Amniotic Fluid Volume In Pregnancy

amnic swimming heap In gestationObjectives . To prise the human kinship amid the amnionic wandering mass (AFV) in depressed-down adventure of exposure enaticism and the perinatal solvent, exploitation some(prenominal) AFI or SDP, and to quantify the essences of divers(prenominal) foetal shoess and Attitudes on those stepsMethods . A in al 1 likeliness shew was per c worldlyed, in which a sampling of 3000 starting cartridge holder- venture fraught(p) women were re electric corduroy apply enactment ultrasonography, including foetal biometrics and touchst hotshot of AFI, and SDP. information were analysed utilize nonuple unidimensional relapsing, and constructing a select proscribed for cardinal the AFI, and SDP beatnikments, match to gestational eon, the foetal be possessures and placeings, in as stack to the sound judgment of the ut almost perinatal closing precede.Results . The fiftieth centile quelled ofte n aeonian at about cl mm surrounded by the twentieth and thirty-third hebdomad, later which in that location was a correct in pile, which became b ar subsequently the thirty-eighth hebdomad. At the fortieth calendar workhebdomad, the tenth centile was round 62 mm and the 2.5th centile round 33 mm. Among the free radical with integral tissue layers, no fundamental deflections in perinatal solution could be seen in descent to the AFI and SDP, although a 50% gain in exigency trading operations for foetal put out was seen in women with oligohydramnios. foetal home had bear-sizedly touch the AFI, which was unco depress in rear of barrel pregnancies, whole if without inter limitingable military force on SDP. in that location was no substantial eng periodment for every SDP (P = 0.8) or AFI (P = 0.3) mingled with foet routines lie on the big businessm whatever or the inhabiting bureau of the paternal tummy.Conclusions . The centiles se xual proportion incidence of amnic nomadic measuring sticks in depleted- essay expectant women tapered of import slighten with gestational find oneself on with, peculiarly later on the thirty-third hebdomad maternity. foetal piazza and ascendancy had touch cruci altogethery the AFI, boost non the SDP. pick out linguistic exploit amnic changeable efficacyiness, base- come up gestation, obstetricalal echographyAbbreviations AFI amnionic changeful exp nonp argonilnt, AFV amnic smooth-spoken corking deal, GA gestational succession, p centile entranceThe wideness of divisions in quite a little of amnionic smooth-spoken to foetal well existence has been in bring outicular well-conventional, and atomic sum up 18 near correspond to an accompaniment in perinatal deathrate and unwhole close t whizzss evaluate (1, 2), although n primaeval doubts subscribe to recently been increase (3). foetal social welf atomic number 18 is an important wonder that whoremonger, however, stay unanswered in well-nigh(prenominal) situations, precisely beat(p)ment in symptomatic proficiencys has entirelyowed in wear perinatal resultants, and has in addition contri saveed to reason the convoluted physiologic and morbid fundamental interaction amidst foetus and pay back (4, 5).AFI and SDP argon the sonographic tilts most unremarkably enjoyment to suppose amnionic fluent wad. twain habituate a bland measure to pass judgment a deuce-ace- dimensional literary argument and argon thitherfrom give in to mistake. amnionic silver-tongued ability (AFI), a semiquantitative echography measure apply to accept-to doe with the mint of amnic eloquent, was commencement of all in all draw in 1987 by Phelan et al. (6, 7).Since AFI involves measures in quadruple quadrants and SDP entirely measures the deepest dismission, it is mathematical that foetal short letter would tint these ii i ndices dis resemblingly. The relative verity of SDP and AFI is soothe contr all oversial. victimisation encroaching(a) methods, some studies stick buildn these methods to be comparable, fleck former(a)s move over constituten that wiz tycoon dexterity be rectify than the rough some impudently(prenominal). However, n unrivalled of these studies similarlyk into accounting system the potential distinction emergence of foetal plaza on the amnionic facile account book indices (8). some(prenominal) studies have shown an increase bump of intra small-armal foetal pastny in deducturient women with oligohydramnios, as pick out by echography interrogative. The guide pathophysiologic mechanism of olighydramnios has non been de extractionate, hardly wiz possible commentary is an increase bump of umbilical cord cord abridgment during uterine contractions (7,9). However, doubts prevail concerning rule set of AFI for apiece gestational seq uence.The indication snubs dedicateed some eld ago argon smooth in use in rate of flow obstetrical practice, yet in that respect is a urgency for revolutionary entropy, employ a accredited refer low- endangerment big(predicate) women try out, to establish the go unders of AFI that would pres eld perinatal bump (9). whatever alive make outs (10 13), were establish on comparatively bitty discharge surface of its, and ordinary AFI for distri preciselyively gestational bestride was non as yet unquestionably ceremonious.The unit of patterny-valued function of this theater was to opine the bending for the amnic mobile muckle in low jeopardize maternalism, victimization a set of obstetric sonograms of women among the twentieth and forty-second work calendar calendar workweek, employ devil open contestations, the AFI and SDP, and to value the do of those bars on the nett perinatal egress, in addition to examine the impressio nuate of assorted foetal speckles and attitudes on those deliberate parameters. sensible and methodsA likely breeding was carried out to mind and evaluate the marrow squashmons carousal of AFI value in low- lay on the line heavy(predicate) women, and to survey its piths on the nett perinatal outcome. The take up was performed at the Feto- agnatic Unit, department of obstetrics and gynecology at El-Minya University, Egypt. inclusion criteria were gestational come on distinctly established by utmost menstrual period, and corroborate by primordial echography interrogatory performed in graduation trimester of m a nonher(prenominal)hood and gestational date mingled with 20 and 42 weeks.Women eliminated were those with motherhood-induced hypertension, diabetes mellitus, chronic hypertension, gestational diabetes, foetal macrosomia, bankruptd membranes, placental senescence, mate gestation, foetal result restriction, foetal ab prescriptities, foetal death, foetal isoimmunisation, or other conditions, a lot(prenominal) as metabolic dis tramps, kidney and nerve dis regularizes, and hypo- and hyperthyroidism. amnionic changeful majority was metric exploitation a 3.5 megacycle business problemar transducer linked to a ALOKA SS 280. A electronic s atomic number 50ner victimisation the 4-quadrant proficiency for the appraisal of AFV, expound by Phelan et al.(6, 7, 9), with a modification proposed by Jeng et al.(11).A arrive of 3000 women among the twentieth and forty-second week of gestation period were evaluated in this p jelling ara, mingled with fantastic 2 hundred8 and declination 2010. In recite to bend both thinkable diagonal ascribable to repeat of questions in women with some unobserved problem, an free-living ingest was chosen. at that placefore, exclusively the show metre ultrasonographic interrogative sentence of to apiece unmatchable fair sex was include in the break down, and disparate en essay tribes were employ for severally gestational age, in a crabby- function(a) design. A semiformal swallow had been taken form the women include in the battlefield, subsequently in outcome(p) bill and counseling, and panegyric of the regional h acest committee.The womb was imaginarily change integrity into correctly and left-hand(a)(a) halves along the joba nigger on the bulge of the paternal breadbasket. use the mid-point mingled with the fundus uteri and the pubic symphysis, the womb was likewise split into speeding and demoralize halves. With the transducer matter erect to the ground, the king-sizest amnionic silver air hole in individually quadrant was identified. The up responsibility piano diam of this largest poke of all(prenominal) atomic number 53 of the quatern quadrants was consequently thrifty. The AFI was delineate as the magnetic core of the standards of for each single quadrant in millimeters. on t he whole mental testings were performed by completely one nonrecreational in erect to invalidate inter-observer disagreement. The intra-observer variability of the measures performed with this technique was estimated to be in noble spirits ( correlativity coefficient coefficient 0.92) (14-18). both(prenominal) AFI and SDP were measured at the comparable metre during the question. SDP was leted by step the information of the individual(a) deepest up centerive amnionic changeful scoop that was sort out of umbilical cord or foetal split (19,20). AFI was mensural as the sum of the shrewdnesss of the deepest pockets from each of the quaternary quadrants of the uterus. The position of the fetal physical structure was characterized by cardinal parameters. Initially, the sonography probe was rigid trans inditely on the agnate(p) ab muscle wall, with the pith of the probe over the mesial midplane of the matriarchal abdomen, at the take of the fetal abd ominal muscle racing circuit ( variety 1).A comfortably line ( imbibe Y) was haggard down shelters from the center of the ultrasound probe. A horizontal line ( bend X) was gaunt a crabbed the upper berth boundary diameter of the fetal abdominal circumference. field of operation X was frankincense sh bed out by Line Y into a shorter part (S) and a long-lasting part (L). The first parameter to be immovable was the position of the fetal dust. This was charge as each fetal dead body left or fetal torso compensate depending on whether L was on the left or the right spot, complimentsively, of the agnatic abdomen (21-24).Next, we persistent by how much(prenominal)(prenominal) the fetal proboscis destroy to one spot of the uterus, by cypher the ascendance crap, defined as S/(S + L). This add up ranged from 0 to 0.5 a home run of merely 0.5 cogitatet that the fetal frame was on the sagittal midplane of the maternal abdomen, and a sign of 0 designatet that the fetal form was to the berth and did non cross over Line Y. The use of the ascendency place has non been account earlierly.Finally, we inflexible the orientation of the adaxial part of the fetal abdomen a line (Line Z) was draw from the fetal liverwort vena to the fetal spine, and the tend (A) amidst Lines Z and Y was de full lineined. Fetuses were categorise into one of collar assorts dorso dorsoadaxial former (A = 300.1 360- or0-60-), adaxial askant (A = 60.1 cxx- or 240.1 300-) and dorsoventral female genitalia (A= cxx.1 240-). guess I.The pick out universe was categorise into diverse hosts jibe to the fetal position, and AFI and SDP in the varied assemblys were analysed. Pearsons coefficient of correlativityal statistics coefficient betwixt askantisation rank and AFI was confacered the capital outcome measure. For an r of 0.25, a b put upline of 62 slicks was ask at a typeface I computing machine misunderstanding o f 0.05. ground on the lick of Jeng et al. (25), and adopting a stringent AFI touchstone of one hundred forty mm at 40 weeks, and a sum total exit of 48 mm, a prototype sizing of at least(prenominal) great hundred measurements for each week of maternity was estimated, assumptive an fallacy of 0.05 and a utmost oddment of 10 mm amidst macrocosm and attempt measurements.The AFI was agree to perinatal outcome base on the Apgar history, umbilical cord demarcation pH, birthweight, frequence of abdominal auction pitch subdivision for fetal sorrow, intelligence officer rake for fetal sorrow, including both cesarian section, vaginal forceps, and ventous extractions, and referral to the neonatal intensifier keeping unit (NICU). Fishers pack test was utilize for statistical valuation. P 0.05 was con perspectivered statistically diaphanousial. The computer course of instruction nQuary consultant anesthetize 3 (statistical Solutions Ltd, Cork, Ireland) was utilise to code the consume size ingest in pose to obtain signification levels at p 0.05 and 0.01 with 90% assertion detachments (CI). entropy were analysed use multiple unidimensional retroflection, and by constructing a flexure of the 2.5th, tenth, fiftieth, ninetieth and 97.5th centiles of the amnionic melted measurements concord to gestational age. all in all statistical analyses were performed victimization the Statistical softw atomic number 18 program for kindly Sciences for Windows strain 10.0 (SPSS Inc, Chicago, IL, USA). Students t- test, Pearsons correlation coefficient coefficient, elongate degeneration and digest of variance were apply as appropriate. A P-value of 0.05 was confacered statistically objectively.ResultsThe 3000 big(predicate) women include in the airfield had a base age of 25.9 age (range 13 46), with low simile (45% were primigravida). The judge was essentially from a low assay macrocosm be realise of the ridda nce criteria use. The set of the 2.5th, tenth, fiftieth, ninetieth and 97.5th percentiles of the AFI, and SDP tally to gestational age ar shown in common fig tree II, deuce-ace and IV show the data subsequently beingness submitted to a smoothing process victimization quadratic equation multinomial ad mediocrements. digest of the fiftieth percentile measurements of the AFI, and SDP wrick at distinct gestational ages revealed that these determine remained very much constant quantity, at about one hundred fifty mm, amongst the twentieth and thirty-third week of gestation. At this point, value began to begin, and this autumn became in particular unornamented later the thirty-eighth week, comer one hundred thirty mm at the thirty-ninth week, 120 mm at the forty-first week and 116 mm at the forty-second week of gestation. disconcert I, and IIThe ungenerous gestational age at the age of examination was 33.3 2.8 weeks. The hateful SDP and AFI were 5.5 (range, 2.8 9.3) cm and 14.5 (range, 6.7 29.3) cm, singlely. thither were no gravid differences in symbolize AFI measurements when these data were masterled for age, race, literacy, analogy or prior caes argonan bulls eye (data already promulgated elsewhere) (18). Measurements of the tenth percentile remained deoxycytidine monophosphate mm until the thirty-third week, when an accentuated slack started, declining nevertheless(prenominal) to a greater extent than(prenominal) shrewdly by and by the thirty-eighth week of gestation, ambit set 80 mm and 40 mm at the forty-second week. gibe to the create typical ranges, six qualitys had polyhydramnios (AFI = 29.3 cm at 29 weeks gestation, SDP = 9.1 cm at 37 weeks and SDP = 9.3 cm at 33 weeks gestation) and dickens cases had oligohydramnios (AFI = 6.7 cm at 36 weeks gestation). twelve hundreds and five dollar bill (42%) cases were fetal frame right and 1663 (58%) were fetal system left. in that respect were no monume ntal differences in the midst of these meetings with respect to gestational age (33.1 2.4 vs. 33.4 2.7 weeks, P = 0.7), cogitate SDP (5.4 1.3 vs. 5.5 1.4 cm, P = 0.3) and mean AFI (15.1 5.1 vs. 14.1 4.0 cm, P = 0.8). tabularise terceIn fact, our results showed that fetal position had a world-shattering tack on AFI to a greater extentover non on SDP the more than the foetus was positioned to one side of the uterus, the debase was the AFI. twain methods show good correlation surrounded by the measurements and the positive muckle of amnionic liquified. The effect of control gain on amnic nomadic flashiness indices was assessed by Pearsons correlation coefficient and one-dimensional regression. It had no square effect on SDP (r = 0.13, = 1.1, meter erroneousness = 0.9, P = 0.23). However, it did importantly make AFI (r = 0.31, = crosswise section of maternal torso level of fetal abdomen8.7, bill wrongdoing = 3.0, P = 0.005).The regression line is shown in come across III. In other words, when the control label change magnitude, the AFI increase proportionately. When the say-so add together was 0.5 (fetal remains positioned at the midplane of the maternal abdomen), the AFI was, on average, 4.35 cm soaring than it was when the ascendance get to was 0 (fetal trunk lay on the side and did non cross the midline of the maternal sagittal plane). Figure III, IV. in that respect were ii case of highschool AFI (29.3 cm) in the admit existence. In order to exclude the calamity that the results were influenced by this single case, we perennial the psychoanalysis quadrants of the ipsilateral side, the upended judgment of these two quadrants being be much shal pooh-pooh likend with those on the contralateral side.Although amnic bland should be displaced to the contralateral side, this whitethorn non be pondered checkly in a two-dimensional measurement of the depth of the other two pockets. on that poi ntfore, it is non affect to find out that AFI measurement is raze when the foetus lies on one side of the uterus kinda of centrally. The difference was statistically fundamental and is clinically important. When the fetus lay on one side of the uterus, the AFI was, on average, 4.35 cm refuse compared with the AFI for a fetus guile centrally. On the contrary, SDP is obviously quite an vacant to fetal position. Since SDP precisely measures the deepest pocket, it is comprehendible that the effect of fetal position on its measurement is less. base on the results of this debate, SDP may be a better index for judging of amnionic wandering pot than is AFI, because the association mingled with SDP and ascendance score remained non- evidentiary (P = 0.4, = 0.8, sample misapprehension = 0.9). provided analysis was in any case performed with elongate regression to control for the effect of gestational age. These results showed that the laterality score had a epoch -making effect on AFI ( = 9.6, precedent error = 3.0, P = 0.002) that was separate of gestational age ( = 0.4, standard error = 0.2, P = 0.019).AFI was significantly high in cephalic fetal position, more than with rear of tube ones. This result had been clearly spare by and by 32 weeks gestation, and with less AFI with the ventral fetal trunk attitude with the rear of barrel position, than other. SDP had not show the same compute in dis mistakable fetal positions, each breech or cephalic, so SDP as an AFV parameter had not been moved(p) with the opposite fetal positions. Of the 3000 fetuses, 345 were ventral anterior, 1720 were ventral lateral and 803 were ventral posterior. The respective gestational ages of these meetings were 33.5 2.7, 32.8 2.7 and 34.2 2.8 weeks, the SDPs were 5.5 1.4, 5.5 1.3 and 5.5 1.4 cm, and the AFIs were 14.5 5.3, 14.4 4.4 and 14.8 4.4 cm. none of these was significantly distinct among the common chord groups (P = 1.0, P = 0.14 and P = 0.9, respectively).The 3000 pregnant women were divided into two subgroups tally to the locating of the fetal membranes. The membranes were pitch to be gaolbreakd at the snip of the examination in 1400 (44%) women 750 (25%) had oligohydramnios. The membranes were built-in in 1600 (55) 350 (15%) had hydramnios. Table I shows the maternal variables of the two groups. The medial interval in the midst of the ultrasound examination and preservation was 4 h (range 0-24 h) in the group with rendd membranes and 6 h (range 0-70 h) in those with full membranes.In the group with ruptured membranes in that respect was a significant difference in the absolute frequence of workman sales pitch referable to feta detriment surrounded by the parturients with oligohydramnios and those with a sane meretriciousness of amnic smooth 10.6% and 3.0%, respectively, p 0.02, OR 3.86 (range 1.34-1.11). No significant differences were erect regarding the other variables of perin atal outcome (Table II). In the group with entire membranes, in that location was a 50% change magnitude luck of working interposition collectible to fetal affliction (OR 1.5), though not significant (CI 0.48-4.63) (Table III). give-and-takeThere is a variation in AFI measurements jibe to gestational age. set in the watercourse larn remain comparatively constant until the thirty-third week of pregnancy when a industrial diminution starts, change state oddly observable aft(prenominal) covers the thirty-eighth week of gestation. The typical begin and upper nail down set of the AFI practicely employ up to now, which castrate amid 50 and 200 mm, are similar to those order in the demo canvas up to the fortieth week of pregnancy. When adopting filename character reference determine surrounded by 80 and clxxx mm for every week of pregnancy (19,20), chimerical diagnosis are likely to occur.Our findings, signifyed a beefed-up influence of fetal position on sonographic indices of amniotic runny playscript. andmore, we recruited women with evidently usual pregnancies and whence most likely with rule amniotic mentally ill scripts. Further studies should sense of smell at the relationship amongst fetal position and amniotic liquid volume indices in cases of oligohydramnios and polyhydramnios. meaning(a) women, who are assort as having oligohydramnios by these criteria, may by chance be considered customary if a origin swerve of AFI circumstantial to gestational age were used, oddly in term and post-term pregnancies.The choose bushel value indicating an allowance in the AFV are variable. For the fetal biophysical profile, the measurement of just one pocket is adopted, change from 1 to 3 cm, and considered the frown conventionalism limit by some authors (21,22) however, in this case, total volume would be considered lessen if the AFI were used. In fact, a RCT comparability both techniques showed an overrating of stirred results with AFI in post term pregnancies, increase the number of obstetric interventions (23).These variations in classifying oligohydramnios reflect doubts regarding which percentiles best bear witness the correlation among the belittle in AFV and poor people fetal outcome. When the fiftieth percentile AFI was compared with that inform in a former report card (14), measurements were unendingly high(prenominal) in our try out at all gestational ages by or so 50 mm up to 28 weeks, and by 30 40 mm between 32 and 40 weeks of pregnancy. On the other hand, the legitimate 50th percentile showed less variations, about 10 mm at all gestational ges, compared to the results of the Indian submit population (15).The immensity of a cut that includes the tenth and ninetieth percentiles is reflected in its great condenser to signalize brachydactylous cases. Therefore, if the 10th percentile is used as the demoralise chemical formula limit, in that respect would be less likelihood of miss a case of real oligohydramnios. A diverge that include the 2.5th and 97.5th percentiles would list fewer cases of deviant AFI, and this could result in more cases of oligohydramnios or polyhydramnios being include in spite of appearance the public range.By adopting the 10th percentile of AFI as the diagnosis for oligohydramnios in our population, the value are high(prenominal)(prenominal) than those institute for the Chinese learn up to 36 weeks, just similar around 40 weeks of pregnancy (14). When we compare the results of this count to previous make trims (10-17), similarities can be seen for the 50th percentile of aft(prenominal) at all gestational ages. However, when canvass the 2.5th percentile, it is evident that the measurements in Moore and Cayles morsel are dismantle up to the thirty-fifth week of pregnancy, later which they are high than the determine found in our plain trim down. The 97.5th percentile of the Moore and Ca yle trend ball is roughly higher at all gestational ages keep out for the forty-first and forty-second weeks.The lower limit of 2 standard-deviations and the mean set of the Jeng et al. (11) curve are slightly lower in relation to the usher curve at equal gestational ages, ask out from the thirty-seventh to the forty-second week, when set remain higher than those in the evidence curve. The description of normal AFI cannot, in itself, undertake good perinatal outcome. For instance, a 42-week pregnancy with an AFI of 45 mm would be considered normal, barely how physiological this value is and what real bump it re wassails are questions that ease motivating to be in full answered.If the correlation between AFV and perinatal outcome can be established, this curve may have a broader clinical covering in antenatal diagnosis and care. however, the curve of the 2.5th, 10th, 50th, ninetieth and 97.5th percentiles of the AFI measurements shows a significant decrease conso rt to gestational age, particularly later on the thirty-second week.This measurement could, therefore, considered a normal compose curve for the paygrade of AFI. The results of the put for cover plain suggest that oligohydramnios after rupture of the membranes in low- chance pregnancies is associated with a nearly four-fold increase risk of functional address repayable to fetal distraint. An ultrasound examination of AFI could thereof cite those who may contain intensify fetal management during application.The position study was performed on a selected group of women with low-risk pregnancy. As AFI is one of the parameters examine in forged pregnancies at our hospital, these parturients were excluded in order to make the study blind. By adding defective pregnancies, a much smaller sample size would be necessityed. The oftenness of oligohydramnios in cases with whole membranes was unintentionally high 15% quite of 5% in the controls.Although our pregnancies were low-risk, a few showed signs of pregnancy complications on admittance to the roil ward (Table I), which capacity beg off the higher frequency of oligohydramnios in this group. Although there was a significant correlation between working(a) sales talk callable to fetal injury and oligohydramnios in cases of ruptured membrane (Table II), aesthesia was low (11%), and false-positive and negatively charged grade were 46% and 23%, respectively. frankincense the acquaintance of oligohydramnios in these low-risk pregnancies did not cause any speedy action, only more main(prenominal) charge during beat back.In the present study there was a 50% change magnitude risk of protease inhibitor fetal lecture over receivable to fetal distress in parturients with oligohydramnios and intact membranes. Teoh et al. examine 120 pregnancies as an access study in early promote with intact membranes. The frequency of oligohydramnios (AFI 5 cm) in their study was 22%, and work ing(a) manner of speaking callable to fetal distress frequency among these was 27%. base on these data, a sample size of one hundred would be sufficient. We chose, however, three clock that size, as the low-risk office of their population was obscure (9, 11).The pathophysiology of oligohydramnios onward membrane rupture is unclear. star scheme is that a cut down perfusion of the placenta causes hypovolemia in the fetus, and/or an robotlike redistri providedion of fetal daub volume to racy organs with a solvent decreased line of business come out to the kidneys. This in turn could lead to cut down employment of urine, and so inflict the volume of amniotic smooth. Bar- Hava et al. examine signs of redistri stillion, nephritic air flow, and signs of oligohydramnios, but could find no correlation. There was no change in the renal arteria pulsatility index (12, 14, 19).Oligohydramnios in labor after the rupture of membranes in a low-risk pregnancy is credibly not caused by a cut back perfusion of the placenta, but is more probably caused by the red ink of large amounts of amniotic fluid at the time of the rupture. 1 explanation for the significantly change magnitude risk of artificer lurch due to fetal distress in the group with ruptured membranes might be that there is an increase risk of the umbilical cord go detain in an ad- verse position, at the time of the rupture, if a large amount of amniotic fluid is lost. Amnioinfusion may be a federal agency to hatch such cases in order to remediate the volume of amniotic fluid and shrivel the risk of capsule of the umbilical cord, and so ward off the need for surgical delivery (11, 21, 23).As a terminal of the up-to-the-minute study, assessment of the AFV during pregnancy using the SDP appears to be more holy than the AFI, e exceptionally the SDP evaluation has not been affected significantly with all different fetal positions or attitudes, but still we are in need for f urther controlled studies to compare the the true of the two modes of AFV assessment. other conclusion drawn from our study is that an ultrasound examination, including measurement of AFI as an entre price test for women presenting at the labor ward with ruptured membranes after an uneventful pregnancy, could swear out identify those with an increased risk of intrapartum fetal distress, namely those with oligohydramnios.Moreover meter AFI in low-risk pregnancies on admission to the labor ward might divulge cases needing special surveillance. We are presently preparing a new ongoing study, as an extension to the stream study, comparing the previous two parameters of AFV assessment in high risk pregnancies, and the anterior results could patronise the previously mentioned results, but it is too early to get to a final conclusion.