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Single Deepest Vertical Pocket or Amniotic Fluid Index as Evaluation Test for Predicting Adverse Pregnancy Outcome (SAFE Trial): A Multicenter, Open-Label, Randomized Controlled Trial EDITORIAL COMMENT

Kehl S, Schelkle A, Thomas A, Puhl A, Meqdad K, Tuschy B, Berlit S, Weiss C, Bayer C, Heimrich J, Dammer U, Raabe E, Winkler M, Faschingbauer F, Beckmann M, Suetterlin M (2016)

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Publication Type: Journal article, Editorial

Publication year: 2016

Journal

Book Volume: 71

Pages Range: 578-580

Journal Issue: 10

Abstract

One of the important aspects of fetal well-being assessment is amniotic fluid volume, lack of which leads to oligohydramnios and consequently adverse perinatal outcomes. Amniotic fluid estimation by ultrasound can be performed by assessment of the amniotic fluid index (AFI) or the single deepest vertical pocket (SDP) technique. This study aimed to investigate the best technique for amniotic fluid volume estimation to predict adverse pregnancy outcomes in both high-and low-risk pregnancies. In a randomized controlled trial (RCT), participants from 4 hospitals in Germany were allocated randomly to AFI or SDP measurement (1: 1). Oligohydramnios was defined by an AFI 5 cm or less or by the absence of an SDP measuring less than 2 x 1 cm. The primary outcome measure was admission to a neonatal intensive care unit (NICU) following childbirth, and other outcome measures included perinatal death, oligohydramnios, labor induction (for oligohydramnios or without specific indication), umbilical artery pH less than 7.10, 5-minute Apgar score of less than 7, meconium-stained amniotic fluid, abnormal cardiotocography, need for fetal scalp blood sampling, assisted vaginal delivery (for fetal distress or without specified indication), and cesarean delivery (for and without fetal distress). Statistical analyses were performed using the Student t test, Mann-Whitney U test,.2 test, or Fisher exact test and a logistic regression analysis or a 2-way analysis of variance. There were fewer women with gestational diabetes and a previous cesarean delivery in the AFI group among the 1002 women analyzed. Women with a high-risk pregnancy were older, shorter, and more overweight than women with a low-risk pregnancy. Postnatal admission rates to the NICU (4.2% vs 5%; relative risk [ RR], 0.85; 95% confidence interval [ CI], 0.481.50) and rate of arterial pH less than 7.10 were similar between the 2 groups (1.6% vs 3%; RR, 0.54; 95% CI, 0.23-1.26). There weremore participants with oligohydramnios (9.8% vs 2.2%; RR, 4.51; 95% CI, 2.37-8.57), more labor inductions for oligohydramnios (12.7% vs 3.6%; RR, 3.50; 95% CI, 1.76-6.96), and higher occurrences of abnormal cardiotocography (32.3% vs 26.2%; RR, 1.23; 95% CI, 1.02-1.50) in the AFI group than in the SDP group. More cases of oligohydramnios and labor inductions for oligohydramnios were found in low-risk pregnancies measured by the AFI method than by the SDP technique, and a lower arterial pH was observed in the AFI group compared with the SDP group in high-risk pregnancies. The AFI technique increased the diagnosis rate of oligohydramnios without improvement in perinatal outcome; hence, the SDP technique is preferred over AFI especially in low-risk pregnancies.

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How to cite

APA:

Kehl, S., Schelkle, A., Thomas, A., Puhl, A., Meqdad, K., Tuschy, B.,... Suetterlin, M. (2016). Single Deepest Vertical Pocket or Amniotic Fluid Index as Evaluation Test for Predicting Adverse Pregnancy Outcome (SAFE Trial): A Multicenter, Open-Label, Randomized Controlled Trial EDITORIAL COMMENT. Obstetrical & Gynecological Survey, 71(10), 578-580.

MLA:

Kehl, Sven, et al. "Single Deepest Vertical Pocket or Amniotic Fluid Index as Evaluation Test for Predicting Adverse Pregnancy Outcome (SAFE Trial): A Multicenter, Open-Label, Randomized Controlled Trial EDITORIAL COMMENT." Obstetrical & Gynecological Survey 71.10 (2016): 578-580.

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