Perinatal outcome and amniotic fluid index in the antepartum and intrapartum periods: A meta-analysis☆,☆☆
Section snippets
Material and methods
A MEDLINE search was conducted for all English-language publications involving human subjects with the key words or phrases being amniotic fluid index, oligohydramnios, and amniotic fluid . The search was limited to the years 1987-1997, since the index publication by Phelan et al,3 which introduced the concept of AFI in 1987. Other inclusion criteria for the studies considered in the meta-analysis were (1) publication in a peer-reviewed journal, (2) determination of AFI by the technique of
Results
Eight publications5, 9, 15, 16, 17, 20, 21, 22 examined the relationship of antepartum AFI to peripartum outcome. Four of these reports5, 15, 20, 22 involved high-risk patients for whom antepartum surveillance was indicated; 3 reports focused on patients with a single complication (diabetic pregnancy,17 severe preeclampsia at <34 weeks’ gestation,9 or gestational age of ≥41 weeks21); and 1 study16 included patients between 37 and 42 weeks’ gestation with intact membranes but did not specify the
Comment
In term pregnancies oligohydramnios, defined by an ultrasonographic determination of AFI ≤5.0 cm, has been suggested as an indication for delivery.14, 15, 18 Ten years after Phelan et al3 described the semiquantitative method of determining the AFI, it is reasonable to reassess the evidence to support the criterion of an AFI ≤5.0 cm as a clinical cutoff point for intervention. Our meta-analysis showed that the use of the AFI for clinical decision making is problematic.
First, the incidence of
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2018, American Journal of Obstetrics and GynecologyCitation Excerpt :In a prospective series of pregnancies with oligohydramnios and FGR,111 the fetal growth centile remained stable over the 8 weeks following the diagnosis, suggesting that the oligohydramnios is not reflecting any risk of progression. Furthermore, a meta-analysis112 of 18 trials showed an association with abnormal 5-minute Apgar, but not with acidosis or perinatal death in SGA (RR, 1.6; 95% CI, 0.9–2.6). Because of the limited evidence, the inclusion of oligohydramnios assessment in management protocols of SGA/FGR is not recommended.
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Reprint requests: Suneet P. Chauhan, MD, Division of Maternal-Fetal Medicine, Regional Women’s Health Care, 853 North Church St, Suite 403, Spartanburg, SC 29303.
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