None of them had any antenatal complications. Only those patients who delivered at 40 weeks were included in the study as we wanted longitudinal data till term. This may be because their observations were based upon retrospective cross sectional data. 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. A polynomial regression analysis of 3rd order was used to find the best fit. Strength of present study is that it is based on longitudinal data of normal healthy pregnant women and percentile curves obtained can be used to define what constitutes normal range of AFI for low risk antenatal patients. Table 1 describes the descriptive data for AFI. The trend of amniotic fluid volume was studied with advancing gestational age. It can be seen that many cells have the values less than 1, but still the difference may be calculated statistically significant if ordinary statistical tests such as paired test were applied and hence we have used Cohen’s test which very well detects the magnitude of change. Accordingly it was estimated that 27 patients are required and we decided to recruit 50 patients to have satisfactory results. to study the pattern of change in AFI on weekly basis from 34 weeks till delivery; to constitute reference ranges of AFI from 34 to 40 weeks of gestation; to find the time interval by which there is a significant fall in AFI, which will help obstetrician to plan an ideal protocol for antenatal ultrasound examination in the third trimester. Significant drop in AFI was noted at two-week intervals. Amniotic fluid index (AFI) is one of the major and deciding components of fetal biophysical profile and by itself it can predict pregnancy outcome. A. Abdelmoula, “Amniotic fluid index versus single deepest vertical pocket as a screening test for preventing adverse pregnancy outcome,”, J. P. Phelan, M. O. Ahn, C. V. Smith, S. E. Rutherford, and E. Anderson, “Amniotic fluid index measurements during pregnancy,”, M. H. Beall, J. P. H. M. van den Wijngaard, M. J. C. van Gemert, and M. G. Ross, “Amniotic fluid water dynamics,”, J. P. Phelan, C. V. Smith, P. Broussard, and M. Small, “Amniotic fluid volume assessment with the four-quadrant technique at 36–42 weeks' gestation,”, S. Iqbal and A. Noreen, “Low amniotic fluid index as a predictor of perinatal outcome in low risk pregnancies at term,”, E. G. Voxman, S. Tran, and D. A. There are definite guidelines for frequency of antenatal testing for high risk pregnant women, but what constitutes an ideal screening program for low risk pregnancies is still unknown . Though it is said that such an event is more common in high risk pregnancies, the fetuses belonging to low risk mothers are not totally immune . S/D ratio is 3.9..MCA/UMBLICAL ARTERY S/D RATIO 1 ... View answer. Typical values include: AFI between 5-25 cm is considered normal; median AFI level is ~14 cm from week 20 to week 35, after which the amniotic fluid volume begins to reduce This was a prospective observational study conducted at the Department of Obstetrics and Gynaecology, Kasturba Medical College, Manipal, from January 2012 to December 2012. 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. The values of all four quadrants were added to obtain the final amniotic fluid index (AFI). reported their findings from patients attending antenatal clinic of Grant Medical College, Bombay, and our findings too match with their data. Uterus was arbitrarily divided into four quadrants using linea nigra as a vertical line and a transverse line passing through umbilicus, as described by Phelan et al. The purpose of the present investigation is(1)to study the pattern of change in AFI on weekly basis from 34 weeks till delivery;(2)to constitute reference ranges of AFI from 34 to 40 weeks of gestation;(3)to find the time interval by which there is a significant fall in AFI, which will help obstetrician to plan an ideal protocol for antenatal ultrasound examination in the third trimester. The AFI values differed throughout the gestation and there was a gradual decline in the values as pregnancy advanced. Background. We have also graphically interpreted findings in the other studies (either mean or 50th percentile values) in Figure 3. At values less than 5, there is higher incidence of perinatal morbidity and mortality and many a time immediate delivery is the only way out [12, 13]. Using polynomial regression analysis, we have established reference standards for AFI ranges from 34 to 40 weeks (Figure 2). This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. are 2 to 3 cm more than all other series at all gestational ages; we presume this may be because the study was done in Indraprastha Apollo Hospital, New Delhi, where patients from very high socioeconomic status are catered. The ultrasound examination was carried out after instructing the patient to empty her bladder. AFI is the fifth parameter in traditional five-point biophysical profile and second parameter in rapid two-point modified BPP (the other one being NST) . Such observations indicate weakness of cross sectional cohort, as the same patients are not followed up sequentially. As mentioned in methodology, we have excluded those who delivered before term as we required AFI from 34 weeks to 40 weeks of gestation for analysis purpose. The examinations were performed with a convex 3.5 MHz probe (Philips HD11XE ultrasound equipment). Department of Obstetrics and Gynaecology, Kasturba Medical College, Manipal University, Manipal 576 104, India. 16 (32%) patients required caesarean delivery for obstetric indication such as failed induction, cephalopelvic disproportion, and fetal distress in labour. Sign up here as a reviewer to help fast-track new submissions. Fluctuations outside of this range define oligohydramnios (too little amniotic fluid) or polyhydramnios (too much amniotic fluid). This might be the reason for their finding of rapid fall of AFI from 34 to 35 weeks, plateauing between 37 and 39 weeks and once again slow fall at 40 weeks. Table 3 indicates Cohen’s values for week to week comparison and it can be seen that not much change was seen in immediate week, but changes became significant when the interval between two scans was more than 2 weeks or more in most of the comparisons. A. Baschat, R. M. Viscardi, B. Hussey-Gardner, N. Hashmi, and C. Harman, “Infant neurodevelopment following fetal growth restriction: Relationship with antepartum surveillance parameters,”, G. Heller, B. Misselwitz, and S. Schmidt, “Early neonatal mortality, asphyxia related deaths, and timing of low risk births in Hesse, Germany, 1990–8: observational study,”, F. A. Manning, “Antepartum fetal testing: a critical appraisal,”, E. A. Dubil, “Amniotic fluid as a vital sign for fetal wellbeing,”, A. F. Nabhan and Y. Amniotic fluid once thought to be a stagnant pool with approximate turn over time of twenty-four hours. These changes are graphically represented in Figure 1. Amniotic fluid index (AFI) is one of the major and deciding components of fetal biophysical profile and by itself it can predict pregnancy outcome. 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. from Iran. Effect size is a simple measure for quantifying the difference between two groups or the same group over time, on a common scale. When sample size is sufficiently large, even the fractional differences are likely to be reported as significant values, hence giving meaningless interpretations. A prospective estimation of AFI was done in 50 healthy pregnant women from 34 to 40 weeks at weekly intervals. An average AFI level is 80 mm to 140 mm when you are in your 20 weeks to 35 weeks of pregnancy.
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