Am J Perinatol 2007; 24(4): 215-221
DOI: 10.1055/s-2007-972926
Copyright © 2007 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA.

Intrauterine Growth Restriction and Oligohydramnios among High-Risk Patients

Suneet P. Chauhan1 , Michelle Taylor2 , Dawn Shields3 , Donna Parker3 , James A. Scardo3 , Everett F. Magann1
  • 1Maternal-Fetal Medicine, Aurora Health Care, West Allis, Wisconsin
  • 2Department of Obstetrics-Gynecology, University of Mississippi, Jackson, Mississippi
  • 3Regional Maternal Fetal Center, Spartanburg Regional Medical Center, Spartanburg, South Carolina
Further Information

Publication History

Publication Date:
19 April 2007 (online)

ABSTRACT

The purposes of this study were (1) to determine the prevalence of oligohydramnios (amniotic fluid index < 5.0 cm) among fetuses with intrauterine growth restriction (IUGR) and newborns identified as small for gestational age (SGA), and (2) among fetuses with IUGR, to determine the predictive accuracy of amniotic fluid index (AFI) ≤ versus > 5.0 cm for adverse peripartum outcomes. This was a retrospective review of high-risk pregnancy that had reliable gestational age (GA) and needed weekly biophysical profile (BPP). Along with 95% confidence intervals (CIs), we calculated the likelihood ratios (LRs) and used guidelines promulgated by Evidence-Based Medicine Working Group. Among the 1859 singletons undergoing BPP, IUGR (estimated fetal weight < 10% for GA) was suspected in 22% (n = 410) and the prevalence of oligohydramnios was 6% (95% CI, 4 to 8%). SGA (birthweight ≤ 10%) occurred among 28% (n = 517) of newborns and oligohydramnios was noted in 6% (95% CI, 4 to 8%). Among fetuses with IUGR, the LR of oligohydramnios to predict cesarean delivery for nonreassuring fetal heart tracing was 2.0 (range, 0.8 to 5.0); for newborns small for gestational age, 1.9 (range, 1.2 to 3.1), and for neonatal intensive care unit admission, 1.4 (range, 0.6 to 2.3) More than 90% of patients with IUGR or SGA have AFI > 5.0 cm, and oligohydramnios with IUGR is a poor predictor of peripartum complications.

REFERENCES

  • 1 American College of Obstetricians and Gynecologists .Intrauterine growth restriction. ACOG Practice Bulletin No. 12. Washington, DC; ACOG 2000
  • 2 American College of Obstetricians and Gynecologists .Ultrasonography in pregnancy. ACOG Practice Bulletin No. 58. Washington, DC; ACOG 2004
  • 3 Chauhan S P, Park D, Shields D, Sanderson M, Cole J H, Scardo J A. Sonographic estimate of birth weight among high-risk patients: feasibility and factors influencing accuracy.  Am J Obstet Gynecol. , In press
  • 4 Hadlock F P, Harrist R B, Sharman R S, Deter R L, Park S K. Estimation of fetal weight with the use of head, body and femur measurements: a prospective study.  Am J Obstet Gynecol. 1985;  151 333-337
  • 5 Alexander G R, Himes J H, Kaufman R B, Mor J, Kogan M. A United States national reference for fetal growth.  Obstet Gynecol. 1996;  87 163-168
  • 6 Phelan J P, Smith C V, Broussard P et al.. Amniotic fluid volume assessment with the four-quadrant technique at 36-42 weeks gestation.  J Reprod Med. 1987;  32 540-542
  • 7 Chauhan S P, Martin R W, Morrison J C. Intrapartum hydramnios at term and perinatal outcome.  J Perinatol. 1993;  13 186-189
  • 8 American College of Obstetricians and Gynecologists .Fetal heart rate patterns: monitoring, interpretation, and management. ACOG technical bulletin. Washington, DC; ACOG 1995
  • 9 Jaeschke R, Guyatt G H, Sackett D L. for the Evidence-Based Medicine Working Group . Users' guide to the medical literature III. How to use an article about a diagnostic test. B. What are the results and will they help me in caring for my patients?.  JAMA. 1994;  271 703-707
  • 10 Chauhan S P, Charania S F, McLaren R A et al.. Ultrasonographic estimate of birth weight at 24 to 34 weeks: a multicenter study.  Am J Obstet Gynecol. 1998;  179 909-916
  • 11 Philipson E H, Sokol R J, Williams T. Oligohydramnios: clinical associations and predictive value for intrauterine growth retardation.  Am J Obstet Gynecol. 1983;  146 271-278
  • 12 Chamberlain P F, Manning F A, Morrison I, Harman C R, Lange I R. Ultrasound evaluation of amniotic fluid volume: I. The relationship of marginal and decreased amniotic fluid volumes to perinatal outcomes.  Am J Obstet Gynecol. 1984;  150 245-249
  • 13 Varma T R, Bateman S, Patel R H, Chamberlain G V, Pillai V. Ultrasound evaluation of amniotic fluid: outcome of pregnancies with severe oligohydramnios.  Int J Gynaecol Obstet. 1988;  27 185-192
  • 14 Manning F A, Hill L M, Platt L D. Qualitative amniotic fluid volume determination by ultrasound: antepartum detection of intrauterine growth retardation.  Am J Obstet Gynecol. 1981;  139 254-258
  • 15 McIntire D D, Bloom S L, Casey B M, Leveno K J. Birthweight in relation to morbidity and mortality among newborn infants.  N Engl J Med. 1999;  340 1234-1238
  • 16 Chauhan S P, Magann E F. Screening for fetal growth restriction.  Clin Obstet Gynecol. 2006;  49 284-294
  • 17 Manning F A, Morrison I, Harman C R, Lange I R, Menticoglou S. Fetal assessment based on the fetal biophysical profile scoring: experience in 19,221 referred high-risk pregnancies. II. An analysis of false-negative fetal deaths.  Am J Obstet Gynecol. 1987;  157 880-884
  • 18 Chauhan S P, Magann E F, Morrison J C, Whitworth N S, Hendrix N W, Devoe L D. Ultrasonic assessment of amniotic fluid does not reflect amniotic fluid volume.  Am J Obstet Gynecol. 1997;  177 291-297
  • 19 Casey B M, McIntire D D, Leveno K J. The continuing value of the Apgar score for the assessment of newborn infants.  N Engl J Med. 2001;  344 467-471
  • 20 Magann E F, Doherty D A, Field K, Chauhan S P, Muffley P E, Morrison J C. Biophysical profile with amniotic fluid volume assessments.  Obstet Gynecol. 2004;  104 5-10
  • 21 Maulik D. Management of fetal growth restriction: an evidence-based approach.  Clin Obstet Gynecol. 2006;  49 320-324

Suneet P ChauhanM.D. 

Aurora Health Care, 8901 W. Lincoln Avenue, PAC

West Allis, WI 53227; reprints not available from the author