females were monitored up to birth. Data was analyzed using SPSS version 23.Results: The mean maternal age was 29.85±5.45 years, and the mean BMI was 29.78±5.62 kg/m . Most of the females had gravida ≥1. Females with oligohydramnios had higher rates of low birth weight (84.6% vs. 51.5%, p=0.001), IUGR (68.5% vs. 22.3%, p=0.001), meconium staining (42.3% vs 7.7%, p=0.001), low APGAR score (50.8% vs. 13.8%, p=0.001), respiratory distress syndrome (72.3% vs 27.7%, p=0.001), birth asphyxia (65.4% vs 23.1%, p=0.001), NICU admission (73.8% vs. 43.1%, p=0.001), and neonatal death (21.5% vs. 5.4%, p=0.001) than women with borderline amniotic fluid index.Conclusion: This observational study demonstrates a significant correlation between oligohydramnios and adverse perinatal outcomes, emphasizing the importance of vigilant monitoring and intervention in pregnancies with low amniotic fluid. How to cite this: Jamsheed S, Abid K. Clinical and Sonological Evaluation of Borderline Amniotic Fluid Index and Oligohydramnios-Its Correlation with Perinatal Outcomes. Life and Science. 2024; 5(1): 16-21. doi: http://doi.org/10.37185/LnS.1.1.378

Assessment of fetal myocardial performance index in pregnant women with SARS-CoV-2 infection: A prospective cohort study.

Our aim was to investigate the effects of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection on fetal myocardial performance in women who had it during their pregnancy. In our prospective cohort study including healthy pregnant women and pregnant with SARS-CoV-2 infection, we collected patients' data between June 2021 and April 2022. Maternal characteristics, gestational age at SARS-CoV-2 infection and ultrasound examination, and body mass index were noted. Fetal biometry, fetal anatomy scanning, placenta, amniotic fluid index (AFI), and Doppler parameters were routinely examined in all patients. Left ventricular myocardial performance index (MPI) was measured during fetal echocardiography examination. Doppler parameters, AFI, and MPI values were compared between two groups. Compared with the control group (n = 80), MPI values were found within normal limits in fetuses of pregnant women with SARS-CoV-2 infection (n = 80) (MPI: 0.38 ± 0.06 in the control groups vs. 0.39 ± 0.05 in the SARS-COV-2 positive group, p = 0.79). There was no relationship between SARS-CoV-2 infection and changes in AFI and umbilical artery pulsatility index (PI) values. Uterine artery PI values were significantly higher in pregnant women with (SARS-CoV-2) infection (0.81 in the control group vs. 0.97 in the SARS-CoV-2 group, p < 0.05). Fetal cardiac functions were not affected in pregnant women with previous (SARS-CoV-2) infection. Further metaanalyses are warranted to confirm the results.

A Study of the Fluid Intake, Hydration Status, and Health Effects among Pregnant Women in Their Second Trimester in China: A Cross-Sectional Study

The fluid intake and hydration status during pregnancy may influence the health outcomes of both the mother and the fetus. However, there are few studies related to this. The aim of the present study was to investigate fluid intake behaviors among pregnant women in their second trimester, to evaluate their hydration status and pregnancy complications, and to further explore the association of fluid intake and the amniotic fluid index (AFI). Participants' total fluid intake (TFI) levels were determined using a 7-day 24 h fluid intake questionnaire. The levels of water intake from food were not recorded or measured. Morning urine samples were collected, and both urine osmolality levels and urine specific gravity (USG) were tested to evaluate their hydration status. Fasting blood samples were also collected and measured for osmolality and complete blood count (CBC). A total of 324 participants completed the study. They were divided into four groups based on quartiles of TFI, including participants with lower (LFI1 and LFI2) and higher (HFI1 and HFI2) fluid intake levels. The median TFI was 1485 mL, and the median values of the four groups with different TFI levels were 1348, 1449, 1530, and 1609 mL, respectively. Only 3.4% of the participants attained the recommended value following an adequate water intake (1.7 L) level for pregnant women in China. Plain water was the main TFI resource (78.8~100.00%), and differences in the plain water intake levels among the four groups were evident (χ2 = 222.027, p < 0.05). The urine osmolality decreased sequentially with increasing TFI values from the LFI1 to HFI2 group, and significant differences in the urine osmolality levels among the four groups were evident (p < 0.05). Meanwhile, the percentage of dehydrated participants decreased from 26.8% in the LFI1 group to 0.0% in the HFI2 group (χ2 = 131.241, p < 0.05). Participants with higher TFI values had higher AFI values (χ2 = 58.386, all p < 0.05), and moderate-intensity correlations were found between TFI and urine osmolality, hydration status, and AFI (all p < 0.05). A large proportion of the participants had insufficient TFIs during the second trimester of pregnancy, and a proportion of the participants were dehydrated. The preliminary analysis showed that the AFI was correlated with the TFI during the second trimester of pregnancy. A sufficient TFI is necessary for pregnant women to improve their hydration status and may have effects on their health. The results can provide appropriate scientific references for the development of beneficial recommendations concerning adequate water intake levels for pregnant women in China.

Frequency of Diabetic and Non-diabetic patients having fetal anomalies at 3rd trimester using ultrasound

Background: Pre-gestational or gestational diabetes in pregnancy is now more common among pregnant mothers as a result of the obesity pandemic. Objective: To determine frequency of diabetic and non-diabetic patients having fetal anomalies at 3rd trimester using ultrasound. Methodology: Descriptive study was conducted at radiology department Chughtai Lab, Lahore. About 250 Diabetic and Non-Diabetic pregnant women of all age were included in this study. Consecutive sampling technique was used Data was analyzed by SSPS version 24.0. All quantitative variables were reported in mean ± S.D were presented in frequency and percentage and bar charts were presented. Results: The mean age of 250 participants was 28±5.1 with minimum age of 15 years and maximum age of 45 years. Out of 250 participants, 210(84%) had no Gestational Diabetes Mellitus and 40(16%) had Gestational Diabetes Mellitus. Out of 250 patients, 204(81.6%) had adequate Amniotic Fluid Index value, 27(10.8%) had Oligohydramnios and 19(7.6%) had Polyhydramnios. In our study 16(6.4%) diabetic patients and 26(10.4%) non-diabetic patients have anomalies. Conclusion: The study concluded that frequency of anomalies doesn’t depend on patients being diabetic or non-diabetic. As in our study diabetic patients are lesser anomalies than the non-diabetic patients.&#x0D;

Predictive Value of Amniotic Fluid Index in Term Small for Gestational Age with Normal Doppler Studies for Perinatal Outcomes

Predictive Value of Amniotic Fluid Index in Term Small for Gestational Age with Normal Doppler Studies for Perinatal Outcomes

The predictive value of amniotic fluid index for adverse perinatal outcome and its correlation to the biophysical profile and doppler velocimetery of umbilical artery and middle cerebral artery

The predictive value of amniotic fluid index for adverse perinatal outcome and its correlation to the biophysical profile and doppler velocimetery of umbilical artery and middle cerebral artery

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 (&lt;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 &lt; 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.

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

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

Does the Summer Season Affect the Amniotic Fluid Volume during Pregnancy?

Amniotic fluid is crucial for the well-being of the fetus. Recent studies suggest that dehydration in a pregnant woman leads to oligohydramnios. We assessed the variation in the amniotic fluid index (AFI) during the summer and non-summer seasons and evaluated neonatal outcomes. We retrospectively reviewed electrical medical records of pregnant women who visited the Konkuk University Medical Center for antenatal care, between July 2005 and July 2019. A total of 19,724 cases from 6438 singleton pregnant women were included after excluding unsuitable cases. All AFI values were classified as 2nd and 3rd trimester values. Additionally, borderline oligohydramnios (AFI, 5–8) and normal AFI (AFI, 8–24) were assessed according to the seasons. The average AFI between the summer and non-summer season was statistically different only in the 3rd trimester; but the results were not clinically significant. In the 3rd trimester, the summer season influenced the increased incidence of borderline oligohydramnios. The borderline oligohydramnios group showed an increased small-for-gestational-age (SGA) rate and NICU admission rate. In the summer season, the incidence of borderline oligohydramnios was seen to increase. This result would be significant for both physicians and pregnant women.

The use of dinoprostone at third trimester in pregnant women with oligohydramnios

The aim of this study was comparing the efficacy of dinoprostone administration for labour induction in pregnant women with oligohydramnios and in pregnant women with normal amniotic fluid volume at third trimester. This retrospective study included 187 pregnant women between January 2015-December 2020. Four quadrant technique was used to determine amniotic fluid index. The cases in the study were divided into two groups as Group:1(the ones with oligohydramnios) and Group:2 (the ones with normal amniotic volume) Age ,gravida, parity ,gestational week according to the last date of menstruation, Bishop score ,dilatation ,hours elapsed after the first contraction, hours elapsed after active contraction, labour entry time (hour) , time elapsed until delivery (hour) , birth weight, Apgar score 0th minute and 5th minute and their distribution between the groups showed similarity (p&gt; 0.05). The values of amniotic fluid index (AFI) (p &lt;0.001) and effacement (p = 0.012) were found to be significantly higher in Group 2 compared to the values of the cases in the Group 1 (p &lt;0.05). It was found in the analysis that the findings of premature rupture of membrane (PROM), oxytocin augmentation need, tachysystole, vaginal delivery rate, caesarean delivery rate, meconium stained amnion rate, neonatal intensive care unit (NICU) need, postpartum hemorrhage, and transfusion need (p = 0.394) were similar between two groups (p&gt; 0.05). We can state that dinoprostone can be used safely and effectively to induce labor in third trimester pregnancies both with normal AFI and oligohydramnios.

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.

Determination of reference values for third trimester amniotic fluid index: a retrospective analysis of a large cohort of pregnancies with comparison to previous nomograms

Purpose To establish a new set of reference values for third-trimester amniotic fluid index (AFI) and compare them to other previously published normograms. Methods A retrospective cross-sectional cohort analysis of all singleton sonographic evaluations >22 gestational weeks in one university affiliated medical center between 2013 and 2017. Pregnancies complicated by rupture of membranes, major anomalies/chromosomal abnormalities were excluded. One evaluation per patient per pregnancy was randomly selected. Reference values were constructed using a best-fit regression model for estimation of mean and standard deviation at each gestational age after normalization of variables and compared with previously published norms. Results A total of 7037 ultrasound evaluations entered the analysis. Correlation between AFI and gestational age was best represented by a first-degree polynomial equation. AFI decreased gradually from 16.4 at 22 weeks to 13.3 at 40 weeks (cm, median). The standard deviation increased with gestational age with AFI ranging from 12.9–20.2 at 22 weeks and 4.7–26.2 at 40 weeks (cm, 2.5–97.5 percentile). Compared to other curves, our reference values demonstrated a higher median AFI throughout all gestation. Conclusions Reference values for the third trimester AFI were established. Curves should be correlated with perinatal outcome prior to wide clinical implementation.

The Correlation Between Amniotic Fluid and Neonatal Weight

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

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.

Sonographic Estimation of Amniotic Fluid Volume Using the Amniotic Fluid Index and the Single Deepest Pocket in a Resource-Limited Setting.

Objective:To determine the normal value of amniotic fluid (AF) volume among pregnant women in a Northern Nigerian population and to determine if there is a relationship between AF index (AFI) and single deepest pocket (SDP) with anthropometric variables.Materials and Methods:A prospective cross-sectional study was conducted among singleton pregnant women at late second and third trimester attending the antenatal clinic in Abubakar Tafawa Balewa Teaching Hospital, Bauchi, from December 2016 to April 2017. The mean AFI and SDP were measured by sonography. Ethical approval was obtained from the institution and informed consent was sought for from all the participants. Descriptive statistics, i.e. mean, standard deviation, and correlation coefficient, were used for the analysis.Results:A total of 206 women, aged between 18 and 40 years, with fetal gestational ages between 22 and 39 weeks were included in the study. The values for AFI in the study ranged from 12 to 28.7 cm, with a mean value of 19.84 ± 3.64 cm, and SDP ranged from 3.7 to 9.1 cm with a mean value of 6.04 ± 1.12 cm. This study found a weak relationship between the anthropometric variables and AFI and SDP and a strong relationship between AFI and SDP with a correlation coefficient of R = 0.901 and P = 0.014.Conclusion:This study found the mean values for AF volume using AFI and SDP in the studied population to be 19.84 ± 3.64 cm and 6.04 ± 1.12 cm, respectively; a strong positive relationship between AFI and SDP; and a negative relationship between body mass index with AFI and SDP.

Polyhydramnios - frequency of congenital anomalies in relation to the value of the amniotic fluid index.

The aims of our study were to assess the correlation between the amniotic fluid index (AFI) value and the frequency and type of fetal anomalies. The material included 94 patients at the third trimester of pregnancy, 60 with mild polyhydramnios, 19 with moderate one, and 15 with severe one. Polyhydramnios was diagnosed if AFI was > 24 cm. All patients were divided into three groups based on the value of AFI: 1) mild polyhydramnios with AFI between 24.1 and 29.9 cm, 2) moderate polyhydramnios with AFI between 30-34.9 cm, and 3) severe polyhydramnios with AFI ≥ 35 cm. The incidence of fetal malformations correlated significantly with the degree of polyhydramnios and was the highest in patients with severe polyhydramnios (53.3%, p = 0.002). Congenital malformations of the gastrointestinal tract were the most frequent fetal anomalies in the whole group of patients (5.3%). Trisomy 18 was the most frequent aneuploidy found in women with polyhydramnios (2.1%). The incidence of fetal congenital anomalies significantly increases with the degree of polyhydramnios, being most frequent in severe one and rather rare in a mild one. Congenital malformations of the gastrointestinal tract were the most frequent anomalies in patients with polyhy-dramnios, especially in women with severe polyhydramnios.