Reference ranges of amniotic fluid index in late third trimester of pregnancy: what should the optimal interval between two utrasound examinations be

Hebbar, Shripad and Rai, Lavanya and Adiga, Prashanth and Guruvare, Shyamala (2015) Reference ranges of amniotic fluid index in late third trimester of pregnancy: what should the optimal interval between two utrasound examinations be. Journal of Pregnancy, 2015. pp. 1-7.

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Abstract

Background. Amniotic fluid index (AFI) is one of the major and deciding components of fetal biophysical profile and by itself it can predict pregnancy outcome. Very low values are associated with intrauterine growth restriction and renal anomalies of fetus, whereas high valuesmay indicate fetal GI anomalies, maternal diabetes mellitus, and so forth. However, before deciding the cut-off standards for abnormal values for a local population, what constitutes a normal range for specific gestational age and the ideal interval of testing should be defined. Objectives. To establish reference standards for AFI for local population after 34 weeks of pregnancy and to decide an optimal scan interval for AFI estimation in third trimester in low risk antenatal women. Materials and Methods.Aprospective estimation of AFIwas done in 50 healthy pregnantwomen from34 to 40weeks atweekly intervals.The trend of amniotic fluid volumewas studiedwith advancing gestational age.Only lowrisk singleton pregnancies with accurately established gestational age who were available for all weekly scan from 34 to 40 weeks were included in the study.Women with gestational or overt diabetesmellitus, hypertensive disorders of the pregnancy, prelabour rupture of membranes, and congenital anomalies in the foetus and those who delivered before 40 completed weeks were excluded from the study. For the purpose of AFI measurement, the uterine cavity was arbitrarily divided into four quadrants by a vertical and horizontal line running through umbilicus. Linear array transabdominal probe was used to measure the largest vertical pocket (in cm) in perpendicular plane to the abdominal skin in each quadrant. Amniotic fluid index was obtained by adding these four measurements. Statistical analysis was done using SPSS software (Version 16, Chicago, IL). Percentile curves (5th, 50th, and 95th centiles) were constructed for comparison with other studies. Cohen’s d coefficient was used to examine the magnitude of change at different time intervals. Results. Starting from 34 weeks till 40 weeks, 50 ultrasound measurements were available at each gestational age. The mean (standard deviation) of AFI values (in cms) were 34W: 14.59 (1.79), 35W: 14.25 (1.57), 36W: 13.17 (1.56), 37W: 12.48 (1.52), 38W: 12.2 (1.7), and 39W: 11.37 (1.71). The 5th percentile cut-off was 8.7 cm at 40 weeks. There was a gradual decline of AFI values as the gestational age approached term. Significant drop in AFI was noted at two-week intervals. AFI curve generated from the study varied significantly when compared with already published data, both from India and abroad. Conclusion. Normative range for AFI values for late third trimester was established. Appreciable changes occurred in AFI values as gestation advanced by two weeks. Hence, it is recommended to follow up low risk antenatal women every two weeks after 34 weeks of pregnancy.The percentile curves of AFI obtained from the present study may be used to detect abnormalities of amniotic fluid for our population.

Item Type: Article
Uncontrolled Keywords: Amniotic Fluid Index; low risk pregnancy; AFI curve; effect size; South India.
Subjects: Medicine > KMC Manipal > Obstetrics & Gynaecology
Depositing User: KMC Manipal
Date Deposited: 17 Jan 2015 04:42
Last Modified: 17 Jan 2015 04:42
URI: http://eprints.manipal.edu/id/eprint/141627

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