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Re: AFIFrom: Terry J. DuBose (tjdubose@chrp.uams.edu)Sat Jun 21 19:15:13 1997
At Thu, 19 Jun 1997, Randy Daniell, M.D. wrote: > >Interested in others reliability on AFI. With the guys I take call with >an AFI of 5 means certian induction, inducible cervix or not. I >personally don't think AFI is that reliable and that a prolonged NST can >tell you much more. I don't know what the incidence of oligo is but our >radiology dept. seems to find an inordinate number of decreased AFI. >What are others experience?-- >Randy Daniell, M.D. > Personally, I place a lot of confidence in the AFI. This is from a Sonographer’s perspective who has spent a lot of time studying maternal/fetal sonography... not a physician. The problem with using the 5 cm cut off is, the AFI will vary throughout pregnancy. Phelan, Ahn, Smith, et all published a table in the J Reproduct Med. 1987, 23:610-604 that is good. I have a graph adapted from that table in FETAL SONOGRAPHY, W. B. Saunders Co. 1996. If there has been no PROM or fluid loss, then low AFI needs to be explained. Most likely it is low urine output. Either UT anomalies, which should be detectable by sonography (agenesis, hydronephrosis, large bladder, etc.). The other is some perfusion problem to the kidneys which lowers urine output. This can be far removed from the urinary tract. One of the most common is IUGR due to placental insufficiency. If there is resistance to flow through the placenta, resulting in elevated Doppler resistive indexes in the Umb. arteries, then the sphincter in the ductus venosus can redistribute the blood to the head and heart and to the disadvantage of the trunk (head sparing IUGR). At least this is the current theory. Hopefully, if you have an earlier dating sonogram, then you can compare growth intervals, if there is reduced growth, and low AFI, then I would suggest you follow *the guys [you] take call with* advice. Just a Sonographer’s opinion, for what it’s worth.
-- Peace, Terry J. DuBose, M.S., RDMS; OBGYN.net Sonographer Correspondent Assistant Professor & Program Director, Diagnostic Medical Sonography University of Arkansas for Medical Sciences, Fellow, AIUM tjdubose@chrp.uams.edu http://www.uams.edu/chrp/dmshome.htm http://www.io.com/~dubose/ http://www.obgyn.net/CORRESP/DUBOSE.HTM VOICE: 501-686-6510 FAX: 501-686-5613 Now is the time for all good folks to come to the aid of the Earth.
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