I agree with James Smeltzer
>From: "James Smeltzer" <James.Smeltzer@wellstar.org>
>Reply-To: ultrasound@obgyn.net
>To: Multiple recipients of list ULTRASOUND <ultrasound@dns.obgyn.net>
>Subject: RE: Measuring AFI in a Diamniotic Twin pregnancy
>Date: Wed, 2 Feb 2005 09:51:55 -0600
>
>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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