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Superiority of the four-quadrant sum over the single-deepest-pocket technique in ultrasonographic identification of abnormal amniotic fluid volumes.
American Journal of Obstetrics and Gynecology 1990 September
Ultrasonographic estimation of amniotic fluid volume is an important adjunct to assessment of fetal well-being. However, no single method has emerged as most predictive. Many ultrasonographers use subjective or single-pocket guidelines in evaluation of amniotic fluid volume. We therefore assessed the ability of a maximum-vertical-pocket technique to identify patients with abnormal volumes of amniotic fluid. A total of 1168 patients was studied. Oligohydramnios (n = 76) was defined as an amniotic fluid index less than 5th percentile for gestational age (70 to 98 mm). Hydramnios (n = 51) was defined when the amniotic fluid index was greater than 95th percentile (185 to 249 mm). The ability of the maximum-vertical-pocket technique to identify cases with oligohydramnios by amniotic fluid index was poor: sensitivity was 42% and positive predictive value was 51%. Fifty-eight percent of cases with oligohydramnios by amniotic fluid index had "normal" values according to the single-pocket technique. The correlation coefficient between amniotic fluid index and maximum vertical pocket was 0.51, R2 = 24%. The correlation between the maximum vertical pocket and amniotic fluid index was somewhat better in cases of polyhydramnios (r = 0.79, R2 = 62%), but the sensitivity, positive predictive value, and false-negative rates were high as in oligohydramnios. These data suggest that the maximum-vertical-pocket technique has adequate specificity but is a poor screening tool. The results demonstrate that use of gestation-specific norms for the amniotic fluid index identifies abnormal amniotic fluid volumes more efficiently than the single-pocket technique.
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