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Re: Measuring AFI in a Diamniotic Twin pregnancyFrom: James Smeltzer (James.Smeltzer@wellstar.org)Wed Feb 2 08:50:59 2005
Hi, I do not think that anyone knows how to do a full AFI on twins but this is as reasonable as any approach for evaluation for amnioreduction therapy. The maximum vertical pocket of fluid in each sac is much older, easier to do, has validity in twin gestation and singletons. I report <1 cm as oligohydramnios, 1-2 as decreased fluid, 2-3 as low normal fluid, 3-7 cm as normal 7-8 cm as high normal, 8-10 cm as increased and peninsula baby (baby is surrounded by water on 3 sides on an ac cut) or 10+ cm as hydramnios. This correlates fairly well with clinical estimates by bimanual examination. Only oligohydramnios and hydramnios are correlated significantly with clinical outcome, so I am not sure why I do this. You would also do much better looking at the MCA angle-corrected VMAX (M1 segment) and MCA and umbilical RI (DRI Difference of RI) and IVC or Ductus venosus for signs of congestive failure. A recent article also emphasizes the ratio of the Abdominal circumferences: http://www.mdlinx.com/ObGynLinx/thearts.cfm?artid=1149456&specid=5&ok=yes Twin pregnancy with hydramnios of both also is at high risk for anomaly. If there is a perinatal center available this is where this patient should be both evaluated and treated if treatment is indicated. I hope this helps. Jim Smeltzer
>>> greg.kesby@sufw.com.au 1/31/2005 11:22:41 PM >>> AS A SUBSPECIALIST IN MATERNAL FETAL MEDICINE I PREFER A TOTAL FOUR QUADRANT AFI AND A DEEPEST POCKET IN EACH SAC. FROM THIS I CAN INFER THE REST. -----Original Message----- From: ultrasound@obgyn.net [mailto:ultrasound@obgyn.net]On Behalf Of Raul Limos Sent: Tuesday, 1 February 2005 3:10 PM To: Multiple recipients of list ULTRASOUND Subject: Measuring AFI in a Diamniotic Twin pregnancy What method to use when you have two amniotic sacs and you want to know if they have polyhydramnios or not? Had a recent case of a diamniotic twin pregnancy (28 weeks and 31 weeks AOG) which on eyeballing alone both sacs appeared to have polyhydramnios. OB-GYN doctor was insisting to measure each individual amniotic sac. There appears to be twin-to-twin transfusion syndrome and/or hydrops fetalis in this pregnancy. Thank you.
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