Borderline Amniotic Fluid Index and Its Relation to Fetal Intolerance of Labor

Wood, S. Lindsay; Newton, Jeanette; Wang, Li; Lesser, Karen B.

doi:10.7863/ultra.33.4.705

Cited by 18 publications

(24 citation statements)

References 24 publications

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“…The literature search flow chart is presented in Appendix 4, Figure 36. We identified 11 studies [88][89][90][91][92][93][94][95][96][97][98] (including the POP study) that met our inclusion criteria, which involved a total of 37,848 patients. The study characteristics are presented in Appendix 4, Table 23.…”

Section: Meta-analysismentioning

confidence: 99%

“…The study characteristics are presented in Appendix 4, Table 23. Only the POP study 88 (n = 3387) included unselected pregnancies, three studies 91,97,98 (n = 1890) included low-risk pregnancies only and seven studies 89,90,[92][93][94][95][96] (n = 32,571) included mixed-risk pregnancies. Two studies 97 (n = 3817) were prospective and nine studies [89][90][91][92][93][94][95][96]98 (n = 34,031) were retrospective.…”

Section: Meta-analysismentioning

confidence: 99%

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Universal late pregnancy ultrasound screening to predict adverse outcomes in nulliparous women: a systematic review and cost-effectiveness analysis

Smith

Moraitis

Wastlund

et al. 2021

Health Technol Assess

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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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Section: Meta-analysismentioning

confidence: 99%

Section: Meta-analysismentioning

confidence: 99%

Universal late pregnancy ultrasound screening to predict adverse outcomes in nulliparous women: a systematic review and cost-effectiveness analysis

Smith

Moraitis

Wastlund

et al. 2021

Health Technol Assess

View full text Add to dashboard Cite

show abstract

“…6 Present study revealed the incidence of operative delivery was significantly higher in oligohydramnios group and borderline liquor compared to the normal group similar to Akshaya K et al 2 Shahida et al and Wood et al have shown no significant difference in the incidence of operative delivery in the borderline AFI group and normal group. 4,7 Fetal distress was found to be the most common indication for cesarean delivery in the oligohydramnios Thomas JS et al Int J Reprod Contracept Obstet Gynecol. 2018 Nov;7 (11):4615-4618 and borderline liquor groups compared to control group though not statistically significant similar as Akshaya K et al and Ashraf J et al 2,5 Several studies have reported significant increase in the incidence of LSCS and the indication for fetal distress among the oligohydramnios group and no significant difference in the borderline AFI group and normal group.…”

Section: Discussionmentioning

confidence: 99%

“…6,8 In present study, there was a significant increase in low birth weight babies among the oligohydramnios group when compared to borderline and normal liquor groups which was similar to Locatelli et al 11 Certain studies have reported increased incidence of IUGR among pregnancies with borderline liquor compared to those with normal liquor. 7,9…”

Section: Discussionmentioning

confidence: 99%

Fetomaternal outcome following labour induction in oligohydramnios and borderline liquor: a retrospective study in a tertiary care hospital

Thomas

Daniel

Selvaraj

2018

Int J Reprod Contracept Obstet Gynecol

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Background: Amniotic fluid provides a protective milieu for the growing fetus in pregnancy and labour. A decrease in the amniotic fluid volume has been associated with increased maternal morbidity and fetal morbidity and mortality. The purpose was to compare the effect of labour induction on the fetomaternal outcome in women with oligohydramnios, borderline liquor and normal liquor at term.Methods: A retrospective study of all the labour induction in women with oligohydramnios, borderline liquor and normal liquor volume at 37-42 weeks gestation in a tertiary care teaching hospital. The demographic characteristics, maternal outcomes like mode of delivery, indication for operative delivery, meconium stained liquor and perinatal outcomes were compared in between the three groups. Parametric data was compared by chi-square test and non-parametric data by students’-test. A p-value less than 0.05 was taken as significant.Results: Among the 2338 deliveries during the study period, labour was induced in 266 women (11.3%). Out of which, 109 cases (40.9%) in oligohydramnios group, 111cases (41.7%) in borderline liquor group and 46 cases in normal liquor group. The incidence of meconium stained liquor, the number of operative deliveries and fetal distress was significantly higher and significantly lower birth weight (<2.5 kg) in the group with oligohydramnios and borderline liquor (p <0.05). Low Apgar score and admission to neonatal intensive care unit was higher in the oligohydramnios group (p<0.05).Conclusions: Induction of labour on detecting borderline liquor at term may help in reduction of maternal and fetal morbidity and mortality.

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“…Several studies suggested that pregnancies with borderline AFI were associated with an increased risk of adverse perinatal outcomes . By contrast, other studies also found that there was no significant difference in pregnancy outcomes in terms of cesarean section for fetal distress, meconium‐stained amniotic fluid, or neonatal complications between women with a borderline AFI versus a normal AFI . Furthermore, borderline AFI in a term pregnancy is generally considered an indication for the induction of labor in routine clinical practice.…”

Section: Introductionmentioning

confidence: 99%

Perinatal outcomes following labor induction with dinoprostone in pregnancies with borderline amniotic fluid index at term: A clinical observation study

Yin

Zhao

Lin

et al. 2018

J of Obstet and Gynaecol

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Borderline Amniotic Fluid Index and Its Relation to Fetal Intolerance of Labor

Cited by 18 publications

References 24 publications

Universal late pregnancy ultrasound screening to predict adverse outcomes in nulliparous women: a systematic review and cost-effectiveness analysis

Universal late pregnancy ultrasound screening to predict adverse outcomes in nulliparous women: a systematic review and cost-effectiveness analysis

Fetomaternal outcome following labour induction in oligohydramnios and borderline liquor: a retrospective study in a tertiary care hospital

Perinatal outcomes following labor induction with dinoprostone in pregnancies with borderline amniotic fluid index at term: A clinical observation study

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