Deepest pocket or AFI when performing prenatal ultrasound?
There are two sonographic techniques that are used to measure amniotic fluid for the purpose of fetal assessment: (1) the amniotic fluid index (AFI) or (2) the single deepest vertical pocket (SDP). Oligohydramnios was defined as AFI ≤ 5 cm or the absence of a pocket measuring at least 2 × 1 cm. In a population of term pregnancies and using a multicenter randomized controlled trial design, the authors found:
In the AFI group, there were increased cases of oligohydramnios (9.8%) compared to SDP (2.2%) as well as increased induction of labor for this particular indication (P < 0.01)
There were significantly more abnormal fetal heart rate (FHR) tracings in the AFI group (32.3%) compared to the SDP group (26.2%), which was more pronounced in women who were otherwise low risk (P=0.03)
Neither test was better at predicting adverse pregnancy outcome, including NICU admissions, and cesarean section rates
The use of AFI resulted in more interventions for diagnoses of oligohydramnios with no benefit, thereby making SDP the preferable approach for assessing amniotic fluid, especially in low risk women
Measuring amniotic fluid volume remains an important part of fetal assessment. The SAFE trial (Ultrasound Obstet Gynecol, 2016), a multicentered randomized controlled trial (RCT), was designed to answer the question as to whether AFI or SDP technique is better in predicting pregnancy outcome. 1052 pregnant women at term with singleton pregnancies were included in this trial which included low risk as well as high risk indications, such as gestational diabetes (GDM), hypertensive disorder, fetal growth restriction, placental insufficiency or intrahepatic cholestasis of pregnancy.
AFI was associated with more women being identified with oligohydramnios, but without any significant benefit in perinatal outcome
The SDP appears to be the favorable approach when estimating amniotic fluid volume in both high and low risk patients
OBG Project CME requires a modern web browser (Internet Explorer 10+, Mozilla Firefox, Apple Safari, Google Chrome, Microsoft Edge). Certain educational activities may require additional software to view multimedia, presentation, or printable versions of their content. These activities will be marked as such and will provide links to the required software. That software may be: Adobe Flash, Apple QuickTime, Adobe Acrobat, Microsoft PowerPoint, Windows Media Player, or Real Networks Real One Player.
Disclosure of Unlabeled Use
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.
The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.
Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information
presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.
Jointly provided by
NOT ENOUGH CME HOURS
It appears you don't have enough CME Hours to take this Post-Test. Feel free to buy additional CME hours or upgrade your current CME subscription plan