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Re: AFI in Twin pregnancyFrom: James Smeltzer (James.Smeltzer@wellstar.org)Mon Oct 10 17:55:38 2005
Hi AFI is not standardized for twins & has not been proven to be better than Max vertical pocket. I measure this for each sac. Single standards I use are < 2cm MVP oligohydramnios, <3 cm decreased fluid 3-8 cm normal, 8-10 Increased fluid, 10+ Hydramnios (or baby a peninsula of the uterus - surrounded on 3 sides by water. Clinical diagnosis of hydramnios is ballotable baby - that can be bounced from hand to hand (not sure this applies as well to twins). Clinical diagnosis of oligo is shrink-wrapped baby (& with twins this is a stuck twin & US clearly superior to manual). Others may agree with me: Amniotic fluid volume assessment in singleton and twin pregnancies. Magann EF, Martin JN Jr. Obstet Gynecol Clin North Am. 1999 Dec;26(4):579-93. Department of Obstetrics and Gynecology, University of Mississippi Medical Center, Jackson, USA. The best method of ultrasonic mensuration to identify abnormal AFV reliably in singletons and the individual sacs of diamniotic twins remains elusive. With respect to twins, localization of the dividing membrane seems to be necessary for AFV assessments of each amniotic cavity. The relationship of ultrasonic estimates, actual AFV, and pregnancy outcome remains undetermined. In the authors' opinion, the subjective assessment in twin gestation may be as accurate as semiquantitative ultrasonic estimates of AFV, similar to the situation in singleton pregnancies. The authors propose that further prospective research address the following questions: (1) What is the appropriate threshold for intervention when AFI decreases to lower ranges? (2) What other factors (e.g., cervical examination, fetal heart rate patterns, underlying obstetric conditions, fetal growth pattern) are important when the AFI falls to low values in making clinical decisions? Perhaps the best testimony to this is the fact that the authors of the standardizing article have not followed up with clear prognostic data of abnormal ones...: Normal values for amniotic fluid index during uncomplicated twin pregnancy. Porter TF, Dildy GA, Blanchard JR, Kochenour NK, Clark SL. Obstet Gynecol. 1996 May;87(5 Pt 1):699-702. Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, USA. OBJECTIVE: To establish the gestational age trends of amniotic fluid index (AFI) in uncomplicated twin pregnancies. METHODS: Amniotic fluid index was measured in uncomplicated twin pregnancies seen between 1985 and 1993 and meeting the following criteria: 1) no maternal medical or obstetric complications, 2) normal growth of both twins by serial ultrasound, and 3) normal amniotic fluid volume by ultrasound. Amniotic fluid index was measured by adding the deepest vertical pockets in four quadrants, defined by the umbilicus and linea nigra. The relation between gestational age and AFI was evaluated using linear regression analysis. RESULTS: Two hundred eighty-two sets of twins were considered uncomplicated; 1101 AFI measurements were performed on these pregnancies between 25.5 and 40.5 weeks' gestation. Percentile values for AFI were determined according to gestational age. The regression equation relating the median AFI to gestational age was: AFI = 19.4 - 0.12 x gestational age (P = .03). The R2 value was 0.04. CONCLUSION: Gestational age trends in normative AFI measurements for twin pregnancies have been established. Their use will facilitate a more reproducible, quantitative diagnosis of oligohydramnios in twins, compared with subjective, qualitative approaches to amniotic fluid volume assessment. Gateway search: "amniotic fluid index" OR AFI AND Twins[MESH] AND (Porter OR Dildy OR Blanchard OR Kochenour OR Clark) 1 MEDLINE/PubMed - journal citations, abstracts Hope this helps... ;^) Jim S
-- James S. Smeltzer, MD, FACOG, SMFM Consultant, Maternal Fetal Medicine Wellstar Physicians' Group Northwest Women's Care 787 Campbell Hill St Marietta GA 30060 James.Smeltzer@wellstar.org VM 678-290-3035 Off 770-528-0260 Page 404-318-3451
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