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Khalil A, Sotiriadis A, D'Antonio F, Da Silva Costa F, Odibo A, Prefumo F, Papageorghiou AT, Salomon LJ. ISUOG Practice Guidelines: performance of third-trimester obstetric ultrasound scan. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2024; 63:131-147. [PMID: 38166001 DOI: 10.1002/uog.27538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 11/03/2023] [Indexed: 01/04/2024]
Affiliation(s)
- A Khalil
- Fetal Medicine Unit, St George's Hospital, St George's University of London, London, UK
| | - A Sotiriadis
- Second Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Faculty of Medicine, Thessaloniki, Greece
| | - F D'Antonio
- Centre for Fetal Care and High-Risk Pregnancy, University of Chieti, Chieti, Italy
| | - F Da Silva Costa
- Maternal Fetal Medicine Unit, Gold Coast University Hospital, and School of Medicine and Dentistry, Griffith University, Gold Coast, QLD, Australia
| | - A Odibo
- Obstetrics and Gynecology Department, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - F Prefumo
- Obstetrics and Gynecology Unit, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - A T Papageorghiou
- Fetal Medicine Unit, St George's Hospital, St George's University of London, London, UK; Nuffield Department for Women's and Reproductive Health, University of Oxford, Oxford, UK
| | - L J Salomon
- URP FETUS 7328 and LUMIERE platform, Maternité, Obstétrique, Médecine, Chirurgie et Imagerie Foetales, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris (AP-HP), Université de Paris, Paris, France
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Whittington JR, Ghahremani T, Friski A, Hamilton A, Magann EF. Window to the Womb: Amniotic Fluid and Postnatal Outcomes. Int J Womens Health 2023; 15:117-124. [PMID: 36756186 PMCID: PMC9900144 DOI: 10.2147/ijwh.s378020] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 01/18/2023] [Indexed: 02/04/2023] Open
Abstract
Amniotic fluid volumes are tightly regulated, and amniotic fluid derangement can indicate maternal complications or fetal abnormalities. Ultrasound estimate of amniotic fluid provides a tool to evaluate the maternal-fetal-placental interface in real-time. Oligohydramnios and polyhydramnios are associated with adverse maternal and neonatal outcomes. Oligohydramnios is associated with adverse maternal and neonatal outcomes including cesarean delivery, operative vaginal delivery, induction of labor, postpartum hemorrhage, small for gestational age neonate, intrauterine demise, neonatal death, NICU admission, and APGAR less than 7 at. 5 minutes of life Polyhydramnios is associated with adverse outcomes including cesarean delivery, induction of labor, placental abruption, shoulder dystocia, cord prolapse, postpartum hemorrhage, intrauterine fetal demise, NICU admission, neonatal death, APGAR less than 7 at 5 minutes of life, large for gestational age neonate, and respiratory distress syndrome. Therefore, Amniotic fluid should be evaluated when maternal or fetal well-being is in question.
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Affiliation(s)
- Julie R Whittington
- Women’s Health Department, Naval Medical Readiness and Training Center Portsmouth, Portsmouth, VA, USA,Correspondence: Julie R Whittington, Women’s Health Department, Naval Readiness and Training Command Portsmouth, 620 John Paul Jones Circle, Portsmouth, VA, 23321, USA, Tel +1-979-848-9665, Email
| | - Taylor Ghahremani
- Department of OB/GYN, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Andrew Friski
- Women’s Health Department, Naval Medical Readiness and Training Center Portsmouth, Portsmouth, VA, USA
| | - Andrew Hamilton
- Women’s Health Department, Naval Medical Readiness and Training Center Portsmouth, Portsmouth, VA, USA
| | - Everett F Magann
- Women’s Health Department, Naval Medical Readiness and Training Center Portsmouth, Portsmouth, VA, USA
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Smith GC, Moraitis AA, Wastlund D, Thornton JG, Papageorghiou A, Sanders J, Heazell AE, Robson SC, Sovio U, Brocklehurst P, Wilson EC. Universal late pregnancy ultrasound screening to predict adverse outcomes in nulliparous women: a systematic review and cost-effectiveness analysis. Health Technol Assess 2021; 25:1-190. [PMID: 33656977 PMCID: PMC7958245 DOI: 10.3310/hta25150] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Currently, pregnant women are screened using ultrasound to perform gestational aging, typically at around 12 weeks' gestation, and around the middle of pregnancy. Ultrasound scans thereafter are performed for clinical indications only. OBJECTIVES We sought to assess the case for offering universal late pregnancy ultrasound to all nulliparous women in the UK. The main questions addressed were the diagnostic effectiveness of universal late pregnancy ultrasound to predict adverse outcomes and the cost-effectiveness of either implementing universal ultrasound or conducting further research in this area. DESIGN We performed diagnostic test accuracy reviews of five ultrasonic measurements in late pregnancy. We conducted cost-effectiveness and value-of-information analyses of screening for fetal presentation, screening for small for gestational age fetuses and screening for large for gestational age fetuses. Finally, we conducted a survey and a focus group to determine the willingness of women to participate in a future randomised controlled trial. DATA SOURCES We searched MEDLINE, EMBASE and the Cochrane Library from inception to June 2019. REVIEW METHODS The protocol for the review was designed a priori and registered. Eligible studies were identified using keywords, with no restrictions for language or location. The risk of bias in studies was assessed using the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) tool. Health economic modelling employed a decision tree analysed via Monte Carlo simulation. Health outcomes were from the fetal perspective and presented as quality-adjusted life-years. Costs were from the perspective of the public sector, defined as NHS England, and the costs of special educational needs. All costs and quality-adjusted life-years were discounted by 3.5% per annum and the reference case time horizon was 20 years. RESULTS Umbilical artery Doppler flow velocimetry, cerebroplacental ratio, severe oligohydramnios and borderline oligohydramnios were all either non-predictive or weakly predictive of the risk of neonatal morbidity (summary positive likelihood ratios between 1 and 2) and were all weakly predictive of the risk of delivering a small for gestational age infant (summary positive likelihood ratios between 2 and 4). Suspicion of fetal macrosomia is strongly predictive of the risk of delivering a large infant, but it is only weakly, albeit statistically significantly, predictive of the risk of shoulder dystocia. Very few studies blinded the result of the ultrasound scan and most studies were rated as being at a high risk of bias as a result of treatment paradox, ascertainment bias or iatrogenic harm. Health economic analysis indicated that universal ultrasound for fetal presentation only may be both clinically and economically justified on the basis of existing evidence. Universal ultrasound including fetal biometry was of borderline cost-effectiveness and was sensitive to assumptions. Value-of-information analysis indicated that the parameter that had the largest impact on decision uncertainty was the net difference in cost between an induced delivery and expectant management. LIMITATIONS The primary literature on the diagnostic effectiveness of ultrasound in late pregnancy is weak. Value-of-information analysis may have underestimated the uncertainty in the literature as it was focused on the internal validity of parameters, which is quantified, whereas the greatest uncertainty may be in the external validity to the research question, which is unquantified. CONCLUSIONS Universal screening for presentation at term may be justified on the basis of current knowledge. The current literature does not support universal ultrasonic screening for fetal growth disorders. FUTURE WORK We describe proof-of-principle randomised controlled trials that could better inform the case for screening using ultrasound in late pregnancy. STUDY REGISTRATION This study is registered as PROSPERO CRD42017064093. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 15. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Gordon Cs Smith
- Department of Obstetrics and Gynaecology, NIHR Cambridge Biomedical Research Centre, University of Cambridge, Cambridge, UK
| | - Alexandros A Moraitis
- Department of Obstetrics and Gynaecology, NIHR Cambridge Biomedical Research Centre, University of Cambridge, Cambridge, UK
| | - David Wastlund
- The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Jim G Thornton
- Division of Child Health, Obstetrics and Gynaecology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Aris Papageorghiou
- Nuffield Department of Obstetrics and Gynaecology, University of Oxford, Oxford, UK
| | - Julia Sanders
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | - Alexander Ep Heazell
- Faculty of Biology, Medicine and Health, School of Medical Sciences, University of Manchester, Manchester, UK
| | - Stephen C Robson
- Reproductive and Vascular Biology Group, The Medical School, Newcastle University, Newcastle upon Tyne, UK
| | - Ulla Sovio
- Department of Obstetrics and Gynaecology, NIHR Cambridge Biomedical Research Centre, University of Cambridge, Cambridge, UK
| | - Peter Brocklehurst
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Edward Cf Wilson
- The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Health Economics Group, Norwich Medical School, University of East Anglia, Norwich, UK
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Ou YH, Liu YK, Zhu LQ, Chen MQ, Yi XC, Chen H, Zhang JP. LncRNA and transcriptomic analysis of fetal membrane reveal potential targets involved in oligohydramnios. BMC Med Genomics 2020; 13:137. [PMID: 32948205 PMCID: PMC7501699 DOI: 10.1186/s12920-020-00792-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 09/03/2020] [Indexed: 11/21/2022] Open
Abstract
Background The multiple causes of oligohydramnios make it challenging to study. Long noncoding RNAs (lncRNAs) are sets of RNAs that have been proven to function in multiple biological processes. The purpose of this study is to study expression level and possible role of lncRNAs in oligohydramnios. Methods In this study, total RNA was isolated from fetal membranes resected from oligohydramnios pregnant women (OP) and normal amount of amniotic fluid pregnant women (Normal). LncRNA microarray was used to analyze the differentially expressed lncRNAs and mRNAs. Kyoto Encyclopedia of Genes and Genomes (KEGG) was used to analyze the main enrichment pathways of differentially expressed mRNAs. Real-time quantitative PCR (qPCR) was used to validate the lncRNA expression level. Results LncRNA microarray analysis revealed that a total of 801 lncRNAs and 367 mRNAs were differentially expressed in OP; in these results, 638 lncRNAs and 189 mRNAs were upregulated, and 163 lncRNAs and 178 mRNAs were downregulated. Of the lncRNAs, 566 were intergenic lncRNAs, 351 were intronic antisense lncRNAs, and 300 were natural antisense lncRNAs. The differentially expressed lncRNAs were primarily located in chromosomes 2, 1, and 11. KEGG enrichment pathways revealed that the differentially expressed mRNAs were enriched in focal adhesion as well as in the signaling pathways of Ras, tumor necrosis factor (TNF), estrogen, and chemokine. The qPCR results confirmed that LINC00515 and RP11-388P9.2 were upregulated in OP. Furthermore, the constructed lncRNA–miRNA–mRNA regulatory network revealed tenascin R (TNR), cystic fibrosis transmembrane conductance regulator (CFTR), ATP-binding cassette sub-family A member 12 (ABCA12), and collagen 9A2 (COL9A2) as the candidate targets of LINC00515 and RP11-388P9.2. Conclusions In summary, we revealed the profiles of lncRNA and mRNA in OP. These results might offer potential targets for biological prevention for pregnant women with oligohydramnios detected before delivery and provided a reliable basis for clinical biological treatment in OP.
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Affiliation(s)
- Yu-Hua Ou
- Department of Obstetrics and Gynecology, Guangdong Women and Children Hospital, Guangzhou, 511400, Guangdong, China.,Department of Obstetrics and Gynecology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, No.107, Yanjiangxi Road, Guangzhou, 510120, Guangdong, China
| | - Yu-Kun Liu
- Department of Obstetrics and Gynecology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, No.107, Yanjiangxi Road, Guangzhou, 510120, Guangdong, China
| | - Li-Qiong Zhu
- Department of Obstetrics and Gynecology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, No.107, Yanjiangxi Road, Guangzhou, 510120, Guangdong, China
| | - Man-Qi Chen
- Department of Obstetrics and Gynecology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, No.107, Yanjiangxi Road, Guangzhou, 510120, Guangdong, China
| | - Xiao-Chun Yi
- Department of Obstetrics and Gynecology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, No.107, Yanjiangxi Road, Guangzhou, 510120, Guangdong, China
| | - Hui Chen
- Department of Obstetrics and Gynecology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, No.107, Yanjiangxi Road, Guangzhou, 510120, Guangdong, China.
| | - Jian-Ping Zhang
- Department of Obstetrics and Gynecology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, No.107, Yanjiangxi Road, Guangzhou, 510120, Guangdong, China.
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Sekhon S, Rosenbloom JI, Doering M, Conner SN, Macones GA, Colditz GA, Tuuli MG, Carter EB. Diagnostic utility of maximum vertical pocket versus amniotic fluid index in assessing amniotic fluid volume for the prediction of adverse maternal and fetal outcomes: a systematic review and meta-analysis. J Matern Fetal Neonatal Med 2019; 34:3730-3739. [PMID: 31709861 DOI: 10.1080/14767058.2019.1691988] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objective: To compare the utility of maximum vertical pocket versus amniotic fluid index for predicting adverse perinatal outcomes.Methods: Systematic review of randomized clinical studies comparing these two ultrasound techniques and random-effects meta-analysis to quantify a range of perinatal outcomes.Result: Six studies with 4278 women were eligible. Use of the maximum vertical pocket reduced the rate of diagnosis of oligohydramnios (pooled relative risk 0.38; 95% confidence interval 0.27, 0.53). Use of the maximum vertical pocket was associated with significantly lower rates of non-reassuring fetal heart tracing, cesarean delivery for fetal distress, and induction of labor for oligohydramnios. There were no differences in the rates of cesarean delivery, presence of meconium, umbilical artery pH <7.1, 5-minute Apgar score <7, or admission to the neonatal intensive care unit.Conclusion: The use of maximum vertical pocket is associated with a lower rate of pregnancy intervention without any worsening of adverse pregnancy outcomes.
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Affiliation(s)
- Subhjit Sekhon
- Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Joshua I Rosenbloom
- Department of Obstetrics and Gynecology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Michelle Doering
- Bernard Becker Medical Library, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Shayna N Conner
- Department of Obstetrics and Gynecology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - George A Macones
- Department of Obstetrics and Gynecology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Graham A Colditz
- Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Methodius G Tuuli
- Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Ebony B Carter
- Department of Obstetrics and Gynecology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
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No. 197a-Fetal Health Surveillance: Antepartum Consensus Guideline. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019; 40:e251-e271. [PMID: 29680082 DOI: 10.1016/j.jogc.2018.02.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE This guideline provides new recommendations pertaining to the application and documentation of fetal surveillance in the antepartum period that will decrease the incidence of birth asphyxia while maintaining the lowest possible rate of obstetrical intervention. Pregnancies with and without risk factors for adverse perinatal outcomes are considered. This guideline presents an alternative classification system for antenatal fetal non-stress testing to what has been used previously. This guideline is intended for use by all health professionals who provide antepartum care in Canada. OPTIONS Consideration has been given to all methods of fetal surveillance currently available in Canada. OUTCOMES Short- and long-term outcomes that may indicate the presence of birth asphyxia were considered. The associated rates of operative and other labour interventions were also considered. EVIDENCE A comprehensive review of randomized controlled trials published between January 1996 and March 2007 was undertaken, and MEDLINE and the Cochrane Database were used to search the literature for all new studies on fetal surveillance antepartum. The level of evidence has been determined using the criteria and classifications of the Canadian Task Force on Preventive Health Care (Table 1). SPONSOR This consensus guideline was jointly developed by the Society of Obstetricians and Gynaecologists of Canada and the British Columbia Perinatal Health Program (formerly the British Columbia Reproductive Care Program or BCRCP) and was partly supported by an unrestricted educational grant from the British Columbia Perinatal Health Program. RECOMMENDATION 1: FETAL MOVEMENT COUNTING: RECOMMENDATION 2: NON-STRESS TEST: RECOMMENDATION 3: CONTRACTION STRESS TEST: RECOMMENDATION 4: BIOPHYSICAL PROFILE: RECOMMENDATION 5: UTERINE ARTERY DOPPLER: RECOMMENDATION 6: UMBILICAL ARTERY DOPPLER.
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Liston R, Sawchuck D, Young D. N° 197a-Surveillance du bien-être fœtal : Directive consensus d'antepartum. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019; 40:e272-e297. [PMID: 29680083 DOI: 10.1016/j.jogc.2018.02.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Van de Waarsenburg MK, Withagen MIJ, van den Noort F, Schagen van Leeuwen JH, van der Vaart CH. Echogenicity of puborectalis muscle, cervix and vastus lateralis muscle in pregnancy in relation to mode of delivery. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2019; 54:119-123. [PMID: 30461093 DOI: 10.1002/uog.20178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 10/04/2018] [Accepted: 10/25/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVES To confirm our previous observation that levator hiatal dimensions and mean echogenicity of the puborectalis muscle (MEP) are significantly different at 12 weeks' gestation in women who delivered by Cesarean section due to failure to progress compared with those who delivered vaginally. The secondary objective was to assess the association between the echogenicity of the cervix and vastus lateralis muscle and mode of delivery. METHODS In this prospective multicenter study, 306 nulliparous women with a singleton pregnancy underwent ultrasound assessments of the pelvic floor at rest, on maximum pelvic floor muscle contraction and on maximum Valsalva maneuver, of the cervix and of the vastus lateralis muscle at 12 weeks' gestation. Dimensions of the levator hiatus, MEP and mean echogenicity of the cervix and vastus lateralis muscle were measured and compared according to mode of delivery. RESULTS Two hundred and forty-nine women were included in the analyses. We were unable to confirm our previous finding that MEP and levator hiatal transverse diameter and area at 12 weeks' gestation are associated significantly with mode of delivery. In addition, we could not demonstrate a significant association between echogenicity of the cervix or vastus lateralis muscle and mode of delivery. Overall, MEP was a mean of 20 points lower in women in the new database as compared with the previous study, despite the use of the same ultrasound equipment. CONCLUSION In a second, independent multicenter dataset, we were unable to confirm our previous finding that levator hiatal dimensions and MEP on pelvic floor muscle contraction are associated significantly with mode of delivery. We also found no association between echogenicity of the cervix or vastus lateralis and mode of delivery. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- M K Van de Waarsenburg
- Department of Obstetrics and Gynecology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - M I J Withagen
- Department of Obstetrics and Gynecology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - F van den Noort
- Department of Obstetrics and Gynecology, University Medical Centre Utrecht, Utrecht, The Netherlands
- Robotics and Mechatronics, Faculty of Electrical Engineering, Mathematics and Computer Science, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - J H Schagen van Leeuwen
- Department of Obstetrics and Gynecology, Sint Antonius Hospital Nieuwegein, Nieuwegein, The Netherlands
| | - C H van der Vaart
- Department of Obstetrics and Gynecology, University Medical Centre Utrecht, Utrecht, The Netherlands
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Sovio U, Smith GCS. Blinded ultrasound fetal biometry at 36 weeks and risk of emergency Cesarean delivery in a prospective cohort study of low-risk nulliparous women. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2018; 52:78-86. [PMID: 28452133 DOI: 10.1002/uog.17513] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 04/19/2017] [Accepted: 04/21/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES To compare the association between risk of emergency Cesarean delivery (CD) and non-customized vs customized ultrasound estimated fetal weight (EFW) at 36 weeks' gestation, determine whether addition of ultrasound EFW to a model based on maternal characteristics alone improved prediction of emergency CD, assess the screening performance of a multivariable model using both EFW and maternal characteristics to predict emergency CD, and determine whether women at high predicted risk of emergency CD based on this model had higher risk of maternal and perinatal morbidity compared with screen-negative women. METHODS We studied 3047 low-risk (no pre-existing medical conditions or acquired complications of pregnancy) nulliparous women from the prospective Pregnancy Outcome Prediction study (Cambridge, UK) cohort, who underwent ultrasound EFW at ∼36 weeks' gestation. Both the women and their clinicians were blinded to fetal biometry results. Emergency CD was defined as delivery by Cesarean section in pregnancies in which the date of delivery had not been prearranged. Additional candidate predictors of emergency CD evaluated were maternal age, height, body mass index (BMI), weight gain, fetal abdominal circumference growth velocity and fetal sex. External validation of the predictive model was performed using routinely collected data from 55 337 births in Scotland between 2003 and 2008. Women with an estimated risk of emergency CD ≥ 40% were defined as screen positive. RESULTS Blinded EFW was associated strongly with the risk of emergency CD (coefficient for increase of 1 SD in EFW, 0.39 (95% CI, 0.30-0.48); odds ratio (OR), 1.48 (95% CI, 1.35-1.62)). The coefficient for customized EFW was similar (0.42 (95% CI, 0.33-0.51); OR, 1.53 (95% CI, 1.39-1.67)); hence, for simplicity, non-customized EFW was employed subsequently. A multivariable logistic regression model combining maternal characteristics (age, height, BMI and weight gain between 12 and 36 weeks) was moderately predictive of emergency CD (area under the receiver-operating characteristics curve (AUC) = 0.68). Addition of blinded EFW to the model increased the AUC to 0.71 and improved prediction (likelihood-ratio test P < 0.0001). Based on this model, 189 (6.2%) women were screen positive and 48% of these delivered by CD. Screen-positive women had elevated risks of severe postpartum hemorrhage (relative risk (RR), 2.49; 95% CI, 1.83-3.38), any adverse neonatal outcome (RR, 1.86; 95% CI, 1.22-2.82) and severe adverse neonatal outcome (RR, 4.03; 95% CI, 1.35-12.03) compared with screen-negative women. The risks of these events were also higher compared with women who had a term CD for breech presentation. The model was similarly predictive of the risk of emergency CD and perinatal morbidity when evaluated using the dataset from Scotland. CONCLUSIONS Ultrasound EFW at 36 weeks, combined with maternal characteristics, can identify women who are at increased risk of subsequent emergency CD. These women are at increased risk of maternal and perinatal morbidity compared with women at low risk of emergency CD and those having CD for breech presentation at term. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- U Sovio
- Department of Obstetrics and Gynaecology, University of Cambridge, NIHR Cambridge Comprehensive Biomedical Research Centre, Cambridge, UK
| | - G C S Smith
- Department of Obstetrics and Gynaecology, University of Cambridge, NIHR Cambridge Comprehensive Biomedical Research Centre, Cambridge, UK
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Yin H, Zhao L, Lin Y, Wang Y, Hu Y, Sun G, Xiao M. Perinatal outcomes following labor induction with dinoprostone in pregnancies with borderline amniotic fluid index at term: A clinical observation study. J Obstet Gynaecol Res 2018; 44:1397-1403. [PMID: 29932485 DOI: 10.1111/jog.13682] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2017] [Accepted: 04/18/2018] [Indexed: 11/29/2022]
Abstract
AIM To compare perinatal outcomes of dinoprostone for induced labor in pregnancies with a borderline versus normal amniotic fluid index (AFI) at term, and to investigate the related factors affecting outcomes of cesarean section. METHODS The retrospective study was carried out in Hubei Maternal and Child Health Hospital with singleton pregnancies of 37-42 weeks' gestation from January to August 2016. A total of 992 subjects were divided into two groups: borderline AFI group (n =125) with 5 < AFI ≤ 8 and normal AFI group (n = 867) with 8 < AFI ≤ 24. RESULTS Time to delivery (P =0.004) and use of oxytocin augmentation (P = 0.011) were significantly lower in pregnancies with borderline AFI. There were no significant differences between the two groups in terms of delivery mode, time to onset of labor, fetal distress, Apgar scores, meconium-stained amniotic fluid, birth weight, or incidences of admission to neonatal intensive care unit (NICU). Gestational hypertension and birth weight were the major factors affecting outcomes of cesarean section in the borderline group (odds ratio [OR] = 13.61, 95% confidence interval [CI] 1.96-94.49, P =0.008 and OR = 1.003, 95% CI 1.001-1.005, P =0.001, respectively). Maternal age (OR = 1.12, 95% CI 1.06-1.19, P < 0.001), parity (OR = 7.57, 95% CI 3.05-18.76, P < 0.001), biparietal diameter (OR = 0.55, 95% CI 0.33-0.91, P = 0.021), and meconium-stained amniotic fluid (OR = 1.56, 95% CI 1.12-2.17, P = 0.009) were related factors in the normal group. CONCLUSION The perinatal outcomes of dinoprostone for induced labor are comparable between the two groups. Gestational hypertension and birth weight are factors related to outcomes of cesarean section in the borderline group.
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Affiliation(s)
- Heng Yin
- Department of Obstetric, Hubei Maternity and Child Health Hospital, Wuhan, China
| | - Lei Zhao
- Department of Obstetric, Hubei Maternity and Child Health Hospital, Wuhan, China
| | - Ying Lin
- Department of Obstetric, Hubei Maternity and Child Health Hospital, Wuhan, China
| | - Ying Wang
- Department of Obstetric, Hubei Maternity and Child Health Hospital, Wuhan, China
| | - Yaping Hu
- Department of Obstetric, Hubei Maternity and Child Health Hospital, Wuhan, China
| | - Guoqiang Sun
- Department of Obstetric, Hubei Maternity and Child Health Hospital, Wuhan, China
| | - Mei Xiao
- Department of Obstetric, Hubei Maternity and Child Health Hospital, Wuhan, China
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Batinelli L, Serafini A, Nante N, Petraglia F, Severi FM, Messina G. Induction of labour: clinical predictive factors for success and failure. J OBSTET GYNAECOL 2017; 38:352-358. [PMID: 29058493 DOI: 10.1080/01443615.2017.1361388] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Induction of labour (IOL) is a widely-used practice in obstetrics. Our aim was to evaluate predictors of vaginal delivery in postdate pregnancies induced with prostaglandins. We conducted a retrospective cross-sectional study with analytic component. A total of 145 women, admitted for IOL after the 41st week of gestation, were induced with a vaginal pessary releasing prostaglandins. Type of delivery, whether vaginal or caesarean, was the outcome. Several maternal and foetal variables were investigated. The Kaplan-Maier curves, monovariate and a multivariate logistic regression were carried out. In our population, 80.7% of women had vaginal delivery after the induction. Multiparity and a high Bishop score at the beginning of the IOL were protective factors for a vaginal delivery (respectively OR 0.16, p = .028 and OR 0.62, p = .034) while age >35 years, and the foetal birth weight >3500 g at the birth, resulted in being risk factors for caesarean section (respectively OR 4.20, p = .006 and OR 3.63, p = .013). IMPACT STATEMENT What is already known on this subject: Induction of labour (IOL) is a widely used practice in obstetrics. Scientific literature shows several predictors of successful induction, although there is no unanimity except for 'multiparity' and 'favourable Bishop score' which are associated with positive outcome of the induction. The main difficulty in finding other predictive factors is the heterogeneity of this field (different local protocols in each hospital, type of induction, populations and outcomes chosen in each study). In addition to that, populations are not always comparable due to the different gestation. For this reason, we decided to select a specific population of women, such as low risk postterm pregnancies induced with prostaglandins, in order to detect possible predictive factors for the success of the IOL for women with uncomplicated pregnancies. What the results of this study add: Our study agrees with existing literature that 'multiparity' and 'Bishop score' are linked with the success of IOL and adds that 'maternal age' and 'foetal birth weight' are significant risk factors for the population of uncomplicated post term pregnancies induced with prostaglandins. What the implications are of these findings for clinical practice and/or further research: Our results agreed with the existing literature regarding parity and Bishop score but not for maternal age and birth weight. This adds new precious data to the literature which could be used for systematic reviews and for implementing IOL guidelines and protocols, nationally and internationally. Our findings could be also used for guiding future research in this field. It will be interesting to investigate the existence of not just specific factors but also any combination of variables which could predict the success of the procedure. At the moment these information cannot be used in terms of decision making for healthcare professionals as no variable is 100% predictive but once further research will be added, we may be able to know when is best time to start the IOL, how to facilitate the success of the procedure and how to best support the woman throughout the whole experience.
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Affiliation(s)
- Laura Batinelli
- a Department of Molecular and Developmental Medicine , University of Siena , Siena , Italy
| | - Andrea Serafini
- b Post Graduated School in Public Health , University of Siena , Siena , Italy
| | - Nicola Nante
- a Department of Molecular and Developmental Medicine , University of Siena , Siena , Italy
| | - Felice Petraglia
- a Department of Molecular and Developmental Medicine , University of Siena , Siena , Italy
| | - Filiberto Maria Severi
- a Department of Molecular and Developmental Medicine , University of Siena , Siena , Italy
| | - Gabriele Messina
- a Department of Molecular and Developmental Medicine , University of Siena , Siena , Italy
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Oligoamnios and Perinatal Outcome. J Obstet Gynaecol India 2017; 67:104-108. [DOI: 10.1007/s13224-016-0938-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 08/16/2016] [Indexed: 10/21/2022] Open
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Simpson L, Khati NJ, Deshmukh SP, Dudiak KM, Harisinghani MG, Henrichsen TL, Meyer BJ, Nyberg DA, Poder L, Shipp TD, Zelop CM, Glanc P. ACR Appropriateness Criteria Assessment of Fetal Well-Being. J Am Coll Radiol 2016; 13:1483-1493. [DOI: 10.1016/j.jacr.2016.08.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Revised: 08/22/2016] [Accepted: 08/24/2016] [Indexed: 10/20/2022]
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Hughes DS, Magann EF. Antenatal fetal surveillance "Assessment of the AFV". Best Pract Res Clin Obstet Gynaecol 2016; 38:12-23. [PMID: 27756534 DOI: 10.1016/j.bpobgyn.2016.08.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 06/10/2016] [Accepted: 08/08/2016] [Indexed: 11/29/2022]
Abstract
The evaluation of amniotic fluid volume (AFV) is an established part of the antenatal surveillance of pregnancies at risk for an adverse pregnancy outcome. The two most commonly used ultrasound techniques to estimate AFV are the amniotic fluid index (AFI) and the single deepest pocket (SDP). Four studies have defined normal AFVs, and although their normal volumes have similarities, there are also differences primarily due to the statistical methodology used in each study. Dye-determined AFV correlates with ultrasound estimates for normal fluid volumes but correlates poorly for oligohydramnios and polyhydramnios. The addition of color Doppler in estimating AFV leads to the overdiagnosis of oligohydramnios. Neither the AFI nor the SDP is superior in identifying oligohydramnios, but the SDP is a better measurement choice as the use of AFI increases the diagnosis rate of oligohydramnios and labor inductions without an improvement in pregnancy outcomes.
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Affiliation(s)
- Dawn S Hughes
- Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Everett F Magann
- Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
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Randomized double-blind placebo controlled study of preinduction cervical priming with 25 µg of misoprostol in the outpatient setting to prevent formal induction of labour. Arch Gynecol Obstet 2016; 295:33-38. [DOI: 10.1007/s00404-016-4173-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Accepted: 08/09/2016] [Indexed: 10/21/2022]
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Kehl S, Schelkle A, Thomas A, Puhl A, Meqdad K, Tuschy B, Berlit S, Weiss C, Bayer C, Heimrich J, Dammer U, Raabe E, Winkler M, Faschingbauer F, Beckmann MW, Sütterlin M. 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. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2016; 47:674-679. [PMID: 26094600 DOI: 10.1002/uog.14924] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Revised: 05/29/2015] [Accepted: 06/05/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE 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. METHODS 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. RESULTS 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. CONCLUSIONS 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.
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Affiliation(s)
- S Kehl
- Department of Obstetrics and Gynaecology, Erlangen University Hospital, Erlangen, Germany
- Department of Obstetrics and Gynaecology, University Medical Centre Mannheim, Heidelberg University, Heidelberg, Germany
| | - A Schelkle
- Department of Obstetrics and Gynaecology, University Medical Centre Mannheim, Heidelberg University, Heidelberg, Germany
| | - A Thomas
- Department of Obstetrics, Charité Virchow-Klinikum, Berlin, Germany
| | - A Puhl
- Department of Obstetrics and Gynaecology, University Medical Centre Mainz, Mainz, Germany
| | - K Meqdad
- Department of Obstetrics, Charité Virchow-Klinikum, Berlin, Germany
| | - B Tuschy
- Department of Obstetrics and Gynaecology, University Medical Centre Mannheim, Heidelberg University, Heidelberg, Germany
| | - S Berlit
- Department of Obstetrics and Gynaecology, University Medical Centre Mannheim, Heidelberg University, Heidelberg, Germany
| | - C Weiss
- Department of Medical Statistics and Biomathematics, University Medical Centre Mannheim, Heidelberg University, Heidelberg, Germany
| | - C Bayer
- Department of Obstetrics and Gynaecology, Erlangen University Hospital, Erlangen, Germany
| | - J Heimrich
- Department of Obstetrics and Gynaecology, Erlangen University Hospital, Erlangen, Germany
| | - U Dammer
- Department of Obstetrics and Gynaecology, Erlangen University Hospital, Erlangen, Germany
| | - E Raabe
- Department of Obstetrics and Gynaecology, Erlangen University Hospital, Erlangen, Germany
| | - M Winkler
- Department of Obstetrics and Gynaecology, Erlangen University Hospital, Erlangen, Germany
| | - F Faschingbauer
- Department of Obstetrics and Gynaecology, Erlangen University Hospital, Erlangen, Germany
| | - M W Beckmann
- Department of Obstetrics and Gynaecology, Erlangen University Hospital, Erlangen, Germany
| | - M Sütterlin
- Department of Obstetrics and Gynaecology, University Medical Centre Mannheim, Heidelberg University, Heidelberg, Germany
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Bleicher I, Vitner D, Iofe A, Sagi S, Bader D, Gonen R. When should pregnancies that extended beyond term be induced? . J Matern Fetal Neonatal Med 2016; 30:219-223. [PMID: 27002548 DOI: 10.3109/14767058.2016.1169520] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To compare maternal and neonatal outcomes associated with a policy for induction of labor at ≥ 41 versus at ≥42 weeks'. STUDY DESIGN Retrospective cohort study of a 2 years' period before and after policy change from induction of labor at ≥ 42 gestational weeks' versus ≥41 gestational weeks. RESULTS During the 41-policy period (N = 968), the induction rate was higher, 60% versus 40% (p < 0.0001) while the cesarean delivery (CD) rate was lower, 15% versus 19.4% (p = 0.0135). Moreover, among women that were induced, the rate of CD was lower during the 41-policy period, 19% versus 27% (p = 0.0067). No significant differences in maternal or neonatal outcomes were noted. There was one case of intrauterine fetal death at 41 + 4 weeks during the 42-policy period. CONCLUSION As a policy for induction of labor at ≥ 41 reduces the rate of CD without any adverse maternal or neonatal outcomes, such a policy seems to be superior to a policy for induction at ≥ 42 weeks.
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Affiliation(s)
| | - Dana Vitner
- a Department of Obstetrics and Gynecology and
| | - Adir Iofe
- b Department of Pediatrics , Bnai-Zion Medical Center, Faculty of Medicine, Technion - Israel Institute of Technology , Haifa , Israel
| | - Shlomi Sagi
- a Department of Obstetrics and Gynecology and
| | - David Bader
- b Department of Pediatrics , Bnai-Zion Medical Center, Faculty of Medicine, Technion - Israel Institute of Technology , Haifa , Israel
| | - Ron Gonen
- a Department of Obstetrics and Gynecology and
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18
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Lee SM, Jun JK, Kim SA, Lee EJ, Kim BJ, Park CW, Park JS. Usefulness of fetal urine production measurement for prediction of perinatal outcomes in uteroplacental insufficiency. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2014; 33:2165-2171. [PMID: 25425374 DOI: 10.7863/ultra.33.12.2165] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVES To evaluate whether fetal urine production measurement is useful for predicting adverse outcomes in patients with uteroplacental insufficiency. METHODS We enrolled patients with uteroplacental insufficiency at 24 to 40 weeks' gestation and normal pregnancies matched for gestational age and divided them into 3 groups according to perinatal outcomes: group 1 (n = 141), a control group of normal pregnancies; group 2 (n = 29), uteroplacental insufficiency without adverse outcomes; and group 3 (n = 18), uteroplacental insufficiency with adverse outcomes. An adverse outcome was defined as 1 or more of the following: (1) cesarean delivery because of fetal distress; (2) admission to the neonatal intensive care unit; (3) cord arterial pH less than 7.15 at birth; and (4) low 5-minute Apgar score (<7). The fetal urine production rate was obtained by serial bladder volume measurement using virtual organ computer-aided analysis. For bladder volume determination, we scanned the bladder in the 3-dimensional mode and defined the bladder surface contour in the reference plane, repeating the rotation of the reference plane with an angle of 30° and determining the surface contour on each plane. Statistical methods, including the Mann-Whitney U test, Fisher exact test, χ(2) test, and Kruskal-Wallis analysis of variance, were used. RESULTS Group 3 had a lower mean fetal urine production rate than groups 1 and 2, whereas the urine production rate was not different between groups 1 and 2 (group 1, 49.0 mL/h; group 2, 59.4 mL/h; group 3, 20.7 mL/h; P < .001 between groups 1 and 3 and between groups 2 and 3). This difference between groups 2 and 3 remained significant after adjusting for the amniotic fluid index, umbilical artery Doppler pulsatility index, and presence of fetal growth restriction. CONCLUSIONS Uteroplacental insufficiency cases with adverse perinatal outcomes had a lower fetal urine production rate than those without adverse outcomes. This difference might be used to predict adverse perinatal outcomes in uteroplacental insufficiency.
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Affiliation(s)
- Seung Mi Lee
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea (S.M.L., J.K.J., S.A.K., B.J.K., C.-W.P., J.S.P.); Department of Obstetrics and Gynecology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea (S.M.L., B.J.K.); and Samsung Medison Co, Seoul, Korea (E.J.L.)
| | - Jong Kwan Jun
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea (S.M.L., J.K.J., S.A.K., B.J.K., C.-W.P., J.S.P.); Department of Obstetrics and Gynecology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea (S.M.L., B.J.K.); and Samsung Medison Co, Seoul, Korea (E.J.L.).
| | - Su Ah Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea (S.M.L., J.K.J., S.A.K., B.J.K., C.-W.P., J.S.P.); Department of Obstetrics and Gynecology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea (S.M.L., B.J.K.); and Samsung Medison Co, Seoul, Korea (E.J.L.)
| | - Eun Ja Lee
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea (S.M.L., J.K.J., S.A.K., B.J.K., C.-W.P., J.S.P.); Department of Obstetrics and Gynecology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea (S.M.L., B.J.K.); and Samsung Medison Co, Seoul, Korea (E.J.L.)
| | - Byoung Jae Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea (S.M.L., J.K.J., S.A.K., B.J.K., C.-W.P., J.S.P.); Department of Obstetrics and Gynecology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea (S.M.L., B.J.K.); and Samsung Medison Co, Seoul, Korea (E.J.L.)
| | - Chan-Wook Park
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea (S.M.L., J.K.J., S.A.K., B.J.K., C.-W.P., J.S.P.); Department of Obstetrics and Gynecology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea (S.M.L., B.J.K.); and Samsung Medison Co, Seoul, Korea (E.J.L.)
| | - Joong Shin Park
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea (S.M.L., J.K.J., S.A.K., B.J.K., C.-W.P., J.S.P.); Department of Obstetrics and Gynecology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea (S.M.L., B.J.K.); and Samsung Medison Co, Seoul, Korea (E.J.L.)
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Abstract
PURPOSE OF REVIEW Nearly 1% of pregnancies are affected by some type of midtrimester oligohydramnios. Evidence is currently accumulating that suggests the better efficacy of the new therapeutic procedures relative to conventional management. This review summarizes the available evidence. RECENT FINDINGS The prolongation of the period between the diagnosis of oligohydramnios and delivery following amnioinfusion and amniopatch techniques appears to be strongly associated with the gestational age and whether the situation was based on rupture of the membranes or not. Case series reveal that amnioinfusion significantly improves the perinatal outcome and prolongs the pregnancy in severe second-trimester oligohydramnios in both idiopathic cases and those involving rupture of the amniotic membranes [preterm prelabor rupture of the membranes (PPROM)]. There is clear evidence of a lower frequency of perinatal complications and successfully prolonged gestation in iatrogenic PPROM after the amniopatch technique relative to population controls. SUMMARY Identification of potentially modifiable risk factors for the successful prolongation of pregnancy complicated with midtrimester oligohydramnios, and previable PPROM is needed for the improvement of treatment strategies and prognosis. Randomized trials are needed to determine whether amniotic fluid-replenishing strategies can improve pregnancy outcomes.
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Wood SL, Newton JM, Wang L, Lesser K. Borderline amniotic fluid index and its relation to fetal intolerance of labor: a 2-center retrospective cohort study. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2014; 33:705-711. [PMID: 24658952 DOI: 10.7863/ultra.33.4.705] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVES To determine whether a borderline amniotic fluid index (AFI) in the third trimester is associated with an increased rate of cesarean delivery for fetal intolerance of labor, meconium-stained amniotic fluid, and intrauterine growth restriction, among other adverse perinatal outcomes. METHODS Patients with a diagnosis of a borderline AFI between January 2008 and August 2012 were identified. Antepartum, delivery, and neonatal data were collected and compared to a cohort with a normal AFI. RESULTS We enrolled 739 patients, including 177 with a borderline AFI (>5 and <10 cm) and 562 with a normal AFI (≥ 10-24 cm); 360 patients delivered at University of Arizona Medical Center, and 379 delivered at St Joseph's Hospital. Combined and individual analyses of each center revealed no significant difference in fetal intolerance of labor (P = .19) or cesarean delivery for fetal intolerance (P = .074) between cohorts. In both settings, patients with a borderline AFI were more likely than those with a normal AFI to undergo antepartum testing (P < .001). A statistically significant increase in intrauterine growth restriction in the borderline AFI group was noted, with a calculated risk ratio of 13.76 (P < .001). There was no difference between groups for meconium-stained amniotic fluid (P = .23), neonatal intensive care unit admission (P = .054), preterm delivery (P = .31), or operative vaginal delivery (P = .45). CONCLUSIONS The findings of this study suggest that there is no difference in the rate of fetal intolerance of labor in pregnancies with a borderline AFI and those with a normal AFI. Pregnancies complicated by a borderline AFI are more likely to undergo antepartum testing, yet the benefit is unclear. Significantly more patients with a borderline AFI had underlying growth restriction, which may provide a useful tool for risk stratification in the management of a borderline AFI.
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Affiliation(s)
- S Lindsay Wood
- Department of Obstetrics and Gynecology, University of Arizona, 1501 N. Campbell Ave, Tucson, AZ 85724 USA.
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Morris RK, Meller CH, Tamblyn J, Malin GM, Riley RD, Kilby MD, Robson SC, Khan KS. Association and prediction of amniotic fluid measurements for adverse pregnancy outcome: systematic review and meta-analysis. BJOG 2014; 121:686-99. [PMID: 24738894 DOI: 10.1111/1471-0528.12589] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2013] [Indexed: 12/31/2022]
Abstract
BACKGROUND Measurements of amniotic fluid volume are used for pregnancy surveillance despite a lack of evidence for their predictive ability. OBJECTIVE To evaluate the association and predictive value of ultrasound measurements of amniotic fluid volume for adverse pregnancy outcome. SEARCH STRATEGY Electronic databases (inception to October 2011), reference lists, hand searching of journals, contact with experts. SELECTION CRITERIA Studies comparing measurements of amniotic fluid volume with adverse outcome, excluding pre-labour ruptured membranes or congenital/structural anomalies. DATA COLLECTION Data on study characteristics, design, quality. Random effects meta-analysis to estimate summary odds ratios (prognostic association) and summary sensitivity, specificity and likelihood ratios (predictive ability). MAIN RESULTS Forty-three studies (244,493 fetuses) were included demonstrating a strong association between oligohydramnios (varying definitions) and birthweight <10th centile (summary odds ratio [OR] 6.31, 95% confidence interval [95% CI] 4.15-9.58; high-risk population [author definition] n = 6 studies, 28,510 fetuses), and mortality (neonatal death any population summary OR 8.72, 95% CI 2.43-31.26; n = 6 studies, 55,735 fetuses; and perinatal mortality high-risk population summary OR 11.54, 95% CI 4.05-32.9; n = 2 studies, 27;891 fetuses). There was a strong association between polyhydramnios (maximum pool depth >8 cm or amniotic fluid index ≥25 cm) and birthweight >90th centile (OR 11.41, 95% CI 7.09-18.36; n = 1 study, 3960 fetuses). Despite strong associations, predictive accuracy for perinatal outcome was poor. AUTHOR'S CONCLUSION Current evidence suggests that oligohydramnios is strongly associated with being small for gestational age and mortality, and polyhydramnios with birthweight >90th centile. Despite strong associations with poor outcome, they do not accurately predict outcome risk for individuals.
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Affiliation(s)
- R K Morris
- Birmingham Centre for Women's & Children's Health & School of Clinical and Experimental Medicine, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK; Fetal Medicine Centre, Birmingham Women's Hospital NHS Foundation Trust, Birmingham, UK
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Amniotic fluid volume in normal singleton pregnancies: modeling with quantile regression. Arch Gynecol Obstet 2013; 289:967-72. [DOI: 10.1007/s00404-013-3087-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2013] [Accepted: 10/30/2013] [Indexed: 11/25/2022]
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Bhagat M, Chawla I. Correlation of amniotic fluid index with perinatal outcome. J Obstet Gynaecol India 2013; 64:32-5. [PMID: 24587604 DOI: 10.1007/s13224-013-0467-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2013] [Accepted: 09/02/2013] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES We aimed to evaluate the predictive value of amniotic fluid index (AFI) (<5) for adverse perinatal outcome in terms of cesarean section for fetal distress, birth weight, meconium staining, Apgar scores, and cord pH at birth. METHODS This was a prospective study of 200 antenatal women booked at Ram Manohar Lohia (RML) Hospital during the years 2009-2011 with gestational age between 34 and 41 weeks. The women's history, clinical examination recorded, and AFI were measured and the perinatal outcome was compared between two groups, i.e., AFI < 5 and >5. RESULTS The cesarean section rate for fetal distress and low birth weight babies, <2.5 kg, was higher in patients with oligohydramnios (p = 0.048, 0.001, respectively). There was no significant difference in meconium staining, Apgar score at 5 min <7, and cord pH at birth between the two groups (p = 0.881, 0.884, 0.764, respectively). CONCLUSIONS Oligohydramnios has a significant correlation with cesarean section for fetal distress and low birth weight babies.
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Affiliation(s)
- Megha Bhagat
- Department of Obstetrics and Gynecology, Dr. Ram Manohar Lohia Hospital, New Delhi, India ; H. NO.-209, Pragati Apartment, Paschim Vihar, New Delhi, 110063 India
| | - Indu Chawla
- Department of Obstetrics and Gynecology, Dr. Ram Manohar Lohia Hospital, New Delhi, India
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Schuit E, Kwee A, Westerhuis MEMH, Van Dessel HJHM, Graziosi GCM, Van Lith JMM, Nijhuis JG, Oei SG, Oosterbaan HP, Schuitemaker NWE, Wouters MGAJ, Visser GHA, Mol BWJ, Moons KGM, Groenwold RHH. A clinical prediction model to assess the risk of operative delivery. BJOG 2012; 119:915-23. [PMID: 22568406 DOI: 10.1111/j.1471-0528.2012.03334.x] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To predict instrumental vaginal delivery or caesarean section for suspected fetal distress or failure to progress. DESIGN Secondary analysis of a randomised trial. SETTING Three academic and six non-academic teaching hospitals in the Netherlands. POPULATION 5667 labouring women with a singleton term pregnancy in cephalic presentation. METHODS We developed multinomial prediction models to assess the risk of operative delivery using both antepartum (model 1) and antepartum plus intrapartum characteristics (model 2). The models were validated by bootstrapping techniques and adjusted for overfitting. Predictive performance was assessed by calibration and discrimination (area under the receiver operating characteristic), and easy-to-use nomograms were developed. MAIN OUTCOME MEASURES Incidence of instrumental vaginal delivery or caesarean section for fetal distress or failure to progress with respect to a spontaneous vaginal delivery (reference). RESULTS 375 (6.6%) and 212 (3.6%) women had an instrumental vaginal delivery or caesarean section due to fetal distress, and 433 (7.6%) and 571 (10.1%) due to failure to progress, respectively. Predictors were age, parity, previous caesarean section, diabetes, gestational age, gender, estimated birthweight (model 1) and induction of labour, oxytocin augmentation, intrapartum fever, prolonged rupture of membranes, meconium stained amniotic fluid, epidural anaesthesia, and use of ST-analysis (model 2). Both models showed excellent calibration and the receiver operating characteristics areas were 0.70-0.78 and 0.73-0.81, respectively. CONCLUSION In Dutch women with a singleton term pregnancy in cephalic presentation, antepartum and intrapartum characteristics can assist in the prediction of the need for an instrumental vaginal delivery or caesarean section for fetal distress or failure to progress.
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Affiliation(s)
- E Schuit
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands.
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Sénat MV. [Management of post-term pregnancies: the role for AFI, biophysical score and doppler]. JOURNAL DE GYNECOLOGIE, OBSTETRIQUE ET BIOLOGIE DE LA REPRODUCTION 2011; 40:785-95. [PMID: 22078136 DOI: 10.1016/j.jgyn.2011.09.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To evaluate the role of ultrasound and doppler assessment in the management of prolonged pregnancies and to state its modalities. METHOD Medline, PubMed, embase and the Cochrane library were searched using terms prolonged pregnancy, post date pregnancy amniotic fluid, ultrasound assessment, doppler, biophysical profile. RESULTS Single deepest vertical pool measurement is the method of choice of the assessment of amniotic fluid. Indeed, when this method was used, significantly fewer case of oligohydramnios were diagnosed and fewer women had inductions of labor. However, this method is not superior to the amniotic fluid index in the prevention of poor perinatal outcomes. There is a significant difference in the incidence of fetal distress, meconium stained fluid and caesarean section for fetal distress when the amniotic fluid is reduced as compared with normal amniotic fluid. However, sensibility and predictive positive value of oligohydramnios to predict poor perinatal outcomes is moderate. Similary, in most studies, diagnosis of an abnormal uterine, umbilical, aortic or cerebral blood flow doppler was associated with a weak prediction of a poor perinatal outcome. Therefore, we do not recommend its use in management of prolonged pregnancy. There were significantly more diagnosis of oligoamnios and more abnormal antenatal monitoring results in the modified biophysical profile group as compared with the group managed with only single deepest pool but no differences in cord blood gases, neonatal outcome, or in outcomes related to labour and delivery were noted between the two groups. Therefore, biophysical profile including AFI offers no advantage in detecting adverse outcomes and may cause more interventions. CONCLUSION Close monitoring of fetal condition including assessment of amniotic fluid by single deepest pool twice a week from 41 weeks of gestation is recommended in the management of prolonged pregnancy. Induction of labor could be considered when oligohydramnios is diagnosed by single deepest pool less than 2 cm.
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Affiliation(s)
- M-V Sénat
- Service de gynécologie-obstétrique, hôpital de Bicêtre, université Paris-Sud, 78, avenue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France.
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Magann EF, Sandlin AT, Ounpraseuth ST. Amniotic fluid and the clinical relevance of the sonographically estimated amniotic fluid volume: oligohydramnios. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2011; 30:1573-1585. [PMID: 22039031 DOI: 10.7863/jum.2011.30.11.1573] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The amniotic fluid volume (AFV) is regulated by several systems, including the in-tramembranous pathway, fetal production (fetal urine and lung fluid) and uptake (fetal swallowing), and the balance of fluid movement via osmotic gradients. The normal AFV across gestation has not been clearly defined; consequently, abnormal volumes are also poorly defined. Actual AFVs can be measured by dye dilution techniques and directly measured at cesarean delivery; however, these techniques are time-consuming, are invasive, and require laboratory support, and direct measurement can only be done at cesarean delivery. As a result of these limitations, the AFV is estimated by the amniotic fluid index (AFI), the single deepest pocket, and subjective assessment of the AFV. Unfortunately, sonographic estimates of the AFV correlate poorly with dye-determined or directly measured amniotic fluid. The recent use of color Doppler sonography has not improved the diagnostic accuracy of sonographic estimates of the AFV but instead has led to overdiagnosis of oligohydramnios. The relationship between the fixed cutoffs of an AFI of 5 cm or less and a single deepest pocket of 2 cm or less for identifying adverse pregnancy outcomes is uncertain. The use of the single deepest pocket compared to the AFI to identify oligohydramnios in at-risk pregnancies seems to be a better choice because the use of the AFI leads to an increase in the diagnosis of oligohydramnios, resulting in more labor inductions and cesarean deliveries without any improvement in peripartum outcomes.
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Affiliation(s)
- Everett F Magann
- Department of Obstetrics and Gynecology, University of Arkansas for the Medical Sciences, Little Rock, AR 72205 USA.
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Abstract
Measuring amniotic fluid pockets with ultrasound is an efficient and reasonably reliable method of evaluating amniotic fluid volume and categorizing relative risk of perinatal morbidity. The most commonly used ultrasound criteria for oligohydramnios, SDP <2 cm and AFI <5 cm, assign approximately 2%-3% and 4%-5% of late preterm pregnancies into the "low amniotic fluid" category. The AFI offers somewhat greater sensitivity and greater precision but has less specificity for predicting perinatal morbidity than does the SDP. Thus, before 34 weeks, use of the AFI <5 cm as a criterion for intensive fetal monitoring, but not as sole criteria for delivery, is recommended. In pregnancies beyond 34 weeks, use of either AFI or SDP to diagnose oligohydramnios can be expected to reliably identify fetuses at risk for compromised perinatal outcome especially if replicate measurements are confirmatory. In such cases, care must be taken to identify comorbid conditions that, together with oligohydramnios, may place the fetus at significant risk. In such cases, delivery is the recommended intervention.
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Affiliation(s)
- Thomas R Moore
- Department of Reproductive Medicine, University of California, San Diego School of Medicine, San Diego, CA 92103, USA.
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Abstract
The finding of oligohydramnios in pregnancy is problematic. The various mechanisms that control amniotic fluid, the inability to precisely measure and quantify the amount, and the relevance of a "decreased" amount of fluid make the management of this finding unclear. Given the limited amount of data, the single deepest vertical pocket may be a better method than the amniotic fluid index to define oligohydramnios. A large prospective study is needed to develop the most optimal management recommendations, especially for idiopathic oligohydramnios at or near term.
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Vivian-Taylor J, Sheng J, Hadfield RM, Morris JM, Bowen JR, Roberts CL. Trends in obstetric practices and meconium aspiration syndrome: a population-based study. BJOG 2011; 118:1601-7. [DOI: 10.1111/j.1471-0528.2011.03093.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Shanks A, Tuuli M, Schaecher C, Odibo AO, Rampersad R. Assessing the optimal definition of oligohydramnios associated with adverse neonatal outcomes. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2011; 30:303-307. [PMID: 21357551 DOI: 10.7863/jum.2011.30.3.303] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
OBJECTIVES The purpose of this study was to compare the use of an amniotic fluid index (AFI) less than 5 cm to the use of an AFI less than the fifth percentile for gestational age in predicting adverse perinatal outcomes. METHODS This was a retrospective cohort study from 1998 to 2008. Patients with an AFI less than 5 cm and those with an AFI less than the fifth percentile were compared to patients with a normal AFI. The primary outcome measure was neonatal intensive care unit (NICU) admission. RESULTS A total of 17,887 patients had complete information for analysis. There were 145 NICU admissions in patients with an AFI less than 5 cm (relative risk, 2.2) compared to 235 in patients with an AFI less than the fifth percentile for gestational age (relative risk, 2.37). The sensitivity and specificity for NICU admission using an AFI less than 5 cm were 10.9% and 95.2% compared to 17.6% and 92.5% for an AFI less than the fifth percentile for gestational age. CONCLUSIONS Oligohydramnios defined as an AFI less than the fifth percentile better predicts fetuses at risk for adverse perinatal outcomes compared to an AFI less than 5 cm.
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Affiliation(s)
- Anthony Shanks
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Washington University, St. Louis, Missouri, USA.
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Abstract
Owing to the frequent use of bedside ultrasound, much is known about the regulation of and normative values for amniotic fluid volume and the mechanisms by which this fluid is regulated. The management protocols for conditions with extremes of amniotic fluid volume have become more exact, resulting in interventions more likely to improve outcome. Much is still unclear; there are no tools to measure amniotic fluid volume with precision, and measurement of fetal urinary output is cumbersome and error-prone.
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Mandruzzato G, Alfirevic Z, Chervenak F, Gruenebaum A, Heimstad R, Heinonen S, Levene M, Salvesen K, Saugstad O, Skupski D, Thilaganathan B. Guidelines for the management of postterm pregnancy. J Perinat Med 2010; 38:111-9. [PMID: 20156009 DOI: 10.1515/jpm.2010.057] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A pregnancy reaching 42 completed weeks (294 days) is defined as postterm (PT). The use of ultrasound in early pregnancy for precise dating significantly reduces the number of PT pregnancies compared to dating based on the last menstrual period. Although the fetal, maternal and neonatal risks increase beyond 41 weeks, there is no conclusive evidence that prolongation of pregnancy, per se, is the major risk factor. Other specific risk factors for adverse outcomes have been identified, the most important of which are restricted fetal growth and fetal malformations. In order to prevent PT and associated complications routine induction before 42 weeks has been proposed. There is no conclusive evidence that this policy improves fetal, maternal and neonatal outcomes as compared to expectant management. It is also unclear if the rate of cesarean sections is different between the two management strategies. After careful identification and exclusion of specific risks, it would seem appropriate to let women make an informed decision about which management they wish to undertake. There is consensus that the number of inductions necessary to possibly avoid one stillbirth is very high. If induction is preferred, procedures for cervical ripening should be used, especially in nulliparous women. Close intrapartum fetal surveillance should be offered, irrespective of whether labor was induced or not.
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Hofmeyr GJ. What (not) to do before delivery? Prevention of fetal meconium release and its consequences. Early Hum Dev 2009; 85:611-5. [PMID: 19822401 DOI: 10.1016/j.earlhumdev.2009.09.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2009] [Accepted: 09/24/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND Meconium-stained amniotic fluid is a common occurrence which places the mother at risk of escalating obstetric interventions, and the baby at risk of meconium aspiration syndrome. METHODS The Cochrane Library was searched for interventions related to care before delivery with useful evidence on the outcomes 'meconium-stained amniotic fluid' and 'meconium aspiration syndrome'. FINDINGS Curtailment of post-term pregnancy reduces the occurrence of meconium-stained amniotic fluid, and meconium aspiration syndrome. Uterine stimulants, particularly misoprostol, are associated with occurrence of meconium-stained amniotic fluid. Amniotomy during labour may be a risk factor for meconium aspiration syndrome. There is little research evidence on the benefits or otherwise of obstetric interventions such as expedited delivery for meconium-stained liquor without other evidence of fetal distress. Amnioinfusion for meconium-stained amniotic fluid improves neonatal outcome only in settings with limited peripartum surveillance. There is insufficient evidence to support the use of amnioinfusion for meconium-stained liquor in settings with adequate peripartum surveillance.
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Affiliation(s)
- G J Hofmeyr
- Effective Care Research Unit, Eastern Cape Department of Health, University of the Witwatersrand, University of Fort Hare, South Africa.
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Schwartz N, Sweeting R, Young BK, Schwartz N, Sweeting R, Young BK. Practice patterns in the management of isolated oligohydramnios: a survey of perinatologists. J Matern Fetal Neonatal Med 2009; 22:357-61. [DOI: 10.1080/14767050802559103] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Nadav Schwartz
- Department of Obstetrics and Gynecology, New York University School of Medicine, 462 First Ave, NB-9E2, New York, NY 10016, USA.
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Haws RA, Yakoob MY, Soomro T, Menezes EV, Darmstadt GL, Bhutta ZA. Reducing stillbirths: screening and monitoring during pregnancy and labour. BMC Pregnancy Childbirth 2009; 9 Suppl 1:S5. [PMID: 19426468 PMCID: PMC2679411 DOI: 10.1186/1471-2393-9-s1-s5] [Citation(s) in RCA: 107] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Screening and monitoring in pregnancy are strategies used by healthcare providers to identify high-risk pregnancies so that they can provide more targeted and appropriate treatment and follow-up care, and to monitor fetal well-being in both low- and high-risk pregnancies. The use of many of these techniques is controversial and their ability to detect fetal compromise often unknown. Theoretically, appropriate management of maternal and fetal risk factors and complications that are detected in pregnancy and labour could prevent a large proportion of the world's 3.2 million estimated annual stillbirths, as well as minimise maternal and neonatal morbidity and mortality. METHODS The fourth in a series of papers assessing the evidence base for prevention of stillbirths, this paper reviews available published evidence for the impact of 14 screening and monitoring interventions in pregnancy on stillbirth, including identification and management of high-risk pregnancies, advanced monitoring techniques, and monitoring of labour. Using broad and specific strategies to search PubMed and the Cochrane Library, we identified 221 relevant reviews and studies testing screening and monitoring interventions during the antenatal and intrapartum periods and reporting stillbirth or perinatal mortality as an outcome. RESULTS We found a dearth of rigorous evidence of direct impact of any of these screening procedures and interventions on stillbirth incidence. Observational studies testing some interventions, including fetal movement monitoring and Doppler monitoring, showed some evidence of impact on stillbirths in selected high-risk populations, but require larger rigourous trials to confirm impact. Other interventions, such as amniotic fluid assessment for oligohydramnios, appear predictive of stillbirth risk, but studies are lacking which assess the impact on perinatal mortality of subsequent intervention based on test findings. Few rigorous studies of cardiotocography have reported stillbirth outcomes, but steep declines in stillbirth rates have been observed in high-income settings such as the U.S., where cardiotocography is used in conjunction with Caesarean section for fetal distress. CONCLUSION There are numerous research gaps and large, adequately controlled trials are still needed for most of the interventions we considered. The impact of monitoring interventions on stillbirth relies on use of effective and timely intervention should problems be detected. Numerous studies indicated that positive tests were associated with increased perinatal mortality, but while some tests had good sensitivity in detecting distress, false-positive rates were high for most tests, and questions remain about optimal timing, frequency, and implications of testing. Few studies included assessments of impact of subsequent intervention needed before recommending particular monitoring strategies as a means to decrease stillbirth incidence. In high-income countries such as the US, observational evidence suggests that widespread use of cardiotocography with Caesarean section for fetal distress has led to significant declines in stillbirth rates. Efforts to increase availability of Caesarean section in low-/middle-income countries should be coupled with intrapartum monitoring technologies where resources and provider skills permit.
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Affiliation(s)
- Rachel A Haws
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | | | - Tanya Soomro
- Division of Maternal and Child Health, the Aga Khan University, Karachi, Pakistan
| | - Esme V Menezes
- Division of Maternal and Child Health, the Aga Khan University, Karachi, Pakistan
| | - Gary L Darmstadt
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Zulfiqar A Bhutta
- Division of Maternal and Child Health, the Aga Khan University, Karachi, Pakistan
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Signore C, Freeman RK, Spong CY. Antenatal testing-a reevaluation: executive summary of a Eunice Kennedy Shriver National Institute of Child Health and Human Development workshop. Obstet Gynecol 2009; 113:687-701. [PMID: 19300336 PMCID: PMC2771454 DOI: 10.1097/aog.0b013e318197bd8a] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
In August 2007, the Eunice Kennedy Shriver National Institute of Child Health and Human Development, the National Institutes of Health Office of Rare Diseases, the American College of Obstetricians and Gynecologists, and the American Academy of Pediatrics cosponsored a 2-day workshop to reassess the body of evidence supporting antepartum assessment of fetal well-being, identify key gaps in the evidence, and formulate recommendations for further research. Participants included experts in obstetrics and fetal physiology and representatives from relevant stakeholder groups and organizations. This article is a summary of the discussions at the workshop, including synopses of oral presentations on the epidemiology of stillbirth and fetal neurological injury, fetal physiology, techniques for antenatal monitoring, and maternal and fetal indications for monitoring. Finally, a synthesis of recommendations for further research compiled from three breakout workgroups is presented.
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Affiliation(s)
- Caroline Signore
- Pregnancy and Perinatology Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, United States Department of Health and Human Services, Bethesda, MD
| | - Roger K. Freeman
- Pediatrix Medical Group, Fort Lauderdale, FL
- Department of Obstetrics and Gynecology; University of California, Irvine; Women's Hospital at Long Beach Memorial Medical Center; Long Beach, CA
| | - Catherine Y. Spong
- Pregnancy and Perinatology Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, United States Department of Health and Human Services, Bethesda, MD
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Abstract
UNLABELLED Postterm pregnancy is defined as one which has progressed to 42 0/7 weeks or beyond. The most common reason to be diagnosed with a postterm pregnancy is inaccurate pregnancy dating, but it is also associated with obesity, nulliparity, and a prior history of postterm pregnancy. The rate of postterm pregnancy appears to be decreasing whether due to improved pregnancy dating or an increase in induction of labor. Postterm pregnancy is associated with both maternal and neonatal morbidity and fetal and neonatal mortality; similarly pregnancies beyond 41 weeks' gestation are associated with increases in these perinatal complications. Prevention of postterm pregnancies may include stripping or sweeping the membranes and unprotected coitus. Management of such pregnancies may include induction of labor and fetal antenatal monitoring. Individual patient management should involve careful counseling regarding the risks and benefits of each of the components of care. TARGET AUDIENCE Obstetricians & Gynecologists, Family Physicians. LEARNING OBJECTIVES After completion of this article, the reader should be able to recall the increasing risks of poor outcomes associated with prolonged pregnancy, demonstrate knowledge regarding gestational dating and use of cervical ripening agents in their care of pregnant women, and use evidence-based information when counseling their term patients regarding postterm pregnancy management.
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Nabhan AF, Abdelmoula YA. Amniotic fluid index versus single deepest vertical pocket: a meta-analysis of randomized controlled trials. Int J Gynaecol Obstet 2008; 104:184-8. [PMID: 19046586 DOI: 10.1016/j.ijgo.2008.10.018] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2008] [Revised: 10/07/2008] [Accepted: 10/21/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To compare the use of the amniotic fluid index with the single deepest vertical pocket measurement, during antepartum fetal surveillance, in preventing adverse pregnancy outcome. SEARCH STRATEGY We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (January 2008), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2008, Issue 2), MEDLINE (1966 to May 2008), and the metaRegister of Controlled Trials (May 2008). We handsearched the citation lists of relevant publications, review articles, and included studies. SELECTION CRITERIA Randomized controlled trials involving women with a singleton pregnancy, whether at low or high risk, undergoing ultrasound measurement of amniotic fluid volume as part of antepartum assessment of fetal well-being that compared the amniotic fluid index and the single deepest vertical pocket measurement. DATA COLLECTION AND ANALYSIS Both authors independently assessed eligibility and quality, and extracted the data. RESULTS Four trials (3125 women) met the inclusion criteria. When the amniotic fluid index was used, significantly more cases of oligohydramnios were diagnosed (risk ratio (RR) 2.33, 95% CI 1.67-3.24), and more women had inductions of labor (RR 2.10, 95% CI 1.60-2.76) and cesarean delivery for fetal distress (RR 1.45, 95% CI 1.07-1.97). There is no evidence that one method is superior to the other in the prevention of poor peripartum outcomes, including: admission to a neonatal intensive care unit; an umbilical artery pH of less than 7.1; the presence of meconium; an Apgar score of less than 7 at 5 minutes; or cesarean delivery. CONCLUSION Single deepest vertical pocket measurement is the method of choice for the assessment of amniotic fluid volume.
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Abstract
The standard definition of a prolonged pregnancy is 42 completed weeks of gestation. The incidence of prolonged pregnancy varies depending on the criteria used to define gestational age at birth. It is estimated that 4 to 19% of pregnancies reach or exceed 42 weeks gestation. Several studies that have used very large computerized databases of well-dated pregnancies provided insights into the incidence and nature of adverse perinatal outcome such as an increased fetal and neonatal mortality as well as increased fetal and maternal morbidity in prolonged pregnancy. Fetal surveillance may be used in an attempt to observe the prolonged pregnancy while awaiting the onset of spontaneous labor. This article reviews the different methodologies and protocols for fetal surveillance in prolonged pregnancies. On the one hand, false-positive tests commonly lead to unnecessary interventions that are potentially hazardous to the gravida. On the other hand, to date, no program of fetal testing has been shown to completely eliminate the risk of stillbirth.
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Affiliation(s)
- Michael Y Divon
- Department of Obstetrics and Gynecology, Lenox Hill Hospital, New York, NY 10075, USA.
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Nabhan AF, Abdelmoula YA. Amniotic fluid index versus single deepest vertical pocket as a screening test for preventing adverse pregnancy outcome. Cochrane Database Syst Rev 2008; 2008:CD006593. [PMID: 18646160 PMCID: PMC6464731 DOI: 10.1002/14651858.cd006593.pub2] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Amniotic fluid volume is an important parameter in the assessment of fetal well-being. Oligohydramnios occurs in many high-risk conditions and is associated with poor perinatal outcomes. Many caregivers practice planned delivery by induction of labor or caesarean section after diagnosis of decreased amniotic fluid volume at term. There is no clear consensus on the best method to assess amniotic fluid adequacy. OBJECTIVES To compare the use of the amniotic fluid index with the single deepest vertical pocket measurement as a screening tool for decreased amniotic fluid volume in preventing adverse pregnancy outcome. SEARCH STRATEGY We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (January 2008), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2007, Issue 2), MEDLINE (1966 to May 2007) and the metaRegister of Controlled Trials (May 2007). We handsearched the citation lists of relevant publications, review articles, and included studies. SELECTION CRITERIA Randomised controlled trials involving women with a singleton pregnancy, whether at low or high risk, undergoing ultrasound measurement of amniotic fluid volume as part of antepartum assessment of fetal well-being that compared the amniotic fluid index and the single deepest vertical pocket measurement. DATA COLLECTION AND ANALYSIS Both authors independently assessed eligibility and quality, and extracted the data. MAIN RESULTS Four trials (3125 women) met the inclusion criteria. There is no evidence that one method is superior to the other in the prevention of poor peripartum outcomes, including: admission to a neonatal intensive care unit; an umbilical artery pH of less than 7.1; the presence of meconium; an Apgar score of less than 7 at five minutes; or caesarean delivery. When the amniotic fluid index was used, significantly more cases of oligohydramnios were diagnosed (risk ratio (RR, random) 2.33, 95% CI 1.67 to 3.24), and more women had inductions of labor (RR (fixed) 2.10, 95% CI 1.60 to 2.76) and caesarean delivery for fetal distress (RR (fixed) 1.45, 95% CI 1.07 to 1.97). AUTHORS' CONCLUSIONS The single deepest vertical pocket measurement in the assessment of amniotic fluid volume during fetal surveillance seems a better choice since the use of the amniotic fluid index increases the rate of diagnosis of oligohydramnios and the rate of induction of labor without improvement in peripartum outcomes. A systematic review of the diagnostic accuracy of both methods in detecting decreased amniotic fluid volume is required.
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Affiliation(s)
- Ashraf F Nabhan
- Department of Obstetrics and Gynecology, Ain Shams University, 16 Ali Fahmi Kamel Street, Heliopolis, Cairo, Egypt, 11351.
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Prise en charge du dépassement de terme. ACTA ACUST UNITED AC 2008; 37:107-17. [DOI: 10.1016/j.jgyn.2007.09.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2007] [Revised: 08/23/2007] [Accepted: 09/12/2007] [Indexed: 11/23/2022]
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References. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2007. [DOI: 10.1016/s1701-2163(16)32622-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Johnson JM, Chauhan SP, Ennen CS, Niederhauser A, Magann EF. A comparison of 3 criteria of oligohydramnios in identifying peripartum complications: a secondary analysis. Am J Obstet Gynecol 2007; 197:207.e1-7; discussion 207.e7-8. [PMID: 17689653 DOI: 10.1016/j.ajog.2007.04.048] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2006] [Revised: 03/19/2007] [Accepted: 04/26/2007] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The objective of the study was to ascertain the diagnostic accuracy of 3 criteria of oligohydramnios in identifying 4 peripartum complications. STUDY DESIGN The 3 definitions of oligohydramnios were amniotic fluid index (AFI) 5.0 cm or less and AFI <5% for gestational age (GA) using nomograms by Moore and Cayle or Magann et al. Likelihood ratio (LR) and guidelines by the Evidence-Based Medicine Working Group were used in the secondary analysis of previously published reports. AFI obtained during antepartum and intrapartum periods were analyzed separately. RESULTS The 95% confidence intervals for the prevalence of oligohydramnios using the 3 criteria are significantly different in the antepartum or intrapartum analysis. The LR was <6 for ante- and intrapartum AFI to identify cesarean delivery for nonreassuring fetal heart rate tracing, Apgar score 3 or less at 5 minutes, umbilical arterial pH <7.00, and newborns' weight 5% or less for GA. CONCLUSION The 3 criteria for determining the adequacy of amniotic fluid are not fungible, and they are not useful diagnostic tests for identifying peripartum complications because LR is <10.
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Abstract
The timely onset of labor and birth is an important determinant of perinatal outcome. Prolonged (postterm) pregnancy--defined as delivery at or beyond 42 weeks' gestation--complicates 10% of all gestations and is associated with increased risks to both fetus (stillbirth, macrosomia, birth injury, meconium aspiration syndrome) and mother (cesarean delivery, severe perineal injury, postpartum hemorrhage). The risk of routine induction of labor (failed induction leading to cesarean delivery) in the era of cervical ripening is lower than previously reported. For these reasons, the authors favor a policy of routine induction of labor for low-risk pregnancies at 41 weeks' gestation.
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Affiliation(s)
- Errol R Norwitz
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT 06520, USA.
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Ross MG, Beall MH, Christenson PD. Amniotic fluid volume and perinatal outcome. Am J Obstet Gynecol 2007; 196:e17. [PMID: 17346507 DOI: 10.1016/j.ajog.2006.09.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2005] [Accepted: 09/25/2006] [Indexed: 11/28/2022]
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Gumus II, Koktener A, Turhan NO. Perinatal outcomes of pregnancies wıth borderline amniotic fluid index. Arch Gynecol Obstet 2007; 276:17-9. [PMID: 17219158 DOI: 10.1007/s00404-006-0309-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2006] [Accepted: 12/11/2006] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Our aim was to determine whether a borderline amniotic fluid index observed during antepartum testing confers a significant risk of adverse perinatal outcome. METHODS Between April 2001 and May 2005, uncomplicated gestations with a singleton non-anomalous fetus, who underwent weekly monitoring of amniotic fluid index (AFI) until delivery during the last trimester and who gave birth at our hospital, were identified for our study. Normal amniotic fluid volume and borderline amniotic fluid were defined as AFI of >10 and <24 cm and >5 and <10 cm, respectively. The groups were compared on maternal data, mode of delivery and perinatal outcomes such as fetal distress, intrauterine growth restriction and meconium fluid. RESULTS A total of 90 cases were identified as borderline amniotic fluid and 277 cases as normal AFI. We observed significant increased incidences of admission to neonatal intensive care unit, intrauterine growth restriction, meconium-stained amniotic fluid, intrapartum fetal distress in the group with borderline amniotic index (P < 0.05). CONCLUSIONS A borderline amniotic fluid index observed in antepartum testing during the last trimester carries an increased risk of adverse perinatal outcomes. These patients should be followed up carefully during the antepartum and intrapartum period.
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Affiliation(s)
- Ilknur Inegol Gumus
- Department of Obstetrics and Gynecology, Fatih University School of Medicine, Bariş Manço Cad., No: 65/9 Balgat, Ankara, Turkey.
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Peregrine E, O'Brien P, Omar R, Jauniaux E. Clinical and Ultrasound Parameters to Predict the Risk of Cesarean Delivery After Induction of Labor. Obstet Gynecol 2006; 107:227-33. [PMID: 16449105 DOI: 10.1097/01.aog.0000196508.11431.c0] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To evaluate whether factors in the maternal history and/or ultrasound parameters are useful in predicting the risk of cesarean delivery after induction of labor. METHODS Maternal age, height, body mass index, parity, gestational age, Bishop score, ultrasonic amniotic fluid volume, fetal head position, estimated fetal weight, and transvaginal cervical length were studied prospectively in 267 women at 36 or more weeks of gestation immediately before induction of labor. Logistic regression analysis was used to determine which factors best predicted the risk of cesarean delivery. Receiver operating characteristic curves and a resampling technique were used to evaluate the model's performance. RESULTS Eighty (30%) of these 267 women had cesarean delivery. Logistic regression was performed and a final model chosen, which included parity (odds ratio [OR] 20.56, 95% confidence interval [CI] 7.97-53.05, P < .001), body mass index (OR 6.17, 95% CI 2.10-18.13, P < .001), height (OR 0.94, 95% CI 0.89-0.98, P = .005), and ultrasonic transvaginal cervical length (OR 1.07, 95% CI 1.04-1.11, P < .001) as the best predictors of cesarean delivery. A risk score was calculated containing these 4 parameters, which predicted reasonably accurately the risk of cesarean delivery. CONCLUSION Parity, body mass index, height, and ultrasonic transvaginal cervical length are the most accurate parameters in predicting the risk of cesarean delivery after induction of labor. A predictive model using these would allow more accurate counseling and better informed consent in the decision-making process regarding induction of labor LEVEL OF EVIDENCE II-2.
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Affiliation(s)
- Elisabeth Peregrine
- Department of Obstetrics and Gynaecology, University College London Hospitals, UK
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