| 20031110-44 The usefulness of ultrasound
assessment of amniotic fluid in predicting adverse outcome in prolonged
pregnancy: a prospective blinded observational
study - BJOG: An
International Journal of Obstetrics and Gynaecology , vol 110,
no 11, November 2003, pp 989-994 Morris JM; Thompson K; Smithey J; et
al - (November 2003) |
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Objective: To determine whether a single ultrasound
scan at or beyond 40 weeks of gestation to detect a single deepest pool of
amniotic fluid <2 cm and amniotic fluid index (AFI) <5 cm is
clinically useful in the prediction of subsequent adverse pregnancy
outcome. Design: A prospective double blind cohort study. Setting: A
university teaching hospital delivering approximately 6000 women annually.
Population: One thousand and five hundred and eighty-four pregnant women
at or beyond 40 weeks of gestation. Methods: Ultrasound assessment of
liquor to detect the single deepest pool of amniotic fluid and derive the
AFI at or after 40 weeks of gestation. Main outcome measures: Perinatal
death, meconium aspiration, birth asphyxia, intervention in labour for
fetal distress, a cord arterial pH <7 and admission to the neonatal
unit. Results: An AFI <5 cm but not a single deepest pool <2 cm was
significantly associated with birth asphyxia or meconium aspiration. An
AFI <5 cm was also significantly associated with caesarean section for
fetal distress in labour, a cord arterial pH <7 at delivery and low
Apgar scores. Despite there being a statistically significant association
with adverse outcomes the sensitivity of AFI was low at 28.6%, 12% and
11.5% for major adverse outcome, fetal distress in labour or admission to
the neonatal unit, respectively. Conclusions: The AFI is superior to a
measure of the single deepest pool as an assessment of the fetus at or
after 40 weeks but has a poor sensitivity for adverse pregnancy outcome.
Routine use is likely to lead to increased obstetric intervention without
improvement in perinatal outcomes. (22 references)
(Author) |
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