Reference Ranges of Amniotic Fluid Index in Late Third Trimester of Pregnancy: What Should the Optimal Interval between Two Ultrasound Examinations Be?

Abstract

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

Sonographic estimation of amniotic fluid volume using the amniotic fluid index and the single deepest pocket in a resource-limited setting

“…The results from this study suggest a normal value of AFI to be 12.4 cm and 28.2 cm at the 5 th and 95 th percentiles, respectively. These findings are similar to those obtained at 5 th percentile by Onwuzu et al [1] with 8.6 cm, Hebbar et al [12] with 8.7 cm, Hinh and Ladinsky[13] with 8.8 cm, and Jeng et al [14] with 8.0 cm. However, the values obtained in our study was higher than those obtained by previous studies,[1115161718] that obtained 4.1, 5.0, 7.7, 7.9, and 7.8 cm, respectively.…”

Comparison of amniotic fluid volumetry between fetal sonography and MRI - Correlation to MR diffusion parameters of the fetal kidney

“…Nevertheless, that study [15] also included early pregnancies (from 14 weeks), while our study involved pregnancies from 19 th week onwards. The AFI-range in the current study is somewhat lower than that of Hebbar et al [16], where the range was from 11.7 to 17.3 cm. This can be explained by the fact that it included women from 34 to 40 GA weeks and also multiple pregnancies.…”

Abnormal liquor volume and mode of delivery

“…9 AFI changes from 11 through 43 weeks gestation, and is determined by the summation of vertical diameter of the largest pockets in each of the four quadrants. 10,11 In our study, 99 (77.3%) of oligohydramnios cases underwent emLSCS and surgery rate was less in mild 24 (18.75%) than moderate 41 (32.03%) and severe 34 (26.56%). Similar findings of AFI as a good predictor of maternal and perinatal outcome, with increased incidence of caesarean and instrumental deliveries in oligohydramnios has been reported.…”