ULTRASOUND Messages for September, 1999: Re: AFI

Re: AFI

From: James S Smeltzer MD

gaperina@mindspring.com

Thu Sep 16 15:42:43 1999

What does this article say about clinical outcome? According to the following article, the study you mention is unethical, IMHO:

TITLE: Uterine artery blood flow response to correction of amniotic fluid volume. AUTHORS:Bower SJ; Flack NJ; Sepulveda W; Talbert DG; Fisk NM AUTHOR AFFILIATION: Centre for Fetal Care, Royal Postgraduate Medical School, London, United Kingdom. SOURCE: Am J Obstet Gynecol 1995 Aug;173(2):502-7 CITATION IDS: PMID: 7645627 UI: 95373576 ABSTRACT: OBJECTIVE: Our purpose was to investigate whether acute alterations of amniotic fluid volume affect uteroplacental perfusion. STUDY DESIGN: Three groups of patients of comparable gestational age were studied in a fetal medicine referral unit: (1) eight pregnancies with severe polyhydramnios because of twin-twin transfusion syndrome undergoing therapeutic amnioreduction, (2) seven with severe oligohydramnios undergoing diagnostic amnioinfusion, and (3) six control women having invasive procedures of similar duration without manipulation of amniotic fluid volume. Color Doppler imaging was used to measure uterine artery impedance index values and quantitative blood flow before and within 15 minutes of the end of the procedure. RESULTS: Quantitative flow measurements increased after amnioreduction (74% median increase of volume flow, range 22% to 329%, p < 0.01) and decreased after amnioinfusion (33% median decrease of volume flow, range 17% to 51%, p < 0.05). Impedance index values increased after amnioinfusion (25% median increase in pulsatility index, range 4% to 71%, p < 0.05) and did not alter with amnioreduction. There were no significant changes in the control group. CONCLUSION: Acute changes in amniotic fluid volume alter uteroplacental perfusion. In twin-twin transfusion syndrome amelioration in uterine flow may improve fetal condition and explain in part the success of serial amnioreduction therapy.

:) Jim Smeltzer, MD

At 02:01 PM 9/11/1999 -0500, you wrote: >Dr. Smeltzer, I am not sure I agree with your statement that: "The
>largest single pocket predates the AFI by decade(s), was never shown to
>be inferior to it...."
>
>The following reference was very convincing to me that the AFI is
>superior to the single largest pocket measurement.
>
>"Sepulveda, Flack, & Fisk, using an infusion method in severe
>oligohydramnios and anhydramnios pregnancies, found that the AFI
>(4-quadrant sum) was more accurate than the single pocket method."
>
>Their methods seem to be a unique and elegant approach to this question.
>
>Peace, Terry J. DuBose, M.S., RDMS
>Little Rock, Arkansas USA
>
>------------------------
>
>------------------------
>At Wed, 08 Sep 1999, James S Smeltzer MD wrote:
>------------------------
>>
>>Dear Joe,
>>
>>The largest single pocket predates the AFI by decade(s), was never shown to
>>be inferior to it, was shown to agree with expert subjective (?!)
>>assessment & with AFI. We grasp at pseudoquantitative measures to provide
>>a level of truth that lacks, IMHO. There are several older studies that
>>indicate that AF not relevant until truly oligo (<1cm). There is a recent
>>study indicating that Doppler is better predictor than AF in IUGR & that AF
>>measure better than the rest of the BPP for the same purpose.
>>
>>My recommendation is to provide referring physicians with information that
>>they can unambiguously use for patient management. For this one it would
>>be AFI - which does encourage a systematic search for fluid. I provide a
>>bottom line clinical impression in all abnormalities of fluid or other
>>measures of fetal status & their clinical significance in the setting of
>>the patient's problems & indications (& in normal ones in which measures
>>are relevant). This is the "interpretation", which constitutes the medical
>>practice part of sonology, IMHO.
>>
>>Jim S
>>
>>At 12:37 AM 9/4/1999 -0500, you wrote:
>>> Is amniotic fluid index an outdated technique? Referring some articles
>>>on medline- largest single pocket has replaced AFI- is that true? One
>>>referring doc insisted on AFI-- I have no literature describing the
>>>method. Do you take the total of all four quadrants in cms? or is the
>>>average of largest pockets taken-- ie: divided by 4? Please describe
>>>exactly how to estimate AFI. Regards, DR.JOE ANTONY
>
>--
>Peace, Terry J. DuBose, M.S., RDMS, FAIUM
>University of Arkansas for Medical Sciences, USA
>Director, Diagnostic Sonography Program
>http://www.uams.edu/chrp/dmshome.htm
>VOICE: 501-686-6510 FAX: 501-686-6513
>Chair, http://www.obgyn.net/us/us.htm
>http://www.io.com/~dubose/
>Now is the time for all good folks to come to the aid of the Earth.
>

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