Superiority of amniotic fluid index over amniotic fluid pocket measurement for predicting bad fetal outcome.
Semiquantitative amniotic fluid volume (AFV) determination is a component of the fetal biophysical profile (BPP). To assess decreased AVF we did BPPs of 174 fetuses within 1 week of delivery. Two methods were used: measurement of the single largest vertical pocket (oligohydramnios = depth < 1 cm) and the four-quadrant amniotic fluid index (AFI) (oligohydramnios = AFI < or = 5 cm). AFV, as determined by each method, was related to measures of fetal outcome (perinatal mortality, fetal distress, Apgar score, meconium-stained amniotic fluid, and intrauterine growth retardation [IUGR]). The AFI was more sensitive in predicting mortality (87.5%) and the following measures of perinatal morbidity: low 5-minute Apgar score (88.8%), fetal distress during labor (86.6%), meconium-stained amniotic fluid (63.6%), and the presence of IUGR (79.4%). The sensitivity of amniotic fluid pocket measurement of < 1 cm was 75%, 72.2%, 66.6%, 47.7%, and 55.8%, respectively, for the same measures. Using the AFI instead of a single pocket measurement in BPP assessment increased the sensitivity and positive predictive value of the BPP from 64.7% to 76.4% and from 45.8% to 68.4%, respectively. Our data suggest that qualitative AFV measurement using the AFI is superior to that of the single largest pocket in multiple component fetal biophysical testing.
Youssef
A A
AA
Department of Obstetrics and Gynecology, Assiut University Hospital, Assiut Medical College, Egypt.
Abdulla
S A
SA
Sayed
E H
EH
Salem
H T
HT
Abdelalim
A M
AM
Devoe
L D
LD
D000653:Amniotic Fluid / Q000000981:diagnostic imaging*; D005260:Female; D005313:Fetal Death; D005315:Fetal Diseases / Q000175:diagnosis* / Q000000981:diagnostic imaging; D005316:Fetal Distress / Q000000981:diagnostic imaging; D005317:Fetal Growth Retardation / Q000000981:diagnostic imaging; D005323:Fetal Monitoring; D006801:Humans; D015994:Incidence; D007226:Infant Mortality; D007231:Infant, Newborn; D016104:Oligohydramnios / Q000000981:diagnostic imaging; D011237:Predictive Value of Tests; D011247:Pregnancy; D011256:Pregnancy Outcome; D012680:Sensitivity and Specificity; D016216:Ultrasonography, Prenatal