From: Reducing stillbirths: screening and monitoring during pregnancy and labour
Source | Location and Type of Study | Intervention | Stillbirths/Perinatal Outcomes |
---|---|---|---|
Reviews and meta-analyses | |||
Hofmeyr et al. 2002 [126] | Japan, USA. Review (Cochrane). 2 studies included (N = 78 women). | Assessed the impact of improved maternal hydration (drinking 2 litres water or intravenous fluids) on amniotic fluid volume and subsequent perinatal outcomes in women with oligohydramnios and normal amniotic fluid volume. | Increased amniotic fluid volume after hydration (women with oligohydramnios): weighted mean difference (WMD) = 2.01 (95% CI: 1.43–2.60) Increased amniotic fluid volume after hydration (women with normal amniotic fluid volume): WMD = 4.5 (95% CI: 2.92–6.08) IV hypotonic hydration (women with olighydramnios): increased amniotic fluid volume=WMD 2.3 (95% CI: 1.36–3.24) Isotonic intravenous hydration: [NS] |
Nabhan et al. 2008 [121] | UK, USA. Review (Cochrane). 4 RCTs included (N = 3125 women). | Compared the predictive value of AFI (intervention) versus single-deepest vertical pocket (comparison) methods of amniotic fluid volume assessment in anticipating adverse perinatal outcomes. | Fetal acidaemia: [NS] Presence of meconium: [NS] Apgar < 7 at 5 min: [NS] Caesarean section: [NS] Diagnosis of oligohydramnios: RR[Random] = 2.33 (95% CI: 1.67–3.24) Induction of labour: RR[Fixed] = 2.10 (95% CI: 1.60–2.76) Caesarean for fetal distress: RR[Fixed] = 1.45 (95% CI: 1.07–1.97) |
Intervention studies | |||
Alfirevic et al. 1997 [123] | UK. Liverpool Women's Hospital. RCT. Singleton, uncomplicated pregnancies (N = 500) with gestational age ≥ 290 days. | Compared the impact of fetal monitoring by either AFI and computerised cardiotocography (intervention), or maximum pool depth and computerised cardiotocography (controls). | PMR: 0/250 in both groups [NS] |
Chauhan et al. 1995 [125] | USA. RCT. Pregnant women 26–42 wks' gestation in early labour. | Compared impact on perinatal outcomes of AFI on admission during early labour (intervention) vs. no AFI (controls). | Caesarean section for fetal distress: RR = 1.3 (95% CI: 1.1–1.7, P = 0.02). [29/447 vs. 14/436 in intervention vs. control groups, respectively.] LBW, macrosomia, Apgar <7, and admissions to the neonatal intensive care unit: [NS]. |
Oral et al. 1999 [124] | Turkey. RCT. Singleton, uncomplicated pregnancies (N = 101) of gestational age ≥ 290 days. | Compared the impact of either AFI and computerised cardiotocography (intervention) vs. maximal vertical pocket and computerised cardiotocography (controls). Electronic fetal heart monitoring was performed in all patients. | PMR: Maximal amniotic fluid vertical pocket appeared to be slightly better than AFI for identifying the post-term pregnancy at risk for abnormal perinatal outcome. |
Observational studies | |||
Anandakumar et al. 1993 [115] | Singapore. National University Hospital. Prospective cohort study. High-risk pregnant women (N = 565). | To evaluate the role of the AFI, used along with NST and fetal acoustic stimulation test, when required, in prediction of adverse pregnancy outcome. | PMR: 6/25, 4 in very low AFI (<5 cm) group (3/4 had reactive NST <7 days before death, P < 0.001 after controlling for NST results). |
Baron et al. 1995 [117] | USA. Prospective cohort study. Pregnant women > 26 wks gestation who had an intrapartum AFI measurement. | Compared rates of adverse fetal and neonatal outcomes in women diagnosed with oligohydramnios via AFI (cases) vs. women with normal AFI (controls). | Meconium staining: RR = 0.67 (95% CI: 0.49–0.92) in cases vs. controls, respectively. Variable decelerations: RR = 1.44 (95% CI: 1.12–1.87) in cases vs. controls, respectively. C-section for fetal distress: RR = 6.83 (95% CI: 1.55–30.4). cases vs. controls, respectively. Neonatal complications: No difference between groups. Sensitivity and specificity of oligohydramnios diagnosis for Caesarean delivery for fetal distress: 78% and 74%, respectively. |
Kreiser et al. 2001 [180] | USA. Retrospective study. Low-risk singleton pregnancies (N = 150) > 30 wks' gestation with decreased AFI. Pregnancies (N = 57) with very low AFI (≤ 5 cm); N = 93 with borderline AFI (>5 cm but < 2.5th percentile). | Compared the impact in pregnancies with low AFI (intervention) vs. those with borderline AFI (controls). | PMR: 0 in both groups [NS] |
Locatelli et al. 2004 [116] | Italy. Prospective study. Uncomplicated, singleton pregnant women (N = 3050) with a non-anomalous fetus reaching 40 wks' gestation recruited from 1997–2000. All women underwent semi-weekly monitoring of AFI until delivery. Oligohydramnios (N = 341). | Compared the rate of oligohydramnios in gestations with adverse perinatal outcome, including 5-min Apgar score < 7; umbilical artery pH < 7.0; Caesarean section for fetal distress; or fetal death (cases) vs. favorable outcome (controls). | Oligohydramnios: 33/167 (19.8%) vs. 308/2883 (10.7%) in cases and controls, respectively; P = 0.001). |
Morris et al. 2003 [120] | UK. University teaching hospital. Prospective, double-blind cohort study. Pregnant women (N = 1584) ≥40 wks of gestation were subjected to ultrasound assessment. | To compare predictive ability single ultrasound scan to detect a single deepest pool of AFI<2 cm (exposed) vs. AFI<5 cm (unexposed) in anticipating subsequent adverse pregnancy outcome. | PMR: 0 in both groups. An AFI <5 cm but not a single deepest pool <2 cm was significantly associated with birth asphyxia or meconium aspiration. Sensitivity of AFI < 5 cm for major adverse outcome: 28.6% |
Myles et al. 1992 [118] | USA. Prospective cohort study. N = 218 pregnant women on whom AFI was performed (N = 125 with greater volume in upper quadrants; N = 93 with greater volume in lower quadrants). | Assessed the predictive value of distribution of amniotic fluid measured by the 4-quadrant method, comparing perinatal outcomes among women with greater amniotic fluid volume in upper quadrants (intervention) vs. lower quadrants (comparison). | Meconium staining: 32.8% vs. 9.7% in intervention vs. comparison groups, respectively (P < 0.0001). 1-min Apgar <7: 12.0% vs. 2.2% in intervention vs. comparison groups, respectively (P < 0.007). Umbilical arterial pH<7.20: 29.6% vs. 8.9% in intervention vs. comparison groups, respectively (P < 0.0105). Umbilical venous pH <7.20: 8.9 vs. 0% in intervention vs. comparison groups, respectively (P < 0.0398). |
Sherer et al. 1996 [181] | USA. Retrospective database study. N = 352 nonhypertensive, nondiabetic pregnant women delivering at < 32 wks' gestation with amniotic fluid measurement performed as part of BPP <24 hours before delivery. | Assessed association of low AFI with fetal movements. | Low AFI associated with reduced fetal movements (P < 0.0001). Higher incidence of chorioamnionitis in patients with no fetal movements (P < 0.005) |
Youssef et al. 1993 [119] | Egypt. Observational study. Fetuses (N = 174) within one wk of delivery. | Compared the impact of the single largest vertical pocket (oligohydramnios = depth < 1 cm) (study group) vs. the 4-quadrant amniotic fluid index (oligohydramnios ≤5 cm) (controls). | The AFI was more sensitive in predicting mortality (87.5%) and the following measures of perinatal morbidity: low 5-minute Apgar score (88.8%), fetal distress during labour (86.6%), meconium-stained amniotic fluid (63.6%), and the presence of fetal growth restriction (79.4%). |