Evaluation of feto-maternal outcome using AFI and SDVP for amniotic fluid assessment; Which is a better method?

Biplab Mukhopadhyay, Syed Nawaz Ahmad, Shefali Agarwal, Shashi Lata Kabra



Background: Abnormal amniotic fluid volume (AFV) may be the only or earliest sonographic sign of an obstetrical problem. There is no clear consensus on the best method to assess amniotic fluid adequacy. The AFI and the SDVP are the more commonly employed techniques for assessing adequacy of amniotic fluid. This study aimed to compare the maternal and foetal outcome when amniotic fluid was measured by these two methods.

Methods: Hundred pregnant women at >28 weeks gestation scheduled for test of biophysical score due to various risk factors were enrolled and divided in two groups of 50 each. In each group, amniotic fluid volume was determined by either calculating the Amniotic Fluid Index (AFI) or measuring the Single Deepest Vertical Pocket (SDVP). Oligohydramnios was declared at cut off of <5 for the former and <2cm for the later method respectively. Maternal and foetal outcomes were compared between the two groups.

Results: Diagnosis of oligohydramnios was 45/50 in group I and 23/50 in group II (p<0.0001). Induction of labour was done in 70.0% in group I and 18% in group II (p<0.0001). Non-reassuring foetal heart rate was seen in 36.0% in group I and 14.0% in group II (p=0.011). Rate of caesarean delivery was significantly higher in group I, 42.0% in comparison of 20.0% in group II (p=0.017). NICU admission were 32.0% in group I and 18.0% in group II (p=0.106).

Conclusions: SDVP is a better choice for determining amniotic fluid to avoid unnecessary interventions without any significant improvement in peripartum outcome measures.


Amniotic fluid, Amniotic fluid index, Single deep vertical pocket

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Ross MG, Brace RA. National Institute of Child Health and Development Conference summary: amniotic fluid biology-basic and clinical aspects. J Matern Foetal Med. 2001;10(1):2-19.

Cunningham FG, Williams JW, Leveno KJ, Bloom S, Hauth JC. Disorder of amniotic fluid volume. Williams Obstetrics. 23rd ed. New York: Mc Graw-Hill Medical; 2009:490-99.

Hashimoto BE, Kramer DJ, Brennan L. Amniotic fluid volume: fluid dynamics and measurement technique. Semin Ultrasound CT MR. 1993;14 (1):40-55.

Sherer DM. A review of amniotic fluid dynamics and the enigma of isolated oligohydramnios. Am J Perinatol. 2002;19(5):253-66.

Croom CS, Banias BB, Ramos-Santos E, Devoe LD, Bezhadian A, Hiett AK. Do semiquantitative amniotic fluid indexes reflect actual volume?. Am J Obstet Gynecol. 1992;167(4):995-9.

Magann EF, Chauhan SP, Kinsella MJ, McNamara MF, Whitworth NS, Morrison JC. Antenatal testing among 1001 patients at high risk: the role of ultrasonographic estimate of amniotic fluid volume. Am J Obstet Gynecol. 1999;180(6):1330-6.

Magann EF, Chauhan SP, Bofill JA, Martin JN. Comparability of the amniotic fluid index and single deepest pocket measurements in clinical practice. Aust N Z J Obstet Gynaecol. 2003;43(1):75-7.

Garmel SH, Chelmow D, Sha SJ, Roan JT, D’Alton ME. Oligohydramnios and the appropriately grown fetus. Am J Perinatol. 1997;14(6):359-63.

Kawasaki N, Nishimura H, Yoshimura T, Okamura H. A diminished intrapartum amniotic fluid index is a predictive marker of possible adverse neonatal outcome when associated with prolonged labour. Gynecol Obstet Invest. 2002;53(1):1-5.

Rogers MS, Wang CC. A comparison of three ultrasound estimates of intrapartum oligohydramnios for prediction of foetal hypoxia-reperfusion injury. Early Hum Dev. 1999;56(2-3):117-26.

Gramellini D, Fieni S. Verrotti C, Piantelli G, Cavallotti D, Vadora E. Ultrasound evaluation of' amniotic fluid volume: methods and clinical accuracy. Acta Bio-Medica de L’Ateneo Parmense. 2004;75(l):40-4.

Phelan TP 1987 Phelan .TP, Smith CY, Broussard P, Small M. Amniotic fluid volume assessment with the four-quadrant technique at 36-42 weeks gestation. J Repro Med. 1987;32(7):540-2.

Chamberlain PF, Manning FA, Morrison I, Harman CR, Lange IR. Ultrasound evaluation or amniotic fluid volume. The relationship of marginal and decreased amniotic fluid volumes to perinatal outcome. Am J Obstet Gynecol. 1984;150(3):245-9.

Nabhan AF, Abdelmoula YA. Amniotic fluid index versus single deepest vertical pocket: a meta-analysis of randomized controlled trials. Int J Gynaecol Obstet. 2009;104(3):184-8.

Magann EF, Chauhan SP, Doherty DA, Magann MI, Morrison JC. The evidence for abandoning the amniotic fluid index in favor of the single deepest pocket. Am J Perinatol. 2007;24(9):549-55.

Rosati P, Guariglia L, Cavaliere AF, Ciliberti P, Buongiorno S, Ciardulli A, et al. A comparison between amniotic fluid index and the single deepest vertical pocket technique in predicting adverse outcome in prolonged pregnancy. J Prenat Med. 2015;9(1-2):12-5.

Stock SJ, Ferguson E, Duffy A, Ford I, Chalmers J, Norman JE. Outcomes of elective induction of labour compared with expectant management: population based study. BMJ. 2012;344.e2838.

Practice bulletin no. 145: antepartum foetal surveillance. Obstet Gynecol. 2014;124(1):182-92.