Search

Objective: The purpose of this review is to examine the evidence that defines normal and abnormal amniotic fluid volumes (AFVs) and current recommendations on the management of abnormalities of AFV. Methods: The studies establishing normal actual AFVs and the ultrasound estimates used to identify normal and abnormal AFVs were evaluated. Recommendations from national and international organizations were reviewed for guidance on the definitions and management of abnormal AFVs. Results: A timeline of the development of the thresholds that define abnormal AFVs was created. Recommendations from 13 national and international guidelines were identified, but the definitions and management recommendations for abnormal AFVs varied considerably between groups. An algorithm for the management of oligohydramnios and polyhydramnios was developed. Knowledge gaps and the structure of future studies were examined. Conclusions: Assessment of AFV is performed multiple times per day in antenatal clinics and hospitals. Current recommendations on defining and managing abnormal AFVs differ between national and international organizations. We have proposed algorithms to assist in the management of abnormal AFVs until further studies can be undertaken. [ABSTRACT FROM AUTHOR]

purpose of this study is to determine if pregnancies with mild idiopathic polyhydramnios have an increased risk for an intrauterine fetal demise (IUFD). Methods: Medical records and amniotic fluid volume ultrasound data from 2016 to 2021 at a university medical center were examined. Pregnancies with fetal anomalies, fetal infection, isoimmunization, multiple gestation, maternal diabetes and oligohydramnios were excluded. Normal amniotic fluid volume was defined as an amniotic fluid index (AFI) < 24 cm which was compared to mild idiopathic polyhydramnios, AFI of ≥ 24.0 cm– 29.9 cm, and moderate/severe polyhydramnios which is an AFI ≥ 30 cm. Results: Of 12,725 patients meeting inclusion study criteria, there were 249 with idiopathic polyhydramnios (n = 249) which was associated with an increased odds of IUFD (aOR) of 3.27 (CI 1.50– 7.15), NICU admission (aOR 1.28, CI 0.96– 1.70), 5-minute APGAR score less than 7 (aOR 2.16, CI 1.52– 3.07), and large for gestational age infant (LGA) (aOR 4.04, CI 2.83– 5.78) compared to normal amniotic fluid volume (AFV). In the mild polyhydramnios group (n = 204, out of the 249 women with polyhydramnios) compared to the 12,476 pregnancies with normal AFV group, IUFD (aOR 3.38, CI 1.46– 7.82), NICU admission (aOR 1.19, CI 0.87– 1.64), 5-minute APGAR score less than 7 (aOR 1.68, CI 1.10– 2.55) and LGA (aOR 3.87, CI 2.59– 5.78). In moderate/severe polyhydramnios group (n = 45) compared to the normal AFV group, there was no increased odds of IUFD (aOR 2.78, CI 0.38– 20.29) or NICU admission (aOR 1.74, CI 0.93– 3.26) but an increased odds for a 5-minute APGAR score less than 7 (aOR 4.94, CI 2.57– 9.53) and LGA fetus (aOR 4.80, CI 2.26– 10.22). Conclusion: There is an increased odds of IUFD in pregnancies complicated by mild idiopathic polyhydramnios. Patients should be counseled on an increased odds of adverse pregnancy outcomes associated with idiopathic polyhydramnios, and in those pregnancies with mild idiopathic polyhydramnios, antenatal fetal surveillance should be considered. [ABSTRACT FROM AUTHOR]