Amniotic fluid index as a predictor of adverse perinatal outcome in the HELLP syndrome

• Published in: Journal of reproductive medicine Vol. 52; no. 4; p. 293
• Main Authors: Barrilleaux, P Scott, Magann, Everett F, Chauhan, Suneet P, York, Brian M, Philibert, Lisa, Lewis, David F
• Format: Journal Article
• Language: English
• Published: United States 01.04.2007
• Subjects: Adult; Amniotic Fluid - chemistry; Apgar Score; Cesarean Section - methods; Cesarean Section - statistics & numerical data; Chi-Square Distribution; Delivery, Obstetric - methods; Delivery, Obstetric - statistics & numerical data; False Positive Reactions; Female; Fetal Distress - diagnosis; HELLP Syndrome - diagnosis; Humans; Infant Mortality; Infant, Newborn; Predictive Value of Tests; Pregnancy; Pregnancy Outcome; Prospective Studies; ROC Curve; Severity of Illness Index
• ISSN: 0024-7758

To evaluate the prognostic value of an amniotic fluid index (AFI) < or = 5 cm for an adverse perinatal outcome in pregnancies with the syndrome of hemolysis, elevated liver enzymes and low platelets (HELLP syndrome). A prospective, observational study of patients with the HELLP syndrome. An ultrasound estimate of amniotic fluid volume was obtained on admission. Adverse intrapartum outcomes included amnioinfusion for variable decelerations and/or indicated abdominal/vaginal operative delivery for nonreassuring fetal heart rate changes. Maternal characteristics and perinatal outcome parameters were compared AFI < or = vs. > 5 cm. Statistical analysis was performed using chi2 analysis, Student's t test and receiver-operator characteristic curve (ROC) analysis. Between January 1996 and February 1999, 120 patients were enrolled. Twenty-six (22%) had an AFI < or = 5 cm. This group did not differ from that with AFI > 5 cm regarding the severity of the HELLP syndrome, admission-to-delivery interval (p = 0.354), variable decelerations in labor (p = 0.06), Apgar score of < 7 at 5 minutes (p = 0.361), cesarean delivery for nonreassuring fetal status (p = 1.0) or significant fetal acidosis (pH < 7.0 [p = 0.2101). ROC analysis revealed no AFI measurement between 0 and 16 cm that was useful for identifying the compromised fetus. Antepartum/intrapartum performance of AFI in patients with the HELLP syndrome is a poor prognostic test for subsequent fetal compromise.