Hence monitoring the AFI has become a standard of antenatal care. Hence, it is recommended to follow up low risk antenatal women every two weeks after 34 weeks of pregnancy. Values. Percentile curves (5th, 50th, and 95th centiles) were constructed for comparison with other studies. where (critical value that divides the central 95% of distribution from 5% in the tails), (critical value that separates the lower 10% of distribution from upper 90%), = standard deviation, and = difference of two means. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Table 3 indicates Cohen’s values for week to week comparison and it can be seen that not much change was seen in immediate week, but changes became significant when the interval between two scans was more than 2 weeks or more in most of the comparisons. The purpose of the present investigation is(1)to study the pattern of change in AFI on weekly basis from 34 weeks till delivery;(2)to constitute reference ranges of AFI from 34 to 40 weeks of gestation;(3)to find the time interval by which there is a significant fall in AFI, which will help obstetrician to plan an ideal protocol for antenatal ultrasound examination in the third trimester. Hence from this table there is substantial evidence that liquor volume decreases significantly over the period of 14 days more in low risk antenatal women. Of the 50 patients who were recruited for the study and were between the age of 22 to 28 years, more than half (32 patients, 64%) were primigravidae and 18 (36%) were multigravidae. Accordingly it was estimated that 27 patients are required and we decided to recruit 50 patients to have satisfactory results. Amniotic fluid index was obtained by adding these four measurements. Data was analyzed using SPSS version 16 for windows (SPSS Inc., Chicago, IL, USA). Uterus was arbitrarily divided into four quadrants using linea nigra as a vertical line and a transverse line passing through umbilicus, as described by Phelan et al. We are committed to sharing findings related to COVID-19 as quickly as possible. AFI curve generated from the study varied significantly when compared with already published data, both from India and abroad. We have also graphically interpreted findings in the other studies (either mean or 50th percentile values) in Figure 3. The two studies [16, 25] are from India, but the reported AFI range has a wide range. However, it must be noted that almost all authors have reported a steady decline in AFI values with the advancing gestational age, except Birang et al. A prospective estimation of AFI was done in 50 healthy pregnant women from 34 to 40 weeks at weekly intervals. These changes are graphically represented in Figure 1. Comparison of AFI values at different gestational ages in various studies. Premium Questions. If minimum (5th centile) and maximum (95th centile) are considered as normal range, it was noted that the corresponding values too were different at different gestational ages; the more advanced the gestational age, the lesser the values. ", Journal of Pregnancy, vol. Adequate fluid volume is detected by ultrasound, and the normal volume is indicated when the AFI (amniotic fluid index) is between 8 to 18 cm. The normal range for amniotic fluid volumes varies with gestational age. At values less than 5, there is higher incidence of perinatal morbidity and mortality and many a time immediate delivery is the only way out [12, 13]. To establish reference standards for AFI for local population after 34 weeks of pregnancy and to decide an optimal scan interval for AFI estimation in third trimester in low risk antenatal women. Starting from 34 weeks till 40 weeks, 50 ultrasound measurements were available at each gestational age. From our statistical analysis, we have found that there is no much decrease in AFI at interval of one week, but thereafter the differences become large and significant. Very low values are associated with intrauterine growth restriction and renal anomalies of fetus, whereas high values may indicate fetal GI anomalies, maternal diabetes mellitus, and so forth. There are definite guidelines for frequency of antenatal testing for high risk pregnant women, but what constitutes an ideal screening program for low risk pregnancies is still unknown [5]. Amniotic fluid index (AFI) is a quantitative estimate of amniotic fluid and an indicator of fetal well-being. As mentioned in methodology, we have excluded those who delivered before term as we required AFI from 34 weeks to 40 weeks of gestation for analysis purpose. Answer: Dear and AFI during pregnancy should be between 8-18 to be considered normal. Question: liquor is less than adequate does worried thats is EFI 8.0 cm Answer : Throughout the pregnancy the level should be around 10 and during labour it can be 8.5 it still ok but should not reduce below this. Amniotic fluid assessment by ultrasound is one of the important tools in assessing the fetal health in all risk categories especially beyond the period of viability [6]. All of them delivered at around 39+ to 40 weeks. There was a gradual decline of AFI values as the gestational age approached term. We hypothesised that a difference of 1.5 cm in the mean AFI would be significantly different from the normal values and accordingly estimated sample size to show a desired level of power of 90% and level of significance 0.05, by using the formula, Question: Liquor is adequate AFi=12 what is the meaning. A polynomial regression analysis of 3rd order was used to find the best fit. Hence it is very important to scan the patient to note such a trend periodically during antenatal visits. Hence, it is important to determine a critical interval at which the fall in AFI becomes clinically significant. The 5th percentile cut-off was 8.7 cm at 40 weeks. It is interesting to note that all the values were within 8 to 25 cm range (which is accepted and established normal range for AFI values worldwide). However, a drastic reduction in its quantity may indicate underlying placental insufficiency, which has definite implications on growing fetus. Only low risk singleton pregnancies with accurately established gestational age who were available for all weekly scan from 34 to 40 weeks were included in the study. Still I am afraid if my fluid level will worsen. A. Baschat, R. M. Viscardi, B. Hussey-Gardner, N. Hashmi, and C. Harman, “Infant neurodevelopment following fetal growth restriction: Relationship with antepartum surveillance parameters,”, G. Heller, B. Misselwitz, and S. Schmidt, “Early neonatal mortality, asphyxia related deaths, and timing of low risk births in Hesse, Germany, 1990–8: observational study,”, F. A. Manning, “Antepartum fetal testing: a critical appraisal,”, E. A. Dubil, “Amniotic fluid as a vital sign for fetal wellbeing,”, A. F. Nabhan and Y. The 5th, 50th, and 95th percentiles ranged from 11.7, 14.6, and 17.3, respectively, at 34 weeks to 8.7, 10.8, and 13.7, respectively, at 40 weeks. The women were medium built, the average height was of 152 to 156 cms, and prepregnancy weight was between 45 and 50 kg. Shripad Hebbar, Lavanya Rai, Prashant Adiga, Shyamala Guruvare, "Reference Ranges of Amniotic Fluid Index in Late Third Trimester of Pregnancy: What Should the Optimal Interval between Two Ultrasound Examinations Be? A fetus in distress should be identified at the earliest so that timely delivery will not only salvage the fetus but also prevent long term neurological impairments such as injury to fetal central nervous system [3]. There are several methods mentioned in the literature to calculate the effect sizes (Cohen 1988 [17], Rosenthal and Rosnow 1991 [26], Partial Eta squared Richardson 2011 [27]) and so forth. Though our results are based on required number of patients by sample size determination, larger number of subjects if studied may yield robust reference curves for AFI and identify extreme values to define what constitutes oligo- or polyhydramnios.
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