SUPERIORITY OF AMNIOTIC-FLUID INDEX OVER AMNIOTIC-FLUID POCKET MEASUREMENT FOR PREDICTING BAD FETAL-OUTCOME

Semiquantitative amniotic fluid volume (AFV) determination is a compon ent of the fetal biophysical profile (BPP). To assess decreased AFV, w e did BPPs of 174 fetuses within 1 week of delivery. Two methods were used: measurement of the single largest vertical pocket (oligohydramni os = depth < 1 cm) and the four-quadrant amniotic fluid index (AFI) (o ligohydramnios = AFI less-than-or-equal-to 5 cm). AFV, as determined b y each method, was related to measures of fetal outcome (perinatal mor tality, fetal distress, Apgar score, meconium-stained amniotic fluid, and intrauterine growth retardation [IUGR]). The AFI was more sensitiv e in predicting mortality (87.5%) and the following measures of perina tal morbidity: low 5-minute Apgar score (88.8%), fetal distress during labor (86.6%), meconium-stained amniotic fluid (63.6%), and the prese nce of IUGR (79.4%). The sensitivity of amniotic fluid pocket measurem ent of < 1 cm was 75%, 72.2%, 66.6%, 47.7%, and 55.8%, respectively, f or the same measures. Using the AFI instead of a single pocket measure ment in BPP assessment increased the sensitivity and positive predicti ve value of the BPP from 64.7% to 76.4% and from 45.8% to 68.4%, respe ctively. Our data suggest that qualitative AFV measurement using the A FI is superior to that of the single largest pocket in multiple compon ent fetal biophysical testing.