Amniotic Fluid Index as a Predictor of Latency After Preterm Premature Rupture of the Membranes

MacMillan, William; Mann, Sanjeet; Shmoys, S.; Saltzman, Daniel H.

doi:10.1055/s-2007-994584

Cited by 14 publications

(8 citation statements)

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“…Similarly, the latency period was lon ger in patients than in controls, suggesting that prophylac tic amnioinfusion may be an interesting, relatively easy and safe procedure, useful in expert hands for the clinical management of pregnancies complicated by preterm pre mature rupture of membranes. These results are in agree ment with previous reports [15,16] suggesting that the degree of oligohydramnios is positively correlated with unfavorable pregnancy outcome in pregnancies compli cated by preterm premature rupture of membranes. Prob ably, in our series, prophylactic amnioinfusion length ened the latency period by increasing the amniotic fluid volume.…”

Section: Discussionsupporting

confidence: 93%

“…Partic ular attention has been paid to the positive effects of amnioinfusion in reducing the frequency and severity of variable decelerations in fetal heart rate during labor as a consequence of increased amniotic fluid volume [6,8,9], Amniotic fluid probably cushions the umbilical cord from compression and therefore reduces the occurrence of vari able decelerations and the rate of cesarean delivery. On the contrary, little information is available on the role of prophylactic amnioinfusion during the latency period, although the residual amniotic fluid volume conditions an increased risk of shortened latency period, endometritis, and nonreactive nonstress test [13][14][15], and the amnioin fusion effect in increasing intrauterine volume is clear.…”

Section: Discussionmentioning

confidence: 99%

“…In particular, no neonatal deaths were observed Amnioinfusion and PROM in patients, while in controls there were two neonatal deaths (11.1 %) because of respiratory distress syndrome. In a retrospective observational study on 51 patients with preterm premature rupture of membranes after 25 weeks, MacMillan et al [15] showed that the residual amniotic fluid volume, as measured by the amniotic fluid index, is predictive of latency. The patients undergoing amnioinfu sion showed an increase in amniotic fluid volume, with a corresponding lower incidence of fetal distress in labor and a significantly decreased mortality rate.…”

Section: Discussionmentioning

confidence: 99%

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Prophylactic Transabdominal Amnioinfusion in Oligohydramnios for Preterm Premature Rupture of Membranes: Increase of Amniotic Fluid Index during Latency Period

Garzetti

Ciavattini

Cristofaro

et al. 1997

Gynecol Obstet Invest

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Objective: This study was designed to: (i) evaluate the effect of amnioinfusion on the latency period in patients with oligohydramnios for preterm premature rupture of membranes, and (ii) to investigate the relationship between changes in the amniotic fluid index and fetal heart rate short-term variability by computerized Hewlett-Packard cardiotocography, longitudinally estimated before and after prophylactic amnioinfusion. Materials and Methods: All singleton pregnancies with prolonged premature rupture of membranes after 25 weeks of gestation and seen at the Institute of Obstetrics and Gynecology, University of Ancona (Italy), between January 1994 and June 1995 were included in the study. Transabdominal amnioinfusion with 150–350 ml warmed normal saline (25–50 ml/min) was performed at weekly intervals. Amniotic fluid volume was assessed ultrasonographically by means of the four-quadrant technique on a weekly basis before and after each amnioinfusion, as well as the short-term variability by a Hewlett-Packard computerized cardiotocographic system. Results: 18 women were enrolled and underwent prophylactic transabdominal amnioinfusion at weekly intervals until delivery. Eighteen controls, who did not undergo prophylactic amnioinfusion, were recruited from our 1992-1993 series and included in the study. The median interval between premature rupture of membranes and delivery was 3.0 weeks (range 1–8 weeks), with an average delivery age of 33.0 weeks (range 27–36 weeks). The latency period was significantly longer in patients who underwent prophylactic amnioinfusion (mean ± SD, 4.1 ± 1.7 weeks) than in controls (1.7 ± 1.0 weeks; p < 0.001). An increase in both the weekly amniotic fluid index (linear regression analysis r = 0.8, p = 0.03) and the weekly short-term variability (linear regression analysis r = 0.82, p = 0.02) was observed among patients who underwent prophylactic amnioinfusion. A direct relationship was observed between the amniotic fluid index and short-term variability (linear regression analysis r = 0.54, p = 0.04). The mean values of fetal movements recorded by computerized tomography during the 20 min of observation significantly increased after amnioinfusion in comparison with those before it (2.6 ± 0.9 and 0.9 ± 0.7 respectively; p = 0.001). Conclusion: The present study has shown a positive effect of prophylactic transabdominal amnioinfusion on the latency period in patients with preterm premature rupture of membranes and oligohydramnios. Among the patients who underwent amnioinfusion, an interesting improvement in fetal heart rate short-term variability was associated with the progressive increase in amniotic fluid volume, as an expression of fetal well-being.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Prophylactic Transabdominal Amnioinfusion in Oligohydramnios for Preterm Premature Rupture of Membranes: Increase of Amniotic Fluid Index during Latency Period

Garzetti

Ciavattini

Cristofaro

et al. 1997

Gynecol Obstet Invest

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“…The clinical significance of a reduced volume of amniotic fluid (AF) in this specific setting is unknown. Such a finding has prognostic significance in patients with preterm premature rupture of membranes (PROM) [1, 11, 20, 25, 30, 36, 46, 50-51]. The objective of the study was to determine the frequency and clinical significance of oligohydramnios in patients with preterm labor and intact membranes.…”

Section: Introductionmentioning

confidence: 99%

Clinical significance of oligohydramnios in patients with preterm labor and intact membranes*,**

Kim¹,

Romero

Lee³

et al. 2011

Journal of Perinatal Medicine

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OBJECTIVE To determine the frequency and clinical significance of oligohydramnios in patients with preterm labor and intact membranes. STUDY DESIGN An amniotic fluid index (AFI) was determined before amniocentesis (<24hrs) in 272 patients with preterm labor and intact membranes (<35 weeks of gestation). Amniotic fluid (AF) was cultured for aerobic and anaerobic bacteria and genital mycoplasmas, and assayed for matrix metalloproteinase-8 (MMP-8). Nonparametric statistical techniques and survival analysis were used. RESULTS 1) The overall prevalence of oligohydramnios (AFI of ≤5cm) in patients with preterm labor and intact membranes was 2.6% (7/272); 2) patients with oligohydramnios had a higher frequency of AF infection and/or inflammation than those without oligohydramnios (85.7% [6/7] vs. 32.8% [87/265]; p<.01); 3) Patients with oligohydramnios had a higher median AF MMP-8 concentration than those without oligohydramnios (median 664.2 [range 16.6 – 3424.7] ng/ml vs. median 2.3 [range <0.3 – 6142.6] ng/ml; p<.01); 4) women with preterm labor and oligohydramnios had a shorter interval to delivery than those without oligohydramnios (median 18 hrs [range 0-74 hrs] vs. median 311 hrs [range 0-3228 hrs]; p<.01), and this difference remained significant after adjusting for gestational age and the presence or absence of AF infection/inflammation CONCLUSION Patients with preterm labor and oligohydramnios are at increased risk for impending preterm delivery and intra-amniotic inflammation and, therefore, may benefit from careful surveillance.

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“…We estimate that 30-37% of ROM will have an AFI !8 cm. The low end of the range was author's assumption while the high end of the range was derived from MacMillan et al 33 The cost of the diagnostic tests used in each decision branch was included. All costs are in 2013 US dollars.…”

Section: Methodsmentioning

confidence: 99%

Placental alpha-microglobulin-1 and combined traditional diagnostic test: a cost-benefit analysis

Echebiri

McDoom

Pullen

et al. 2015

American Journal of Obstetrics and Gynecology

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Amniotic Fluid Index as a Predictor of Latency After Preterm Premature Rupture of the Membranes

Cited by 14 publications

References 4 publications

Prophylactic Transabdominal Amnioinfusion in Oligohydramnios for Preterm Premature Rupture of Membranes: Increase of Amniotic Fluid Index during Latency Period

Prophylactic Transabdominal Amnioinfusion in Oligohydramnios for Preterm Premature Rupture of Membranes: Increase of Amniotic Fluid Index during Latency Period

Clinical significance of oligohydramnios in patients with preterm labor and intact membranes*,**

Placental alpha-microglobulin-1 and combined traditional diagnostic test: a cost-benefit analysis

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