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Measurement of amniotic fluid volume

DOI: https://doi.org/10.29296/25877305-2023-01-03

Associate Professor Yu. Trusov, Candidate of Medical Sciences; Professor
V. Kramarsky, MD; N. Fayzullina, Candidate of Medical Sciences
Irkutsk State Medical Academy of Postgraduate Education. Branch, Russian Medical Academy of Continuing Professional Education, Ministry of Health
of Russia

The qualitative or semi-quantitative assessment of amniotic fluid volume (AFV) is a standard component of every ultrasound in the second and third trimesters of pregnancy. AFV abnormalities are associated with various pregnancy complications. In clinical practice, ultrasound (US) assessment of AFV is used in conjunction with other clinical and sonographic parameters (biophysical profile, non-stress test, estimated fetal weight on ultrasound, clinical examination) to make effective medical decisions to maintain fetal well-being in the management of pregnancies with obstetric complications. US is the most common AFV assessment technique, in which AFV is determined on a basis of the opinion of a physician (qualitatively) or on a basis of the value of the maximum vertical pocket (MVP) and amniotic fluid index. These techniques are well suited for detecting fetuses with normal AFV; however, they have insufficient accuracy for diagnosing oligohydramnios and polyhydramnios. Furthermore, ultrasound AFV assessment in twins poorly corresponds with the reference values for oligohydramnios and polyhydramnios. Despite this, it is advisable to use qualitative and semi-quantitative (MVP) methods for AFV assessment. Results for each twin are interpreted using the same MVP criteria as those for single fetuses.

obstetrics and gynecology
amniotic fluid volume
maximum vertical pocket
amniotic fluid index

  1. ACOG practice bulletin. Antepartum fetal surveillance. Number 9, October 1999 (replaces Technical Bulletin Number 188, January 1994). Clinical management guidelines for obstetrician-gynecologists. Int J Gynaecol Obstet. 2000; 68 (2): 175–85.
  2. Magann E.F., Doherty D.A., Field K. et al. Biophysical profile with amniotic fluid volume assessments. Obstet Gynecol. 2004; 104 (1): 5–10. DOI: 10.1097/01.AOG.0000131618.14176.00
  3. American Institute of Ultrasound in Medicine. AIUM practice guideline for the performance of obstetric ultrasound examinations. J Ultrasound Med. 2013; 32 (6): 1083–101. DOI: 10.7863/ultra.32.6.1083
  4. Salomon L.J., Alfirevic Z., Berghella V. et al. Practice guidelines for performance of the routine mid-trimester fetal ultrasound scan. Ultrasound Obstet Gynecol. 2011; 37 (1): 116–26. DOI: 10.1002/uog.8831
  5. Ott W.J. Reevaluation of the relationship between amniotic fluid volume and perinatal outcome. Am J Obstet Gynecol. 2005; 192 (6): 1803–9. DOI: 10.1016/j.ajog.2004.12.062
  6. Locatelli A., Zagarella A., Toso L. et al. Serial assessment of amniotic fluid index in uncomplicated term pregnancies: prognostic value of amniotic fluid reduction. J Matern Fetal Neonatal Med. 2004; 15 (4): 233–6. DOI: 10.1080/14767050410001668671
  7. Chauhan S.P., Sanderson M., Hendrix N.W. et al. Perinatal outcome and amniotic fluid index in the antepartum and intrapartum periods: A meta-analysis. Am J Obstet Gynecol. 1999; 181 (6): 1473–8. DOI: 10.1016/s0002-9378(99)70393-5
  8. Dildy G.A. 3rd, Lira N., Moise K.J. Jr. et al. Amniotic fluid volume assessment: comparison of ultrasonographic estimates versus direct measurements with a dye-dilution technique in human pregnancy. Am J Obstet Gynecol. 1992; 167 (4 Pt 1): 986–94. DOI: 10.1016/s0002-9378(12)80025-1
  9. Magann E.F., Whitworth N.S., Files J.C. et al. Dye-dilution techniques using aminohippurate sodium: do they accurately reflect amniotic fluid volume? J Matern Fetal Neonatal Med. 2002; 11 (3): 167–70. DOI: 10.1080/jmf.
  10. Nabhan A.F., Abdelmoula Y.A. Amniotic fluid index versus single deepest vertical pocket as a screening test for preventing adverse pregnancy outcome. Cochrane Database Syst Rev. 2008; 2008 (3): CD006593. DOI: 10.1002/14651858.CD006593
  11. Kehl S., Schelkle A., Thomas A. 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. Ultrasound Obstet Gynecol. 2016; 47 (6): 674–9. DOI: 10.1002/uog.14924
  12. Hughes D.S., Magann E.F., Whittington J.R. et al. Accuracy of the Ultrasound Estimate of the Amniotic Fluid Volume (Amniotic Fluid Index and Single Deepest Pocket) to Identify Actual Low, Normal, and High Amniotic Fluid Volumes as Determined by Quantile Regression. J Ultrasound Med. 2020; 39 (2): 373–8. DOI: 10.1002/jum.15116
  13. Magann E.F., Perry K.G. Jr., Chauhan S.P. et al. The accuracy of ultrasound evaluation of amniotic fluid volume in singleton pregnancies: the effect of operator experience and ultrasound interpretative technique. J Clin Ultrasound. 1997; 25 (5): 249–53. DOI: 10.1002/(sici)1097-0096(199706)25:53.0.co;2-d
  14. Reddy U.M., Abuhamad A.Z., Levine D. et al. Fetal imaging: executive summary of a joint Eunice Kennedy Shriver National Institute of Child Health and Human Development, Society for Maternal-Fetal Medicine, American Institute of Ultrasound in Medicine, American College of Obstetricians and Gynecologists, American College of Radiology, Society for Pediatric Radiology, and Society of Radiologists in Ultrasound Fetal Imaging workshop. Obstet Gynecol. 2014; 210 (5): 287–97. DOI: 10.1016/j.ajog.2014.02.028
  15. Chamberlain P.F., Manning F.A., Morrison I. et al. Ultrasound evaluation of amniotic fluid volume. I. The relationship of marginal and decreased amniotic fluid volumes to perinatal outcome. Am J Obstet Gynecol. 1984; 150 (3): 245–9. DOI: 10.1016/s0002-9378(84)90359-4
  16. Magann E.F., Chauhan S.P., Washington W. et al. Ultrasound estimation of amniotic fluid volume using the largest vertical pocket containing umbilical cord: measure to or through the cord? Ultrasound Obstet Gynecol. 2002; 20 (5): 464–7. DOI: 10.1046/j.1469-0705.2002.00802.x
  17. Magann E.F., Nolan T.E., Hess L.W. et al. Measurement of amniotic fluid volume: accuracy of ultrasonography techniques. Am J Obstet Gynecol. 1992; 167 (6): 1533–7. DOI: 10.1016/0002-9378(92)91734-r
  18. Horsager R., Nathan L., Leveno K.J. Correlation of measured amniotic fluid volume and sonographic predictions of oligohydramnios. Obstet Gynecol. 1994; 83 (6): 955–8. DOI: 10.1097/00006250-199406000-00011
  19. Rutherford S.E., Phelan J.P., Smith C.V. et al. The four-quadrant assessment of amniotic fluid volume: an adjunct to antepartum fetal heart rate testing. Obstet Gynecol. 1987; 70 (3 Pt 1): 353–6.
  20. ACOG Committee on Practice Bulletins-Obstetrics. ACOG Practice Bulletin. Clinical management guidelines for obstetricians-gynecologists. Number 55, September 2004 (replaces practice pattern number 6, October 1997). Management of Postterm Pregnancy. Obstet Gynecol. 2004; 104 (3): 639–46. DOI: 10.1097/00006250-200409000-00052
  21. Phelan J.P., Ahn M.O., Smith C.V. et al. Amniotic fluid index measurements during pregnancy. J Reprod Med. 1987; 32 (8): 601–4.
  22. Alley M.H., Hadjiev A., Mazneikova V. et al. Four-quadrant assessment of gestational age-specific values of amniotic fluid volume in uncomplicated pregnancies. Acta Obstet Gynecol Scand. 1998; 77 (3): 290–4.
  23. Khadilkar S.S., Desai S.S., Tayade S.M. et al. Amniotic fluid index in normal pregnancy: an assessment of gestation specific reference values among Indian women. J Obstet Gynaecol Res. 2003; 29 (3): 136–41. DOI: 10.1046/j.1341-8076.2003.00089.x
  24. Hinh N.D., Ladinsky J.L. Amniotic fluid index measurements in normal pregnancy after 28 gestational weeks. Int J Gynaecol Obstet. 2005; 91 (2): 132–6. DOI: 10.1016/j.ijgo.2005.07.007
  25. Myles T.D., Santolaya-Forgas J. Normal ultrasonic evaluation of amniotic fluid in low-risk patients at term. J Reprod Med. 2002; 47 (8): 621–4.
  26. Magann E.F., Chauhan S.P., Hitt W.C. et al. Borderline or marginal amniotic fluid index and peripartum outcomes: a review of the literature. J Ultrasound Med. 2011; 30 (4): 523–8. DOI: 10.7863/jum.2011.30.4.523
  27. Magann E.F., Morton M.L., Nolan T.E. et al. Comparative efficacy of two sonographic measurements for the detection of aberrations in the amniotic fluid volume and the effect of amniotic fluid volume on pregnancy outcome. Obstet Gynecol. 1994; 83 (6): 959–62. DOI: 10.1097/00006250-199406000-00012
  28. Chauhan S.P., Magann E.F., Morrison J.C. et al. Ultrasonographic assessment of amniotic fluid does not reflect actual amniotic fluid volume. Am J Obstet Gynecol. 1997; 177 (2): 291–6. DOI: 10.1016/s0002-9378(97)70189-3
  29. Magann E.F., Doherty D.A., Chauhan S.P. et al. How well do the amniotic fluid index and single deepest pocket indices (below the 3rd and 5th and above the 95th and 97th percentiles) predict oligohydramnios and hydramnios? Am J Obstet Gynecol. 2004; 190 (1): 164–9. DOI: 10.1016/s0002-9378(03)00859-7
  30. Magann E.F., Chauhan S.P., Barrilleaux P.S. et al. Ultrasound estimate of amniotic fluid volume: color Doppler overdiagnosis of oligohydramnios. Obstet Gynecol. 2001; 98 (1): 71–4. DOI: 10.1016/s0029-7844(01)01400-4
  31. Odibo I.N., Whittemore B.S., Hughes D.S. et al. Addition of Color Doppler Sonography for Detection of Amniotic Fluid Disturbances and Its Implications on Perinatal Outcomes. J Ultrasound Med. 2017; 36 (9): 1875–81. DOI: 10.1002/jum.14223
  32. Moore T.R., Cayle J.E. The amniotic fluid index in normal human pregnancy. Am J Obstet Gynecol. 1990; 162 (5): 1168–73. DOI: 10.1016/0002-9378(90)90009-v
  33. Magann E.F., Sanderson M., Martin J.N. et al. The amniotic fluid index, single deepest pocket, and two-diameter pocket in normal human pregnancy. Am J Obstet Gynecol. 2000; 182 (6): 1581–8. DOI: 10.1067/mob.2000.107325
  34. Magann E.F., Chauhan S.P., Whitworth N.S. et al. Subjective versus objective evaluation of amniotic fluid volume of pregnancies of less than 24 weeks' gestation: how can we be accurate? J Ultrasound Med. 2001; 20 (3): 191–5. DOI: 10.7863/jum.2001.20.3.191
  35. Magann E.F., Whitworth N.S., Bass J.D. et al. Amniotic fluid volume of third-trimester diamniotic twin pregnancies. Obstet Gynecol. 1995; 85 (6): 957–60. DOI: 10.1016/0029-7844(95)00054-u
  36. Ippolito D.L., Bergstrom J.E., Lutgendorf M.A. et al. A systematic review of amniotic fluid assessments in twin pregnancies. J Ultrasound Med. 2014; 33 (8): 1353–64. DOI: 10.7863/ultra.33.8.1353
  37. Magann E.F., Chauhan S.P., Whitworth N.S. et al. Determination of amniotic fluid volume in twin pregnancies: ultrasonographic evaluation versus operator estimation. Am J Obstet Gynecol. 2000; 182 (6): 1606–9. DOI: 10.1067/mob.2000.107440
  38. Magann E.F., Doherty D.A., Ennen C.S. et al. The ultrasound estimation of amniotic fluid volume in diamniotic twin pregnancies and prediction of peripartum outcomes. Am J Obstet Gynecol. 2007; 196 (6): 570.e1-6. DOI: 10.1016/j.ajog.2007.01.030
  39. Magann E.F., Chauhan S.P., Whitworth N.S. et al. The accuracy of the summated amniotic fluid index in evaluating amniotic fluid volume in twin pregnancies. Am J Obstet Gynecol. 1997; 177 (5): 1041–5. DOI: 10.1016/s0002-9378(97)70011-5
  40. Hill L.M., Krohn M., Lazebnik N. et al. The amniotic fluid index in normal twin pregnancies. Am J Obstet Gynecol. 2000; 182 (4): 950–4. DOI: 10.1016/s0002-9378(00)70352-8