DECREASED AMNIOTIC-FLUID VOLUME AT LESS-THAN 32 WEEKS OF GESTATION ISASSOCIATED WITH DECREASED FETAL MOVEMENTS

The objective of this study was to assess the relationship between amn iotic fluid volume (AFV) and fetal movements at < 32 weeks gestation a s assessed by routine biophysical profile (BPP). From a database of 46 5 consecutive nonhypertensive, nondiabetic patients delivering at < 32 weeks gestation, patients with singleton, nonanomalous fetuses with A FV and fetal movements determined as part of a BPP assessment within 2 4 hours of delivery were studied. Amniotic fluid volume was scored 0 t o 2, according to the following criteria:largest pocket in vertical di ameter < 1 cm = 0; < 2 but > 1 cm = 1; greater than or equal to 2 cm = 2. Fetal movements (FM) were scored over 30 minutes: O if absent, 1 i f 1 to 2 movements, 2 if greater than or equal to 3 gross (limb/trunk) movements. Variables assessed included fetal presentation, gestationa l age (GA), premature rupture of membranes (FROM) as a principal indic ation for delivery, clinical chorioamnionitis (diagnosed by previously published criteria), histologic parameters of infection (in amnion an d umbilical cord assessed by a single pathologist blinded to clinical data), and neonatal outcome. Statistical analyses included contingency tables and analysis of variance with p < 0.05 considered significant. Three hundred and fifty-two patients met the inclusion criteria. One hundred and sixty-seven patients (47%) had FROM as a primary indicatio n for delivery. Infrequently, decreased fetal well-being manifested by a BPP < 7 of 10 points was an indication for delivery despite prematu rity (n = 7). Of the 352 patients, 80 (23%) had AFV = 0, 60 (17%) had AFV = 1, and 212 (60%) had AFV = 2; and 12 (3%) had FM = 0, 30 (9%) FM = 1, and 310 (88%) FM = 2. There was a significant correlation betwee n decreased AFV and decreased fetal movements (p < 0.0001). Fetal pres entation and GA were not significantly different between patients base d on score of fetal movements. The incidence of clinical chorioamnioni tis was significantly greater in patients with FM = 0 (p < 0.005). We conclude that decreased AFV is associated with decreased fetal movemen ts irrespective of fetal presentation or gestational age. Neonatal out come (umbilical vasculitis, sepsis, intraventricular hemorrhage) is af fected only in unusual cases in which otherwise uncompromised (nonhypo xic, nonacidotic) fetuses have low scores on both these antepartum ult rasonographic parameters.