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Journal of Family & Reproductive Health Dec 2023The outcomes and management of low amniotic fluid index (AFI) in pregnancy are controversial. The purpose of this study was to determine the relationship between low AFI...
OBJECTIVE
The outcomes and management of low amniotic fluid index (AFI) in pregnancy are controversial. The purpose of this study was to determine the relationship between low AFI and perinatal outcomes.
MATERIALS AND METHODS
This prospective study was conducted on 420 uncomplicated singleton pregnant women with a gestational age of over 28 weeks who referred to Al-Zahra Hospital in Rasht (Iran) for routine perinatal care. Pregnant women were divided into 3 groups of 140 patients based on the AFI and were followed up until delivery. Three groups included normal (8
oligohydramnios (AFI≤5cm) AFI. RESULTS
The three adverse outcomes of respiratory distress, hospitalization in NICU, and length of hospitalization were statistically significantly different between the two groups with normal and borderline AFI and in the borderline group was more than the normal group. Adverse outcomes including; low birth weight (LBW), small for gestational age (SGA), respiratory distress, 1- min APGAR scores<7, hospitalization in NICU and its duration were statistically significantly different between the two groups with normal AFI and oligohydramnios, and it was more in the oligohydramnios group than the normal group. The three adverse outcomes of LBW, SGA and1- min APGAR scores<7 in the two borderline and oligohydramnios groups had statistically significant differences and were more in the oligohydramnios group than the borderline group.
CONCLUSION
Consideration to the AFI in perinatal care to predict adverse perinatal outcomes and perform necessary interventions to improve these outcomes is necessary.
PubMed: 38807617
DOI: 10.18502/jfrh.v17i4.14591 -
Radiographics : a Review Publication of... Jun 2023Amniotic fluid (AF) is an integral part of the fetal environment and is essential for fetal growth and development. Pathways of AF recirculation include the fetal lungs,...
Amniotic fluid (AF) is an integral part of the fetal environment and is essential for fetal growth and development. Pathways of AF recirculation include the fetal lungs, swallowing, absorption through the fetal gastrointestinal tract, excretion through fetal urine production, and movement. In addition to being a marker for fetal health, adequate AF is necessary for fetal lung development, growth, and movement. The role of diagnostic imaging is to provide a detailed fetal survey, placental evaluation, and clinical correlation with maternal conditions to help identify causes of AF abnormalities and thereby enable specific therapy. Oligohydramnios prompts evaluation for fetal growth restriction as well as genitourinary issues, including renal agenesis, multicystic dysplastic kidneys, ureteropelvic junction obstruction, and bladder outlet obstruction. Premature preterm rupture of membranes should also be clinically excluded as a cause of oligohydramnios. Clinical trials evaluating amnioinfusion are underway as a potential intervention for renal causes of oligohydramnios. Most cases of polyhydramnios are idiopathic, with maternal diabetes being a common cause. Polyhydramnios prompts evaluation for fetal gastrointestinal obstruction and oropharyngeal or thoracic masses, as well as neurologic or musculoskeletal anomalies. Amnioreduction is performed only for maternal indications such as symptomatic polyhydramnios causing maternal respiratory distress. Polyhydramnios with fetal growth restriction is paradoxical and can occur with maternal diabetes and hypertension. When these maternal conditions are absent, this raises concern for aneuploidy. The authors describe the pathways of AF production and circulation, US and MRI assessment of AF, disease-specific disruption of AF pathways, and an algorithmic approach to AF abnormalities. RSNA, 2023 Quiz questions for this article are available through the Online Learning Center.
Topics: Infant, Newborn; Female; Pregnancy; Humans; Amniotic Fluid; Oligohydramnios; Polyhydramnios; Fetal Growth Retardation; Placenta; Diabetes Mellitus
PubMed: 37200220
DOI: 10.1148/rg.220146 -
The Journal of Maternal-fetal &... Dec 2023The aim of this review is to evaluate the relationship between the use of non-steroidal anti-inflammatory drugs (NSAIDs) during last trimesters of the pregnancy and the... (Review)
Review
OBJECTIVE
The aim of this review is to evaluate the relationship between the use of non-steroidal anti-inflammatory drugs (NSAIDs) during last trimesters of the pregnancy and the reduction of amniotic fluid.
METHODS
Electronic databases were searched (PubMed, Medline, and Scopus). Selection criteria included studies reporting the relationship between oligohydramnios and use of NSAID during pregnancy. We analyzed the median age of women, weeks of pregnancy at the beginning of the drug administration, kind of medication, period of exposure and dosage, deepest vertical pocket (DVP), and amniotic fluid index (AFI).
RESULTS
Of the 68 records identified, we analyzed 29 studies investigating the administration of NSAIDs, including 11 studies examined the administration of the Indomethacin, four articles have focused on the use of Nimesulide, and only two manuscripts considered the use of Diclofenac. We found a strict correlation between the development of oligohydramnios and the use of NSAIDs. The oligohydramnios is reversible, and the normal amount of amniotic fluid is restored after the interruption of the treatment.
CONCLUSIONS
The use of NSAIDs should be considered when maternal benefits outweigh the potential fetal risk, at the lowest effective dose for shortest duration. Beyond 48 h of NSAIDs treatment, we consider ultrasound monitoring of amniotic fluid, and we suggest stopping therapy if a decline AFI is present.
Topics: Pregnancy; Female; Humans; Oligohydramnios; Amniotic Fluid; Anti-Inflammatory Agents, Non-Steroidal; Pregnancy Trimester, Third; Ultrasonography; Pregnancy Outcome
PubMed: 38092425
DOI: 10.1080/14767058.2023.2253956 -
Clinics in Perinatology Dec 2020Full-term deliveries are defined as occurring between 39 weeks and 40 weeks and 6 days. Because contemporary research suggests improved outcomes with delivery in the... (Review)
Review
Full-term deliveries are defined as occurring between 39 weeks and 40 weeks and 6 days. Because contemporary research suggests improved outcomes with delivery in the term period compared with the early term period, nonindicated delivery should be pursued no earlier than 39 weeks. There are, however, multiple medical, obstetric, and fetal indications for delivery before 39 weeks, and the obstetric provider must weigh the risks and benefits of delivery versus expectant management on both the mother and fetus. This review serves to provide a basic framework of evidentiary support toward optimizing the term delivery.
Topics: Abruptio Placentae; Cesarean Section; Cholestasis, Intrahepatic; Congenital Abnormalities; Delivery, Obstetric; Diabetes, Gestational; Female; Fetal Growth Retardation; Humans; Hypertension; Hypertension, Pregnancy-Induced; Labor, Induced; Obesity, Maternal; Oligohydramnios; Pregnancy; Pregnancy Complications; Pregnancy Complications, Cardiovascular; Pregnancy in Diabetics; Pregnancy, Twin; Severity of Illness Index; Stillbirth; Term Birth; Time Factors
PubMed: 33153663
DOI: 10.1016/j.clp.2020.08.010 -
International Journal of Women's Health 2023Amniotic fluid volumes are tightly regulated, and amniotic fluid derangement can indicate maternal complications or fetal abnormalities. Ultrasound estimate of amniotic... (Review)
Review
Amniotic fluid volumes are tightly regulated, and amniotic fluid derangement can indicate maternal complications or fetal abnormalities. Ultrasound estimate of amniotic fluid provides a tool to evaluate the maternal-fetal-placental interface in real-time. Oligohydramnios and polyhydramnios are associated with adverse maternal and neonatal outcomes. Oligohydramnios is associated with adverse maternal and neonatal outcomes including cesarean delivery, operative vaginal delivery, induction of labor, postpartum hemorrhage, small for gestational age neonate, intrauterine demise, neonatal death, NICU admission, and APGAR less than 7 at. 5 minutes of life Polyhydramnios is associated with adverse outcomes including cesarean delivery, induction of labor, placental abruption, shoulder dystocia, cord prolapse, postpartum hemorrhage, intrauterine fetal demise, NICU admission, neonatal death, APGAR less than 7 at 5 minutes of life, large for gestational age neonate, and respiratory distress syndrome. Therefore, Amniotic fluid should be evaluated when maternal or fetal well-being is in question.
PubMed: 36756186
DOI: 10.2147/IJWH.S378020 -
Clinics in Perinatology Mar 2024Preterm infants with bronchopulmonary dysplasia (BPD) are prone to develop pulmonary hypertension (PH). Strong laboratory and clinical data suggest that antenatal... (Review)
Review
Preterm infants with bronchopulmonary dysplasia (BPD) are prone to develop pulmonary hypertension (PH). Strong laboratory and clinical data suggest that antenatal factors, such as preeclampsia, chorioamnionitis, oligohydramnios, and placental dysfunction leading to fetal growth restriction, increase susceptibility for BPD-PH after premature birth. Echocardiogram metrics and serial assessments of NT-proBNP provide useful tools to diagnose and monitor clinical course during the management of BPD-PH, as well as monitoring for such complicating conditions as left ventricular diastolic dysfunction, shunt lesions, and pulmonary vein stenosis. Therapeutic strategies should include careful assessment and management of underlying airways and lung disease, cardiac performance, and systemic hemodynamics, prior to initiation of PH-targeted drug therapies.
Topics: Infant; Infant, Newborn; Female; Humans; Pregnancy; Bronchopulmonary Dysplasia; Hypertension, Pulmonary; Infant, Premature; Placenta; Premature Birth
PubMed: 38325941
DOI: 10.1016/j.clp.2023.12.002 -
International Journal of Environmental... Sep 2022Sildenafil, a phosphodiesterase 5 inhibitor with a vasodilatory and anti-remodeling effect, has been investigated concerning various conditions during pregnancy. Per... (Review)
Review
Sildenafil, a phosphodiesterase 5 inhibitor with a vasodilatory and anti-remodeling effect, has been investigated concerning various conditions during pregnancy. Per indication, we herein review the rationale and the most relevant experimental and clinical studies, including systematic reviews and meta-analyses, when available. Indications for using sildenafil during the second and third trimester of pregnancy include maternal pulmonary hypertension, preeclampsia, preterm labor, fetal growth restriction, oligohydramnios, fetal distress, and congenital diaphragmatic hernia. For most indications, the rationale for administering prenatal sildenafil is based on limited, equivocal data from in vitro studies and rodent disease models. Clinical studies report mild maternal side effects and suggest good fetal tolerance and safety depending on the underlying pathology.
Topics: Female; Fetal Growth Retardation; Hernias, Diaphragmatic, Congenital; Humans; Hypertension, Pulmonary; Phosphodiesterase 5 Inhibitors; Pre-Eclampsia; Pregnancy; Sildenafil Citrate
PubMed: 36141480
DOI: 10.3390/ijerph191811207 -
Pediatric Clinics of North America Feb 2021The causes of kidney disease in pediatric patients are evenly divided between congenital abnormalities of the kidney and urinary tract and acquired disorders. Nearly 10%... (Review)
Review
The causes of kidney disease in pediatric patients are evenly divided between congenital abnormalities of the kidney and urinary tract and acquired disorders. Nearly 10% to 15% of adults in the United States have chronic kidney disease (CKD); there are no comparable data in children. Regardless of patient age, CKD is a systemic problem that affects every organ system, including the lung. We review the tests used to diagnose and evaluate kidney disease and the main clinical syndromes that are likely to be encountered to aid the pulmonology consultant who is asked to evaluate patients with kidney disease.
Topics: Child; Humans; Kidney Diseases; Lung Diseases; Renal Replacement Therapy; Urogenital Abnormalities
PubMed: 33228933
DOI: 10.1016/j.pcl.2020.09.008 -
European Journal of Obstetrics,... Jun 2020
Topics: Adult; COVID-19; Cesarean Section; Female; Humans; Infant, Newborn; Oligohydramnios; Pregnancy; Pregnancy Complications, Infectious; Pregnancy Trimester, Third
PubMed: 32376075
DOI: 10.1016/j.ejogrb.2020.04.047 -
American Journal of Obstetrics and... Sep 2022Second- and third-trimester obstetrical ultrasound examinations include an amniotic fluid volume assessment. Professional organizations' clinical guidance recommends... (Review)
Review
Second- and third-trimester obstetrical ultrasound examinations include an amniotic fluid volume assessment. Professional organizations' clinical guidance recommends using semiquantitative techniques, such as the single deepest vertical pocket or amniotic fluid index, for this purpose. The single deepest vertical pocket is described as the preferred method of assessing amniotic fluid volume based on fewer oligohydramnios diagnoses and labor inductions with no demonstrable difference in pregnancy outcomes compared with the amniotic fluid index. We offer an alternative interpretation of the evidence for this advice, drawn from 6 randomized clinical trials and 2 meta-analyses comparing the single deepest vertical pocket to the amniotic fluid index. Individually and collectively, these reports are underpowered to detect significant differences in maternal and perinatal outcomes by study group. Moreover, randomized clinical trials comparing maternal and perinatal outcomes resulting from a policy of labor induction at or beyond 37 weeks of gestation vs expectant care consistently favor labor induction, the very intervention paradoxically cited as favoring the single deepest vertical pocket vs the amniotic fluid index. We conclude that the amniotic fluid index should be considered a reasonable method for third-trimester amniotic fluid assessment and diagnosing oligohydramnios.
Topics: Amniotic Fluid; Female; Humans; Oligohydramnios; Pregnancy; Pregnancy Outcome; Pregnancy Trimester, Third; Ultrasonography, Prenatal
PubMed: 35452652
DOI: 10.1016/j.ajog.2022.04.016