Amniotic fluid index as a predictor of adverse perinatal outcome in the HELLP syndrome.
OBJECTIVE
To evaluate the prognostic value of an amniotic fluid index (AFI) < or = 5 cm for an adverse perinatal outcome in pregnancies with the syndrome of hemolysis, elevated liver enzymes and low platelets (HELLP syndrome).


METHODS
A prospective, observational study of patients with the HELLP syndrome. An ultrasound estimate of amniotic fluid volume was obtained on admission. Adverse intrapartum outcomes included amnioinfusion for variable decelerations and/or indicated abdominal/vaginal operative delivery for nonreassuring fetal heart rate changes. Maternal characteristics and perinatal outcome parameters were compared AFI < or = vs. > 5 cm. Statistical analysis was performed using chi2 analysis, Student's t test and receiver-operator characteristic curve (ROC) analysis.


RESULTS
Between January 1996 and February 1999, 120 patients were enrolled. Twenty-six (22%) had an AFI < or = 5 cm. This group did not differ from that with AFI > 5 cm regarding the severity of the HELLP syndrome, admission-to-delivery interval (p = 0.354), variable decelerations in labor (p = 0.06), Apgar score of < 7 at 5 minutes (p = 0.361), cesarean delivery for nonreassuring fetal status (p = 1.0) or significant fetal acidosis (pH < 7.0 [p = 0.2101). ROC analysis revealed no AFI measurement between 0 and 16 cm that was useful for identifying the compromised fetus.


CONCLUSIONS
Antepartum/intrapartum performance of AFI in patients with the HELLP syndrome is a poor prognostic test for subsequent fetal compromise.
Barrilleaux
P Scott
PS
Department of Obstetrics and Gynecology, University of Mississippi Medical Center, Jackson 39216-4505, USA. jmorrison@ob-gyn.umsmed.edu
Magann
Everett F
EF
Chauhan
Suneet P
SP
York
Brian M
BM
Philibert
Lisa
L
Lewis
David F
DF
D000328:Adult; D000653:Amniotic Fluid / Q000737:chemistry*; D001034:Apgar Score; D002585:Cesarean Section / Q000379:methods / Q000706:statistics & numerical data; D016009:Chi-Square Distribution; D036861:Delivery, Obstetric / Q000379:methods / Q000706:statistics & numerical data; D005189:False Positive Reactions; D005260:Female; D005316:Fetal Distress / Q000175:diagnosis*; D017359:HELLP Syndrome / Q000175:diagnosis*; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D011237:Predictive Value of Tests; D011247:Pregnancy; D011256:Pregnancy Outcome; D011446:Prospective Studies; D012372:ROC Curve; D012720:Severity of Illness Index