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Q&A

Antepartum Fetal Assessment

Poster Session 2

(555) Does Amniotic Fluid Index Predict Adverse Pregnancy Outcomes in Preterm Prelabor Rupture of Membranes?

Tuesday, February 13, 2024
3:30 PM – 5:00 PM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level

    Primary & Presenting Author(s)

  • Pooja Brar, MD (she/her/hers)

    University of Pittsburgh Medical Center, Harrisburg Hospital
    Harrisburg, PA, United States

    • Coauthor(s)

  • AH

    Avi Hameroff, MD

    Fellow - Maternal Fetal Medicine
    University of Pittsburgh Medical Center, Harrisburg Hospital
    Harrisburg, PA, United States

Objective:

Preterm prelabor rupture of membranes (PPROM) is associated with increased maternal and fetal morbidity. Inpatient management of PPROM after viability is recommended, however, the optimal antenatal surveillance protocol is not well defined. While some providers measure the amniotic fluid index (AFI) weekly, the clinical utility of this practice is unclear. Our objective was to determine if there was an association between AFI and adverse perinatal outcomes in pregnancies with PPROM.


Study Design:

This was a retrospective study of singleton pregnancies over a six-year period admitted with PPROM between 23 to 33-6/7 weeks gestation that had measurements of amniotic fluid at admission. Patients with multiple gestation, chorioamnionitis, nonreassuring fetal status, or advanced labor at time of admission were excluded. Patients were stratified into two groups: AFI < 5 cm and AFI > /= 5 cm. Demographics were collected for both groups. The primary outcomes were latency until delivery, mode of delivery, and indication for delivery. Secondary outcomes included gestational age at delivery, postpartum length of stay (LOS), Apgar scores, birthweight, NICU admission rate, perinatal death, and NICU LOS. 


Results:

109 cases met inclusion criteria. Of those patients, 39% were delivered via cesarean section (42/109). AFI was < 5 in 38 patients (34.9%) and > /=5 in 71 patients (65.1%). There was no statistically significant difference in demographics, latency until delivery, or mode of delivery between the two groups. Greater AFI measurement was associated with a higher fetal birthweight (p=0.0004), higher one minute Apgar scores (p=0.0201), and shorter NICU LOS (p=0.0138). 


Conclusion:

AFI assessment at time of admission for PPROM was not a predictor of pregnancy latency or mode of delivery, although a greater measurement was associated with increased birthweight and decreased LOS in the NICU. Further research is required to identify an optimal method of evaluation of these at-risk pregnancies.