A Systematic Review of Amniotic Fluid Assessments in Twin Pregnancies

Abstract

The objectives of this systematic review were to examine the reproducibility of sonographic estimates of amniotic fluid volume (AFV) in twin pregnancies, compare the association of sonographic estimates of AFV with dye-determined AFV, and correlate AFV with antepartum, intrapartum, and perinatal outcomes in twin pregnancies. Studies were included if they were adequately powered and investigated antepartum, intrapartum, and/or perinatal adverse outcome parameters in twin gestations. Studies with comparable populations and exclusion criteria were merged into forest plots. Data comparing the accuracy of AFV assessment, correlation of AFV with gestational age, and adverse outcomes were tabulated. Five of the 6 studies investigating AFV by the amniotic fluid index as a function of gestational age reported data fitting a quadratic equation, with fluid volumes peaking at mid gestation and then declining. This trend was less pronounced when AFV was assessed by the single deepest pocket (2 of 4 studies reporting a quadratic fit). Polyhydramnios was associated with prematurity in 2 of 4 studies (1 amniotic fluid index and 1 single deepest pocket), and oligohydramnios was associated with prematurity in 1 single deepest pocket study. Stillbirth was the only intrapartum outcome reported in more than 1 study. Perinatal outcomes associated with polyhydramnios included neonatal death (P < .05 in 1 of 2 studies), low Apgar scores (1 of 2 studies), neonatal intensive care unit admission (1 of 2 studies), and low birth weight (2 of 3 studies).

Esophageal atresia in twins compared to singletons: In utero manifestation and characteristics

“…Whether these signs develop less in twins or are less noticed, is beyond the scope of this study and should be assessed prospectively. As earlier mentioned, a difference in the assessment and perception of the amniotic fluid volume between singleton and multiple pregnancies 20,21 could potentially lead to underdiagnosis of polyhydramnios in this group.…”

“…Polyhydramnios is the most common indirect sign of EA, 3 making it an important indication to scan for EA/TEF. However, there are factors that might affect the perception and attitude towards polyhydramnios in multiple pregnancies 20,21 . First of all, the presence of two gestational sacs in one cavity could affect our subjective estimation and quantitive measurement of amniotic fluid volume 20 .…”

“…However, there are factors that might affect the perception and attitude towards polyhydramnios in multiple pregnancies 20,21 . First of all, the presence of two gestational sacs in one cavity could affect our subjective estimation and quantitive measurement of amniotic fluid volume 20 . Secondly, as the most common etiology for polyhydramnios in monochorionic pregnancy is twin to twin transfusion syndrome, 22 this might lead clinicians to overlook EA as a possible diagnosis.…”

Placenta Morphological and Amniotic Fluid Biochemical Changes Associated with Mid-Gestation Single and Twin Pregnancies in Red Sokoto Goats

“…More placental fluid is both required and secreted in twin pregnancy in order to provide the enabling environment for the developing fetuses (Hill et al 2000). The greater space created by the twin fetuses also helps to accommodate the fluid secreted (Ippolito et al 2014). (Fig.…”

Outcomes of oligohydramnios in term pregnancy ending in normal vaginal delivery or C section irrespective of induction

“…Because of this pattern, AFV can be clinically assessed by measuring fundal height and evaluating the baby using ultrasonography at any point throughout the pregnancy. 7,8 When there is a disparity between the fundal height measurement and the gestational age, it is important to consider amniotic fluid abnormalities as a possible cause. Inconsistencies necessitate an ultrasound examination of the amniotic fluid.…”